Your cover story did a fine job of illuminating the rampant misgivings about the state of healthcare business ethics ("Perception is everything," March 7, p. 6). It did not, however, offer many practical solutions to the problems outside of the codes of ethical conduct issued by professional associations. Although these codes are rhetorically forceful and occasionally insightful, they often lack true mechanisms of accountability and concrete courses of action for organizations and individuals to ensure ethical business practices.
My suggestion would be for the healthcare industry to take a closer look at the business requirements contained in the Sarbanes-Oxley Act of 2002, specifically Section 404, which requires ongoing documentation, evaluation, testing and remediation of financial reporting controls by an organization's own management team as well as outside auditors. Those organizations that have already prepared for compliance under 404 would most certainly attest to the value of a well-controlled financial environment as a buffer against individual misconduct and fraud.
Regrettably, at this point in time, Sarbanes-Oxley only applies to Securities and Exchange Commission-regulated companies, and therefore, has not popped up on the radar screens of many not-for-profit or privately owned healthcare organizations. The question is, can our industry really talk about what your publication calls "Ethics in the Enron era" without holding itself to the same standard as Enron and other publicly traded companies?
... to a crisis of corruption
I thought the piece on physician ethics was superb, but I think the data support an even stronger conclusion. A recent study put the cost of unnecessary imaging in the U.S. at $16 billion annually.
When owners of equipment and facilities have the ability to recommend use of these services to individuals who really have no way to know if a need for the service exists or that the owners profit from their recommendations, the door to corruption is wide open.
We are in need of moral leadership in healthcare. A follow-up article from the payer perspective would be most interesting.
President and chief executive officer
Florida Hospital Memorial System
Ormond Beach, Fla.
Having worked in rural healthcare for 35 years, I found the article "The doctor in the dell" to be a welcome sight (March 14, p. 44). The growing use of pesticides and fertilizer is of paramount concern in farm communities. People are inhaling, ingesting and otherwise living in these chemicals.
Your coverage draws attention to this overlooked area and the need for control, education and safety in regard to these materials.
Health information management
St. Joseph's Regional Medical Center
In your article on a study of medication errors resulting from a computerized physician order entry system, you quote Suzanne Delbanco, chief executive officer of the Leapfrog Group ("Defending CPOE," March 14, p. 10).
She comments that the CPOE system that was the subject of the Journal of the American Medical Association report is "quite an old system. No system is any better than how it is designed and improved."
It is this quality of analysis or perspec- tive that is so unsettling to some in the medi- cal community.
Too often CPOE advocates only compare the latest and most optimal version of the system against sub-optimal non-CPOE medication ordering systems. Why should demonstrably flawed older CPOE systems be immune from critical analysis?
The Food and Drug Administration has approved many medications because they were shown to save lives.
Some of these have later been taken off the market because they also killed many people. Let's be a little more discerning regarding the reported benefits of CPOE.
Coke R. Smith
Sunnyside (Wash.) Community Hospital
What's right in healthcare
I appreciated the article by Ralph Loos on what's missing in discussions of healthcare costs ("What about the benefits?" Feb. 28, p. 16). Those of us who work in healthcare see a quality of life that was not there just a few short years ago.
This is not a plea for uncontrolled spending but for recognition of the incredible and yet costly strides that we have seen. Those once confined to a wheelchair with crippling arthritis now get knees and hips replaced or pain-relieving medications.
Although it's not where we would like it, the survival rates in cancer have be- come phenomenal.
Cardiovascular disease outcomes have improved because of preventive care, drug therapy, pacemakers and advances in rehabilitation care.
Just as we have much to be concerned about as we try to fix our healthcare system we have much of which we should be proud.
Cardiovascular wellness and rehabilitation
Columbia St. Mary's Hospital
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