"The basis of effective government is public confidence, and that confidence is endangered when ethical standards falter, or appear to falter."

John F. Kennedy

WE have been discussing conflict of interest when making ethical decisions. In this discussion board, we will be examining in this case study an important and challenging decision that a public health department director is making. Please read the case study and answer the questions that follow.

You are the Director of Richville County Public Health Dept. in Richville, NY, and like every other county since the economic downturn of 2008, you are forced to be doing much more, with much less.

Your background with your graduate degree in health sciences as well as your membership in several professional organizations has kept you in touch with the many challenging issues in the field and that your county is currently facing. In the past, Richville's emergency medical services were provided by the county.

Even with the tax revenue stream, the cost of these programs surpasses the allocated funding, and the costs continue to steadily rise year after year. Additionally, when emergency EMS or fire services are rendered, to the extent a bill is generated for services performed, the county has an unofficial policy that it will contact the patient for payment, and even send strongly worded letters to encourage settlement or a payment plan, but will stop short of litigating the matter in court.

While this leaves the community with a positive feeling about the emergency medical services, it contributes to the growing deficit for covering costs in the budget.

A councilman has approached you with an idea about outsourcing the provision of emergency medical services to a for profit company, Regional Emergency Services, that is funded and operated by a private equity group.

Outsourcing will save the county money. Your initial projections indicate savings of around 15%, which are variable; however, regardless of how the projections work out, Regional Emergency Services has guaranteed Richville County a cost savings of 10%. Though the numbers seem right, you are skeptical about this solution and where that cost savings would come from, especially since your spouse just told you about a horrifying article he/she just read entitled "When You Dial 911, Wall Street Answers."

You are also weary of the transition because you are relatively positive that some of the other council members have a vested interest in the private equity company backing Regional Emergency Services because they are shareholders in the equity company.

Time is ticking as the annual budget meeting is fast approaching and you feel immense pressure to find some type of solution to not only stop, but also narrow, the deficit created by this health service in the county budget. A key responsibility of your role as Director of the County Health Dept. is to be sure that you are within your Dept.'s budget guidelines.

After reading the Wall Street Journal article: Ivory, D. et al., When You Dial 911 and Wall Street Answers (Links to an external site.)

APA format/refences answer the following questions:

Please identify if there is a conflict of interest and if so, at what level (organizational, individual) or both??

If you agree that there is a conflict of interest, who are the key individuals involved in this conflict?

Explain and support with a rationale how this conflict of interest might be resolved? Are there additional ethical issues/dilemmas that need to be addressed and if so, what are they?? Be sure to support your rationale with ethical theories/principles.