Hospital Code of Ethics Critique

Hospital Code of Ethics Critique

Philosophy - System of Inquiry

OUR PRINCPLES of ETHICAL CONDUCT INCLUDE:

LEGAL & ETHICAL REQUIREMENTS

Compliance with applicable laws, rules and regulations governing Lenox Hill

Hospital and its Affiliates.

This provision is unnecessarily vague and invites individual interpretation where that is counterproductive. A better approach would be to set forth the concept of compliance with applicable rules and regulations" completely apart from the body of the code of conduct, making more clear that this is a philosophy that underlies the entire code of ethics itself. In this regard, the section heading is worded appropriately, but the formatting seems to suggest that this is simply one of the code's provisions, rather than its underlying philosophy. The danger, especially when it appears as the first provision, is that it seems to invite personal interpretation of what laws, rules, and regulations apply, which is contrary to its intent.

PATIENT RELATIONS

Provision of patient care that is medically necessary and appropriate in a respectful and dignified manner, without regard to race, color, creed, sex, ethnic origin, age, disability, sexual orientation, source of payment, or other classification prohibited by law.

It is unnecessary, and potentially problematic to include the highlighted words, medically necessary. Obviously, the intent of the wording is merely to characterize correctly) that all elements of patient care are, indeed, medically necessary. However, it unnecessarily invites independent interpretation of what is "medically necessary" when, in fact, that is not desired in most cases. Likewise, the word appropriate is literally accurate, but also problematic for the same reason. A better formulation of the same concept would be the following:

Provision of all elements of patient care in a respectful and dignified manner, without regard to race, color, creed, sex, ethnic origin, age, disability, sexual orientation, source of payment, or other classification prohibited by law."

MANAGED CARE RELATIONSHIPS

Avoidance of improper financial incentives under managed care contracts that would result in underutilization of medically necessary services.

This provision is problematic because it seems to invite independent evaluation of specific financial incentives with respect to whether or not they might result in underutilization of services. Furthermore, it also seems to invite the same subjective consideration as to what services are medically necessary. The intention here is to caution against any motivation by financial incentives, without qualification.

Furthermore, the provision should also address the mere appearance of any financial incentives with regard to managed care. Therefore, a better formulation would read as follows:

Avoidance of any financial incentives or the appearance of financial incentives under managed care or the contracts that relate to any element of patient care or the rendering of any medical services."

PRIVACY and CONFIDENTIAL INFORMATION

Protection and safeguarding of information created in the conduct of Lenox Hill

Hospital and its affiliates business including patient information, staff data, financial data, research data, strategic plans, statistical information, purchasing agreements and contracts.

The words information created are an unnecessary limitation that narrow the applicability of the provision, contrary to its obvious intent to apply as broadly as possible. Under a literal interpretation, the provision, as drafted, does not apply to any of the types of information listed unless that information is "created" by the hospital.

Therefore, a better formulation of that portion of the provision would read as follows:

Protection and safeguarding of any and all information created, accessed, maintained, collected, transmitted, duplicated, or utilized by the hospital or by any of the hospital's employees, agents, associates, consultants, contractors, and any other person or entity affiliated in any way with the hospital..."

Business PRACTICES

Avoidance of transactions that excessively benefit private individuals in contravention of laws and regulations applicable to tax-exempt organizations.

This provision is extremely problematic because it invites multiple levels of subjective determination of what constitutes a "contravention of law" and what regulations are "applicable," to tax-exempt organizations. A better formulation would read as follows:

Avoidance of any transactions pertaining to tax-exempt organizations that benefit private individuals without a specific evaluation by hospital administration and approval by hospital administration and clearance by hospital legal counsel that those transactions are permissible."

Incentivizing Compliance:

The best opportunity to promote understanding of the role of the compliance officer and to provide incentive for compliance would by reformulating the final provision to read as follows: