These Things Happen
Review the case of Paradise Hills Medical Center, below. The CEO has asked
you for a recommendation. What will you tell him?
PARADISE HILLS Medical Center is a 500-bed teaching hospital in a major
metropolitan area of the South. It is known throughout a tri-state area for its
comprehensive oncology program and serves as a regional referral center for
thousands of patients suffering from various forms of malignant disease.
Paradise Hills is affiliated with a major university and has residency programs in
internal medicine, surgery, pediatrics, obstetrics/gynecology, psychiatry,
radiology, and pathology, all fully accredited by the Accrediting Commission for
Graduate Medical Education. In addition, Paradise Hills also has an oncology an
oncology fellowship program, a university-affiliated nursing program, as well as
training programs for radiology technicians and medical technologists. All of
these teaching programs are highly regarded and attract students from across the
nation.
Paradise Hills enjoys an enviable reputation throughout the area. It is known for
its high-quality care, its state-of-the-art technology, and its competent, caring
staff. While Paradise Hills is located within a highly competitive healthcare
community, it boasts a strong market share for its service area. Indeed, its
oncology program enjoys a 75 percent market share and its patients provide
significant referrals to the surgery, pediatrics, and radiology programs as well.
Paradise Hills is a financially strong institution with equally strong leadership.
Its past successes, in large part, can be attributed to its aggressive, visionary
CEO and his exceptionally competent management staff.
But all is not as well as it seems to be at Paradise Hills. While the oncology
program still enjoys a healthy market share, it has been slowly but steadily
declining from its peak of 82 percent two years ago. In addition, the program’s
medical staff are aging and some of its highest admitting physicians are
contemplating retirement. The oncology fellowship program was established a
few years ago in anticipation of this, but unfortunately, thus far the graduates of
this program have not elected to stay in the community. Of most concern to the
CEO and his staff is the fact that the hospital’s major competitor has recently
recruited a highly credentialed oncology medical group practice from the
Northeast and has committed enormous resources to strengthening its own
struggling oncology program.
Last week the board of trustees for Paradise Hills had its monthly meeting with a
fairly routine agenda. However, during review of a standard quality assurance
report, one of the trustees asked for clarification of a portion of the report
indicating that 22 oncology patients had received radiation therapy dosages in
excess of what had been prescribed for them. The board was informed that the
errors had occurred due to a flaw in the calibration of the equipment. The board
was also informed that the medical physicist responsible for the errors had been
asked to resign his position. The question was then asked if the patients who
were recipients of the excessive radiation had been told of the error. The CEO
responded that it was the responsibility of the medical staff to address this issue
and it was their decision that the patients not be informed of the errors. The
board did not concur that the responsibility for informing the patients of the
errors rested solely with the medical staff and requested that the administrative
staff review the hospital’s ethical responsibility to these patients, as well as its
liability related to this incident, and report back to the board within two weeks.
The CEO and his management staff responsible for the radiology department and
the oncology program met with the medical staff department chairmen for
internal medicine and radiology, the program medical directors for oncology and
radiation therapy, and the attending oncologists. The CEO reported on the board
discussion related to the incident and the board’s request for a review of the
actions taken, specifically the decision to not inform the affected patients.
The physicians as a whole agreed that the adverse effects of the accidental
radiation overdose on the patients were unknown. Therefore, they argued the
patients should not be told of the incident. These are cancer patients and they
don’t want or need any more bad news, the oncologists argued. “Let’s face it,
these patients are terminal.” “Informing the patients of this error will only
confuse them and destroy their faith and trust in their physicians and in the
hospital,” they added. Furthermore, they claimed, informing the patients of the
errors may unnecessarily frighten them to the extent that they may refuse further
treatment and that would be even more detrimental to them. Besides, argued the
physicians, advising the patients of potential ill effects just might induce these
symptoms through suggestion or excessive worry. Every procedure has its risks,
insisted the chairman for radiology, and these patients signed an informed
consent.
Physicians know what is best for their patients, the attending oncologists
maintained, and they will monitor these patients for any ill effects. The
department chairman for internal medicine volunteered that, in his opinion, this
incident is clearly a patient-physician relationship responsibility and not the
business of the hospital. Besides, added the chairman of radiology, informing the
patients would “just be asking for malpractice litigation.”
The medical director for the oncology program then suggested that the board of
trustees and the management staff “think long and hard” about the public
relations effect of this incident on the oncology program. “Do you really think
patients will want to come to Paradise Hills if they think we’re incompetent?”, he
asked.
The CEO conceded that he supported the position of the medical staff in this
matter and he, too, was especially concerned about preserving the image of the
oncology program, but “his hands were tied” since the board clearly considered
this an ethical issue and one that would be referred to the hospital’s ethics
committee for its opinion.
The physicians noted that if indeed it was the subsequent recommendation of the
ethics committee that these patients be informed, then realistically, that
responsibility would rest with the patient’s primary care physician and not with
any of them. Part 2
8.2
These Things Happen
Review the case of Paradise Hills Medical Center, below. The CEO has asked
you for a recommendation. What will you tell him?
PARADISE HILLS Medical Center is a 500-bed teaching hospital in a major
metropolitan area of the South. It is known throughout a tri-state area for its
comprehensive oncology program and serves as a regional referral center for
thousands of patients suffering from various forms of malignant disease.
Paradise Hills is affiliated with a major university and has residency programs in
internal medicine, surgery, pediatrics, obstetrics/gynecology, psychiatry,
radiology, and pathology, all fully accredited by the Accrediting Commission for
Graduate Medical Education. In addition, Paradise Hills also has an oncology an
oncology fellowship program, a university-affiliated nursing program, as well as
training programs for radiology technicians and medical technologists. All of
these teaching programs are highly regarded and attract students from across the
nation.
Paradise Hills enjoys an enviable reputation throughout the area. It is known for
its high-quality care, its state-of-the-art technology, and its competent, caring
staff. While Paradise Hills is located within a highly competitive healthcare
community, it boasts a strong market share for its service area. Indeed, its
oncology program enjoys a 75 percent market share and its patients provide
significant referrals to the surgery, pediatrics, and radiology programs as well.
Paradise Hills is a financially strong institution with equally strong leadership.
Its past successes, in large part, can be attributed to its aggressive, visionary
CEO and his exceptionally competent management staff.
But all is not as well as it seems to be at Paradise Hills. While the oncology
program still enjoys a healthy market share, it has been slowly but steadily
declining from its peak of 82 percent two years ago. In addition, the program’s
medical staff are aging and some of its highest admitting physicians are
contemplating retirement. The oncology fellowship program was established a
few years ago in anticipation of this, but unfortunately, thus far the graduates of
this program have not elected to stay in the community. Of most concern to the
CEO and his staff is the fact that the hospital’s major competitor has recently
recruited a highly credentialed oncology medical group practice from the
Northeast and has committed enormous resources to strengthening its own
struggling oncology program.
Last week the board of trustees for Paradise Hills had its monthly meeting with a
fairly routine agenda. However, during review of a standard quality assurance
report, one of the trustees asked for clarification of a portion of the report
indicating that 22 oncology patients had received radiation therapy dosages in
excess of what had been prescribed for them. The board was informed that the
errors had occurred due to a flaw in the calibration of the equipment. The board
was also informed that the medical physicist responsible for the errors had been
asked to resign his position. The question was then asked if the patients who
were recipients of the excessive radiation had been told of the error. The CEO
responded that it was the responsibility of the medical staff to address this issue
and it was their decision that the patients not be informed of the errors. The
board did not concur that the responsibility for informing the patients of the
errors rested solely with the medical staff and requested that the administrative
staff review the hospital’s ethical responsibility to these patients, as well as its
liability related to this incident, and report back to the board within two weeks.
The CEO and his management staff responsible for the radiology department and
the oncology program met with the medical staff department chairmen for
internal medicine and radiology, the program medical directors for oncology and
radiation therapy, and the attending oncologists. The CEO reported on the board
discussion related to the incident and the board’s request for a review of the
actions taken, specifically the decision to not inform the affected patients.
The physicians as a whole agreed that the adverse effects of the accidental
radiation overdose on the patients were unknown. Therefore, they argued the
patients should not be told of the incident. These are cancer patients and they
don’t want or need any more bad news, the oncologists argued. “Let’s face it,
these patients are terminal.” “Informing the patients of this error will only
confuse them and destroy their faith and trust in their physicians and in the
hospital,” they added. Furthermore, they claimed, informing the patients of the
errors may unnecessarily frighten them to the extent that they may refuse further
treatment and that would be even more detrimental to them. Besides, argued the
physicians, advising the patients of potential ill effects just might induce these
symptoms through suggestion or excessive worry. Every procedure has its risks,
insisted the chairman for radiology, and these patients signed an informed
consent.
Physicians know what is best for their patients, the attending oncologists
maintained, and they will monitor these patients for any ill effects. The
department chairman for internal medicine volunteered that, in his opinion, this
incident is clearly a patient-physician relationship responsibility and not the
business of the hospital. Besides, added the chairman of radiology, informing the
patients would “just be asking for malpractice litigation.”
The medical director for the oncology program then suggested that the board of
trustees and the management staff “think long and hard” about the public
relations effect of this incident on the oncology program. “Do you really think
patients will want to come to Paradise Hills if they think we’re incompetent?”, he
asked.
The CEO conceded that he supported the position of the medical staff in this
matter and he, too, was especially concerned about preserving the image of the
oncology program, but “his hands were tied” since the board clearly considered
this an ethical issue and one that would be referred to the hospital’s ethics
committee for its opinion.
The physicians noted that if indeed it was the subsequent recommendation of the
ethics committee that these patients be informed, then realistically, that
responsibility would rest with the patient’s primary care physician and not with
any of them.
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