Florida’s Governor Scott and the Public’s Trust

Brian Klepper

Originally Posted 1/17/16 on The Doctor Weighs In

A CNN investigation by Elizabeth Cohen and Katherine Grise asserts that Florida Governor Rick Scott’s administration has scuttled longstanding state hospital quality standards after two Republican political groups received large contributions from Tenet. A for-profit hospital firm, Tenet, operates St. Mary’s Hospital in Palm Beach, which has been scrutinized recently for a high death rate in its pediatric cardiology program. External reviews concluded that the hospital’s program had too few surgeries to develop and maintain competency.

Florida’s pediatric community is scandalized. Louis St. Petery, a prominent Florida pediatric cardiologist, calls the action eliminating the quality standards “outrageous.” Dr. William Blanchard, Chairman of Pediatric Cardiology at Orlando’s Nemours Children’s Hospital, said eliminating the standards is “both poor public policy and poor politics.”

But a comment with greater gravitas and more directly to the point comes from Cleveland Clinic’s Chief of Cardiology Steven Nissen.

If we abandon medical standards, we create a free-for-all system in which any hospital or provider can perform any procedure without regard to the qualifications of the medical staff or capabilities of the program. [That] puts the most vulnerable and precious patients at unacceptable risk.

Mr. Scott’s office and Tenet both deny discussing scrapping the standards or the suggestion that axing them is related to the St. Mary’s Hospital investigation. Instead, Florida’s Department of Health, presumably speaking for the Governor’s office, said the standards were removed because the Legislature had never given permission for the quality standards to be put into place.

In other words, Mr. Scott would have us think it a coincidence that the standards, in place for more than three decades, became a concern only after Tenet contributed $100,000 in 2013 and another $100,000 in 2014 to the Republican party and to a Scott political action committee.

It’s also hard not to point out that all it took was $200,000 to effect such an important policy change

Dangerously poor hospital quality is a very serious problem that should be unacceptable in public policy. But Mr. Scott’s actions bring up even more serious questions.

Is Florida’s Republican party comfortable with the perception that it is willing to sacrifice patient welfare—and in this case, babies’ welfare—in favor of corporate interests? If not, where is the public outrage of other Republican leaders?

If quality standards are as important as the medical communities seem to believe they are, where are the calls by major health care organizations—for example, the Florida Hospital Association and the Florida Medical Association—for reinstatement of the standards?

It’s also hard not to point out that all it took was $200,000, a pittance in this case, to effect such an important policy change. Who knew that public policy could be bought so inexpensively?

One of democracy’s gravest threats is lobbying money that favors special interests at the expense of the public interest. Dispensing with hospital quality standards represents a particularly troublesome action that endangers us all. The Governor should reverse course on this issue and assert his support of quality standards that apply across all health care. Making exceptions for wealthy donors corrodes public trust in a system that we all desperately depend on, especially when the chips are down.

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