Friday, May 31, 2013

Keeping quiet about medical wrongdoing

A while back, when I was on the road giving a medical school talk, my hosts booked me into a series of back-to-back interviews with pleasant people wearing suits who had no idea who I was.  One exception, however, was a hospital “compliance officer.”  She had read (and apparently even liked) White Coat, Black Hat.  I had just finished reading Charles Graeber’s The Good Nurse, which is about a serial killer nurse who murdered at least forty patients, and perhaps hundreds, in hospitals across Pennsylvania and New Jersey.  To say that The Good Nurse paints hospital administrators in a poor light would be an understatement.  At one institution after another, hospital risk managers, compliance officers and assorted vice-presidents either knew or strongly suspected that Cullen was killing their patients, yet they kept the murders quiet and sent Cullen along to his next job with neutral or positive references. 

As it turned out, the compliance officer had read The Good Nurse.  She loved it.  So I asked: “How could these cover-ups possibly happen?”  She told me that the story didn’t really surprise her, and that in fact, she had left a previous job for similar reasons, as a kind of conscientious objection to administrators turning a blind eye to wrongdoing. I asked, “Where exactly did that occur?”

This is where the conversation turned extremely uncomfortable. Her face flushed red. She laughed nervously.  “You’re really putting me on the spot, aren’t you?”  She stammered, looked at her watch and noticed, gosh, it was much later than she thought. She had another appointment. It was really good to have this conversation. Good luck with the talk.

In an article for yesterday, I compared the actions of the hospital functionaries in The Good Nurse to the actions taken by University of Minnesota attorneys and administrators in the Markingson case.  It’s not a flattering comparison, but I don’t think it’s far-fetched.  Once a case of wrongdoing is put in the hands of bureaucrats whose job description is to protect the finances and reputation of the institution, it should be no surprise that they do their jobs. Yet their success depends on the silence of many others.

Over the past two years I’ve heard from a number of people who say they know of serious problems with psychiatric research here at the University of Minnesota.  Some are former patients or research subjects; some are family members of patients; some have worked on psychiatric wards.  They all thank me for writing about Dan Markingson’s suicide, and for pressing for an investigation into the possibility that others have been injured or mistreated.  Yet very few people are willing to speak out themselves.

I understand this. Some people fear for their jobs. Others may be afraid of legal retaliation by the university. Some people have experienced deeply painful losses, and just want to put the entire experience behind them. Yet it is also true that if Mary Weiss and Mike Howard had never spoken out – loudly and fearlessly, for years – the suicide of Dan Markingson in the CAFÉ study would have remained a secret.  No one would have ever known. To me, that is a frightening, deeply demoralizing thought.

1 comment:

  1. Thanks Carl for a very enlightening article. Having been on the inside looking out regarding the issues you raised on why more people don’t speak-out I’m of the belief it’s because the “authority” has more power and is better armed than we are. Historically, real change through revolutions and coup d'etat's only happened when what we have to gain is greater than what we have to lose, and the risk of dying is better than the certainty of living. And if you're not going for revolution when dealing with the UMN, then you're not going for any real change. The current state of self-government at the UMN is bureaucracy- that is; it is specifically designed to resist change, for to admit change is needed is to admit there may be fault. Nothing will ever change at the UMN unless change takes place starting with President Kaler and/or a new Medical School Dean; otherwise it’s the same old University with new puppets on the thrones.


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