By Dan Matas, Founder of OutcomesBase, Inc.
Ethics is a big reason in which compliance departments exist. Ethics paves the way for how we make decisions and what factors need to be considered when making decisions. While compliance is a large umbrella covering all aspects of healthcare service delivery, the bottom line of compliance is about “doing the right thing,” which is the main reason I felt called to become a compliance professional.
Recently I finished reading the book 5 Days at Memorial by Sheri Fink. It is the harrowing story of Memorial hospital, one of those impacted by hurricane Katrina, that continued to operate for five days after the storm hit before they could be fully evacuated. Previously Memorial had been a safe harbor during storms and many community members, in addition to patients and staff, took solace there. However, during Katrina, they did not have running water or much electricity, and faced horrible conditions that worsened by the day. On the fifth day, with hope dwindling, some of the doctors made a decision to make some of the worse-off patients “more comfortable” who were considered in too poor of shape to be evacuated, by injecting them with morphine and midazolam. This combination of chemicals sped up their bodies in shutting down, and all who received these injections never left the hospital alive. Although the book itself is relatively objective in its description of the events, it does a nice job of talking through the character, the conditions, the situation, and the potential motivations of the doctors and nurses involved in the euthanasia-like activities. As a healthcare professional, it also poses a lot of questions about morals and ethics involved with providing quality care to patients that are worth spending some time to think through.
While reading the book, I was reminded of a compliance conference session I attended a few years ago where the hospital compliance team recounted the horrific details of how they dealt with the aftermath of a mass shooting. It wasn’t the loss of life that made me think of the comparison, but more the situation of operating in the face of disaster. When an emergency happens, healthcare workers must rely on their compliance team to lead the way in what to do. This is why we take effort to put together emergency plans and evacuation routes, and require that drills be run. If staff don’t know what to do in a high stakes, high stress situation, then they are left to fend for themselves and make their own decisions. And all decisions have lasting impacts.
From my point of view, Memorial Hospital was underprepared for the hurricane and did not have the appropriate emergency protocols in place. Had the doctors and nurses been better equipped to maintain their patient care throughout the event, there would have been a lot less death among the patients in addition to those who were lethally injected. Since Katrina, there has been quite a bit of discussion on the proper triaging of patients and the protocols for caring for patients in a disastrous situation. It has also been well-documented by reputable medical associations since the event, that providing drugs to speed up a patient’s death (outside of very specific circumstances) is not ethical and is not an accepted medical or emergency-relief practice.
I have found the role of compliance officer to be challenging for many reasons in the past. Through the role, specifically involved in ABA settings, I have been exposed to things I would have never imagined: a client pulling a gun on an employee in their home, a client spraying an employee with mace, allegations of misconduct from clinicians, various client and staff injuries, a client running away, a parent threatening to come to our office and beat up an employee…the list goes on.
Overall, the things I have encountered have never been even close to the life or death situation that occurred at Memorial hospital in Louisiana. Throughout those five days, the medical staff underwent malnourishment, exhaustion, excruciating heat, little sleep, and yet still put a focus on caring for their clients. It’s incredibly humbling to think about how many people are in the healthcare field because they truly care about helping those in need.
When I think back on all my years working in ABA, and all of the amazing clinicians I have worked alongside, I am astounded by their lack of ego. ABA isn’t a field where providers are making lots and lots of money. The industry is busting at the seams because of the families in need of services, but the reimbursement rates don’t pave a way for many high-level salaries. And yet, each and every day that a BCBA is working with a client, and modifying protocols, and providing better intervention strategies for a family, or identifying better reinforcers, they are making a positive impact on the life of individuals. It truly is a beautiful thing to watch. I have been lucky enough to hear the parent calls praising the work of their teams and hearing their child say “I love you” for the first time.
I do what I do, because I am surrounded by passionate and brilliant clinical excellence; people who have given me hope that ABA is instilling a lasting change in our communities. I am so grateful that I fell into this industry, and I hope to also uphold high quality and ethics in the complimentary work that I do.
Sheri Fink closes her book with a quote: “It is hard for any of us to know how we might act under such terrible pressure, but we, at least, have the luxury to picture in advance how we would want to make the decisions.” I’ve thought about these words a lot since initially reading them. I agree, and also think that when truly faced with a perfect storm, we are human and we are fallible, so having a strong sense of personal values, ethics, and clear protocols on what to do, empowers our bodies to react in a way that cares for others in the best way possible. Although compliance can feel daunting in many ways, I truly believe that it helps strengthen the quality, the ethical integrity, and the delivery of ABA services.
If you have a business and want to talk ethics, compliance, or want to ensure that you have emergency preparedness protocols in place, reach out to us at OutcomesBase for a free consultation. This stuff is important!
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