‘Reputation Recovery’: The Ebola Patient Crisis in Dallas

December 31, 2014


Everyone in the U.S. public-health community knew that it was only a matter of time.

As Ebola ran out of control in West Africa, and American doctors and nurses were infected and sent back to the United States for treatment at designated infectious-disease-treatment centers, it was inevitable that someone infected or exposed would travel on his or her own and show up in the emergency room of a “regular hospital.” That hospital would be put to the test. Eventually, one hospital would bear the responsibility of being the first to spot the symptoms and make the diagnosis, without any advance warning, and then to diagnose and treat this life-threatening disease.

Unfortunately, when it happened at that first hospital at the end of September, Texas Health Presbyterian Hospital Dallas, things did not go well. The doctors missed the initial diagnosis. And then, despite the hospital’s heroic efforts, the patient, Thomas Eric Duncan, did not survive. Two nurses who cared for Duncan were also infected. The hospital admitted that it made mistakes.

Because this was the first case of Ebola diagnosed in the United States, it immediately became Page One news. The firestorm was compounded by public fear the patient had infected others, and one of these nurses flew to another state on a commercial flight. Fear trumped scientific facts about transmission of the disease, and public anxiety ratcheted up with each passing day.

The reputation and bottom line of Texas Health Presbyterian Hospital Dallas were damaged. Physicians reported patients canceling appointments or wanting to have procedures done at other facilities, and there was a 25-percent drop in revenues in October when the ER closed. Nurses went public and accused the hospital of not providing proper training and protection. The public waited for the hospital to explain what had gone wrong, and The Dallas Morning News cited a “deep loss of public trust” in a facility that was once known as one of the city’s most prestigious.

While Texas Health Presbyterian is now in what’s being called a “reputation recovery” mode, with help from an aggressive campaign created by a leading PR agency, the organization suffered. Because all of us in public relations are only a moment away from a crisis in our own organizations, looking at the Ebola situation in Dallas and its communications challenges can provide valuable lessons.

The statement that came too late

When Dr. Daniel Varga, the chief clinical officer of Texas Health Resources, the parent company of Texas Health Presbyterian Dallas, testified before Congress in October about the hospital’s experience, his statement was close to textbook perfect. He expressed sorrow, admitted problems, provided details and apologized, saying:

"It’s hard for me to put into words how we felt when our patient Thomas Eric Duncan lost his struggle with Ebola on October 8. It was devastating to the nurses, doctors and team who tried so hard to save his life. We keep his family in our thoughts and prayers. Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team, we made mistakes. We did not correctly diagnose his symptoms as those of Ebola. We are deeply sorry.

“Also, in our effort to communicate to the public quickly and transparently, we inadvertently provided some information that was inaccurate and had to be corrected. No doubt that was unsettling to a community that was already concerned and confused, and we have learned from that experience as well.

Additional statements followed, along with a full-page “letter to the community” ad, which included more details on the mistakes that people had made.

Unfortunately these statements — which provided a needed acknowledgment of fault, details of mistakes and appropriate apologies — came several weeks too late and these communications missteps brought unexpected consequences.

The hospital’s handling of the Ebola crisis provided valuable lessons for PR professionals to help us refine our approach in crisis situations. Here are three key takeaways:

• Transparency is critical — as long as the information is accurate. Transparency means getting information to the public quickly, but it can be better to sacrifice speed in a case like this. In its statement to Congress, Texas Health Presbyterian Dallas noted that it was trying to be transparent. But in that rush, the information that it gave the PR staff to take public proved to be inaccurate.

In crises, one or two questions usually emerge from reporters as the “must-answer” questions that need to be treated with utmost caution to ensure that the answers are 100-percent accurate. In the case of Texas Health Presbyterian, the first question was: Why wasn’t the patient diagnosed correctly on his first visit to the ER, when he had some possible Ebola symptoms and had just come from Africa? The hospital blamed technology, specifically the computerized patient chart, in a jargon-heavy statement that was confusing even to people who work in health care.

While documentation of the patient’s travel history was in the nursing-workflow portion of the patient chart, it would not have automatically appeared in the physician’s standard workflow, making it difficult for them to diagnose Ebola.

A day later, the hospital essentially retracted its statement by saying: “There was no flaw in the [computerized patient chart] in the way the physician and nursing portions interacted related to this event.”

For PR and communications pros, the takeaway is: If you’re not 100-percent sure that the information that your statement is based on is accurate, then it is better to wait and be transparent than have to retract your statement. As a PR veteran once said to me, “The only statement no one can ever make you retract is: ‘I don’t know.’”

Not immediately having the final answer doesn’t mean being silent or saying the dreaded “no comment.” A response such as “We are investigating” won’t make reporters happy, but it does reassure the layperson that the organization is trying its best. That said, at some point, the public and media will expect an answer — and if they don’t get one, then they’ll start suspecting a cover-up or incompetence. Once the answers are available, transparency requires sharing them. 

The next question that the media and public cared about was: Given the diagnostic mistake, and the fact that two nurses became infected while caring for the patient, was the hospital really prepared to handle an Ebola case?

Again, Texas Health Presbyterian’s responses sounded good at the beginning, but then the organization’s credibility was damaged. On the day the patient was admitted, the hospital’s epidemiology chief, Dr. Edward Goodman said, “We have had a plan in place for some time now for a patient presenting with possible Ebola. We were well prepared to care for this patient.”

Only a few weeks later, after the patient had died and the two nurses were infected, some nurses went public to contradict that statement. One of the two infected nurses appeared on the “Today” show to say that the nurses as a group  — including herself — had not been prepared, trained or ready. The first time that she’d even tried on the protective garb, she “was heading in to take care of the patient,” she said.

In the hospital’s statements to Congress, its officials indicated that they believed they were prepared for the crisis because they had disseminated Ebola information from the Centers for Disease Control and Prevention throughout the hospital. However, hospital officials apparently didn’t provide any communication that was two-way, interactive and repeated, to ensure that the staff would put the information into action.

Hospital leaders may have genuinely believed that they prepared their staff, but the nurses felt like they needed to be trained in person and drilled on exactly what to do. The leaders realized this later, as cited in their Congressional testimony, saying: “Communicating is critical, but is no substitute for training.” Public relations and communications professionals might add that dissemination isn’t a substitute for communication.

• Managing the media is best done proactively, but you can’t skip your responsibility to be responsive. The hospital initiated its media outreach by releasing dozens of statements and updates and holding routine press conferences. Yet reporters, particularly those from major media outlets such as CNN and The Washington Post, complained that the hospital wasn’t responding to their questions.

Ironically, CNN’s Anderson Cooper described Texas Health Presbyterian’s unresponsiveness as a “lack of transparency” — the very thing hospital officials said they were striving for when they initially made statements later revealed as inaccurate. The pendulum swing — from rushing to put out statements that they then had to retract or clarify, to not responding to inquiries from well-known reporters — was understandable but unfortunate. Cooper complained that the hospital only became responsive when “called before Congress.” 
It may be that when executing a proactive outreach program, the time for callbacks was limited, especially when the PR team hadn’t received any new specifics to offer.

Anyone who’s ever managed communications for a major crisis knows how stale and frustrating the “nothing new, we still have no details” drill can become. But returning calls and responding with that statement precludes reporters from saying, “The hospital doesn’t respond.” To the public, this can sound as if the organization doesn’t care, is stonewalling, hiding something — or worse, that its officials really don’t know what’s going on.

• When people have clearly made mistakes, they should express apologies as soon as possible. Some PR professionals refer to the “three A’s” of crisis management when it’s clear that the organization is at fault: Acknowledge the situation, admit to the obvious facts and apologize. Too often, organizations ignore that third “A” until late in the communications process, when apologizing upfront might have made all the difference in terms of public perception.

The hospital had acknowledged the problem of the missed diagnosis and begun admitting what it thought were the facts. But it didn’t formally convey the caring, genuine statement that “We are so sorry for what has happened and we apologize to those affected and to the community” until the medical facility’s officials testified before Congress — and this was during the follow-up statements, which meant that for days, the community was left to wonder if the hospital really was sorry. For Texas Health Presbyterian, this was even more critical because Thomas Eric Duncan’s family was going public with concerns and questions in a way that made it appear the hospital was not helping them or being sensitive to their needs. Family members reported hearing about Duncan’s condition on the radio, rather than from the hospital.

In an op-ed that The Dallas Morning News published on Oct. 14, Duncan’s nephew wrote, “We asked, we begged, we pleaded” for information about possible treatments. The hospital responded that it was talking with the CDC. In perhaps its most poignant statement, the family wrote: “The day Thomas Eric died, we learned about it from the news media, not his doctors.”

If an error ends up harming someone — even if there will likely be lawsuits in the future — then the organization should express its apologies immediately, so that the public, the people affected and its own employees hear it. As one PR expert said, “The public can accept mistakes and even misdeeds; what they cannot accept is if the organization doesn’t seem to care.”

A focus on transparency

Life goes on, as it does after a crisis. Patients become less fearful, volume and revenues pick up, and in the case of Texas Health Presbyterian Hospital Dallas, its “PresbyProud” YouTube campaign reminds the community of the esteem in which they always have held the hospital.

And in the aftermath, hospitals, health officials and company leaders worldwide realize that simply distributing information does not guarantee that people will  read, understand or act on it, and that dissemination is not a synonym for communication. Whether the news is as simple as a change in office locations or information that affects life and death, communication must be dynamic, interactive, two-way and managed with the same level of attention given to all critical business functions.

Kathleen Larey Lewton, APR, Fellow PRSA
Kathleen Larey Lewton, APR, Fellow PRSA, past national president of PRSA and principal of Lewton, Seekins & Trester, has spent 40 years as PR counsel for leading health systems and academic medical centers. Email: klewton@lstllc.com.


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