Physician viewpoint: CEOs should be liable for medical errors amid staff shortages

CEOs and boards need to be held liable for staffing-related safety issues in their hospitals, especially when they created the issues in the name of profit, Robert Derlet, MD, and Mark Borden, MD, argued in an article published in Emergency Medicine News.

Emergency departments across the country are understaffed and staff overworked, but the issues aren't being resolved. The authors argue too many hospital CEOs and administrative staff don't understand — and some don't want to understand — how the ED works. When asked how often one administrator goes to the ED to talk to staff, the authors said they responded, "I avoid that place at all costs. I might get some terrible disease or be spit on by one of your psycho patients."

Many hospital problems go beyond mismanagement and ineptitude, the authors contend. Some are downright negligence, such as perpetuating hallway care, short-staffing EDs, prioritizing data over patients, replacing physicians with practitioners, muzzling the front line and poor judgment by boards.

The solutions? 

Start with making administrators take the Hippocratic Oath. 

"The advent of physician servants has made the CEO the ultimate decision-maker about patient care, and therefore that is who should be held responsible for decisions that affect its quality," the authors wrote. Some CEOs or board members may refuse to sign the oath, and if so, they shouldn't be hired, they added. 

"A hospital administrator and the board are still responsible even if they don't take the Hippocratic Oath," the authors said. "Our attitude as physicians must be that anyone who chooses to work in a hospital has tacitly assumed the responsibility to prioritize patient welfare."

Then start encouraging physician complaints. When problems arise, physicians should write to the media, their unions and their legislators, and take to social media. The public should hear about issues, especially if the board that chose a poor-performing or unqualified CEO is responsible, the article said. 

"Changes motivated by profit rather than quality of care must be examined critically, and we must not be afraid to denounce those decisions. Our professional societies must ensure that a physician can speak out on behalf of patients without suffering," the authors wrote.

Physicians should advocate for themselves when facing legal action. 

"We advise [emergency physicians] named in a lawsuit as a result of their hospital's gross negligence in providing the ED with resources to sue the CEO," the authors wrote.

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