PRIVATIZING THE COUNTY HOSPITAL

The board of physicians of the Green River County Hospital convened for their monthly meeting to discuss cases and hospital business. The big issue at hand was the proposal to turn over management of the hospital to a private contractor, namely Four Corners Health Partners (FCHP). It was a small outfit that had started buying up health facilities in the Colorado Plateau region, but was quickly expanding into other areas of the country. For public health care institutions, FCHP was now offering consulting services and, in this case, actual management of the county hospital.

The county commission had asked the board of physicians for its recommendations. The Director of Medical Staff, Dr. Melvin Wood called the meeting to order.

The first item on our agenda is preparing a response to the county commissions inquiry. They want our perspective on the contract as proposed by FCHP for management of this hospital. Who would like to speak first?

Several doctors raised their hands, but the director recognized Dr. Sophia Kopper, the senior physician on staff.

Most of us here have already heard from colleagues and friends who work in facilities owned or managed by FCHP. The picture isnt pretty. FCHP does appear to deliver on its mission of lowering costs but it does so at the expense of patient care. The people Ive talked to are frankly too scared to come out in the open and voice their concerns for fear of losing their jobs. My own independent research has revealed that FCHP has been involved in numerous scandals. Their public relations and lobbying efforts appear to be extremely effective in squelching complaints before they come to the publics attention. I think this outfit is unethical. We should tell the county commissioners that we unequivocally oppose this deal.

Sophia, theyre talking about closing this hospital. We may not have any alternative, said Dr. Wood.

Mel, do you know if the county commission has explored other companies? asked Dr. Kopper.

No, I dont. Lets face it though, we are in a sparsely populated part of the country and I doubt that many companies would want to operate here.

Dr. Kopper did not respond. Her eyes glanced around at the other physicians.

Finally, Dr. Wood asked if anyone was in favor of recommending approval of the contract. Only Dr. Kopper responded.

Mel, we have all met informally before coming here. All of us are in agreement that, as our representative, you should write a strong memo saying that we are unanimous in our objection to signing a contract with FCHP. I so move.

Several physicians simultaneously seconded the motion.

We have a motion on the floor. All those in favor say Aye. Dr. Wood was met with a resounding chorus of voices.

All those opposed say Nay.The room was silent.

All right, Ill prepare a memo and forward it to the commission.

Later that day, Dr. Wood had lunch with the hospital administrator and a representative from FCHP.

When the administrator left to visit the restroom, the FCHP representative said to Dr. Wood, Im aware that your staff physicians have some reservations about our company. I can assure youz, Dr. Wood, that any problems we may have had in other jurisdictions have just been growing pains. We re a good company. Your administrator is eligible for retirement and I doubt that he will make the move to FCHP, should we get the contract. For somebody like you, however, I believe you will find an opportunity to come and grow with our company. You already have management experience and we like what we see. Im sure that we could come to some arrangement about a significant increase in salary, not to mention stock options. Keep that in mind while you write the report.

Dr. Wood was thankful that at just that moment, the hospital administrator came back to the table.

Later that day, Dr. Wood looked over the accounting books and agreed with the county budget office that the hospital could not continue under the current financial arrangements. As he wrote the letter to the county commissioners, he deliberately softened the objections of the Green River County Hospital Board of Physicians. (Sharp 74-76)

Reference:

Sharp, Brett S., Grant Aguirre, and Kickham. Managing in the Public Sector: A Casebook in Ethics and Leadership. Pearson Learning Solutions, 2013.

SUBJECTIVISM
Subjectivism is the belief that there are no universal truths. This view can
be seen most clearly in the philosophical concept of solipsism. Solipsism is the
theory which says that the self is all one can really know.
CULTURAL RELATIVISM
While subjectivism holds that ethics are based in the individual, cultural relativism holds that ethics are based in the group. That is, what is ethical depends
on the culture of a given society. This theory again appears attractive because
societies do vary widely in their practice.
PSYCHOLOGICAL EGOISM
Psychological egoism is a major challenge to ethics in that it is a deterministic
theory. By deterministic, we mean that it posits that people cannot really help
the way they act. If this is true, it presents a major problem for ethics because
it would be unfair to judge someone for behavior over which he or she has
absolutely no control.
UTILITARIAN THEORY (TELEOLOGICAL ETHICS)
This theory was largely developed by late 18th and early 19th century thinkers
such as Jeremy Bentham and John Stuart Mill. This theory holds that acts are
judged to be morally right or wrong not in and of themselves, but rather by
the results that follow from the acts. Therefore, no act is in and of itself right
or wrong.DUTY ETHICS (DEONTOLOGICAL ETHICS)
In contrast to teleological ethics above, deontological or duty ethics is not
concerned with the consequences of an act. Duty ethics says that we are
morally obligated to act in a certain way regardless of consequence. Thus,
those that ascribe to this theory deny that the ends justify the means.
VIRTUE ETHICS
Virtue ethics can be traced back to Aristotle and his two major ethical works
Nichomachean Ethics and Eudemain Ethics. The idea behind virtue ethics is
that we should determine what characteristics are desirable and then try to
promote those characteristics in people.
THE MORAL MINIMUM
Now that we have presented most of the major ethical theories along with
their shortcomings, students often ask us what a moral minimum standard
would entail. Based on our study of ethics we believe that a moral minimum
would consist of a number of components. However, we must caution that
any such list of components is just a minimum. We believe that an acceptable
moral minimum would entail the following:
1. When faced with an ethical dilemma you must, to the extent possible, be
objective.
2. You must be willing to analyze the situation and develop possible
solutions, and you must be willing to consider other people”s ideas if they
are presented.
3. You must be willing to consider the impact your decision will have on all
parties involved.
4. Your decision should be based on a logical analysis of your known possible
solutions.
5. Finally, you must be willing to act on this rational analysis.

Sharp, Brett S.; Aguirre, Grant; Kickham, Kenneth (2011-01-11). Managing the Public Sector: A Casebook in Ethics and Leadership (Page 14). Pearson HE, Inc.. Kindle Edition.

For this discussion, first briefly explain why you selected the case study you identified.

(I am currently employed as a mental health screener at a local hospital and we are merging with Geisenger this summer.)

Explain what you believe to be the ethical issue or issues involved in the situation. Keep in mind that you may have to make your own conclusions based on the information available.

Explain which ethical principles you would apply to the situation and why.

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