Failure To Care
Failure to Care: Whistleblowing in Healthcare is a hard hitting book about both the importance and significance of whistleblowing as a mechanism for accountability within healthcare institutions.
With a strong emphasis on lawful, ethical and compassionate care, in this book, author Kyle Gilrain authentically blends his professional experience with scholarship and personal stories to provide the reader a unique experience. Failure to Care: Whistleblowing in Healthcare serves as a narrative and roadmap for protecting patients and becoming a highly effective whistleblower.
[Excerpt] For many, whistleblowing often falls within the scope of morality and is grounded in individuals with a firm moral compass. This strong moral compass implies an individual blows the whistle due to a strong set of moral beliefs. This can be described as the moral model.
[Excerpt] The failure to act, advocate, or blow the whistle can leave an indelible mark on the very people healthcare professionals are sworn to protect. For healthcare professionals, failure to protect people in our care is one of the most egregious violations of our own codes of ethics, the professional regulations governing our particular field, and the laws (state and federal) that have been enacted to ensure we do no harm to the people in our care. Worse, failing to act becomes a permanent stain on our own individual and overarching moral compass.
[Excerpt] Moreover, when other colleagues act in fielty to an agency or in a manner that protects unethical acts, this leaves the ethical practioner to be viewed by others with derision. When the practitioner’s fielty is to the entity of malpractice and maleficence, they are holding up that fraudulent and false healthcare entity. Simply stated, doing nothing props up bad agencies and makes them look good when they are not.
As many healthcare professionals are aware, this false propping up of bad agencies has paved the way for large and complex health systems to dominate the healthcare market with substandard care and fraud. The micro practioner will look to help as many patients as they can within a system, however deeply flawed that system is. The thematic problem with the micro prospective here is that it leads to other patients being mistreated, abused, and even murdered under the umbrella of substandard care. In a healthcare facility with multiple staff, no one practioner can provide high quality care to every patient. High quality care requires a dedicated and committed team of people, who each follow their respective codes of ethics and laws and has the strength of character to do the right thing by patients, always. Moreover, these facilities that deviate from ethics and laws are often entities that spend large sums of money to protect their financial interests above all else.
[Excerpt] This fear of retaliation becomes particularly true in cases, such as those illustrated in my case example of Agency One, where people have borne witness to adverse actions that happened to others who spoke up. Indeed, watching 18 directors forced out in 17 months, as was the case in Agency One, could truly serve to give pause to some of the best advocates. Profane figureheads will see any form of advocacy as a betrayal and the most abject treachery. This type of leader is generally too short-sighted, and does not possess the skill set, to correlate the facts that doing the right thing leads to better patient care, which almost always ultimately leads to more clients and higher profits. Profane figureheads often put the healthcare practioner into a false choice between moral distress or moral courage.
[Excerpt] Similarly, there is also a dearth of information regarding the effectiveness of residential treatment programs in improving the lives of youth. Simply, we are likely to find out that youth being discharged from these programs are the same or possibly worse off than before they entered the programs.
[Excerpt] Many of us had multiple meetings behind closed doors discussing what could be done about the abusive staff and leadership at this facility. Many felt powerless and did not know what to do or how to activate other external systems effectively. Worse, many of the staff that had been there a while saw the external systems repeatedly fail to effectively address the problems that plagued this facility.
[Excerpt] All the aforementioned fraud, abuse, and harm to patients would be far less possible, if not impossible, if healthcare organizations did not have accomplices and imposters. Accomplices and imposters are the anodyne people of the healthcare facility. Accomplices and imposters are also those individuals who actively perpetuate the problems. They have no discernable commitment to their codes of ethics, or to the law, and act simply to keep their own jobs. Both accomplices and imposters are equally bad for the safety and treatment of the patients throughout our nation’s healthcare organizations
[Excerpt] This corporate brigand exists to help protect the agency and not the patients. They clean up any mess that leaves the agency vulnerable to outside attacks such as investigations and lawsuits. They are there to ensure the agency is protected at all costs and to help facilitate building the case against the person who called in the first place and to minimize and consequences to the company by whatever means necessary. Rest assured, even if you are able to get information to corporate compliance anonymously, the behind closed-door meetings will be largely about “what staff member do you think reported this?” The outward focus may appear to be about cleaning up the wrongdoings, but the tacit goal will be to seek and eliminate the person who complained. It’s a cynical point of view, but this is the reality I have experienced in multiple settings with different companies. That said, there are reasons to call corporate compliance and there are reasons not to.
[Excerpt] This chapter is not about the colleagues who sat next to you and turned a blind eye to misconduct. Rather, this chapter is about the unfaithful angels who loom in our accrediting, licensing, and protective agencies who thematically fail to protect patients. It is about those whose job it is to investigate and protect but fall woefully short of their stated purpose. That said, this chapter is not intended to be ignominious toward these individuals or these entities. This chapter is perhaps a cautionary tale that one should not, when blowing the whistle, look toward these entities with exhortation. They will not save you and they often will not save the patients. Even though their fiduciary duties indicate they are obligated to protect, one cannot count on the unfaithful angels.
[Excerpt] Let’s continue our discussion about unfaithful angels with the dissolution that a national accreditation is somehow meaningful or indicative of high-quality patient care. It simply is not. There are countless examples of a nationally accredited programs where patients have been abused and the agency has provided thematically substandard care.
[Excerpt] Many people are familiar with whistleblowers by virtue of hearing about people who came before us. Some of the highest profile and widely publicized cases serve to dot the whistleblower landscape with both cautionary tales and to punctuate the risks associated with speaking up. There are even a few stories of people being rewarded with, what most would consider, large sums of money. Whistleblowers are important assets through every sector of our government and throughout our systems of care. Healthcare whistleblowing is no exception. Let us stand on the shoulders of those who came before us.
[Excerpt] As you go about your work, read every email you receive once for the content and what you are supposed to do and then read it again for potential use in a future lawsuit. Once you have examined an email with this lens in mind, print it and keep it. Emails are wonderful bodies of evidence.
[Excerpt] With the blink of a leadership change you might find yourself having worked in a great environment that abruptly degenerated into one of deception, fear, and unease.
[Excerpt] In sharing parts of my whistleblower packet of information with these offices, it eventually led to a face-to-face meeting in which four officials from the state’s Attorney General’s office. In preparing for these meetings, I organized all my documentation in different binders and put them each in chronological order. Since I spent so much time reviewing the timeline of events, I had a profound and impressive mastery of these materials. These officials asked questions and reviewed documentation and eventually made the determination to bump the case up to the Federal Bureau of Investigations (FBI).
[Excerpt] Similarly, I do not believe the healthcare professionals obligation ends when they simply report substandard care or maltreatment to one of the accomplices, imposters, or unfaithful angels. There is ample evidence that the people in the accomplice, imposter, and unfaithful angel positions frequently fail to protect people and fail to take meaningful action. Effective advocates simply cannot rest on these laurels. Until the problem is eliminated, there is always more that can be done.
[Excerpt] I have worked with so many fantastic healthcare workers over the course of my career. The vast majority of the healthcare workers I have had the privilege of working with carry themselves with professionalism and take their code of ethics and duty to the clients and patients they serve seriously. There are a few healthcare workers that I have worked with who stand out as truly exceptional human beings.
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