Ayn Rand style completion works about as well in the healthcare industry as it did at Sears:
On a Thursday morning this past April, 61-year-old Darryl Young was lying unconscious in the eighth-floor intensive care unit of Newark Beth Israel Medical Center. After suffering from congestive heart failure for years, Young, a Navy veteran and former truck driver with three children, had received a heart transplant on Sept. 21, 2018. He didn’t wake up after the operation and had been in a vegetative state ever since.
Machines whirred in his room, pumping air into his lungs. Nutrients and fluids dripped from a tube into his stomach. Young had always been fastidious, but now his hair and toenails had grown long. A nurse suctioned mucus from his throat several times a day to keep him from choking, according to employees familiar with his care. His medical record would note: “He follows no commands. He looks very encephalopathic” — brain damaged.
That day, in another wing of the hospital, where a group of surgeons, cardiologists, transplant coordinators, nurses and social workers gathered for their weekly meeting in a second-floor conference room, his name came up.
“Anything on Darryl Young?” asked cardiologist Dr. Darko Vucicevic, according to a recording of the meeting obtained by ProPublica.
The recordings show that the transplant team was fixated on keeping him alive, rather than his quality of life or his family’s wishes, because of worries about the transplant program’s survival rate, the proportion of people undergoing transplants who are still alive a year after their operations. Federal regulators rely on this statistic to evaluate — and sometimes penalize — transplant programs, giving hospitals across the country a reputational and financial incentive to game it. Newark Beth Israel’s one-year survival rate for heart transplants had dipped, and if Young were to die too soon, the program’s standing and even its own survival might be in jeopardy.
June 30, Zucker explained at the meeting, was the date of the next report by a federally funded organization that tracks transplant survival rates. “If he’s not dead in this report, even if he’s dead in the next report, it becomes an issue that moves out six more months,” he said in the recording.
In the ensuing months, the doctors continued to leave Young’s family in the dark, according to his sister Andrea and employees familiar with Young’s care. They didn’t want to run any risk that the people who loved him would interfere with their agenda: boosting the program’s numbers. “I’m not sure that this is ethical, moral or right,” Zucker told the team at the April meeting, but it’s “for the global good of the future transplant recipients.”
Arthur Caplan, head of the Division of Medical Ethics at NYU School of Medicine, reviewed transcripts of the recordings, including discussions about Young. “The management of this patient is egregiously unethical,” he said. “Prolonging ‘dying’ to preserve a flawed transplant program makes a mockery of transplant medicine and is an assault on both ethics and compassion.”
This is unalloyed evil, and everyone who knew of it, and refused to report it, should be banned from the practice of medicine forever.
It is unalloyed evil. The metric is not the problem.