Las Vegas Sun

October 19, 2017

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How we come to accept wrong as the new right

‘Normalized deviance’ can lead to tragedy

Space shuttle Challenger exploded in a split second two decades ago, but the disaster was years in the making.

The primary cause — an O-ring that failed in low temperatures — was only part of the story. Engineers knew the O-ring turned brittle in the cold, but their warnings were ignored because of what sociologist and author Diane Vaughn calls the “normalization of deviance.”

Politics and a culture of compliance led decision-makers to determine it was an acceptable risk. “They redefined evidence that deviated from an acceptable standard so that it became the standard,” Vaughn wrote.

Health care in Nevada also seems to suffer from a normalization of deviance. In two recent high-profile cases — the hepatitis C crisis and the widespread abuse of Nevada’s foreign doctors — trained professionals apparently ignored strong evidence of wrongdoing.

Fifty thousand people had to be tested for infectious diseases because of a hepatitis C outbreak caused by unsafe injection practices at Endoscopy Center of Southern Nevada. Nurse anesthetists infected patients with tainted blood by reusing syringes, possibly under the orders of their boss, investigators said.

The community asked: How could licensed professionals do such a thing? Why did those involved not speak out?

David Forman, assistant professor of philosophy at UNLV, compares the culture at the Endoscopy Center to the circumstances leading to the Challenger disaster. Groupthink takes over and pressure builds to conform, he said.

“People who go against the standard line of the organization feel like they’re not just expressing a difference of opinion, but that they’re traitors,” said Forman, who teaches a course on health care ethics.

Problems are compounded when people comply with the nonstandard procedure and don’t suffer consequences, Forman said. They begin to reason: Nothing bad happened, so maybe this is OK.

The same psychology might explain how people knew for years that doctors in Las Vegas were profiting by overworking foreign doctors, underpaying them, and ordering them away from the medically needy patients they were supposed to serve so they could bring in more revenue in hospitals.

The Sun’s 2007 investigation of the “J-1” visa waiver program prompted immediate reforms by the Nevada State Health Division. But the truth is, members of the medical community and officials from the state kept silent for years about the abuses.

“I knew what was going on before, but it wasn’t my part to blow any whistles or anything like that,” said a Las Vegas doctor who teaches at a local medical school.

The exploitation had become part of the status quo. Normalized deviance.

We like to think that people will stand up for what’s right, Forman said, but psychological research shows that people won’t take a stand if it might require sacrifice.

Which highlights the importance of regulation, he said. Ethical health care providers — and they are the majority — have long complained about inept regulation in Nevada. The problems are so egregious they fuel conspiracy theories about corruption on the Nevada Board of Medical Examiners and in the State Health Division.

Indeed, the state received a half-dozen letters between 2001 and 2004 from J-1 doctors who complained about the abuses by their employers — one of them was copied to the Nevada Board of Medical Examiners and the Nevada attorney general’s office.

Nothing was done. Worse, the same employers named in the complaints were allowed to hire five additional foreign doctors.

Critics of these Nevada regulators don’t use the term “normalized deviance” to describe the inept oversight, but they could.

Should it be allowed to continue?

NASA failed to correct its problems, and on Feb. 1, 2003, the space shuttle Columbia disintegrated while streaking through the Texas sky.

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