Ethics Case Controversy:
On Monday, the 18th of November in 2019, a patient at a southern New Jersey hospital received a kidney transplant that was not intended for them but intended for a patient that had a similar kidney match. The hospital in this case is the Virtua Our Lady of Lourdes Hospital located in Camden, New Jersey (Haider). This hospital is the only hospital in southern New Jersey that has the resources and technology to do such organ transplants. The specific place where the transplants have been performed in the past was the Lourdes Regional Organ Transplantation Center (Helsel). This center has been performing kidney transplants since 1974 where no such mistakes have occurred before. The patient that received the early kidney transplant was 51-years-old however the names of both patients were never released.
The hospital’s clinical team was quick to figure out that a problem had occurred with the kidney transplant as it only took the doctors one day to sense something was wrong. Soon after finding this information out, the staff, specifically the medical director and the transplant coordinator, quickly apologized to the patient who was supposed to receive the transplant but had not. Luckily the patient did not have to wait a long time because within six days, the patient received a transplant of their own. The hospital reported that both of the patients were doing well and recovering strongly from the operations. After finding out of this mistake, the hospital reported the incident to the Organ Procurement and Transplantation Network as well as the New Jersey Department of Health (Mulford).
The executive vice president and chief clinical officer, Dr. Reginald Blaber, spoke to the press stating that the mistakes of this magnitude are rare and additional verification would have prevented this error. He also stated that the hospital immediately instituted additional measures and educational reinforcement to help ensure that such incident will never happen again (Helsel). Before any other organ or kidney transplants were conducted, the hospital made sure to place additional checks to further drive its point that the incidents were a one-time thing and will not be a problem in the future. In all of the time that the New Jersey Sharing Network has partnered with the hospitals who do transplants, such a situation has not occurred once. The organization is responsible for organ recovery specifically for the state of New Jersey and it is reported that the nonprofit organization handles around six hundred organ recoveries each year.
The stakeholders for the Virtua Our Lady of Lourdes Hospital in southern New Jersey include the senior executive team, the senior leadership team, and board of trustees. Within the senior executive team, the president and chief executive officer is Dennis W. Pullin, the executive vice president and chief operating officer is John M. Matsinger, the executive vice president and chief financial officer is Robert Segin, and the executive vice president and chief clinical officer is Reginald Blaber (Senior Leaders). The senior executive team is not limited to these partners however these members hold the highest positions within the hospital.
Dr. Reginald Blaber
The senior leadership team includes but is not limited to the senior vice president and the manager of integrated operations Lisa Ferraro, the senior vice president and chief information officer Thomas F. Gordon, the senior vice president and manager of partnerships and business development Barry Graf, and the president associated with VirtuaPhysicianPartners Tarun Kapoor. The board of trustees include the chairman David Kindlick, the vice chairman Edward Cloues, and the president and chief executive officer Dennis W. Pullin to name the top tier members (Senior Leaders). All of these members oversee the procedures of the hospital and the clinical team, medical director, and transplant coordinator perform such procedures.
The late Milton Friedman believed that the only goal of business is to profit. This would later form into the idea of Individualism which states that the only obligation that a business person has is to maximize profit for the owner and the stockholders (Salazar). Such an ethical idea can only occur when the executives of the company are staying within the boundaries of the laws and regulations of the operating company or industry. Friedman also stressed that within this ethical theory, all business operations have to be done in a truthful and honest manner.
The Virtua Our Lady of Lourdes Hospital in southern New Jersey is specifically a for profit hospital as there are some throughout the United States whom are not for profit. Due to the stature and experience needed to be a well renowned hospital, mistakes come ever so often. During a hospital’s daily activities, the staff are partaking in Individualism as they make sure customer safety is at the top priority which allows for increased customer loyalty and profit from serving the patients. On the other hand, in the case of Virtua Hospital, giving the wrong patient the kidney transplant goes against such Individualistic theory.
From the incident that occurred, the public statement by the hospital and the public reaction from the United States would determine the size of the loss of profit that the hospital should expect to incur. When such mistakes occur, the public loses trust for the specific hospital as they believe that a mistake like this could eventually occur again. When the public loses trust, the less often they will seek the help of Virtua Hospital in the time of need. The less patients coming in to be observed, the less profits that the hospital will receive. If the case had been more serious and one of the transplant patients had passed away from the medical complications then the legal battles that would ensue would also have a large effect on the profits for that quarter or year.
John Stuart Mills among others believed that we, as regular people, can determine the ethical significance of any action by looking at the consequences of such. Easier ways to view Utilitarianism is by identifying the ethical theory with the policies of “maximizing the overall good” or producing “the greatest good for the greatest number” (Salazar). Throughout the government of the United States, such an ethical theory can be easily seen as the democracy set in place provides the greatest good for the greatest number of citizens. However, the Virtua Hospital case opposes this Utilitarianism theory.
When looking at the consequences of the actions of the hospital in this case, neither patient was particularly injured or hurt in any way. Moreover, both patients ended up being completely healthy in the end each with their own kidney. On the other hand, if the hospital had not acted quickly and the original transplant patient did not receive a kidney over a longer span of time then there would be a direct effect against Utilitarianism as the hospital would not be providing the maximized overall good. In the real-life case, the hospital still followed most of the rules set by Utilitarianism due to the health of both patients being fine allowing for the overall happiness to be maximized.
Kantianism was first introduced by Immanuel Kant in the 18th century. The basic principles that he believes that we should follow to achieve the best results from this ethical theory begins with acting rationally which he states is not acting inconsistent in one’s own actions nor considering oneself exempt from the rules (Salazar). The principles continue to include that one should allow and help people to make rational decisions, respect people, their autonomy and their individual needs and differences and to be motivated by Good Will which is seeking to do what is right because it is right. The rules one should follow to live such a life based on Kantianism are considered the deontological constraints.
Within this case, the clinical team performed the correct actions after realizing their mistakes. In Kantianism, no one is exempt from the rules so when the clinical team reported the incident to the Organ Procurement and Transplantation Network as well as the New Jersey Department of Health they were following such principles. By reporting the incident to the authorities, the hospital was risking legal action from an investigation that began soon after the incident occurred however no one is exempt from the rules so in Kant’s eyes, the hospital did the correct action. On top of this, the hospital staff can be seen as “good” within this ethical theory due to having the right motivation when reporting the incident and apologizing to both of the patients. The clinical team knew that they had made a mistake and owned up to it even though repercussions for the employees and the hospital could have occurred.
Kantianism includes the categorical imperative which Kant believes is the Law of Rationality. Within the categorical imperative, there are three formulations including the Formula of Universal Law, the Formula of Humanity, and the Formula of Autonomy (Salazar). The Formula of Autonomy would assist with the additional checks performed before the hospital conducts the organ transplants. This formula states that when one legislates laws, all parties must be willing to obey them as well as all members should be able to rationally agree on them. The pre-checks before the transplants should be made so that it respects the rationality of oneself as well as all others that may be affected by it. All in all, the hospital made a rare but huge mistake when giving the kidney transplant to the incorrect patient however the hospital was not purposely trying to be unethical in its procedures.
The virtue theory of ethics is a tradition that seeks a full and detailed description of those character traits, or virtues, that would constitute a good and full human life. This theory specifically focuses on the moral character of a person based on practice of such virtues. These virtues include courage, honesty, temperance, and justice. In the case of the hospital, the medical team and the hospital as a whole enacted in the correct ways of virtue theory.
By going to the public and making a statement as well as an apology to the patients and families involved, the staff was being just for the mistake that they made and so they were practicing the honesty and courage. If the medical staff had brushed the issue under the rug and ignored the mishap then they would be going against it. However, by making adjustments to the system and process being used for transplants, the hospital is seeking the practice of strong and right virtues. The hospital could have gone further by compensating the victims for the time of hardship so that the patients know that the character of the medical staff is right and just and they are willing to make up for any mistake.
Justified Ethics Evaluation:
The actions performed by the Virtua Hospital were not justified due to the harm it could have done on the two patients but it is not specifically unethical. Hospitals are one of the most vital places where accidents should not occur in excess. Moreover, when the accidents do occur, actions such as the ones that Virtua Hospital performed from the consequences of its actions should be universal for all hospitals around the world. The medical staff and all involved recognized the issue as soon as possible which was within a day’s period, made public statements and apologies regarding the issue at hand and changed the policies within the hospital so that a situation like such would not occur again. Ethically speaking, the medical staff that was involved did not purposely mean to place a kidney into the incorrect patient, the situation was a complete accident and the hospital handled the aftermath correctly and quickly even letting the Department of Health know as soon as possible. However, on the off chance that the original transplant patient did not receive a new kidney within a week then the hospital would have had larger ethical issues that may have been less justifiable.
Accidents that occur in the medical field usually end up causing some of the worst results. Whether it be diagnosing the incorrect disease, giving patients the incorrect medication or giving a kidney transplant to the wrong patient; all of these can have lethal and legal repercussions.
In resolving such an issue like giving a kidney transplant to the incorrect patient, the hospital should first acknowledge the mistake. This acknowledgement should be a public response by the medical staff along with a public apology to the patients and their families who were involved. The hospital and the overseeing health corporations of the hospital should then investigate the issue to see if any suspicious or illegal activities were occurring. If so, act accordingly with the laws to provide repercussions to those involved. If not, then determine what occurred to make the transplant go wrong. In this case, the medical staff had made a simple mistake due to the two patients having the same name and similar ages. To combat this, the hospital will need to implement in depth guidelines to make sure a mistake like this could not occur again. Such ideas for guidelines include color coded filing, larger font sizes on the important information within the medical records or checking and rechecking the medical records hourly to make sure the information is reliable and up to date. On top of this, a rebranding strategy may be set into place so the public can have a different image of the newly renovated and updated hospital.
Virtua strives to provide the highest quality of care to all patients through the responsibility of all employees. Moreover, this process is ever changing and improving to provide the best care possible with the most up-to-date techniques. The original mission statement of the hospital stresses that they will “help you be well, get well and stay well”. The new and improved mission statements express that it is the employee’s responsibility to make sure that this quality retains a high standard. This is an improvement as each employee is responsible in the case of a mistake and all employees should be improving themselves and their practices so that quality is the highest at all times.
As previously stated in the new mission statement, creativity and ingenuity are highly sought after in this profession and specifically this hospital. The employees, management and executives all need to work together to improve and update their practices and techniques so that the hospital can run smoothly and with the highest quality of care. The hospital should also focus on creating a caring culture. Such culture allows for easier patient-doctor relationships where the patient in need can be open and honest about how they are feeling. The last core value that the hospital should include is customer safety and loyalty. Especially within a hospital, customer safety is essential. A patient should be comfortable that the doctors will perform a safe and successful operation or provide the correct medication without side effects. With customer safety, comes customer loyalty. When a patient feels safe and comfortable with the medical staff, then there is a higher chance of loyalty of the patient for the hospital.
To ensure ethical productivity and monitoring within the hospital, there will have to be changes in the policies. As stated in the article, as soon as the mistake was found, the hospital implemented additional checks to ensure that the correct patients were receiving the correct treatments. These checks could include revisiting medical records, organizing the waitlist so that top priority patients are first or forcing hourly updates on medical information to ensure they are up-to-date and correct. With changes in policies, comes new and improved employee training. Here, the hospital can go in-depth to what the requirements are for the additional checks and provide insight on what to do if a mistake like such occurs again.
The best course of action for the hospital would not be firing the medical staff involved as it may place a somber aspect on the working environment by expressing the notion of if an employee or employees make mistakes then they are gone. Instead, the hospital should hire more staff members so there is less information and conflict for each employee to deal with. Such a move may not help the company to flourish in the short run however it will improve the status of the company long-term.
The action plan developed for the hospital will promote business profits over a long-term process through marketing and improvement of practices. The business productivity will come from the new mission statement that places that responsibility of the patient’s well-being into the hands of the employees. This productivity will improve with the new hiring’s as their will be competition for status upgrades and pay raises. To ensure good ethics and the core values, executives will have continuously check on management and management will have to continuously check on employees. Along with a checking system, the feedback of the patients will be vital in determining if the medical staff had treated them with the highest quality of care and safety.
Bryce St. Germain
Haider, M., & Frehse, R. (2019, November 27). A New Jersey hospital admits giving a kidney transplant to the wrong person. Retrieved from https://www.cnn.com/2019/11/26/us/nj- hospital-kidney-transplant-wrong-person/index.html
Helsel, P. (2019, November 27). New Jersey hospital gives kidney to wrong transplant patient. Retrieved from https://www.nbcnews.com/news/us-news/new-jersey-hospital-gives- kidney-wrong- transplant-patient-n1092361
Mulford, K. (2019, November 27). Hospital says donated kidney was transplanted into wrong patient in NJ. Retrieved from https://www.usatoday.com/story/news/nation/2019/11/26/kidney-transplanted-into- wrong-patient-new-jersey-hospital-says/4314849002/
Senior Leaders & Board of Trustees. (n.d.). Retrieved from https://www.virtua.org/about/senior- leadership
The Kidney Transplant Waitlist – What You Need to Know. (2017, February 10). Retrieved from https://www.kidney.org/atoz/content/transplant-waitlist