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Back to Basics

The business community needs a refresher course on ethics. And don't think the health care industry is above it all.

by Emily Friedman

In the past year, this society, which has always trumpeted market capitalism as the best financial and political system on earth, has witnessed something of an ethics meltdown among the powers that be. Arthur Andersen, the accounting firm once revered as the gold standard of auditing, has collapsed after being found guilty, in a federal trial, of fraudulent accounting practices. Executives of cable firm Adelphia, telecommunications giant WorldCom, even Enron (although most of its top leaders, for some reason, as of this writing remain untouched by the long arm of the law) have been arrested and taken away in handcuffs. The former head of Tyco, Dennis Kozlowski, is being sued by his own company for using $245 million in unauthorized employee loans to buy yachts and fine art and then failing to repay the money. Columnist and author Bob Greene, an advocate for abused children, was forced to resign from the Chicago Tribune staff in September after admitting that he had had a sexual relationship with a teenager. Even that paragon of good behavior, Martha Stewart, is under investigation by the Justice Department (after she refused to provide information to Congress) for what might delicately be called creative investment practices.

Small wonder, then, that a Chicago Tribune poll conducted in July found that, among other things, 66 percent of the public believes that "compared with 10 to 20 years ago, ethical standards of major corporations have changed for the worse," and 76 percent believe that "top corporate executives put their own personal interests ahead of the interests of workers and shareholders." Gee, I wonder why.

Yes, Health Care, Too

Health care executives and trustees might view all this as something of a spectator sport, but it isn't. Our sector has had some big-time moral meltdowns of its own. Sherif Abdelhak, former head of the Allegheny Health, Education, and Research Foundation, which declared bankruptcy after all its money mysteriously disappeared, began serving prison time in September after pleading guilty to pillaging many of the health system's protected charitable endowments. Five former hospital CEOs are doing time for embezzlement, two more for Medicare fraud, and one for racketeering and conspiracy. Cryolife, which sells organs and tissue, and Eclipsys, a health care software vendor, both face class action suits for accounting irregularities. Employees of pharmaceutical firm TAP have been indicted for paying kickbacks to physicians, and Eli Lilly has been subpoenaed in Florida for questionable marketing of Prozac.

Kansas City, Missouri, pharmacist Robert Courtney diluted cancer drugs to increase his profits. Several physicians have been convicted of fraud and unnecessary surgery; in one case in Chicago, patients died as a result. Both the hospital CEO and the surgeon are in prison. And the Connecticut attorney general has launched an investigation of United HealthCare after the health plan, which is required to pay for child immunization, urged patients to obtain them instead from the state's free program for low-income residents. And at a time when the drums of war are beating and our military men and women are being lauded (and sometimes politically exploited) as heroes, the Veterans Administration health system has adopted a policy of not "actively recruiting" any new patients. This includes the World War II veterans who helped save this planet from the Third Reich.

I don't think these health care leaders have anything to crow about. They should be eating crow instead, and, sadly, not all of them are; Abdelhak is still pleading that his actions were justified.

Ethics 101

In an interview in the February-March 1999 issue of American Heritage, Pulitzer Prize-winning historian David McCullough explained why he had chosen the Johnstown Flood as the subject of his first book. He replied that the flood--which was caused when the dam of an artificial lake used exclusively by the very wealthy broke and inundated the valleys below, killing hundreds of people--illustrated one of the "darker aspects of history." He said that the flood was "a morality lesson about our pathetic human inclination to think that because people are in positions of responsibility, they are therefore behaving responsibly."

Health care leaders occupy positions of singular responsibility. Most of them deserve it. Despite this fact, it might be a good time to get back to some ethics basics, as a sort of instant refresher course. Given that the readers of this column are health care professionals, and, one assumes, not strongly attracted to felonious activity, we will skip the parts about child molestation, embezzlement, fraud and other criminal behaviors. We already know that they are wrong.

So here are some basic ethics precepts. Because this is a secular publication, I will not call them 10 commandments, but rather 10 suggestions.

In 1957, an executive gave a major speech in which he asked, "Is our profession so impressed with its ivory-tower position in the public mind that we are not hearing basic criticisms of our work?" The speaker was Arthur Andersen managing partner Leonard Spacek. He ushered in the golden era at Andersen, when its audits were so uncompromising, and its ethics so taut, that they became the preeminent firm in the field. Years later, they squandered all the social and ethics capital they had so carefully garnered, and their once-golden firm lies in ruins.

The same cannot be allowed to happen in health care; the stakes are too high and the possible harm too great. We do not deal in stocks and bonds; we deal in human lives. People trust us. And in a wounded society, being able to retain faith in those whom you have honored with your trust is not just desirable; it is essential. For us, and for those we serve.

This article first appeared in the November/December 2002 issue of Health Forum Journal

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