Ethics at OSF

 

Tuesday, March 14, 2006

Ethics Committee at OSF

The American Medical Association’s representative of the Ethics Standards Group sent me a copy of relevant opinions from the American Medical Association's Code of Medical Ethics.

During the fall of 2001, I had spoken to Dr. Gerald McShane, Director of the Ethics Committee at OSF-Corporate, regarding my opinion of the conflict of interest at OSF with its relationship with Advanced Medical Transport. Dr. McShane advised me at the time that he did not think that OSF’s ethics committee should be consulted regarding this. He told me that he did not feel it was an appropriate topic to be brought up as an ethical issue. However, I thought it was appropriate for many reasons. 

I then went to Joseph Piccione, Corporate Ethicist at OSF, about the same issue, and he stated that I was mandated to bring up this issue regarding AMT. However, when I wrote five OSF Corporate leaders about what I regarded was a serious conflict of interest with AMT in May 2002, I never received an answer from anyone.

In the Spring of 2004, a former Haitian Hearts patient, Willie Fortune, needed to come back to OSF for pacemaker surgery. Haitian Hearts offered OSF-SFMC full charges for Willie’s surgery. I examined Willie in Haiti and he was in big trouble and needed a new pacemaker to replace his old pacemaker that had been put in at OSF. However, Willie was denied this surgery by OSF. I asked Mr. Piccione to take Willie's case of patient abandonment to the ethics committee at OSF for formal review. I never heard whether Willie’s abandonment was even discussed by the ethics committee at OSF and never heard from anyone on the ethics committee besides Piccione who said he was pretty "helpless to do anything". I wondered how Piccione could be "helpless to do anything" as the head OSF Corporate Ethicist?

So the OSF ethics committee didn’t help out when they were needed. The issues they needed to honestly discuss were very close to home--AMT and Willie Fortune–too close to discuss without bias.

Some recommendations to OSF regarding ethics committees from the AMA may include the following from the AMA literature:

1. Generally, the function of the ethics committee should be to consider and assist in resolving unusual, complicated ethical problems involving issues that affect the care and treatment of patients within the health care institution. And the people involved here would be the thousands of people in Peoria who call 911 each year and my Haitian Hearts patients who really needed OSF and the fine physicians and nurses who cared for them.  

2. Ethics committee members should not have other responsibilities that are likely to prove incompatible with their duties as members of the ethics committee. This would be to avoid conflict of interest with members of the ethics committee. Dr. McShane told me that Keith Steffen sat on the ethics committee, thus he did not think it was appropriate to bring up AMT. I also asked Dr. McShane for my impending termination and Keith’s management style in his office to be brought up to the OSF ethics committee . McShane discouraged this also due to Steffen’s presence. I wonder if it ever occurred to anyone that maybe Keith Steffen should not be on the ethics committee. In 2003, Piccione and McShane sat on the Diocesan Haitian Hearts committee and were not helpful regarding the survival of Haitian Hearts at OSF and Haitian kids at OSF. Therefore, I don’t see how Willie would get a “fair hearing” with Piccione, McShane, and Steffen on the ethics committee.  It seems Willie's life was not important to OSF. 

3. When a religious order operates a medical center, the mission statements should be taken into consideration in the committee’s recommendations. Respect for life, taking care of the poor and marginalized should be important to the OSF ethics committee…that is, if they will discuss the topic. (In 2004, we were able to get Willie out of Haiti and emergently operated at Vanderbilt Children's Hospital where he received a new pacemaker.)

Below is an article written by Joe Piccione in InterBusiness news in 2002. In 2005, Jackson Jean-Baptiste, a Haitian Hearts patient was denied care at OSF and died. 

Welcome to InterBusiness Issues

Saint Francis Medical Center

Joseph Piccione

June 2002

Ethics a Mainstay in Health Care

When people hear the word "ethics" they tend to think in negative terms. That is too narrow of a perspective, but with the recent Enron and Arthur Andersen debacle it is easy to understand why that negative view persists.

In classical Greek philosophy, ethics was considered a positive good to be attained and aChieved; for example, doing good in a good way made for happy people. Ethics is about good character and good decisions. Health care in the West is rooted in the Hippocratic tradition with its sense of duty, but also its professional fulfillment.

Living in today's pluralist society doesn't foster a common ethical theory. More collaboration is needed before there is consensus on norms, values, and happiness. For example, the Catholic Church and likewise, Catholic health care, does not support any form of assisted suicide. Yet the state of Oregon passed a law legalizing physician-assisted suicide, not making it ethical, but making it legal in that state.

All health care, regardless of the sponsoring organization, values human dignity. In fact, the five hospitals in the tri-County area all follow and support the standards of the Joint Commission of Accredited Healthcare Organizations. On the very first page of the Standards Manual, the Commission notes, "Patients have a fundamental right to considerate care that safeguards their personal dignity and respects their cultural, psychosocial, and spiritual values." The first page ends with "managing the hospital's relationships with patients and the public in an ethical manner."

Jim Moore, OSF Healthcare System CEO, frequently states in presentations health care is the second most regulated area behind nuclear power plants. There are many checks and balances to make certain rules and regulations are followed by those of us in health care so we always do what is right. Recently, there has been a proliferation of newly-formed compliance departments in hospitals and corporate offices of health care systems to further ensure adherence to the vast number of rules and regulations (state and federal) under which health care entities operate.

The Health Insurance Portability and Accountability Act was passed by Congress and will have many positive impacts on patients and providers; chief among them are specific mandates regarding patient confidentiality which compliance departments and many others in health care are actively planning to address in time for implementation by April 2003.

Another forum to ensure we in health care do what is right is the ethics committee. All hospitals have an ethics committee which can be accessed by patients, family members, and care providers to foster patient involvement or to discuss a concern or question. Maintaining and enhancing human dignity is one of the major guiding principles of ethics committees and health care in general.

Ethics is both ancient and contemporary, and continues to be an active mainstay in health care today. Ethics has an abiding place in health care-primarily among the professionals who encounter persons at times of their vulnerability.

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Did Mr. Piccione really believe what he wrote?