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Another Cautionary Tale
SURVEY OF OPHTHALMOLOGY
VOLUME 56 NUMBER 3 MAY–JUNE 2011
EDITORIAL Another Cautionary Tale Dr. Tom Harbin’s Waking Up Blind; Lawsuits Over Eye Surgery (Minneapolis, MN, Langdon Street Press, 2009) is a painful read. I once naively believed that academic departments provided checks and balances that made endemic malpractice impossible. Harbin’s account of the events at Emory University’s Department of Ophthalmology between 1976 and 1997 challenges this assumption. The consequences for patients and faculty when the politically connected and financially productive chair of a department goes off the rails are devastating. A wrong eye corneal transplant performed at the end of a busy day prompts some faculty to question other actions of their chair, and this ignites a conflagration. As the conflict between the chair and the two members of the department who stand their ground escalates, the stakes get higher and higher: The eventual result being millions of dollars of liability payments and damage to the careers (and psyches) of all concerned. Harbin memorably comments, ‘‘When doctors fight, lawyers feast.’’ This is a real page turner, and I cannot do the story justice in a few paragraphs, but it does expose the soft underbelly of our academic medical centers. Although these events occurred roughly 30 years ago, the issues raised remain current. Managing faculty practices and the hospitals associated with them has become quite remunerative, requiring generation of large amounts of income from clinical work, grants, and donations to support highly paid administrators. At a recent medical staff meeting the retiring chief executive of the safety net hospital where I work justified her salary of well over one million dollars as the going rate for administering
a Boston hospital before defending an additional one-time, multimillion dollar payout from the board of trustees as fair compensation for lack of certain retirement benefits. At about the same time the hospital was cutting positions in maintenance and interpreter services. The head of the Emory Clinic saw nothing wrong with paying himself over one million dollars in 1983 (which Harbin points out is equivalent to more than two million dollars now), giving a $250,000 bonus to the department chair, and then asking him to cut department overhead. The chair proceeded to fire the physician’s assistant who had witnessed his wrong eye surgery and the secretary of one of his critics. Money colors decisions and may corrupt values. At Emory, their well-paid administrators were unwilling to look hard at the cash cow that their department of ophthalmology represented when unnecessary surgery and fraudulent billing were alleged. The anguish of a truth-teller was dismissed as ‘‘a rather nebulous expression of concern.’’ The Professional Standards and Ethics Committee of the Emory Clinic formally reprimanded this whistleblower for asserting ‘‘a moral superiority to your colleagues and peers.’’ Harbin comments, ‘‘And so Emory University, owned by the Methodist Church, with a board partially comprised of Methodist bishops and headed by an ordained minister, reprimanded one of its faculty for asserting moral superiority.’’ There are no winners in this internecine conflict. There are lessons to be learned. John W. Gittinger, Jr., MD Editor-in-Chief
183 Ó 2011 by Elsevier Inc.
0039-6257/$ - see front matter doi:10.1016/j.survophthal.2011.02.004
VOLUME 56 NUMBER 3 MAY–JUNE 2011
EDITORIAL Another Cautionary Tale Dr. Tom Harbin’s Waking Up Blind; Lawsuits Over Eye Surgery (Minneapolis, MN, Langdon Street Press, 2009) is a painful read. I once naively believed that academic departments provided checks and balances that made endemic malpractice impossible. Harbin’s account of the events at Emory University’s Department of Ophthalmology between 1976 and 1997 challenges this assumption. The consequences for patients and faculty when the politically connected and financially productive chair of a department goes off the rails are devastating. A wrong eye corneal transplant performed at the end of a busy day prompts some faculty to question other actions of their chair, and this ignites a conflagration. As the conflict between the chair and the two members of the department who stand their ground escalates, the stakes get higher and higher: The eventual result being millions of dollars of liability payments and damage to the careers (and psyches) of all concerned. Harbin memorably comments, ‘‘When doctors fight, lawyers feast.’’ This is a real page turner, and I cannot do the story justice in a few paragraphs, but it does expose the soft underbelly of our academic medical centers. Although these events occurred roughly 30 years ago, the issues raised remain current. Managing faculty practices and the hospitals associated with them has become quite remunerative, requiring generation of large amounts of income from clinical work, grants, and donations to support highly paid administrators. At a recent medical staff meeting the retiring chief executive of the safety net hospital where I work justified her salary of well over one million dollars as the going rate for administering
a Boston hospital before defending an additional one-time, multimillion dollar payout from the board of trustees as fair compensation for lack of certain retirement benefits. At about the same time the hospital was cutting positions in maintenance and interpreter services. The head of the Emory Clinic saw nothing wrong with paying himself over one million dollars in 1983 (which Harbin points out is equivalent to more than two million dollars now), giving a $250,000 bonus to the department chair, and then asking him to cut department overhead. The chair proceeded to fire the physician’s assistant who had witnessed his wrong eye surgery and the secretary of one of his critics. Money colors decisions and may corrupt values. At Emory, their well-paid administrators were unwilling to look hard at the cash cow that their department of ophthalmology represented when unnecessary surgery and fraudulent billing were alleged. The anguish of a truth-teller was dismissed as ‘‘a rather nebulous expression of concern.’’ The Professional Standards and Ethics Committee of the Emory Clinic formally reprimanded this whistleblower for asserting ‘‘a moral superiority to your colleagues and peers.’’ Harbin comments, ‘‘And so Emory University, owned by the Methodist Church, with a board partially comprised of Methodist bishops and headed by an ordained minister, reprimanded one of its faculty for asserting moral superiority.’’ There are no winners in this internecine conflict. There are lessons to be learned. John W. Gittinger, Jr., MD Editor-in-Chief
183 Ó 2011 by Elsevier Inc.
0039-6257/$ - see front matter doi:10.1016/j.survophthal.2011.02.004