InstructionsSupporting Lectures:Review the following lecture: Antitrust Laws/Conflict of InterestProjectThe project assignment provides a forum for analyzing and evaluating relevant topics of this we

CASE 73

Conflict of Interest

Dale Buchbinder

You are the executive in charge of finances for the operating room at Sleepy Hollow General Hospital. It has come to your attention that you have five major orthopedic surgeons, all using different vendors for their knee and hip implants. You have held several meetings with the implant companies and determined that if you went with one standard set of implants, you could reduce your implant costs by 40%, a potential net savings of $2.8 million to your institution in the next year. This seems to be a reasonable objective, and you set up meetings with the different orthopedic surgeons.

First you meet with Dr. Goodcut and tell him you would like to standardize the implants in the hospital. Dr. Goodcut tells you he believes that this is a good idea. However, he will only use the products from Alpha Company. He has used them for many years, he knows how to use the equipment, and feels they are by far the best product.

You next meet with Dr. Safari, one of your busiest orthopedic surgeons. You again explain this process. He in turn agrees this is a good idea. However, he will only use the products from Beta Company. He has essentially the same logic and reasons as Dr. Goodcut. This is beginning to seem like a theme.

You meet with the three remaining busy orthopedic surgeons to see if they might be interested in switching to another implant company. However, two of the surgeons would like to know what is in it for them if they make the switch. The third surgeon in this group will only use products from Gamma Company. He has the same reasons that you have previously heard from the first two surgeons. At best, you may be able to go with three vendors instead of five;however, this will yield only a $200,000 savings.

You are a bit concerned at the surgeons’ reluctance to select a standard implant company. Their reasoning seems insincere to you. You begin to examine the websites of each of these companies. Each company lists physicians who have either been involved in the development of the product, or have played consulting roles with their companies. Additional investigation leads you to the discovery that Dr. Goodcut has been involved with the development of the products at Alpha Company. In addition, he is listed on the patent for several other devices. You find similar relationships between the companies and the other two orthopedic surgeons who are unwilling to switch their implants. You begin to be concerned these surgeons have more reasons than stated to resist switching. Each of them may, in fact, have a conflict of interest.*

Discussion Questions

1.    What are the facts in this situation?

2.    What are three organizational issues this case illustrates?

3.    Are the industry relations with the three surgeons in your institution appropriate? Is the use of the company products appropriate for the surgeons? Does this represent a conflict of interest?

4.    Is it possible that these orthopedic surgeons who have played a role in the development of a product feel that it is the best product for their patients? Or, do you think this is a ruse by the company to ensure the surgeons’ loyalty and incentivize them to continue to use their products?

5.    Is there a way to bring consensus and standardize the implants in your institution? Create and present a plan that demonstrates this can be accomplished without alienating the busy surgeons. Remember, these surgeons are in private practice and have the ability to take their cases to a competing hospital.

6.    What steps should the administration of your hospital take in the future to prevent these types of issues from occurring again? Provide your reflections and personal opinions as well as your recommendations and rationale for your responses.

ADDITIONAL RESOURCES

Borkowski, N. (2011). Organizational behavior in health care (2nd ed.). Sudbury, MA:Jones and Bartlett.

Buchbinder, S. B., &Buchbinder, D. (2012). Managing healthcare professionals. In S. B. Buchbinder &N. H. Shanks (Eds.), Introduction to health care management (2nd ed., pp. 211–247). Burlington, MA: Jones &Bartlett.

de Melo-Martin, I. (2011). More clarifications: On the goals of conflict of interest policies. American Journal of Bioethics, 11(1), 35–37.

Fallon, L. F., &McConnell, C. R. (2007). Human resource management in health care:Principles and practices. Sudbury, MA: Jones and Bartlett.

Morrison, E. E. (2011). Ethics in health administration: A practical approach for decision makers (2nd ed.). Sudbury, MA: Jones and Bartlett.

Nakayama, D. (2010). In defense of industry-physician relationships. The American Surgeon, 76(9), 987–994.

Rothman, D. (2012). Consequences of industry relationships for public health and medicine. American Journal of Public Health, 102(1), 55.

Rothman, S. M., Raveis, V. H., Friedman, A., &Rothman, D. J. (2011). Health advocacy organizations and the pharmaceutical industry: An analysis of disclosure practices. American Journal of Public Health, 101(4), 602–609.

* “Conflict of interest is a term used to describe when an individual can be influenced by money or other considerations to act in a way that is contrary to the good of the organization for whom he or she works or the patient for whom he or she should be advocating in their best interests”(Buchbinder &Buchbinder, 2012, p. 223).