We really shouldn't have any secrets," says Ralph Lawson, Baptist Health South Florida's chief financial officer, in last week's cover story on the impact of Sarbanes-Oxley (Dec. 6, p. 6).
Lawson was talking about not-for-profit hospital systems adhering to the law's financial reporting requirements despite the fact that it applies (for now) only to for-profit corporations. His attitude is laudable and, we hope, contagious. For too long, many corporations and government policymakers have made a cult of secrecy. Unfortunately, too many healthcare institutions and healthcare policymakers also have shrouded themselves in the same cloak of invisibility.
When organizations create a culture of closed mouths and classified information, it's because they have lost sight of whom they are supposed to serve. Self-aggrandizement and the preservation of power by select individuals become more important than the common good.
HealthSouth Corp. is a classic example of a company that scrambled its priorities. Serving patients, employees and stockholders was lost in the frenzy to accumulate more money and prop up a corrupt executive team. The judicial system will decide what, if anything, former HealthSouth chieftain Richard Scrushy is guilty of, but given everything that has been disclosed in court, his challenge to Sarbanes-Oxley's constitutionality is as amusing as Al Capone challenging the tax code.
On a less outrageous but still distressing note in the secrecy file, we have the continuing efforts of the healthcare profession to shield itself from information disclosure on patient safety and quality. Just last week, for example, a state judge rejected the Florida Hospital Association's bid to delay implementation of a state constitutional amendment requiring hospitals to release incident reports detailing adverse events. Voters approved the amendment in the November election. The association argues that the amendment's requirements are too vague and hospitals may inadvertently violate privacy laws. Perhaps that's true, but there's a decades-long history of industry foot-dragging on medical errors. Decreased revenue and legal liability fears are the reasons. Postponing the day providers actually may have to do something beyond window dressing on medical errors has become the prime directive. The good of the patients has become a secondary priority, and most providers so far have done little to change that.
(By the way, anyone interested in a good account of trying to overcome this code of silence should read an article headlined "The Bell Curve" in the Dec. 6 issue of the New Yorker. The story, written by a surgeon, recounts the efforts to break down professional resistance to data-sharing, grading and patient participation in the search for the best treatments for cystic fibrosis.)
Finally, like a lot of other observers, we noted the sudden loquaciousness of HHS Secretary Tommy Thompson in announcing his resignation. He told us of his fears concerning the food supply, terrorism and avian flu, as well as the way the government oversees drug safety. He also said he regrets that Congress didn't give HHS the authority to negotiate lower drug prices in the Medicare prescription benefit bill. That last one is a real hoot. Thompson's CMS administrator muzzled the chief Medicare actuary on the bill's projected cost, which was much higher than advertised.
It would have been nice if Thompson had told Congress how he felt about the Medicare measure before lawmakers approved the turkey. He also could have told the nation about the other problems he thought needed tackling when he had access to the Oval Office and could do something about them. It looks as if the secretary took the "secret" part of his title too seriously-a common affliction in Washington these days. That's a malady that strikes when you forget your first duty is to serve the American people, not political interests.
