Monday, September 24, 2012

Saying No to Authority: Black and White and Gray Perspectives

About 100,000 people die each year due to errors in health care according to the Institute of Medicine.  We have a lot of fixing to do to reduce the chance for errors that lead to those deaths.  People in health care will have to confront each other, seek clarification, forgive each other rapidly and move ahead.  When and how do we need to push back to save lives?  Who may be disappointed or angry about the tension induced by pushing back?

“Captain, I need you to fly me to these coordinates to check in with one of my companies,” said the Engineer Battalion commander near Khe Sanh in Viet Nam in 1971 during operation Lam Son 719.  I was a helicopter pilot in the engineer group headquarters flying support for one of our three battalions on that day.  I called for a clearance to fly to his unit and received word that it was a no-fly zone since an F-4 jet was just shot down in that area.  (Let’s see, if the enemy can hone in on a jet that flies really fast, they might have no problem aiming at an OH-58 (Kiowa) helicopter that flies a lot slower, keeping me from getting the  Lieutenant Colonel to his objective and eliminating us and our helicopter from the war zone- and the earth).

“Sorry, Sir, but we’re not allowed to fly there temporarily.  It’s been designated a no-fly area since a jet was just shot down there.”  “Captain, take me there immediately,” he responded.  “I’m sorry, Sir, but I don’t have clearance by our security to fly there.”  He made a couple angry, grumbling comments, sort of venting his frustration at me.  He was a leader, committed to his people,  who was willing to do whatever it took to get the job done.  His unit was not actively engaged in a fire fight or other situation that required immediate command presence for life and death decisions.  He wasn’t satisfied with my answer. 

“Sir, Let me get you the Colonel (Group Commander) on the radio so you and he can clarify our options.”  The colonel reaffirmed our inability to get to those coordinates until the no-fly was lifted, after clarifying mission issues with this battalion commander. He still was annoyed with me and not pleased.
We flew to another of his companies first after which we were cleared to fly to the previously off limits coordinates.   

On return to his battalion encampment area and before landing, I noted puffs of white smoke inside his perimeter, consistent with white phosphorus from artillery fire and, since the enemy didn’t have any white phosphorus rounds, I knew it was from our own troops.

I told him on the intercom, “Sir, your position is receiving friendly fire, we can’t land yet.”  He responded briskly, “That’s bullshit, we are not taking fire.”  “Look out your window, please, Sir.”  He exploded with a few expletives about who was attacking their unit with friendly fire, etc.  I had his unit frequency waiting for him to communicate, while I called artillery coordination to report the friendly fire.  No one was killed, fortunately.  After the white puffs stopped, I was able to deliver him back to his troops and his headquarters.

After the operation was complete, all pilots in our group HQ unit who supported his battalion during Lam Sanh 719 were recommended for, and received, the Army Commendation Medal, except one- me.  I am pleased to have not received that medal.

We do the best we can and seek clarification, but time marches on, so decisions are made, actions taken and forgiveness offered.  In health care, we will have to push back a bit more often in the name of patient protection.  Sometimes, feelings will be hurt and nerves frayed, but hopefully forgiveness will be offered rapidly and lives will be saved.

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