John Livingston

Today’s Hospital Quagmire of Ethics vs Profits

Conflicts occur when medical practices are balanced against profitability.

Our two major non-profit hospitals in Idaho are in the middle of a cultural war that they have no idea how to extricate themselves from. It comes at a time when some very bad business decisions were made long before Covid arrived on the scene and are finally “coming home to roost”. St. Luke’s and to a much lesser degree St. Al’s have forgotten who they are, and as a result the respect that generations of doctors and nurses and administrators earned since these institutions were founded before the beginning of the 20th century, has eroded away precipitously.

Urban vs rural-conservative vs progressive socialism-Sectarian vs secular. We see this in the way that St. Luke’s has handled the conflict of “Baby Cyrus”. We see this in the way St. Luke’s administrators inserted themselves into the doctor patient relationship during Covid. Decisions being made by hospital administrators to require that algorithms designed by government bureaucrats to be implemented by Federal and State “emergency orders”. Most of these bureaucrats have never taken care of sick patients at the bedside, however this gave them access to Covid transfer payments creating enormous conflicts of conscience. Many of these healthcare workers and doctors had the dilemma of whether they should remain quiet or speak up against hospital policies and risk losing their jobs.

The value and sanctity of life and the predicates upon which various groups stake a claim to their positions regarding abortion, transgenderism, end of life issues have become more than just matters of policy. These issues have become a matter of faith and conscience especially for people who are working directly with patients.

The upper levels of management and the hospital Boards that in years past have reflected the values of the communities they represented and worked for, have now become isolated enclaves of “progressive wokeism”. They have become like so many large corporations throughout the country that have embraced diversity equality and inclusion (DEI) programs and supported the LGBTQ agenda. This has included grooming small children and transgenderism indoctrination before adulthood and support programs that deploy hormone altering and body mutilating surgical procedures. Local hospitals have embraced a political theology that is inconsistent with most Idahoans, but most importantly it is inconsistent morally and ethically with most doctors, nurses, and technicians involved in daily patient care.

The Catholic Sisters that founded St. Al’s, and the Episcopalian religious and lay persons that founded St. Luke’s should be rolling over in their graves today. These hospitals were founded on Biblical principles which embraced “Biblical Justice” principles and are very different from the so called “Social justice” humanistic ideals being embraced today by both organizations.

Concepts of Biblical justice have been why most doctors, nurses, and technicians chose to serve in their respective professions. Caring for the poor, taking care of those living on the margins, the infirmed and elderly were based on articles of faith and charity imprinted on their hearts. Never was a patient’s sexual identity, gender, ethnicity, or station in life a question because we are informed by our faith to take care of everyone. When economics and profits are combined with gaming a system of “transfer payment” reimbursements, it supplants those articles of faith and people at the patient’s bedside become conflicted if not resigned to the fact that they are now working a job, and not fulfilling a vocation.

The Boards and upper management at our two hospitals need to reassess their mission statements. One Catholic Sister at St. Al’s told me years ago—”John, remember no margin no mission”. Words by the way I never saw written on any mission statement, but that I heard repeated more than once in “executive sessions”. Maybe they were foretelling of an age when clinicians would become beholding to administrators—maybe even employed by hospitals instead of their patients! Covid, patients and their families are finally becoming aware of the fact their doctors for the most part are working for an employer—not for patient and family. I would recommend that the powers that be at St. Al’s look at their own mission statement. It says nothing about “empire or real estate development”. Read it out loud after you pray to yourselves or before meetings, and most certainly before Board meetings. Most importantly in the case of St. Al’s reinstate daily Mass in your hospital and make it available to everyone—patients, employees and administrators. Thank God for the great gift you have been given stewardship over. Ask for His continued love and Mercy over all who serve and are patients there. This care should be for everybody irrespective of anything including sexual identity, race, or gender. We are all God’s children.

I don’t know what to say to St. Luke’s. I would say embrace the Christian principles of your founding. Embrace “Biblical Justice” not “social justice”. Understand that there is a big cultural and spiritual gap between those who are leading your institution, and those who are taking care of patients, and the people in your community. If you don’t come to grips with that single fact it is my opinion as a “non-expert” that anything the organization does financially in the long or short term will be unsuccessful. The great majority of doctors, nurses and technicians working at your institution see their work as a professional vocation which adheres to a philosophy of “service before self”. That reinvestment in valuable human capital will be the source of future success and will in the long term continue the traditions of your founding.

It is time for people of faith to step up and speak out. “Love the sinner and despise the sin”. Take care of all sick patients no matter who they are or how they choose to express their individuality. Do not support policies that interfere with the God given “free will” of an unborn child or a child who has not reached the age of informed consent (18yrs) in Idaho.

Currently I don’t think either hospital is capable of speaking to the people they are serving about any of these issues. I pray that I am wrong.

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9 replies on “Today’s Hospital Quagmire of Ethics vs Profits”

The hijacking of hospitals by the corporate world began in the late 70’s and the business model has only grown since that time, removing the very principles discussed here. It will only become worse with the technological advances being made by corporations to provide care based on technology rather than compassion. There are some professionals who are removing themselves from this and our support should be given to them for our healthcare needs. Hopefully, both St Luke’s and St Al’s will feel some of the economic effects from this. Very insighful article.

Idaho had a prohibition against the corporate practice of medicine dating back to an Idaho Supreme Court opinion of Worlton v Davis (1957) which cited with authority the California prohibition on that practice.

By the mid 1990s the Board had fallen under the sway of outside counsel who by persuaded the board that it was a dead letter, despite their being no statute or case law to the contrary. Thus began the gobbling up of physician practices (initially) and ultimately hospitals until we have the situation that we are faced with today.

Divestment and reinstatement of that prohibition is the road back to physician professionalism. We shall not see it until the backs of ISCI, IHA, and the IMA are broken.

Excellent article, thanks. One error: Diversity Inclusion and Equity should be presented using the appropriate acronym – DIE

May heaven richly bless and prosper the author of this article, Dr. John Livingston, and equally, Gem State News for publishing it! It leaves little more to be said except to affirm that every Idahoan of genuine faith and conscience needs to back up and support this dissertation with our own voices and with our prayers… help deliver Idaho and all its institutions back to true Godliness. And lastly, I just want to say how WONDERFUL and HOPEFUL it is that in this one same week Idaho Dispatch has published the like-principled letter of Diego Rodriguez, as he so righteously and courageously addressed it on his own behalf and that of Ammon Bundy to the all the principals involved in these same two hospitals!
May God protect and speed His truth and justice throughout Idaho!
Thank You.
Carol J. Asher
Idaho County

Wonderful article. Keep up the demand for accountability on these “health systems” who have truly lost their way. It’s time the boards are challenged and integrity restored. Government dollars flooding into self-proclaimed nonprofits has only led to more medical dogma and one-size-fits all medical care. Their reputations have deteriorated greatly in recent years and accelerated during their lucrative government bailout covid crisis.

The doctor-patient relationship has suffered greatly. The government bureaucrats and hospital administrators need to be held accountable. Command control, socialized medicine doesn’t work and the pandemic proved it.

Speaking of profits, Dr Goldfarb lays out the profits over patients in an article on the explosion of gender clinics (vide St Luke’s “Essence Clinic”).

“There is no question that financial rewards play a role in the adoption of gender affirming care. Hospitals and physicians generate substantial payments from insurers or self-pay patients when children enter into the transition protocols.”

Publius. Thank you for your wise and prescient comments. “No margin–no mission”. BIG MARGIN—-still no mission.

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