CityMD is a healthcare company that runs urgent cares based in New York. When COVID-19 came to the United States and testing became available, many turned to CityMD for these services. They also had antibody testing to determine if patients had antibodies to the coronavirus. However, they ended up mistakenly telling patients that were positive for antibodies that they were now immune to the coronavirus, something that was not proven and might not be true. After the news broke, CityMD came forward and acknowledged their mistake, and contacted the affected patients. This analysis will look at this case from the ethical theories of individualism, utilitarianism, Kantianism, and virtue theory. An individualist, who values maximizing profits within the law, would argue that this was wrong, as a mistake like this could hurt profits, even though nothing illegal was done. A utilitarian, who values happiness for all, would feel negatively about this case because being lied to and in danger would make people unhappy. A Kantian, who values treating people with respect, would say that this is wrong because people were lied to. Lastly, a virtue theorist would say that CityMD acted unethically because they lied, violating the cardinal virtues. Going forward, CityMD should be more proactive with reviewing what they put out and doing their research. They should also continue to maintain transparency and take responsibility for their actions.
Company Background
CityMD is an urgent care company that was co-founded in 2010 in New York, New York by four ER doctors, including Dr. Richard Park, CEO. The company operates 136 urgent care centers throughout New York, New Jersey, and Washington state. (CityMD)
CityMD’s aim is to make healthcare inclusive. Their mission is to serve their communities by “providing quality medical care through convenient access and an exceptional experience, and we consider this mission with every patient that walks through our doors.” They state that they hire the best board-certified doctors, and provide them with “ongoing medical training and information, along with the most modern technology.” They are also “built upon the philosophy of serving patients with kindness.” (CityMD)
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| People wearing masks waiting to be tested for COVID-19 outside CityMD in New York City, April 30, 2020 |
When the coronavirus came to the United States, with the first case being in Seattle and cases skyrocketing in the New York area, CityMD stepped up and started testing many people. They now offer three tests for COVID-19: the rapid test, the PCR test, and the blood (antibody) test. (CityMD, 2020) The first two test for whether you currently have the virus, and the third tests if you have antibodies for the virus. According to the Daily Telegraph, “CityMD administered about 314,000 [COVID-19] tests across New York City, as of June 26. In total, 26 per cent of the tests came back positive.” (Gale) They test at all their locations across New York, New Jersey, and Washington.
Ethics Case Controversy
When the first COVID-19 case was diagnosed in the US on January 20th, no one expected it to get as big as it did. But on March 11th, the World Health Organization (WHO) declared COVID-19 a pandemic. Many places countrywide started to quarantine, and New York and New Jersey, being some of the first, started on March 28th. (NBC) On April 2rd, after many people had contracted and recovered from the coronavirus, the FDA approved the first antibody test for COVID-19. (Mandavilli)
These tests were very new, and no one quite knew what they could tell us, other than whether or not someone had had COVID-19 at one point. According to the University of Maryland Medical System, antibody tests are primarily being used to “help determine how widespread coronavirus infection is in certain communities.” (UMMS) They go on to say that “this can be beneficial for creating public policy and better understanding how to keep communities safe.” Many, though, have taken these antibody tests as a sign of being immune to the coronavirus. This is what most likely led to CityMD’s mistake. The World Health Organization says that “most people who are infected with COVID-19 develop an immune response within the first few weeks after infection. Research is still ongoing into how strong that protection is and how long it lasts. WHO is also looking into whether the strength and length of immune response depends on the type of infection a person has: without symptoms (‘asymptomatic’), mild or severe.” (WHO) While the antibody test shows that you had an immune response from the coronavirus, it doesn’t tell you whether you are protected enough from reinfection. “In general, reinfection means a person was infected (got sick) once, recovered, and then later became infected again. Based on what we know from similar viruses, some reinfections are expected. We are still learning more about COVID-19.” (CDC) Dr. Maria Van Kerkhove, head of the WHO’s emerging diseases and zoonosis unit, said, “Four months into this pandemic, we’re not able to say an antibody response means someone is immune.” (WHO) Some sources “found that people who recover from even mild cases of COVID-19 produce antibodies that are believed to protect against infection for at least 5 to 7 months, and could last much longer.” (Schimelpfening) However, this is a new virus and the little evidence we have is not enough to prove immunity, “simply because not enough studies have been done yet.” (Schimelpfening) Despite the lack of evidence, on May 11th, the news broke that CityMD had told 15,000 people who had positive antibody test results that they were immune to the coronavirus. (Feuer) They had made antibody tests available to those who had previously tested positive for COVID-19, those who believed they already had it and have been symptom-free for at least two weeks, and for those who believe they were exposed to the virus. (ABC) There was also no charge from CityMD for these tests, as they waived insurance copays. This led to many people getting tested and being told that they were now immune, even though there was no solid research to show that this was true. While CityMD might have been using unproven assumptions about immunity, it could also have been an honest mistake. According to CityMD, the mistake was “due to an editing error in the patient portal,” and they described the situation by saying that “some CityMD patients have received incorrect information saying a positive result on the COVID-19 antibody test confers immunity...CityMD patients getting the COVID-19 antibody test are given several documents explaining that a positive result does not mean they are immune to COVID-19.” (Feuer) While we don’t have access to the exact documents that patients received, this must have confused many patients. That being said, this mistake may have been an error from reusing documents from past viruses where immunity was known. This led many people to believe, for at least a short time, that they were immune, which put them in danger of being careless and exposing themselves to getting reinfected. 
COVID-19 antibody test
“The common perception is that if you test positive for COVID-19 antibodies, you’re “safe” from COVID-19 and are immune. But there are many factors in antibody testing, and not all tests are created equal.” (Tripucka) In fact, Professor Helen Ward says, “This very large study has shown that the proportion of people with detectable antibodies is falling over time...We don’t yet know whether this will leave these people at risk of reinfection with the virus that causes COVID-19.” (Ellis) After CNBC reached out, CityMD did say that they “removed the incorrect language and will contact all patients to ensure they have the correct information,” however, it is uncertain how much damage had already been done by then by a company that many people looked to for safe, accurate information. As of now, their website currently states, under the description for the antibody test, “This test will detect if you have had prior exposure to or infection with COVID-19 and have built antibodies for the virus. For most viral illnesses, a positive antibody means prior exposure to a virus and possible immunity to future infection. As COVID-19 is a novel (new) infection, it is unclear if a positive antibody offers immunity.” (CityMD, 2020)
People in New York City during the pandemic
being careless by not wearing masks,
putting themselves and others at risk
Stakeholders
This particular case has two main stakeholders. On one side, we have CityMD and its executives, and on the other side, we have the patients of CityMD. CityMD is responsible for the information they provide to their patients, and their patients should be able to trust CityMD to care for them and provide them with accurate information. CityMD will be affected depending on how they handle situations of misinformation. Patients will be affected based on who they trust and how long they believe potential lies. Since CityMD is popular for its health care, people should be able to trust it, and breaching that trust could have dangerous effects.
Individualism
One way to view this case is from an individualist perspective. Milton Friedman’s theory of individualism states that a company has the responsibility to maximize profits for the owners (which are most often stockholders) within the law. Right or wrong aside, as long as it’s legal and makes a profit, an action is considered permissible according to individualism. The individualist would not view the CityMD case as permissible. While nothing they did was against the law, they told patients misleading information, and as a healthcare company, this breach of trust could hurt their business. When the news came out that they had done this, they acknowledged their mistake, but by then it was after the fact and the damage had already been done. They surely must have lost customers and business from this situation, which means they aren’t operating individualistically. They didn’t maximize profits and in this way, their action is deemed impermissible.
Utilitarianism
Another way to view this case is from a utilitarian perspective. The goal of utilitarianism is to maximize happiness for all in the long run. Instead of “good” versus “bad”, things are measured based on what is good, better, or best according to how many people are happy, and how happy they all are. A utilitarian would most likely take a negative view of CityMD’s case. The two main stakeholders in this case were CityMD and its patients. After we found out that CityMD made the mistake that it did, many patients had to find out that they were lied to, and CityMD had to own up to their faults and contact everyone. Long term, neither party will be very happy. After finding out they were lied to about their immunity and indeed in danger of reinfection, patients won’t be happy. And after having to admit they were wrong and take a hit to their public image, CityMD also won’t be very happy. While it is unclear from the research available whether there was backlash or a spike in COVID-19 cases after this incident, this was still an impermissible action that made many people unhappy.
Kantianism
Another way to examine this case is with Kantianism, which is the philosophy of Immanuel Kant. Kantianism’s goal is to treat every person with respect, not using anyone as a mere means, and not lying or manipulating in any way. It doesn’t regard the ends so much as the means of how one got there. No matter how “good” the results of an action are, the means to get there must follow Kant’s ethics to be considered permissible. A Kantian would argue that CityMD’s case was a very bad situation. First and foremost, 15,000 patients were lied to. Even if it was an honest mistake, not putting in the effort to research or review what they’re saying is a disrespectful move by the company. CityMD didn’t take the patients’ health and safety into consideration before releasing the information that said they were immune, and in this way, they violated the formula of humanity, which is the claim that people should not just be a means to an end. CityMD treated their patients as mere means (by lying to them) to an end (making their company look good and profit). Kant would be pleased that CityMD later told the truth, respecting their patients by correcting their mistake, but overall, this situation would be considered unethical according to Kant.
Virtue Theory
The last way we’ll look at this case is with virtue theory. This ethical perspective is all about one’s character, and whether or not they not only act virtuously but are virtuous. It judges based on whether one acts with good character traits, specifically the four cardinal virtues. The four cardinal virtues associated with virtue theory are courage, justice, honesty, and temperance. In order for an action to be considered ethical, or permissible, one must act with all four of these virtues. A virtue theorist would overall take a negative view of this case. We can look at both the action and the aftermath to determine whether CityMD demonstrated these virtues. CityMD did not act with honesty or temperance when they carelessly released false medical information regarding immunity. However, CityMD did act with courage and justice when they owned up to their mistake and sought to tell all their patients the truth. Other good business virtues such as fairness, humility, and good leadership were also shown by the way CityMD reacted to the problem they were faced with. Since they didn’t show all of the cardinal virtues though, virtue theory would count this situation as unethical.
Justified Ethics Evaluation
In my opinion, CityMD acted unethically. They released significant medical information about immunity without making sure it was completely accurate, and for a healthcare company, that could have very dangerous effects, such as many patients getting reinfected with COVID-19 after thinking they were immune. They did try to fix their mistake, but we don’t know how much damage was already done by then, and the fact that they made this mistake in the first place trumps the fact that they fixed it. All four of the ethical theories we looked at agree with this view as well. Lying to people about important health information is not ethical on any level. This could have been avoided simply by reviewing things and being more proactive with doing research.
Company Action Plan
CityMD’s problem was that they had led their patients to believe that they were immune to the coronavirus if they had received a positive antibody test. When this mistake went public, CityMD was quick to admit that it was wrong and that this was because of an error in the patient portal. They also contacted the affected patients to let them know as well. CityMD did a very good job in resolving the issue by themselves, but they can still go a step further to improve. They should be proactive in spreading the truth about COVID-19 and immunity to their patients and communities. They should also be vigilant about the accuracy of the information they use or provide to patients.
CityMD’s mission statement is to “make healthcare as inclusive as possible.” An improvement to this statement would be a mission to “make healthcare inclusive while maximizing accuracy and transparency for patients.” As of now, their focus is on the people they serve and how they serve them. However, especially in the medical community, they need to pay just as much attention to the accuracy of the information they provide as to who it’s for. This new mission strikes the right balance that allows CityMD to best care for their customers.
There are a few core values that exemplify what CityMD should strive for. These include customer safety, honesty, accountability, and learning. They should work first and foremost for the patients and making sure they are safe and well taken care of, then they should be committed to continually learning and being honest about medical facts and about when they make mistakes.
In order to ensure that this problem doesn’t happen again, CityMD can make sure to review all of the information that comes out of their company. This may include hiring people to proofread their documents, or researchers to double check the accuracy of what they’re saying. And if the issue was just a technical error in the patient portal, they can train people on how to use this resource and have IT make sure no mistakes go out. In regards to their public image, no improvements or marketing schemes need to be made. They did a great job at correcting their error and are currently back to being a thriving, respected business, opening new locations to this day. However, this plan of committing to research and transparency will benefit them as a whole because they will become more knowledgeable and trusted, which is sure to increase profits as more people come to CityMD for their medical needs as a place that values inclusion and honesty, which is key for being an ethical business.
Sarah Mollin
References
“Coronavirus News: CityMD Changes Messaging after Telling 15,000 Patients with Antibodies in New York, New Jersey They Have Immunity.” ABC7 New York, WABC-TV, 13 May 2020, abc7ny.com/citymd-coronavirus-antibody-immunity-tests/6176201/.
Feuer, Will. “CityMD Mistakenly Told 15,000 People with Coronavirus Antibodies They're Immune.” CNBC, CNBC, 11 May 2020, www.cnbc.com/2020/05/11/citymd-mistakenly-told-15000-people-with-coronavirus-antibodies-theyre-immune.html.
“Coronavirus Disease (COVID-19): Herd Immunity, Lockdowns and COVID-19.” World Health Organization, World Health Organization, 2020, www.who.int/news-room/q-a-detail/herd-immunity-lockdowns-and-covid-19.
“Coronavirus Immunity.” University of Maryland Medical System, 2020, www.umms.org/coronavirus/what-to-know/diagnosis-symptoms/immunity.
Schimelpfening, Nancy. “How Long Does Immunity Last After COVID-19? What We Know.” Healthline, Healthline Media, 14 Oct. 2020, www.healthline.com/health-news/how-long-does-immunity-last-after-covid-19-what-we-know.
"Immunity in New York as high as 68pc, tests suggest; Antibodies Findings raise hope that affected areas in London could protect themselves from a second wave." Daily Telegraph [London, England], 10 July 2020, p. 11. Gale OneFile: Health and Medicine, https://link.gale.com/apps/doc/A629046739/HRCA?u=mlin_w_westnew&sid=HRCA&xid=35f0a5aa. Accessed 14 Nov. 2020.
“Reinfection with COVID-19.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 2020, www.cdc.gov/coronavirus/2019-ncov/your-health/reinfection.html.
Tripucka, Jennifer. “If You Tested Positive for COVID-19 Antibodies via City MD, You Should Read This.” Hoboken Girl, Hoboken Girl Publishing, 13 May 2020, www.hobokengirl.com/city-md-covid-19-antibody-testing-news/.
Ellis, Ralph. “COVID-19 Antibodies Decline Over Time, Study Shows.” WebMD, WebMD, 2020, www.webmd.com/lung/news/20201028/covid-19-antibodies-decline-over-time-study-says.
“On a Mission to Do More.” CityMD, www.citymd.com/our-story.
“COVID-19 Testing Information.” CityMD, 2020, www.citymd.com/news/covid-19-testing-update.
Mandavilli, Apoorva. “F.D.A. Approves First Coronavirus Antibody Test in U.S.” The New York Times, The New York Times, 2 Apr. 2020, www.nytimes.com/2020/04/02/health/coronavirus-antibody-test.html.
NBC New York. “CDC Issues 14-Day Travel Advisory for New York, New Jersey, Connecticut.” NBC New York, NBC New York, 28 Mar. 2020, www.nbcnewyork.com/news/local/even-with-relief-bill-passed-no-rest-for-ny-as-cuomo-says-peak-of-crisis-still-yet-to-come/2348306/.
