April 4, 2019; New York Times
Yesterday, ProPublica and the New York Times published the latest in their investigation into the governance problems at Memorial Sloan Kettering Cancer Center, citing a just-completed review by law firm Debevoise & Plimpton. The review’s findings were damning, calling out a laissez-faire culture that extended from the boardroom out into the practices among leading doctors and administrators.
It concluded that officials frequently violated or skirted their own policies; that hospital leaders’ ties to companies were likely considered on an ad hoc basis rather than through rigorous vetting; and that researchers were often unaware that some senior executives had financial stakes in the outcomes of their studies.
Reports have described the environment as one in which venture capitalists spend freely, vying for control of the latest advances in cancer treatment, and where doctors and administrators were in effect cutting special deals with them. In such a context, of course, Sloan Kettering had a responsibility to be unstinting in its oversight of relationships that might lessen the objectivity of the hospital’s work and mitigate its ethical responsibilities to put the interests of its patients first.
The report itself is being held back but was summarized by Mark P. Goodman, cochair of the law firm’s commercial litigation group, who cited “a number of instances of serious noncompliance with MSK’s conflict-of-interest policies.”
The conflicts and some profit-making deals—which were not specified at the meeting—did not occur through intentional misconduct, Mr. Goodman said. Rather, the review exposed inadequate oversight and a lack of established protocols for examining whether employees’ and executives’ affiliations with corporations could result in biased results that favored a company’s products.
Goodman said the review did not find that the ethical shortcomings caused any harm either to patients or research. But this position may strain credulity in the face of some of the links already found. As just one example among many top doctors, administrators, and board members at Memorial Sloan Kettering, the institution’s chief medical officer, Dr. José Baselga, resigned in September after it was determined that he had not disclosed his receipt of millions of dollars from drug and healthcare companies in return for articles in medical journals. Other resignations ensued, but it took until January for Memorial Sloan Kettering to bar its top executives from serving on the corporate boards of drug and healthcare companies and to limit the ways in which personnel could try to make an extra buck on the 23,500 cancer patients served at the hospital each year.
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Nevertheless, Goodman maintains there were no findings of any “a conscious decision to engage in misconduct.”
“Although we did not identify evidence of breaches of fiduciary duty, we did find that processes and controls for the review and management of senior executive and board-level conflicts were deficient and resulted in instances of noncompliance with MSK policies,” Goodman said. Specifically, plans to manage executive conflicts of interest, a requirement at the hospital, “were not implemented because it was felt to be unnecessary or because there was a failure to realize that a management plan was needed.”
In other words, the public is to believe that these were just a bunch of unsophisticated good-hearted folk who wandered into a danger zone by mistake.
Mr. Goodman also said that hospital leaders’ corporate ties were handled differently from other employees. Beginning in 2014, senior executives were no longer required to vet financial relationships with a conflict-of-interest advisory committee because the hospital felt the committee should not be asked to make decisions about executives to whom it reported. While Mr. Goodman said that rationale made sense, the general counsel’s office—tasked with overseeing the leaders’ conflicts—did not put in place formal procedures to examine potential problems.
“As a result,” Mr. Goodman said, “conflicts were allowed to persist without formal firewalls in place.”
The institution would like us all to pay attention to its new and improved conflict-of-interest policies, but perhaps it is not yet time. We would suggest that an institution now seen as having neatly hidden some pretty troubling relationships worth many millions of dollars to organizational stewards behind a curtain for so many years should, were it completely in a reform mindset, release reports rather than merely characterizing them to the public. That is what atonement and reconciliation requires.—Ruth McCambridge