Presidents Without Oversight

Presidents Without Oversight


Leonard Zwelling

         Everyone needs a boss or should have some sort of supervision. Even bosses need bosses. The biggest CEO has a corporate board that oversees the wellbeing of the company, the value of its stock, and the excellence of its products. Why? Because no one is above some sort of governance or shouldn’t be when the goal is excellence.

         It may come as a shock to young people studying the American government that this is also true of the President of the United States because the current occupant of the White House appears to do what he wants and is called to account by no one. The Constitution established several checks and balances on all aspects of the government, but the latest impeachment incident with Mr. Trump and what has transpired since suggests that neither the legislative nor judicial branch has any checks on the executive branch. Trump was right all along. He probably could shoot someone on Fifth Avenue and suffer no consequences.

         Let it not be lost on anyone that the Democrats made a mess of this by jumping the gun by impeaching Trump before they did a thorough investigation of his wrong-doing by calling primary witnesses to his misdeeds. Ms. Pelosi was also right in her reluctance to move forward with impeachment. In the end, the whole thing blew up in the faces of the Democrats. You gotta love them, those Democrats. They just can’t help but mess up.

         But the President of the United States is not the only president with little or no oversight. This is also true at MD Anderson where the president has always had carte blanche being theoretically overseen by the Board of Regents, a group of political appointees only one of whom is usually from Houston and none of whom may actually know anything about cancer. For years I have urged the founding of a real board of trustees for MD Anderson consisting of people from Houston who actually know something about the running of a cancer center. This will never be allowed to happen by the Board of Regents or the University of Texas officials in Austin, but the Board of Visitors could be morphed from a boosters’ club to a real advisory board and not just famous or rich people who still know nothing about cancer, but instead made up of people who both care and know. There is nothing of which I am aware that prevents the president of MD Anderson from forming a real board and investing it with some power. But to do that would require some fancy footwork in Austin and a hard search for the right people to sit on such a board.

         Over the years I have met many members of the Board of Visitors. To a person I have found them to be delightful and caring people dedicated to the MD Anderson mission. I have also found most of them to know little or nothing about modern medicine or cancer care. Thus, the MD Anderson president can, like the President of the United States, do pretty much what he wants to. Judging by the performance of the immediate previous president of MD Anderson, how wise is this course of action and what are the chances that disaster could happen again?

         Dr. LeMaistre took me with him to Austin more than once. Sometimes it was to report on a clinical research mishap to the Board of Regents and sometimes it was to advocate to the Legislature. Dr. Mendelsohn sent me to the Texas Legislature to testify on behalf of CPRIT back in 2007 and I did sitting right next to Lance Armstrong. You get my drift. MD Anderson should not be reporting up to Austin. It’s major challenges are local and, in fact, I would argue its metastases around the country are a bad strategic idea that I really cannot understand unless it is to sell the name for more money. You cannot outsource MD Anderson care or the expertise of the 1515 faculty. MD Anderson is not Kentucky Fried Chicken.

         It is probably a good idea to reconsider the governance of MD Anderson while the political winds are wafting softly now that the Chinese faculty and blood transfusion controversies have died down and, I understand, the coffers are full. What a great time to reassess rather than to sit on laurels.

         MD Anderson needs a real board. Of course, the United States may need one too and the meetings can’t be at Trump Tower.

         The importance of oversight is emphasized in the financial world by the op-ed in The Wall Street Journal on February 20, 2020 by former Securities and Exchange Commission chairman Arthur Levitt:

         In all phases of professional life, the oversight of work done for the good of another—fiduciary work—needs oversight. The auditors need to be audited as Levitt points out. Presidents need to be held accountable. Everyone needs a boss.

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