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VOL. 36 | NO. 42 | Friday, October 19, 2012

Saving face while saving lives at Saint Thomas

Rehabbing hospital's public image will take skilled crisis management

By Hollie Deese

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Saint Thomas Hospital has treated more than 15 percent of patients involved in the meningitis outbreak.

-- Photo: Lyle Graves | Nashville Ledger

By Oct. 1 when people in Nashville were first getting wind about the meningitis outbreak that has to date infected 63 people and killed eight across the state, local and national health officials had already been hard at work since Sept. 18 trying to identify what patients were sick with and how it happened.

But from the moment that first story broke, Saint Thomas Hospital has had more than a health crisis on its hands. Its public image also has been at stake as their name was automatically linked to the heart of the problem, thanks to tainted steroids distributed from the ninth-floor Saint Thomas Outpatient Neurosurgery Center on the hospital campus. Those steroids were purchased from the New England Compounding Center in Massachusetts through Barry Cadden, the NECC founder who was licensed in Tennessee. On Oct. 15, the NECC surrendered its Tennessee license and is now banned from doing business in the state.

The hospital itself might not be culpable for the outbreak, and yet many news stories or articles on news sites like CNN.com were quick to flash photos of the Saint Thomas campus whenever they talked about the ongoing story.

“I think it is important to talk about who else is involved in this crisis,” says Steven Fink, president and CEO of Lexicon Communications Corp., one of the leading crisis management firms in the country. Lexicon specializes in public relations, crisis management and communications, media relations and crisis management training. “Saint Thomas, in a sense, is a victim. Not to put them in the same category as the victims who died, but in the sense that presumably they were dealing with a company they had dealt with before and did not think they were doing anything wrong in buying this steroid from this lab in Massachusetts.”

Saint Thomas is certainly not the first company to face an image problem. Locally, Gibson Guitar Corp. got backlash after violating environmental laws and importing banned exotic wood. Toyota’s latest recall has been handled better than its bumbling tactics a few years ago when cars were recalled after drivers died due to sticking accelerator pedals.

But handling a health care crisis is especially difficult, not only because lives are on the line, but because of the privacy and regulatory laws in place to protect the patient.

“Health care is tough because your consumers are patients and at the end of the day, you always do have a life on the line,” says Christine Ricci, chief communication officer for Kansas-based B.E. Smith, a full-service healthcare leadership firm that includes helping clients through crises.

“A lot of the situations we go in to are very unstable situations and they will call us in to bring stability,” she adds. “It may not always be to the point of true crisis management, but typically there are some very tough situations.”

Put the consumer first

There is a formula to ensure the best possible results when regaining the public’s confidence. Tim Morgan, the chief operating officer at B.E. Smith has seen plenty of positive action in his 25 years in the health care industry, but he has seen plenty of missteps too especially when the company doesn’t appear to be putting the consumer first.

“If you put the consumer first and are very transparent about doing that, you tend to come off as being very much authentic and real and honest, and your consumers tend to appreciate that,” Morgan says.

Saint Thomas voluntarily closed the neurosurgery center on Sept. 20. After that, they immediately began calling patients, which began with about 150 but has expanded to about 1,200.

Early calls to the potentially affected were criticized for their vagueness in not mentioning meningitis by name, but state Health Commissioner Dr. John J. Dreyzhner defended that course of action on a press call last week as necessary to determine the root of the problem.

“We have said from the outset that this is an evolving situation,” he explains. “When those contacts first began we believe the clinic was very proactive, working with us from the beginning before we even really knew what was going on. We knew we had a cluster of cases. We knew that some people had had strokes, some people had had meningitis, and we weren’t sure at that point if there were other potential things going on.

“We did not want to contaminate our case-finding efforts, which can lead to very great difficulty in determining the true cause of the issue.”

Instead, at the request of the Tennessee Department of Health, Saint Thomas Outpatient Neurosciences Center did not specifically discuss the possibility of meningitis in these initial calls. Instead, the call center asked patients if they were experiencing symptoms, including headaches, fever, dizziness, stiff neck and sensitivity to light.

But the commissioner did acknowledge that the situation could have certainly been handled better.

Classic Crises

A time line of five classic PR crises and how industries changed afterwards

Three Mile Island

A partial nuclear meltdown on the Pennsylvania power plant on March 28, 1979, was the worst of its kind in history. Days went by as employees of the utility company tried to decide if an evacuation was necessary and conflicting statements were released to the public. Public fear was fueled by the release of the nuclear accident film The China Syndrome just days before. The accident resulted in new regulations for the nuclear industry.


In October 1982, seven people in suburban Chicago died after taking extra-strength Tylenol laced with cyanide after bottles on the shelves were tampered with. Johnson and Johnson immediately recalled product in the entire country at a loss of $100 million dollars. When the product was reintroduced to consumers it had tamper-resistant packaging, becoming the first company to comply with a new FDA mandate.

Exxon Valdez

On March 24, 1989, the single-hulled oil tanker ran aground in Alaska, spilling hundreds of thousands of barrels of crude oil in one of the biggest spills in history.  Congress has passed legislation requiring all tankers to be double-hulled by 2015.


A 1993 outbreak of E. Coli that killed four children was traced to more than 70 Jack-In-The-Box restaurants in four states, mainly Washington, where restaurants had been cooking meat to national standards, not those dictated by the state. After the incident, the restaurant changed their nationwide mandates and now all meat products made in the U.S. are required to comply with stricter regulations.

Mad Cow Disease

After an outbreak of Mad Cow Disease spread across Europe in 1996, American cattlemen had a problem on their hands after an episode of the Oprah show exposed to millions how dead cows are ground up and fed to other cows in this country. A year later the FDA banned protein made from cows, sheep and other animals to be used in feed.
– Hollie Deese

“Our initial guidance to Saint Thomas was to avoid speaking about specific syndromes,” he says. “We later rescinded that guidance and we began discussing what the specific issues of concerns were. We were partners in that. Hindsight is 20/20 but at that time it was the best available information that we had and could assure that we were doing what was appropriate to the public service, to make sure we had an investigation that would yield good answers.”

Communicate, don’t be defensive

Now is not the time to hide anything, no matter how bad it may look, experts say. Daily press briefings that began Oct. 1 have kept the media informed of daily changes and updates, and this week the hospital is conducting one-on-one interviews as the situation has grown more stable. But despite the best efforts to assure the public that Saint Thomas Hospital did not knowingly purchase and administer tainted medicine, multiple news outlets like CNN continue to attach an image of the hospital with many earlier stories.

“We appreciate the media assistance in continuing to provide the public with information,” says St. Thomas’ Dr. Robert Latham, one of the clinicians who initially reported early cases and Chief of Medicine, Medical Administrator for the Hospitalist Program and Director of Infectious Diseases Program at the hospital.

“We continue to ask your assistance in assuring the public that the only center that received the tainted steroids was the ninth-floor Outpatient Neurosurgery Center, which is separate from the hospital or any other outpatient center on the Saint Thomas campus.”

Communication is key for image survival, Fink says.

“Failure to communicate is the biggest mistake a company can make in managing a crisis,” he explains. “And then when they communicate, they need to set the right tone. Companies can get very defensive. This is not a time to be defensive. People have died. It is a public health crisis so they need to be compassionate. They need to understand that people have suffered, other people are frightened, they are unsure.

“They are looking for answers, they are looking for comfort, they are looking for security. And Saint Thomas needs to provide that. If they are transparent in what they are doing, and if they do not allow the lawyers to run the show, that they will have an excellent chance of regaining the position they held in the community beforehand.”

Take action

Closing the clinic was the right thing to do, Fink says, as well as considering banning the purchase of drugs from non-regulated companies. In a crisis, a company needs to be proactive and confident to gain the public’s trust.

“I was involved in Seattle in the infamous Jack-In-The-Box crisis, and everybody was writing them off like they would never recover,” Fink says. Four children died in the 90s after eating burgers contaminated with E. Coli from the chain. And while the restaurant was cooking its meat to national standards at the time, the state’s standards were higher and the restaurant neglected to make the switch. But to repair its image, kitchen practices were changed across the board.

“If Saint Thomas can put in place measures that help ensure the safety of their patients like Jack-In-The-Box did by turning up the temperature, so to speak, they will be surprised that in no time at all people will have confidence in them.”

Social media can come into play in a big way here, but historically health care companies have not been big users of Twitter and Facebook. In fact, St. Thomas Health’s official Twitter page has just 29 followers, which doesn’t always make it an effective tool in getting information out. But it might be just as well, as wrangling employee comments on social media sites can be just as damaging to the reputation of a company.

“Health care is still learning and growing when it comes to social media,” Ricci says. “About two years ago only 20 percent of health care organizations were actually utilizing social media, so healthcare is still learning and growing in that space.”

Fortune 100 companies, on the other hand, have monitoring systems in place and even secretly plant users to provide positive social media commentary.

Don’t over share and be prepared

When it comes to a health care crisis, extreme balance is needed thanks to privacy laws in place to protect the patients. But that can also tie the hands of doctors wanting to alert the public to a potential problem. But keeping the public abreast of the chronology of events, how patients are responding to treatment and following up frequently with patients who have been treated, but also tested and released, is important.

One of the rules of crisis management if it involves a third party is to work on what you can do and not talk about what the third party is doing, experts say. In this case, Saint Thomas should focus on what it is doing now and what changes they will make in the future and let NECC fight its own battles.

“If you have not dealt with a crisis before it can be pretty scary for your organization,” Morgan says. “And health care is a very tough industry because you are managing a lot of regulatory type of situations.

“Anything can happen when you are dealing with a lot of pharmaceutical and equipment third parties. Things can happen with those third parties but you don’t want to get into a war with that third party and be slanderous toward that third party. That can open up a lot of legal issues for your organization. What you want to do is focus on what you know and what you can control, which is your organization.”

Having a plan in place and rehearsing that plan can do wonders to help a company deal with a crisis before it gets too out of control. But no one can predict every element that will come in to play in a crisis situation. “We have rehabilitated a lot of images, but I do not have a magic wand,” Fink says. “Especially in a crisis when people have died. All they can do is soldier on and do the best that they can and make sure that whatever they are doing, they are taking steps to make sure what happened before never happens again.”

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