For-profit and nonprofit worlds present ultimate conflict
Re “Boston hospitals should put patients’ trust first” (Editorial, April 12): It is broadly accepted that the primary duty of an officer or director of a for-profit business is to advance the financial interests of the business. Conversely, it is the primary duty of an officer or director of a not-for-profit entity to consider the interests of those served by their organization. I submit that those two premises present an unresolvable dilemma to anyone serving simultaneously as an officer of a nonprofit hospital and as a director of a for-profit company. To maintain that it can be done without conflict of interest is absurd. History confirms this.
Furthermore, at that level one should avoid even the appearance of a conflict of interest. Plausible deniability is not sufficient. That hospital leaders may lose some insight into what their for-profit suppliers are up to is a specious argument. Between sales calls and advertising in professional journals, businesses make themselves heard when they have something they want to tell you. Traditionally, the real problem has been judging the accuracy of the information provided.
I would carry this argument one step further: Because of the inherent conflict between patients’ interests and business interests, I don’t believe that for-profit hospitals should be allowed to exist.
James W. Slack
These relationships compromise public trust
The recent Globe Spotlight Report (“As hospitals open their doors to corporate ties, ethical worries follow,” Page A1, April 4) revealed a yawning gap between Boston’s nonprofit teaching hospitals’ well-paid presidents and CEOs and their counterparts nationally in accepting paid board memberships of publicly traded companies.
We’re to believe that by doing so, these executives gain needed insights into broad industry developments that enhance their hospital leadership roles. Notwithstanding this specious attempt to sanitize this unsavory practice, serving on the board of a single company provides insight to only that company while creating potential and perceived conflicts of interest that hinder rather than enhance their performance as hospital leaders. This requires these hospitals’ own boards to create expensive oversight processes as guardrails to prevent actual conflicts of interest.
Despite all this window dressing, it’s impossible for these hospital chiefs to maintain fiduciary relationships with both their fellow shareholders of the companies on whose boards they sit and with their nonprofit hospitals when the two may be in conflict. No matter how much they may abstain from voting in such circumstances, the public trust is forever compromised.
As a former health care executive, I remember when pursuing such financial self-interest, especially in such contrast to national norms, would properly be perceived as distasteful and unseemly greed at best and highly unethical at its core. Today’s incestuous hospital governance appears to profess little interest in medical ethics.
Since meaningful self-correction seems unachievable, it falls to our elected officials to take measures to impose the needed remedies. A simple solution would be to prohibit such private profiteering by hospital executives as a prerequisite for maintaining their hospitals’ nonprofit status.
Certainly, Massachusetts’ progressive legislative delegation can be counted on to put an end to this financial chicanery and restore the integrity of our great medical centers as beyond reproach.
Or can they?
John A. Lynch