Monday, March 10, 2014

Will it be a whitewash?

In five days, the president of the University of Illinois is due to receive the report from the Vice President for Research that will evaluate the circumstances surrounding the use of the University's name and reputation in support of a private medical equipment supplier.  Recall that the VP was charged to "conduct a methodical assessment of policies, guidelines, procedures and practices, and where corrective changes are required we will take the appropriate action."

As I have noted:

Karisa King and Jodi Cohen at the Chicago Tribune have published an excellent story about how some doctors and admininstrators decided to use the name and reputation of the University of Illinois in support of a medical device company.  With access to internal emails, it becomes clear that an explicit decision was made to do so by very high-ranking officials:

Benedetti, the head of surgery, sought advice and permission from Jerry Bauman, interim vice president for health affairs, and Dr. Dimitri Azar, dean of the College of Medicine, according to an Oct. 23 email obtained under the Freedom of Information Act.

"On one side it would be a lot of free publicity for our program, on the other side we could be criticized to be included in an industry generated campaign," Benedetti wrote. The two responded separately that the visibility would be good for the program.

It will be revealing to see how the report deals with the question of how these people recklessly gave themselves an exemption from the specific language of the Campus Administrative Manual:

In general, the University cannot permit its image to be used in any commercial announcement, in a commercial or artistic production, including the World Wide Web or in any other context where endorsement of a product, organization, person, or cause is explicitly or implicitly conveyed.

There are two possibilities.  The one offered to date by the University's spokesperson is that participating in the ad was "a good faith effort" to promote expertise that has "demonstrably beneficial outcomes for patients," but the execution was perhaps not well thought-out.

With such a conclusion, the University would be admitting that its policies are a nullity.  As long as someone felt that the business interests of the hospital would be well-served, the rules could be abrogated.

The second possibility is that these three high administrative officials are found to have knowingly violated the University's rules but get a mild slap on the wrist or less.  In such a case, the University would likewise be admitting that its policies are a nullity: As long as you are high up enough in the organization, the rules need not be followed.

Well, there is a third possibility, that the University sends a message--through appropriate punishment--that the ethical rules under which it operates are real.  As I noted back in January:

Regular readers know that I tend to operate in a no-blame mode, i.e., be hard on the problem and soft on the people.  But when someone has violated the public trust in an institution to support the commercial goals of a private company, they have shown such poor judgment that consideration must be given to terminating their employment.

And how much more so now that we know that this equipment manufacturer has provided cash support and has other close relations with UIC faculty.

I'm guessing we won't see much in this report that indicates a serious look at the recent violations.  The University has invested too much in its robotic surgery program to take an action that might suggest that any aspect of that program is untoward, influenced by the equipment manufacturer, or unsupported by clinical evidence.  Likewise, the University has made it clear that the highest ranking official who rules on matters of potential conflicts of interest can have deep and close financial relationships with firms whose interests overlap UIC's.

So, what's it to be?  Whitewash #1 or whitewash #2 or a clean break from past practices?  The resolution will eventually reflect on the Board of Trustees, some members of which are especially known for their public service reputation.  Will they stand by and watch as the reputation of their University is again dragged through the mud?


Pat Thomas said...

Keep up the good work Paul. Keep the pressure on!!! Our family found out the hard way that U of I staff is not following POLICIES POSTED throughout the hospital and clinics.

At one point I wanted to testify to the board. But the situation was just too heartbreaking for me.

Also, Paul, take a look at online reviews of U I hospital.

Anonymous said...

I would imagine it will be difficult to select one person to punish; this seems to be a general breakdown in ethical attitudes at the institution. However, there remains opportunity to regain trust - first, by forswearing any other Intuitive involvement in any further marketing, and turning down their funding for such. Second, by initiating or participating in legitimate clinical trials (NOT funded by Intuitive) aimed at finding out exactly how useful the robot is for certain types of surgery (instead of saying "We believe". Give me a break). Third, by instituting a policy whereby faculty members including the Dean who sit on outside boards are required to sign over their earnings from such service to the hospital foundation for patients' benefit, to mitigate any suggestion of COI. Fourth, to be completely transparent concerning the questions about the training, board certifications and other qualifications of the international surgeons who appear to head the program, by publishing this material in the report. Fifth, to hopefully lay to rest the allegations that one such surgeon is performing gynecologic surgery with the robot, lacking the proper credentials to do so. Sixth, by instituting sweeping externally led ethics training throughout the institution so their faculty and trainees understand what is expected.

This would go at least partially down the road to regaining any shreds of ethical behavior.

nonlocal MD

Barry Carol said...


If the culture of a hospital, especially an academic medical center, needs to change, who has the power to change it? Is it the CEO, the BOD or some combination of both? My perception is that hospital BOD’s consist mostly of local luminaries who are there mainly for the social prestige and to help cultivate wealthy potential donors to contribute to the hospital’s endowment or latest capital campaign.

If I were a hospital CEO, I would want a BOD that had expertise in business issues, medical issues and ethical issues including those who could bring a perspective from outside of the healthcare sector. With healthcare undergoing significant change in the years ahead due to the ACA and other factors, such expertise is needed now more than ever, in my opinion.

Paul Levy said...

Exactly, Barry. And it is more complicated at U of I because the Board is for the entire university, not just the health system. Frankly, it is incomprehensible that such a board is likely to have enough of a handle on medical issues to do a good job on that front. Even hospital-centric boards sometimes struggle to do the job well.

Nonetheless, in Illinois, that board has to set the ethical standards for the organization.

Terri said...

Didn't they have the university and St of Illinois ethics training ?
Perhaps not enough teeth in it.

Mitch said...

Great post. Sadly, I think you are right in expecting numbers 1 or 2.

Keep after them. This is an especially visible and shameful episode.