Nothing to indicate that no resuscitative care should be provided. But Bob Manning had no interest in dying; after almost forty years of living with almost complete paralysis, he was a remarkably vital man.
As Dr. Chew noted when he told me about this incident, end-of-life decisions are a fit subject for a physician to discuss with a patient. But this nurse was not a caregiver; she was an agent of a company that would lose money if Manning went on living and would profit from his death.
"She was asking me to die," Manning told me.
Dr. Chew agreed: "She wanted Bob to have a DNR order and was quite insistent."
The nurse turned out to be an employee of a medical advice company called Concentra. When I asked Tom Fogarty, the doctor who is a cofounder of Concentra about this, he did something unusual. Unlike the top executives who will not come to the phone or who speak only through written statements, Fogarty set out to find out what happened. When he got back to me he was guarded about what he shared, but he made it clear he was aghast that any medical professional representing a financial interest in someone's life would even inquire about a DNR order. He also volunteered that after a brief spell, his company had gotten out of the line of business that the nurse had been part of. How much better American business would be if we had more chief executives who dealt forthrightly with issues instead of hiding behind publicists and lawyers, not to mention squads of burly security guards.
Now, to be clear, I do not think for a moment that Warren Buffett knew that the nurse working for his Cologne Re insurance company was going to ask Bob Manning, in effect, to die the next time he had a medical emergency. But that does not mean Buffett is free of responsibility for what happened. Buffett often says that his style is to let his managers run their shops, as long as they make their numbers, meaning their expected level of profit. His management style is widely praised in news reports and in profiles of the "Oracle of Omaha." By giving managers the freedom to run their business units as they see fit, Buffett takes on a duty to demand the highest ethical standards. That would not, in my opinion, include gouging customers on coal shipping rates as his BNSF railroad does. Nor would an ethical chief executive allow anyone in his employ ever to suggest that anyone should die to bolster a company's profits. But that is what happens under the Buffett style, in which by his own account he focuses on whether managers, some of whom resort to immoral conduct to give their billionaire boss what he demands, "make their numbers."
The reality is that what Manning had been saying all along, even before we met in 1997, was true. The insurance company wanted him to die. They had made it difficult for him to get care, they had for years refused to replace the crane Helen used to hoist him out of bed after the gears were stripped, they made it hard for him to get supplies to avoid infections. And finally a nurse hired by a Warren Buffett company carne right out and asked him, in effect, why he was not going to die the next time he had a medical emergency.
Bob Manning lived until 2009. To this day, his family says they are still owed money to which he was entitled. They are owed more than that.
David Cay Johnston "Free Lunch" (2007)
