HLTH 8136 Week 7 Overdose Report Disclosure Case Example

A Neighborhood Missing From the Naloxone Priority List: A Disclosure Case on an Overdose Report Undercount, a Planned Silent Fix and the Order in Which an Epidemiologist Should Use Voice Before Considering Exit

Student Name

Walden University

HLTH 8136: Leadership, Professionalism, and Ethics in Public Health Practice

Instructor Name

Month Day, Year

A Neighborhood Missing From the Naloxone Priority List: A Disclosure Case on an Overdose Report Undercount, a Planned Silent Fix and the Order in Which an Epidemiologist Should Use Voice Before Considering Exit

What Was Found

An epidemiologist at a county health department, invented for this case, is preparing next year's overdose surveillance report when she notices a problem in last year's. A coding step that assigned deaths to neighborhoods by address dropped records with apartment numbers written in a nonstandard format. Most neighborhoods lost a handful of deaths, too few to change their ranking. One neighborhood, with many large apartment buildings, lost enough that it fell off the published list of priority areas for naloxone distribution. The department's outreach team used that list to decide where to place naloxone boxes and run training sessions this year. The epidemiologist does not know how many deaths were missed in total, only that the neighborhood's corrected count would have placed it on the list.

Who Knows

The epidemiologist told her supervisor, who told the deputy director. Leadership's plan is to correct the method in next year's report, with a technical note, and not to revise or announce anything about last year's. Their reasons are understandable: a correction would draw press attention to the department's errors at a time when the overdose program is under budget scrutiny, and the outreach plan for this year is already under way.

What the Public Is Relying On

The report is not an internal document. The outreach team relied on it, and so did community organizations, a hospital system and a pharmacy chain that used the list to choose where to stock naloxone and run events. Residents of the missing neighborhood had no reason to think their area was overlooked. Two items in the 2002 public health ethics code speak to this: agencies owe communities the facts they hold that bear on policy and program choices, and they owe prompt action on what they know, within their mandate and means (Thomas et al., 2002). Both principles apply. The corrected ranking is information the community needs, and the time to act on it is this year, while naloxone placement is being decided, not after another year of overdoses.

Why the Silent Fix Falls Short

Leadership's plan fixes the method but not the decision that relied on it. Correcting next year's report means the missing neighborhood will appear on next year's list, which helps residents in a year's time. It does nothing for this year, when naloxone boxes are being placed and trainings scheduled. A fix that protects the department's record while leaving a known gap in protection reverses the order the Principles set out, in which the community's need for information comes before the institution's comfort. The plan also treats the error as a technical matter for epidemiologists, when its effects reached partners outside the department who made their own decisions on the list. Those partners have a claim to know what the department now knows.

Internal Routes

Hirschman (1970) described three responses available to members of an organization that is declining in quality: exit, leaving or going outside; voice, trying to change the organization from within; and loyalty, which raises the cost of exit and makes voice more likely. His framework helps structure the epidemiologist's decision because it puts voice first for someone who is loyal to the organization and believes it can be changed.

Voice has several steps here. The epidemiologist can write a memo to the deputy director that sets out the error, the affected neighborhood and the decisions that relied on the list, and that proposes a targeted correction: notify the outreach team and the partner organizations now, add the neighborhood to this year's distribution plan and post a brief correction notice on the report's web page. She can ask for a meeting that includes the department's director and its communications lead, so the decision is made by the people accountable for it. She can also raise the matter with the department's data governance committee, if one exists, or with its ethics advisor. Each step should be dated and kept, so that if the matter is later reviewed, the record shows what was known, when and by whom.

Loyalty, in Hirschman's sense, is what makes voice worth trying. The epidemiologist has reasons to believe that leadership will listen when the decision is framed around residents rather than around the department's reputation.

What Happens if Those Routes Fail

If leadership refuses a targeted correction, the epidemiologist faces the question of exit. Exit here does not have to mean resigning or going to the press. The narrowest outside step would be to tell the outreach team and partner organizations directly, so that naloxone reaches the neighborhood this year, while leaving the public correction to leadership. A wider step would be to raise the matter with the county's board of health, which oversees the department. Going to the media would be justified only if the internal and oversight routes had been tried and had failed, and if the harm of continued silence were serious and ongoing.

The APHA code names professionalism and trust as core values of the field (American Public Health Association, 2019). A silent fix risks both. If the error is discovered later by a journalist or a resident, the department's credibility will suffer far more than it would from a prompt correction.

Handling Uncertainty

The epidemiologist does not know the full size of the undercount. That uncertainty is a reason for care in what is said, not for silence. A correction can state what is known: that a coding error affected neighborhood counts, that one neighborhood should have been on the priority list and that the department is reviewing the full effect. Waiting for a complete count before telling anyone would delay the one action the known facts already support.

Recommendation

The epidemiologist should use voice first and in writing, proposing a targeted correction that puts the missing neighborhood back on this year's naloxone plan and notifies partners. If that fails, she should take the narrowest outside step that protects residents, telling the outreach team and partners, before considering wider disclosure. The order matters: it gives the department every chance to correct its own error while ensuring that residents of the missing neighborhood are not left without naloxone for another year.

References

American Public Health Association. (2019). Public health code of ethics.

Hirschman, A. O. (1970). Exit, voice, and loyalty: Responses to decline in firms, organizations, and states. Harvard University Press.

Thomas, J. C., Sage, M., Dillenberg, J., & Guillory, V. J. (2002). A code of ethics for public health. American Journal of Public Health, 92(7), 1057-1059. https://doi.org/10.2105/AJPH.92.7.1057