Scandal in Patient Safety Movement
Patient safety physician Bob Wachter has posted an important description of a scandal that has just emerged in the patient safety community on his blog Wachter’s World. As Bob describes it, the scandal centers around patient safety physician/expert Chuck Denham. “The scandal, which broke two weeks ago,” Wachter writes, “involves a $40 million fine levied by the Department of Justice against a company called CareFusion. The company allegedly paid Denham more than $11 million in an effort to influence the deliberations of a “safe practices” committee of the National Quality Forum co-chaired by Denham.
The post elicited dozens of comments by prominent patient safety experts, including Bob Wears, an ER physician in Florida who is an expert on many patient safety issues, including the over reliance on healthcare HIT, which he wrote about in the book I co-edited with Ross Koppel entitled First Do Less Harm: Understanding the Inconvenient Problems of Patient Safety. In his reply to the Wachter blog post, Bob wrote that:
“There’s an issue in this scandal that has not yet been discussed. it is a ‘structural’ problem, which means that episodes like this are likely to be repeated unless we can deal with it. That issue is the concentration of power. When any single organisation, no matter how pure its people and motives, winds up in a position to swing thousands of economic decisions, the temptation to resort to unsavoury means of influencing it will become overwhelming, and eventually someone will succumb. Better people and more stringent COI requirements will not change that ultimate reality.
This issue is of course not limited to patient safety; it certainly played a role in the financial collapse that led to the Great Recession, among other things. We need to think carefully about to avoid, even dismantle, these concentrations in favour of a more distributed, polycentric mode of supervisory control. It may be more complicated and less efficient, but in the long run will be safer.”
In my reply to Bob Wears’ comment on the blog, I wrote the following that I’d like to share here.
Bob Wears makes a really important comment here when he highlights the structural issues involved in this case. Reading it, I keep wondering why we are so surprised by this development. The patient safety movement operates in, not outside of, a wider culture that has always been –and has become even more obsessed — by individual advancement, celebrity, greed, and the marketplace — as in the selling of everything from inanimate objects to critical aspects of individual and social interaction. Reading the details that we know about this scandal reminds me of the book Jerry Kassirer wrote a number of years ago. In his excellent book On the Take he detailed the influence of Big Pharma on medicine. Is it surprising that some patient safety physicians would also be on the take when so many of their colleagues in medicine are too? (Nursing, by the way, likes to think of itself as exempt from this but sadly, it’s not). When that seems to be the norm rather than the exception? Reading Bob’s (Wachter’s) analysis of this scandal I am also reminded of recent articles in the New York Times exposing the practice of a hospital that tried to fire ER docs who wouldn’t admit patients to the hospital despite the fact that they didn’t need hospitalization (http://www.nytimes.com/2014/01/24/business/hospital-chain-said-to-scheme-to-inflate-bills.html?_r=00) or dermatologists who charge $25,000 for removing a tiny basal cell carcinoma (http://www.nytimes.com/2014/01/19/health/patients-costs-skyrocket-specialists-incomes-soar.html)
We, as a society, have not resolved how we define the goal of medicine. It is all well and good for physicians, nurses, and others to insist that they are patient-centered. The facts, however, are unarguable. In the market dominated US healthcare system, there seems to be a lot of confusion about the goals of medicine. Too many health care professionals and administrators seem to believe that they are entitled to do more than make a good living but rather are entitled to make a killing. That making a killing in the metaphoric sense may lead to patients dying quite literally is all too often ignored.
What is tragic about this incident is that shakes patients’ and the public’s credibility in a movement — the patient safety movement — that should have our unshakable support. When I read Jerry Kassirer’s book, and other work on the influence of Big Pharma on physician treatment and prescribing patterns, I came away wondering whom I could trust? I even worried about the judgment of my wonderful PCP — someone whom I doubt would be influenced by drug detail men. He, after all, was reading the same studies everyone else was and how many of these studies were subtly or not so subtly influenced by Big Pharma. Now we find that some physicians in the patient safety movement are similarly influenced by similar ties. This is, to put it mildly, not good at all. The discussion begun here must be extended in ways that may be very uncomfortable but must nonetheless be not only approached but embraced.