Hospital Ethics Committees: Coordinating across Institutions

I was pleased to read that these two New York hospitals coordinate some of their ethics committee activities.  The ethics committees of St. Elizabeth Medical Center and Faxton St. Luke’s Healthcare "meet jointly every month to discuss ethical issues, which are similar at both hospitals."  



I am looking for more examples of multi-institutional ethics committees.  I want to bolster my argument that this is the best way to balance responsiveness and fairness for issues like decision making for the unbefriended and adjudicating end-of-life conflicts.  

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Rodger William Kelly Had Sex with Unconscious Neighbor to "Save Her Life"

Rodger William Kelly was charged with the rape of his unconscious neighbor.  But he claims that he only had sex with her in an attempt "to save her life."



Kelley told Utah police that he found his 29-year-old neighbor unconscious and began to have sex with her because "he was trying to save her life."  "He said he did place [his penis] inside of her to try and get her temperature up," police said in a probable cause statement filed in 5th District Court.  (Int'l Bus. Times)



Utah has a Good Samaritan Act that provides "a person who renders emergency care at or near the scene of, or during an emergency . . . is not liable . . . ."   But the Act shields only civil, not criminal, penalties.  Moreover, for immunity, the defendant must render the care "in good faith" and cannot be "grossly negligent."  It seems unlikely Kelley satisfies those conditions.

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Lana Barnes, Surrogate in Futility Dispute, Convicted of Medicaid Fraud

Lana Barnes was the surrogate in the most famous medical futility case in Minnesota.  



She insisted on non-indicated treatment at many Minneapolis area hospitals before one hospital challenged her in court and had her replaced as her husband's substitute decision maker.  



Last week, Lana Barnes was convicted of Medicaid fraud in connection with her husband's care.

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Man Oppressed by the Triumphs of Medicine

I enjoyed "The River" by James Guglielmi, yesterday, at the Art Institute of Chicago.  You see 4 women alongside the expanse of blue water, hemmed in by a monolithic concrete riverbank with an industrial landscape in the distance.  There is a vivid contrast between the natural and man-made landscapes.  One critic noted that Gugliemi's work suggests "the theme of man oppressed by his own great triumphs."  

This resonates with the all-too-common theme of the dying patient in the ICU "oppressed" by the triumphs of medical science.  In both the Gugliemi scene and in the ICU, we have developed some awesome technology.  But we too often let it get out of control and detract from a natural and enjoyable life.

 

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African Americans - Medical Mistrust Persists

African Americans still can’t get over the Tuskegee Experiment.  



Four decades after the infamous study on syphilis’ impact on black men ended in rural Alabama, mistrust of medical science resonates in the lack of African American participants in potentially life-saving clinical trials and studies.  (Charlotte Post)  



We see this same distrust in low advance directive completion rates and higher rates of end-of-life treatment conflict.

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Medicare Data Access for Transparency and Accountability Act (Medicare DATA Act)

I recently blogged about two new databases that add transparency to Medicare and Medicaid information.  First, ProPublica launched Nursing Home Inspect.  Second, the Association of Healthcare Journalists launched a hospital inspection database.  



These two databases may soon be joined by another.  U.S. Senators Chuck Grassley, R-Iowa, and Ron Wyden, D-Ore., say that despite a recent federal ruling affirming that Medicare data should be available to the public and federal efforts to make some data publicly available, much more still needs to be done to make Medicare claims data fully transparent. 



“Medicare is a $500 billion program with billions of dollars going out in error each year,” Grassley said. “The bad actors get bigger and bolder all the time. They stay out of law enforcement’s reach all too often. It’s time to try new things. More transparency about billing and payments increases public understanding of where tax dollars go and foster accountability. The bad actors might be dissuaded if they knew their actions were subject to the light of day.”



“Medicare claims data transparency seems to be moving in the right direction, but we’re just not there yet,” Wyden said. “Aggregated data and statistical averages can hide differences between providers and settings, and don’t allow Americans to truly compare their health care choices. In order to enjoy the benefits of full transparency, Medicare claims data should be readily available to the public.”



Grassley and Wyden plan to reintroduce the Medicare Data Access for Transparency and Accountability Act (Medicare DATA Act). The bill would require the Secretary of Health and Human Services to issue regulations to make available a searchable Medicare payment database that the public can access at no cost. The bill also clarifies that data on Medicare payments to physicians and suppliers do not fall under a Freedom of Information Act exemption.

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Wisconsin Bishops - Now and at the Hour of Our Death

The Wisconsin’s Catholic bishops just released the third edition of their pastoral letter on end of life health care decision-making and advance care planning, Now and at the Hour of Our Death. 

The letter voices the bishops’ concern and compassion for those facing critical health care decisions, and shares a moral and ethical framework for making such decisions.  Fortunately, the letter does not go far as the radical Catholic Medical Association white paper about which I will be writing more soon.

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