Case 2-10
Gateway Hospital
Troy just returned from a business trip for health care administrators in Orlando. Kristen, a
relatively new employee who reports to him, also attended the conference. Troy works for Gateway
Hospital, a for-profit hospital in the St. Louis area. The Orlando conference included training in the newest
regulations over health care, networking with other hospital administrators, and reports on upcoming
legislation in health care. The conference was in early March and coincided with Troy’s kids’ school spring
break so the entire family traveled to Orlando.
The hospital’s expense reimbursement policy is very clear on the need for receipts for all
reimbursements. Meals, for those not included in the conference, are covered within a pre-set range. Troy
has never had a problem following those guidelines. However, the trip to Orlando was more expensive than
Troy expected. He did not attend all sessions of the conference to enjoy time with the family. Upon return
to St. Louis Troy’s wife suggested that Troy submit three meals and one extra night at the hotel as business
expenses when they are personal expenses. Her rationale was that the hospital policies would not totally
cover the business costs of the trip. Troy often has to travel and misses family time that cannot be recovered
or replaced. Troy also knows his boss has a reputation of signing forms without reading or careful
examination.
Kristen is approached by the head of the accounting department about Troy’s expenses that seem
high and not quite right. Kirsten is asked about the extra night because she did not ask for reimbursement
for that time. Kristen knows it can be easily explained by saying Troy had to stay an extra day for
additional meetings, a common occurrence for administrators, although that was not the case. She also
knows that the hospital has poor controls, a culture of “not rocking the boat,” and other employees have
routinely inflated expense reports in the past. Assume you are in Kristen’s position. How would you
respond to the inquiry of the head of the accounting department? In considering your response, evaluate the
following issues.
Questions
1. What is at stake for the key parties? What is at stake for you (Kristen)?
The key parties in the case are Troy, his wife, Kristen and the hospital. Troy has performance reviews and
status as a supervisor at stake. He and his wife also have at stake the reimbursement of expenses (in the
short-term the expenses may seem high, but in the long-term the amount is material). Kristen as a new
employee is in a position of having to lie about the expenses or act as a whistle-blower on Troy. If Kristen
2. What are the main arguments that you [Kristen] are trying to counter assuming you know
Troy’s position on the matter and what are the reasons and rationalizations you need to
address?
Troy may want to argue that it is only one night, he has been a long time employee, the amount is not
material, everyone else does the same, and that he will cover for Kristen in the future. Kristen will need to
3. What should Kristen do and what ethical considerations should influence her decision?
Kristen should articulate her values that are important to her, such as the honesty, integrity, responsibility,
and trustworthiness. She should look for enablers in the company to support her position. She should also