has asked you for a recommendation. What will you tell him?
PARADISE HILLS Medical Center is a 500-bed teaching hospital in
a major metropolitan area of the South. It is known throughout a
tri-state area for its comprehensive oncology program and serves as
a regional referral center for thousands of patients suffering from
various forms of malignant disease.
Paradise Hills is affiliated with a major university and has
residency programs in internal medicine, surgery, pediatrics,
obstetrics/gynecology, psychiatry, radiology, and pathology, all
fully accredited by the Accrediting Commission for Graduate Medical
Education. In addition, Paradise Hills also has an oncology an
oncology fellowship program, a university-affiliated nursing
program, as well as training programs for radiology technicians and
medical technologists. All of these teaching programs are highly
regarded and attract students from across the nation.
Paradise Hills enjoys an enviable reputation throughout the
area. It is known for its high-quality care, its state-of-the-art
technology, and its competent, caring staff. While Paradise Hills
is located within a highly competitive healthcare community, it
boasts a strong market share for its service area. Indeed, its
oncology program enjoys a 75 percent market share and its patients
provide significant referrals to the surgery, pediatrics, and
radiology programs as well.
Paradise Hills is a financially strong institution with equally
strong leadership. Its past successes, in large part, can be
attributed to its aggressive, visionary CEO and his exceptionally
competent management staff.
But all is not as well as it seems to be at Paradise Hills.
While the oncology program still enjoys a healthy market share, it
has been slowly but steadily declining from its peak of 82 percent
two years ago. In addition, the program’s medical staff are aging
and some of its highest admitting physicians are contemplating
retirement. The oncology fellowship program was established a few
years ago in anticipation of this, but unfortunately, thus far the
graduates of this program have not elected to stay in the
community. Of most concern to the CEO and his staff is the fact
that the hospital’s major competitor has recently recruited a
highly credentialed oncology medical group practice from the
Northeast and has committed enormous resources to strengthening its
own struggling oncology program.
Last week the board of trustees for Paradise Hills had its
monthly meeting with a fairly routine agenda. However, during
review of a standard quality assurance report, one of the trustees
asked for clarification of a portion of the report indicating that
22 oncology patients had received radiation therapy dosages in
excess of what had been prescribed for them. The board was informed
that the errors had occurred due to a flaw in the calibration of
the equipment. The board was also informed that the medical
physicist responsible for the errors had been asked to resign his
position. The question was then asked if the patients who were
recipients of the excessive radiation had been told of the error.
The CEO responded that it was the responsibility of the medical
staff to address this issue and it was their decision that the
patients not be informed of the errors. The board did not concur
that the responsibility for informing the patients of the errors
rested solely with the medical staff and requested that the
administrative staff review the hospital’s ethical responsibility
to these patients, as well as its liability related to this
incident, and report back to the board within two weeks.
The CEO and his management staff responsible for the radiology
department and the oncology program met with the medical staff
department chairmen for internal medicine and radiology, the
program medical directors for oncology and radiation therapy, and
the attending oncologists. The CEO reported on the board discussion
related to the incident and the board’s request for a review of the
actions taken, specifically the decision to not inform the affected
The physicians as a whole agreed that the adverse effects of the
accidental radiation overdose on the patients were unknown.
Therefore, they argued the patients should not be told of the
incident. These are cancer patients and they don’t want or need any
more bad news, the oncologists argued. “Let’s face it, these
patients are terminal.” “Informing the patients of this error will
only confuse them and destroy their faith and trust in their
physicians and in the hospital,” they added. Furthermore, they
claimed, informing the patients of the errors may unnecessarily
frighten them to the extent that they may refuse further treatment
and that would be even more detrimental to them. Besides, argued
the physicians, advising the patients of potential ill effects just
might induce these symptoms through suggestion or excessive worry.
Every procedure has its risks, insisted the chairman for radiology,
and these patients signed an informed consent.
Physicians know what is best for their patients, the attending
oncologists maintained, and they will monitor these patients for
any ill effects. The department chairman for internal medicine
volunteered that, in his opinion, this incident is clearly a
patient-physician relationship responsibility and not the business
of the hospital. Besides, added the chairman of radiology,
informing the patients would “just be asking for malpractice
The medical director for the oncology program then suggested
that the board of trustees and the management staff “think long and
hard” about the public relations effect of this incident on the
oncology program. “Do you really think patients will want to come
to Paradise Hills if they think we’re incompetent?”, he asked.
The CEO conceded that he supported the position of the medical
staff in this matter and he, too, was especially concerned about
preserving the image of the oncology program, but “his hands were
tied” since the board clearly considered this an ethical issue and
one that would be referred to the hospital’s ethics committee for
The physicians noted that if indeed it was the subsequent
recommendation of the ethics committee that these patients be
informed, then realistically, that responsibility would rest with
the patient’s primary care physician and not with any of them.