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Gentiva's Odyssey Healthcare Settles Again, Signs Yet Another Corporate Integrity Agreement

The Milwaukee Journal-Sentinel <a href="http://www.jsonline.com/news/milwaukee/whistleblower-case-on-hospice-fraud-settled-for-25-million-e54d9un-141143483.html">reported</a> a legal settlement worth noting.  Here are the basics: <blockquote>One of the nation's largest providers of hospice care has agreed to pay $25 million to settle a Medicare fraud case initiated after a former company nurse in Milwaukee filed a whistle-blower suit. It was the second such settlement in six years for Odyssey Healthcare Inc., which paid the federal government $12.5 million in 2006 after another Wisconsin-based employee sued.</blockquote> Also, <blockquote>Medicare provides a benefit meant to cover hospice care for the terminally ill. It covers 24-hour in-home nursing service only during limited crisis periods. But from 2006 to 2009, Odyssey practiced a pattern of enrolling and recertifying non-terminal patients, and billing for continuous care that wasn't necessary or reasonable, according to the False Claims Act suit filed in 2008 but just unsealed Thursday.</blockquote> As is usual in such cases, Odyssey's parent company denied that it did anything wrong: <blockquote>Odyssey, which operates in 26 states, is now part of Atlanta-based Gentiva Health Services, which runs hospice offices in West Allis and Burlington. Gentiva officials declined to comment, but referred to an announcement it posted on its investor relations website last month. 'Gentiva cooperated fully with this investigation, which covered a period prior to our acquisition of Odyssey, and the settlement is consistent with our efforts to instill Gentiva's culture of compliance throughout the company,' said John Camperlengo, general counsel and chief compliance officer. The statement said the firm is proud of the care its thousands of hospice clinicians provide, and of Gentiva's efforts to ensure strict compliance with all regulatory requirements.</blockquote> The Implications of the Need for a New Corporate Integrity Agreement However, there are some disturbing aspects of this case that require a bit more explanation. First, as noted by the Associated Press (in a story available <a href="http://www.thonline.com/news/iowa-illinois-wisconsin/article_d2a4d2d0-8f73-53c2-86dc-e6ff3c7e2ab5.html">here</a> from the Dubuque [Iowa] Telegraph-Herald), <blockquote>Besides agreeing to pay the $25 million settlement, Odyssey entered a five-year corporate integrity agreement with the federal government.</blockquote> Now corporate integrity agreements are not known for their effectiveness. In fact, as we noted in <a href="http://hcrenewal.blogspot.com/2011/07/executives-get-rich-despite-ethical-and.html">this blog post</a>, according to <a href="http://files.shareholder.com/downloads/GTIV/1338648526x0x456437/CEA1782E-FB2C-4850-A530-9CF06AA6C55B/Gentiva_AR_2010.pdf">Gentiva's 2010 annual report</a>, its Odyssey subsidiary had been subject to a corporate integrity agreement arising from its 2006 settlement, one which was apparently not effective in preventing its misbehavior from 2006 to 2009. However, corporate integrity agreements do serve as markers for the need to improve the integrity of the corporations who need to make them. In this case, why would Gentiva be asked to sign such an agreement if its integrity were already beyond reproach? So Gentiva's current "culture of compliance" is open to question. The Implications of "Enrolling and Recertifying Non-Terminal Patients" A quick read of the Journal-Sentinel and Associate Press stories above might give the impression that what Odyssey did wrong involved a billing technicality, admittedly, one that allowed it to collect more money that that to which it would otherwise be entitled. This story actually goes beyond the issue of fraud, and raises important concerns about patient care. The enrollment  by a hospice of patients who are actually not terminally ill could have serious adverse effects on such patients. As we noted in <a href="http://hcrenewal.blogspot.com/2011/07/prepare-them-to-die-for-profit-hospices.html">this post</a>, hospices are meant for patients with very limited life expectancies. The goal of hospice is to provide comfort and palliation, not active treatment of illnesses. So if patients who actually do not have such severely limited life expectancies are admitted to a hospice, they might be denied therapy that could actually make them feel better, or even cure acute illnesses or prolong their lives. For example, a hospice patient who developed an open wound might not get maximal wound therapy, as in an example (allegedly involving a different commercial hospice provider) in the post above. So it is possible that Odyssey's enrolling and re-certifying of non-terminally ill patients could have lead to failure to provide some of these patients with the care they should have had. Whether this did or did not occur in individual cases, and what adverse effects may have been produced is not clear from the coverage of this case.   Summary As I wrote in 2011, .... There has been a lot of blather from politicians in the US about "death panels" in debates about health care reform. Many such politicians seem worried that the US government has or will have death panels under the new health care reform legislation. We have criticized that legislation for not addressing many important health care problems. No one, however, has convincingly demonstrated how its provisions would convene "death panels." Wendell Potter argued in his book, <a href="http://wendellpotter.com/deadlyspin">Deadly Spin</a>, (see <a href="http://hcrenewal.blogspot.com/2011/02/wendell-potters-deadly-spin.html">this post</a>) that for-profit insurance companies had their own "death panels." The Bloomberg article strongly suggests that for-profit hospices may also act like death panels. In search of more revenue, for-profit hospices may enroll patients who are not at the end of life, but then provide them only "comfort care," so that if they develop new conditions that are treatable, they are likely to die in the absence of treatment. I am waiting for the politicians who so enthusiastically condemned the supposed "death panels" to be found in health care reform legislation to condemn for-profit hospices for behaving like death panels. In my humble opinion, the case discussed above are the strongest argument yet that we need to reconsider our headlong rush to turn health care, particularly the direct care of patients, over to relatively unregulated, for-profit corporations. The cases above suggest that the pursuit of revenue ahead of patients' welfare by such organizations may lead to sick and dead patients. I cannot see how for-profit direct patient care can be made safe for patients without intense government regulation. If any of those vocal advocates of "free market" health care (in the absence of any good explanation of how health care can ever be an ideal free market, see <a href="http://hcrenewal.blogspot.com/2010/08/how-fallacy-of-perfect-health-care.html">this post</a>) can explain to me how for-profit hospices can be made safe for patients without such regulation, I would welcome their attempts. Meanwhile, this just calls out for legislative and legal investigation, and urgent policy changes.   By the way, the case above also shows how the current approach used by the government to address misbehavior in health care does not work.  We have noted previously how these <a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements">legal settlements</a> often only lead to financial penalties imposed on companies, not individuals, which diffuses their impact, and provides no disincentives to future bad behavior by individuals.  Sometimes <a href="http://hcrenewal.blogspot.com/search/label/corporate%20integrity%20agreement">corporate integrity agreements</a> are added, but as in the current case, they also seem not to deter future bad behavior.   So, I further conclude, de rigueur, to really deter bad behavior, those who authorized, directed or implemented bad behavior must be held accountable. As long as they are not, expect the bad behavior to continue. Real health care reform needs to make health care leaders accountable, and especially accountable for the bad behavior that helped make them rich.

Gentiva's Odyssey Healthcare Settles Again, Signs Yet Another Corporate Integrity Agreement

The Milwaukee Journal-Sentinel reported a legal settlement worth noting. Here are the basics: One of the nation's largest providers of...

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Courses and Conferences on Health Care Ethics, Corruption, Marketing

Two courses and two conferences of interest to Health Care Renewal readers are coming soon. Short Course: Why Do Physicians Not Make Rational, Evidence Based Decisions? A full-day course at the <a href="http://smdm2012.com/">14th Biennial European Meeting of the Society for Medical Decision Making</a> on Sunday, 10 June, 2012 in Oslo, Norway. Taught by bloggers Dr Roy Poses and Dr Wally Smith, the course will address both the effects of cognitive psychological limitations and of external influences by vested interests leading to less than optimal decisions. A full description of the course is <a href="http://smdm2012.com/course_proposals">here</a>.   Online Course: Corruption in the Health Sector A 30 hour online course given by the <a href="http://www.u4.no/">U4 Anti-Corruption Resource Center</a>, offered in collaboration with the Boston University School of Public Health.  The course is "on causes and consequences of corruption in the health sector; vulnerabilities in drug supply systems, informal payments, and strategies to minimise the problems."  A full description is <a href="http://www.u4.no/training/online-training/corruption-in-the-health-sector">here</a>.  Conference: Deception, Incentives and Behavior A two-day conference given by the Rady School of Management, University of California - San Diego, on 20-21 April, 2012 in San Diego, California, USA.  This will be a multidisciplinary meeting to facilitate "research of deception and related unethical behavior in the fields of economics and psychology/judgment and decision making (JDM)." The conference web-site is <a href="http://rady.ucsd.edu/dib-symposium">here</a>.  Conference: Third Annual PharmedOut Conference on How Patient Harms May Result from Industry Promotion A two-day conference given by <a href="http://www.pharmedout.org/">PharmedOut</a> at Georgetown University in Washington, DC on 14-15 June, 2012.  The conference will focus on the how industry promotion may lead to under-use, over-use, or mis-use of drugs and devices. The conference web-site is <a href="http://pharmedout.org/2012Conference.htm">here</a>.

Courses and Conferences on Health Care Ethics, Corruption, Marketing

Two courses and two conferences of interest to Health Care Renewal readers are coming soon. Short Course: Why Do Physicians Not Make Rationa...

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Why Health Care Leaders Remain Unaccountable: How the Family Invisibly Promoted the "Divine Right of CEOs"

We have frequently discussed the lack of <a href="http://hcrenewal.blogspot.com/search/label/accountability">accountability</a> of health care leaders, which we sometimes have described as CEO exceptionalism. We have noted how health care leaders almost never seem to need to take responsibility for their organizations' misbehavior and its outcomes, (look <a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements">here</a>) and in fact can command ever increasing <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">compensation</a>, no matter how badly they or their organizations do.  Some of the more recent examples of this phenomenon were: <div></div><div></div><ul><li>William Weldon, soon to retire as CEO of Johnson and Johnson, has commanded eight-figure yearly compensation despite severe manufacturing problems leading to 30 product recalls since 2009, and multiple ethical lapses leading to legal settlements and guilty pleas (see<a href="http://hcrenewal.blogspot.com/2012/02/semi-retirement-of-salesman-weldon-to.html"> this post</a>).</li><li>Non-profit hospital system CEOs got bonuses and raises, or departed with golden parachutes as their systems faced financial losses and laid off employees, or after their medical staff questioned their management (see <a href="http://hcrenewal.blogspot.com/2012/01/three-golden-parachutes-and-some.html">this post</a>).</li><li>A non-profit hospital CEO got a golden parachute ostensibly because he engineered a successful merger.  However, the merger never took place (see <a href="http://hcrenewal.blogspot.com/2011/11/new-low-hospital-ceo-got-golden.html">this post</a>.) </li></ul>Others examples can be found <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">here</a>.  Moreover, such executive compensation is almost never justified with anything approaching evidence or logic.  When health care organizations can be bothered to try to explain executive compensation, they revert to rote compliments (executives are called "brilliant" or "visionary") without further explanation, e.g., look <a href="http://hcrenewal.blogspot.com/2011/10/peer-benchmarking-lake-wobegone-effect.html">here</a> and <a href="http://hcrenewal.blogspot.com/2011/09/more-repeats-of-talking-points.html">here</a> and <a href="http://hcrenewal.blogspot.com/2011/09/talking-points-sans-original-thought-to.html">here</a>), or even fall back to <a href="http://hcrenewal.blogspot.com/search/label/logical%20fallacies">logical fallacies</a> (e.g.look <a href="http://hcrenewal.blogspot.com/2011/12/more-tales-of-hospital-ceo-compensation.html">here</a>). Why Does Unaccountable Leadership Persist Unchallenged? Why this absurd state of affairs persists and is getting worse, and why it is so little noticed outside of this blog, is a real question.  One explanation we just <a href="http://hcrenewal.blogspot.com/2012/03/golden-calf-explains-how-economism-lead.html">raised</a> is that society has gotten used to "the divine rights of CEOs," partially because of the success of an ideology that has been called "economism," that in turn is based on some old and now rarely accepted religious teachings that have somehow infiltrated what is supposed to be a science. The Family as a Supporter of the "Divine Right of CEOs" A related explanation comes from <a href="http://jeffsharlet.com/content/about-the-family/">The Family</a>, published in 2008, written by<a href="http://jeffsharlet.com/"> Jeff Sharlet</a>.  It suggests that such outmoded beliefs have been promoted by an extreme, nearly invisible, but influential religious sect called "The Family" that has been around since the 1930s.  The Family has powerfully promoted its fringe religious beliefs to influence policy and politics.  I strongly recommend reading the book for further details, or at least a summary article, <a href="http://www.harpers.org/archive/2003/03/0079525">Jesus Plus Nothing</a>, Shalet published in 2003 in Harpers. Let me summarize the relevant points.  Because many will seem far-fetched, I will provide quotes from the book to back each up, with page references from the Harper Paperback edition.  Italics were added for emphasis. Secrecy The Family, formerly the Fellowship, is secretive, and functions behind a variety of front organizations. <blockquote>The family has operated under many guises, some active, some defunct: National Committee for Christian Leadership, International Christian Leadership, National Leadership Council, the Fellowship Foundation, the International Foundation. (P 20-21)</blockquote> Extreme Theology While nominally Christian, the Family is at the far extreme of the spectrum, and embraces beliefs that many would find far-fetched, or worse. It discounts the Bible and the Holy Trinity, and hence is hardly fundamentalist in the usual sense of the word. The Family’s <blockquote>origins lie not in the New Testament, which is ultimately little more than a fabric from which the Family constructs contemporary realities....” (P 61)</blockquote><blockquote>Not Jesus plus scripture, since scripture, after all, contains a great deal besides Jesus. No burning bush, no voice in the whirlwind, no Daniel, no lions. (P 252).</blockquote> It discounts the Holy Trinity. <blockquote>[Current Family leader Douglas] Coe and his inner circle do believe in the trinity; a Washington fundamentalist activist told me,’ but they’ll given the Father and the Holy Ghost the weekend off. Because they clutter the conversation. Jesus is so easily presented. (P 252)</blockquote> Some call it a dominionist sect, that is, one that seeks a return to the very earliest Christianity, before any organized churches.   <blockquote>The Family’s beliefs appear closer to a more marginal set of theologies sometimes gathered under the umbrella term of dominionism, characterized ... by William Martin, a religious historian at Rice University, and Billy Graham’s official biographer.... Dominionist theologies hold the Bible to be a guide to every decision, high and low, from whom God wants you to marry to whether God thinks should buy a new lawn mower. Unlike neo-evangelicals, who concern themselves chiefly with getting good with Jesus, dominionists want to reconstruct early Christian society, which they believe was ruled by God alone. (P 44)</blockquote> (Note, however, that the emphasis on the Bible as guide appears to contradict the discounting of scripture above.) Links to the Powerful The Family has had ties to numerous powerful politicians. <blockquote>The Family is in its own words an ‘invisible’ association, although it has always been organized around public men. Senator Sam Brownback (R., Kansas), chair of a weekly off-the-record meeting of religious right groups called the Values Action Team (VAT) is an active member, as is Representative Joe Pitts (R., Pennsylvania),... Others referred to as members include senators Jim DeMint of South Carolina,...; Pete Dominici of New Mexico...; Chuck Grassley (R., Iowa); James Inhofe (R., Oklahoma); Tom Coburn (R., Oklahoma); John Thune (R., South Dakota); Mike Enzi (R., Wyoming); and John Ensign.... ‘Faith-based Democrats’ Bill Nelson of Florida and Mark Pryor of Arkansas,... are members.... (P18)</blockquote> Many other politicians, some very well known, from both major parties appear as Family members or friends in the book. Since the 1950s, the Family has supported the National Prayer Breakfast. (P 195).  The "Divine Right" of Leaders The Family believe that those who are powerful are those chosen by God to be powerful, and hence must obeyed. Family founder Abraham Vereide, better known as Abram <blockquote>“would become an exponent of religion for the elite - the ‘up and out,’ as he called them.... He termed this trickle-down faith the Idea, and it was really the only idea he ever had - the only one, he believed, God gave him. In one sense, it was nothing more than a defense of the status quo. It neither challenged power nor asked for anything from the powerful but their good intentions. ( P 91)</blockquote><blockquote>“Power lies in things as they are. God has already chosen the powerful, his key men. ( P 96)</blockquote><blockquote>‘We work with power where we can, build new power where we can’t.’ The words belong to Doug Coe, who seized the Fellowship’s top spot in a succession struggle following Abram’s death in 1969 and began transforming it into what I eventually encountered as the Family. ( P 121.)</blockquote> The "Divinely Chosen" Leaders Need Not be Accountable to Any Man The powerful, because they are chosen by God and are instruments of God’s will, need not be accountable, at least to any other humans. <blockquote>This, Abram decided, was what it meant to die to the self: to turn all responsibility over to God. That such a transfer meant the abdication of any accountability for one’s actions, that it provided justification for any ambition, did not occur to him. (P 125)</blockquote><blockquote>A Fellowship tract titled Studies for Public Men, 10,000 of which were printed up by a Chevron Oil executive, claimed that such abuses [refers to an Army General who worked with Coe and was subsequently jailed for selling surplus weapons to 'Third World gangs'] are inevitable, but not attributable to the piety with which such men cloaked their misdeeds. When pious men committed crimes, went the thinking, godlessness was to blame - ‘secularism in its worst form!’ In a Section titled ‘Accountablity,’ the tract explained why the Fellowship should not be held accountable for the actions of its individual members.... ‘Persisting in the accusation of collective guilt immobilizes a society,’ advised the tract. Perhaps, but the Fellowship denied the very concept of guilt for the powerful. That was a legalistic notion, an encroachment on God’s sovereignty.... (P 220)</blockquote><blockquote>We’re all sinners, and thus shouldn’t judge those whom God places in authority. (P 241)</blockquote> The "Divine Right" Extends Even to Dictators The Family’s support of powerful, unaccountable leadership is suggested by how it tolerated, and sometimes supported vicious dictatorships. <blockquote>Understand Abram’s weirdly ambivalent relationship with fascism.... (P 124)</blockquote><blockquote>In Frankfurt, Abram claimed, God personally revealed to Abram a key man to quietly help manage the internal affairs of Germany’s elite: Dr Otto Fricke, an austere German churchman with an uncomfortable past. ‘You are God’s man for this hour in Germany,’ Abram told him. Had Abram asked about Fricke’s role in Germany’s previous hour, Fricke would have begged off explaining his activities during the Third Reich. As a radio preacher, he’d been recruited by Goebbels to propagandize,.... (P 159)</blockquote><blockquote>Coe counseled a Haitian senator and then Haiti’s ambassador to the United States, easing both into commitments to a Christ-led nation, with the understanding the Christ Coe preached led not toward the socialism that tempts any bitterly poor people but toward an economics of ‘key men’ who would share their wealth as God instructed them. Senators Frank Carlson and Homer Capehart, both members of the Foreign Relations Committee, did the follow-up work, leading a Fellowship delegation of twelve businessmen to instruct the Haitian parliament in prayer cell politics. Francois ‘Papa Doc’ Duvalier, who would declare himself president for life but also the nation’s official ‘Maximum Chief of the Revolution’ and ‘Electrifier of Souls’ - he was the weirdest and most vicious dictator in the Western Hemisphere - impressed the senators with his spirituality.</blockquote><blockquote>Not only did South Korea hold a prayer breakfast, but its dictator, General Park Chung Hee, tried to use the Fellowship to channel illegal funding to congressional candidate’s of [President Richard] Nixon’s selection. (P 216)</blockquote><blockquote>In 1968, Abram declared [Indonesian dictator] Suharto’s coup a ‘spiritual revolution,’ and Indonesia under his rule an especially promising nation, hope for the future in Abram’s later years. (P 245)</blockquote> The family also had cordial relationships with South Vietnamese leader General Nguyen Van Thieu (P 248) and Filipino dictator Ferdinand Marcos (P 249)   Summary   Sharlet's book suggests how the Family's increasing influence has led to the infiltration into the general society of the notion that all current leaders, including and particularly corporate CEOs, have a "divine right," and can thus not be held accountable by mortal men, even though that notion, if expressed this clearly, would seem ridiculous to a vast majority of the population.  It is possible that the major reason that most health care leaders have become unaccountable is some sort of subconscious acquiescence to the notions of economism (as discussed <a href="http://hcrenewal.blogspot.com/2012/03/golden-calf-explains-how-economism-lead.html">here</a>), and promulgated by the Family.  However, this acquiescence then is largely by people who would likely reject the bizarre religious beliefs that underpin these notions if those beliefs and their origin were made clear.   All those who do not believe that all earthly leaders are divinely chosen need to challenge the leaders chosen by human to be accountable to humans.    As a society we need to wake up from our dazed acquiescence to ideas that border on crazy.  We need to challenge rote justifications and talking points for that which makes no sense, but serve to make the powerful more powerful.

Why Health Care Leaders Remain Unaccountable: How the Family Invisibly Promoted the "Divine Right of CEOs"

We have frequently discussed the lack of accountability of health care leaders, which we sometimes have described as CEO exceptionalism. We...

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Rerun: Health Information Technology Basics From Calif. Nurses Association and National Nurses Organizing Committee

I think this post <a href="http://hcrenewal.blogspot.com/2010/04/health-information-technology-basics.html">from two years ago</a> on IT realities in healthcare merits a repeat appearance. --------------------------- I have never before seen a document like the one entitled "Health Information Technology Basics", by the Institute for Health & Socio-Economic Policy, California Nurses Association and the National Nurses Organizing Committee. It is available <a href="http://www.calnurses.org/research/pdfs/ihsp_tech_basics_sept_2009.pdf">at this link</a> (PDF). [Note- now at archive.org <a href="http://web.archive.org/web/20100202074048/http://www.calnurses.org/research/pdfs/ihsp_tech_basics_sept_2009.pdf">here</a> - ed.] It is long but contains rather interesting views on the issue of health IT, management and clinicians (nurses). <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2kPMNq2zuprs2la92q9jJFG3VU5EB9TYmXG1TJUCE-fc6BX0hfDmvzTnZayFxED27w7lFQkE3rmvehts9-hBnHn3bOjPJoYZMF219p7p1rvHUXdvEiAsYfy9u7pgPuYWp6sSY0MH5dgrE/s1600/whereispatient.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5715319571018970930" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2kPMNq2zuprs2la92q9jJFG3VU5EB9TYmXG1TJUCE-fc6BX0hfDmvzTnZayFxED27w7lFQkE3rmvehts9-hBnHn3bOjPJoYZMF219p7p1rvHUXdvEiAsYfy9u7pgPuYWp6sSY0MH5dgrE/s320/whereispatient.jpg" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 233px;" /></a>From the PDF, this cartoon is satirical but touches on a most serious issue - distraction due to technology. Click to enlarge. </div> I find the following passages of particular interest as they reflect views we express on this blog, and attack the notion of cybernetic miracles being wrought: <blockquote>Skill is the ability, drawn from education and experience, to do something expertly. It can also be defined as the effective exercise of professional judgment in non-routine situations. Following prescribed rules, as a machine would, makes an employee competent to perform tasks, but it doesn’t make the employee skilled. They can do their job as long as there are no surprises. But when something unexpected happens, the rules break down, and caring for patients means facing the unexpected every day. Only skilled health professionals can cope with the unexpected. To know what to do, they have to rely on their own judgment. The exercise of judgment is the essence of skill. ... Much health information technology is skill-degrading. As the work of health professionals becomes increasingly automated, they lose the ability to do their jobs without HIT. To make matters worse, they’re expected to keep pace with machines. They serve the machines rather than doing the more gratifying work of patient care, and ultimately they’re compensated less well. </blockquote> And this: <blockquote>Displacement [of people by machines] is hard to spot because it’s unlikely to appear as a one-to one correspondence; that is, you probably won’t find a robot sitting in your colleague’s chair tomorrow. It’s more likely to happen piecemeal, over an extended period, and through attrition. <ul><li>The job of patient care will be redefined, privileging technical over clinical skills.</li><li>The hospital will begin to hire more HIT specialists and fewer RNs.</li><li>Functions performed in the past by health professionals will be fragmented and reallocated between machines and less-skilled employees.</li><li>Increased technical efficiency will enable the hospital or HMO to expand without expanding its workforce.</li></ul></blockquote> And this: <blockquote>Use of any hospital technology must be consistent with safe, therapeutic, and effective patient care. Health information technology is a complete unknown in this regard. It’s an enormous social experiment designed by computer scientists and implemented by hospital administrators. HIT hasn’t grown organically from the needs of patients but has been imported from other industries. Known as enterprise resource planning, it’s adapted from similar technology designed to manage business operations on a massive scale and already being used to run the world’s largest corporations. Caring for patients isn’t business. It requires compassion, judgment, and advocacy. Because RNs have the moral right and legal duty to advocate for patients, they have to be able to override the automated decision-making of HIT designed to serve business interests. RNs have to work collectively to control health information technology rather than trying to fix it. It’s important to recognize that tinkering can’t fix HIT because its primary purpose is to mechanize, or routinize, patient care. It’s designed to quantify the unquantifiable, to replace the patient with an imaginary statistical norm. High-quality healthcare can’t be mechanized because it depends on people—on patients and caregivers—and people are infinitely more complex and capable than computers can ever be.</blockquote> Amen to that. Read the entire document for a union-oriented view of health IT. It contains many truisms regarding HIT irrational exuberance and the control issues of the healthcare management class. -- SS

Rerun: Health Information Technology Basics From Calif. Nurses Association and National Nurses Organizing Committee

I think this post from two years ago on IT realities in healthcare merits a repeat appearance. --------------------------- I have never bef...

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The Golden Calf Explains How Economism Lead to the Divine Right of CEOs

Our fellow blogger (on <a href="http://brodyhooked.blogspot.com/">Hooked: Ethics, Medicine and Pharma</a>), family physician and bioethicist Dr Howard Brody, has written a book on economic ideology that helps explain some of the issues we frequently discuss. Dr Brody's book, <a href="http://www.amazon.com/Golden-Calf-Economism-American-Policy/dp/1463762755">The Golden Calf</a>, is about how the social science of economics has been taken over by an ideology he and others call "economism."  Economism Economism consists of these major ideas: <ul><li>"'The economy' is a separate and distinct sphere of society."  This means that economic planning can be independent of consideration of the rest of society.</li><li>"Even if only a part of society, the economy is the primary part."  Thus economic planning, thinking, policies etc take precedence over other planning, thinking, policies, etc.</li><li>"People are, at core, economic beings.  The laws of the marketplace describe virtually asll of their behavior and the reasons for it.  People are beings of economic exchange, driven first to make money and then to spend on the goods obtainable in the marketplace."  So all other human thought, values, emotions, etc are less important.  The answer to the question, "what does love have to do with it?" is nothing.  Neither does honesty, morality, or ethics have to do with it.</li><li>"Economic calculation is the best way to understand, value, and manage human life.  It is appropriate that every aspect of our lives be thought of and analyzed in terms of economic calculations."  This essentially asserts that economists, economic thinking, and the marketplace should rule the world.  </li><li>"The economy, above all else, must be managed solely with an eye towards its own technical requirements - that is, what economists study.  There ought to be no interference from politicians, or policymakers, or moralists, or anyone else."  Thus, not only should greed be considered good, but greed ought to be enacted into law.  </li></ul>Economism's Prescription for Health Care Stated so baldly, economism may seem absurd.  However, it is easy to see its influence.  For example, Dr Brody explained how economism would state: <blockquote>what sort of health system the U.S. ought to have. It would be one that is governed by the laws of the market, and that treats all aspects of health care as consumer goods. How much any person 'needs' health care would be determined by one thing only - what that person is willing to pay on the open market. Anything else would be denounced as illegitimate interference with the market by politicians, policymakers, and other do-gooders.</blockquote> This, of course, corresponds very well with a lot that is said about health care by its current leaders. How often have we heard about the health care market, and how the only way to improve health care is market-based reforms? (Look <a href="http://hcrenewal.blogspot.com/2010/08/how-fallacy-of-perfect-health-care.html">here</a>).  How often have we heard leaders of hospitals refer to their "industry?" How often have we heard of patients as consumers, and doctors as providers? The list can go on. The problems are that economism does not provide good tools for prediction or management of the economy. Worse, <blockquote>If we want to live in a society that reflects basic human values, including acceptable moral rules, economism is a very poor guide. Yet economism is blind to its own deficiencies. it claims to be able to tell us the definitive answer to any problem in any aspect of human life, and accuse us of being irrational if we disagree with its proposals. If a powerful elite takes over control of a society, wedded to economism as their belief system, then the results for that society could be disastrous.</blockquote>The origins of economism provide an explanation for a phenomenon we have often seen in health care, the lack of <a href="http://hcrenewal.blogspot.com/search/label/accountability">accountability</a> of health care leaders, which we sometimes have described as CEO exceptionalism. We have noted how health care leaders almost never seem to need to take responsibility for their organizations' misbehavior and its outcomes, (look <a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements">here</a>) and in fact can command ever increasing <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">compensation</a>, no matter how badly they or their organizations do. The Religious Origins of Economism To understand this explanation, first note that Dr Brody suggested that economism is not a science. It did not arise out of an effort to use logic and reason to explain evidence. Instead, it seems to have come from two strains of religious thought that got translated into economic terms.  Dr Brody suggest that while it may make sense to think of economism as an ideology, it functions more like a religion, so that viewing economics ruled by economism as a social science would be a very big mistake. The first strain was the Protestant evangelism found in England in the 18th century. Evangelicals of that time <blockquote>regarded poverty as part of a divine program. Evangelicals interpreted the mental anguish of poverty and debt, and the physical agony of hunger or cold, as natural spurs to prick the conscience of sinners. They believed that the suffering of the poor would provoke remorse, reflection, and ultimately the conversion that would change their fate [in the afterlife]. In other words, poor people were poor for a reason, and helping them out of poverty would endanger their mortal souls.</blockquote>Thus, people who fail in the marketplace of life are sinners. Markets should not be regulated to prevent such failure, because doing so would prevent their still possible salvation. On the other hand, the Puritanism of the 17th and 18th centuries, and its 19th century evolution in the US <blockquote>was creeping up on the idea, not only that material wealth and worldly success was a good thing in the eyes of God, but that seeing oneself become successful and wealthy was the strongest possible sign of God's grace and one's status among the Elect.</blockquote> Things then got more extreme. <blockquote>The moderate idea that those who enjoy material wealth in the earthly life may have been especially favored by God seems gradually to have morphed into the extreme idea that God wishes us to bestow on the super-rich our adulation and unquestioning allegiance.</blockquote> So, <blockquote>For example, Reverend Russell Cornwell's lecture called 'Acres of Diamonds' proved so popular after he first wrote it in 1870 that he was called upon to give it six thousand times over the next quarter century. He preached: 'I say you ought to get rich, and it is your duty to get rich.'</blockquote> Thus, <blockquote>We have been conditioned to believe that wealth is an infallible sign of God's favor.</blockquote> Here is the religion behind CEO exceptionalism, lack of CEO accountability, outrageous CEO compensation, the imperial CEO. CEOs can become extremely wealthy, and "wealth is an infallible sign of God's favor," generating the notion of the divine right of CEOs. Summary No wonder that we have yet to see any logic or evidence to support CEO exceptionalism. Instead, we have seen logical fallacies used to support <a href="http://hcrenewal.blogspot.com/2011/05/logical-fallacies-to-defend-ceos-from.html">lack of CEO accountability</a> and <a href="http://hcrenewal.blogspot.com/2010/09/logical-fallacies-in-defense-of-million.html">immense CEO compensation</a>. The wealth of our leaders cannot be addressed with logic and evidence if it is a sign of God's favor. Thus, anyone whose religious beliefs are perfectly compatible with 18th century English evangelism and 17th through 19th century British and American Puritanism and its aftermath might be happy with the divine right of CEOs, and with economism in general. However, Dr Brody makes the powerful point that economism functions like a religion, and at best is an ideology, not scientific paradigm. Anyone who is uncomfortable with the religious beliefs that underlie it ought to be very uncomfortable with its precepts, as should anyone who believes that economics or health care should be based on evidence and logic. Specifically, in health care and in the larger economy, anyone who does not believe that rich CEOs are especially favored by God should question why they should be so rich, and why they should be so unaccountable. Dr Brody has written a powerful and important book which goes a long way to explain the irrationality that has infected health care. People of all, or of no religious beliefs should pay attention.

The Golden Calf Explains How Economism Lead to the Divine Right of CEOs

Our fellow blogger (on Hooked: Ethics, Medicine and Pharma ), family physician and bioethicist Dr Howard Brody, has written a book on econom...

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A distasteful result of data mining, "artifical intelligence" and hospital advertising

A distasteful result of data mining, "artificial intelligence" and hospital advertising: Last night in some ad-hoc Internet wanderings I ended up at a YouTube video of the touching ending of the movie "<a href="http://en.wikipedia.org/wiki/Ghost_%281990_film%29">Ghost</a>" with Demi Moore and the late <a href="http://en.wikipedia.org/wiki/Patrick_Swayze">Patrick Swayze</a>. A computer-generated ad popped up, advertising the prowess of a local big-name hospital in treating pancreatic cancer. <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZXcRX3YyW0N5JhN_O5LPliIqy9XI5yrZSDvJ14-5OrAhp_scfPbeaDb7Gv_zjZIE8sa1x0AeHJodHpXUQron-KKqeUTcylzKOYVJJLQMJZlKh9ypoWydAxYNSK06FLAaWxD7sDZbb7EEg/s1600/ghost.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5714943348416696978" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZXcRX3YyW0N5JhN_O5LPliIqy9XI5yrZSDvJ14-5OrAhp_scfPbeaDb7Gv_zjZIE8sa1x0AeHJodHpXUQron-KKqeUTcylzKOYVJJLQMJZlKh9ypoWydAxYNSK06FLAaWxD7sDZbb7EEg/s320/ghost.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 276px; height: 194px;" /></a>I really don't want to see medical ads about cancer when watching this... </div> Considering the context: how gross. So much for cybernetic "artificial intelligence" <a href="http://hcrenewal.blogspot.com/2011/01/ibms-watson-jeopardy-and-revolutioning.html">replacing the human mind</a>. -- SS

A distasteful result of data mining, "artifical intelligence" and hospital advertising

A distasteful result of data mining, "artificial intelligence" and hospital advertising: Last night in some ad-hoc Internet wander...

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Infanticide As A Right: Killing Babies No Different From Abortion, "Experts" Say?

Holy Hippocrates... This is nihilism at its finest. This is what happens when "education" turns into madness. Infanticide of newborns becomes a right: <blockquote>The Telegraph Feb. 29, 2012 <a href="http://www.telegraph.co.uk/health/healthnews/9113394/Killing-babies-no-different-from-abortion-experts-say.html">http://www.telegraph.co.uk/health/healthnews/9113394/Killing-babies-no-different-from-abortion-experts-say.html</a> Parents should be allowed to have their newborn babies killed because they are “morally irrelevant” and ending their lives is no different to abortion, a group of medical ethicists linked to Oxford University has argued. The article, published in the Journal of Medical Ethics, says newborn babies are not “actual persons” and do not have a “moral right to life”. The academics also argue that parents should be able to have their baby killed if it turns out to be disabled when it is born. The journal’s editor, Prof Julian Savulescu, director of the Oxford Uehiro Centre for Practical Ethics, said the article's authors had received death threats since publishing the article. He said those who made abusive and threatening posts about the study were “fanatics opposed to the very values of a liberal society”. The article, entitled “After-birth abortion: Why should the baby live?”, was written by two of Prof Savulescu’s former associates, Alberto Giubilini and Francesca Minerva. They argued: “The moral status of an infant is equivalent to that of a fetus in the sense that both lack those properties that justify the attribution of a right to life to an individual.” Rather than being “actual persons”, newborns were “potential persons”. They explained: “Both a fetus and a newborn certainly are human beings and potential persons, but neither is a ‘person’ in the sense of ‘subject of a moral right to life’. </blockquote><div class="fifthPar"></div> My observations: 1. These medical ethicists should keep their "ethics" within their own families. 2. One wonders if the current non-consensual human subjects experimentation known as "health IT" is justified by the same "ethicists." -- SS Addendum March 1, 2012: We've been here before. From another blog: Tacitus, a.k.a Publius (or Gaius) Cornelius Tacitus (AD 56 – AD 117) was a senator and a historian of the Roman Empire. Tacitus criticized the "rebels" of the time for, among other things, their refusal to kill newly born babies: <a href="http://en.wikisource.org/wiki/The_Histories_%28Tacitus%29/Book_5" rel="nofollow nofollow" target="_blank">http://en.wikisource.org/wiki/The_Histories_%28Tacitus%29/Book_5</a> . See section 5. Such a practice was apparently <a href="http://en.wikipedia.org/wiki/Infanticide#Pagan_European_tribes">no big deal</a> then. This "ethics" proposed at Oxford represents a return to uncivilizedness. -- SS

Infanticide As A Right: Killing Babies No Different From Abortion, "Experts" Say?

Holy Hippocrates... This is nihilism at its finest. This is what happens when "education" turns into madness. Infanticide of new...

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