Code of Ethics Breakdowns Which

¶ … code of ethics breakdowns which occurred in the Tenet Hospital Group, and how they have addressed these ethical lapses with their current ethics statements. It then addresses questions of ethics formulation and enforcement in healthcare, and how it impacts my practice as a healthcare professional.

The Tenet Case

The fundamental case for Tenet was a clear lapse in the basic patient care guidelines that form part of the Hippocratic Oath: first, do no harm. Tenet employed a Korean-American cardiologist in its Redding, California hospital who was amongst the most prolific interventional cardiologists in the United States, despite being in a town with 80,000 inhabitants in a relatively remote area of California (City Data, 2007). This cardiologist performed thousands more angioplasties than would be indicated for the size of the city (Wynne, 2003).

The ethical lapses occurred both at the local (Redding) level and at the upper management level of Tenet Healthcare, a multi-hospital, for-profit company based in Santa Barbara, California. The local ethics breaches included: (1) using a low-cost "come-on" to patients from hundreds of miles for initial cardiac screening, (2) misdiagnosing in a way that permitted a good deal more angioplasties than would otherwise be medically necessary.

The ethical lapses on the part of Tenet management were the inability to monitor the appropriate granting of medical care in their centers. (Weintraub, 2002). While Tenet's CEO, Jeffrey Barbakow, was lionized on Wall Street for continued strong operating performance, Redding was but one of several Tenet institutions performing unnecessary, but profitable, operations in cardiac surgery, interventional cardiology and orthopedics.

Why the Code of Ethics is Important in the Healthcare Field

Ethics are particularly necessary in medical care because the medical professionals essentially control their reimbursement through the therapies they prescribe. Even if a doctor's prescribed form of treatment does no harm, but enriches the doctor, that is an ethical lapse on the part of the physician and the institution which employs him/her.

Strengths and Weaknesses of Ethics Codes in Healthcare code of ethics is only as good as its enforcement and reinforcement. In most states, medical ethics codes are reviewed as they are with most professions -- by a board of peers in the profession. The obvious concern is that professionals may be hesitant to censure one of their own.

A less obvious concern was obvious at Redding: there are few physicians with the expertise in the same institution to critically evaluate a physician's decision-making about patient therapies. In order to truly be judged by his/her peers, a physician in an outlying area like Redding should be periodically visited by others to evaluate outcomes.

It is clear that Tenet's top management failed its ethical responsibilities in two ways: (1) they failed to reinforce the ethical guidelines central to any hospital or medical management group, and (2) they failed to monitor the performance of their institutions to insure that they were ethically compliant.

How Individual's Professional Conduct is Guided or Not Guided by the Code of Ethics.

Individuals in the medical profession take an oath to conduct themselves in an ethical manner. Nurses have a 9-point oath, which is fairly far-reaching. Physicians' oaths are shorter, but no less binding. Since each profession (this includes firemen, lawyers and accountants, not just healthcare professionals) has an important 'self-policing' element, the primary enforcer of ethical conduct is the professional his/herself.

As we proceed towards more procedure-based medical techniques and professional medical management, it is also the responsibility of the institution in which the healthcare professional works to insure that ethical guidelines are followed.