Public Relations Dilemma at the Harristown Hospital and Health System--Case Study

Public Relations Dilemma at the Harristown Hospital and Health System

“This is Roemer,” answered Steve Roemer, the Vice President for Public Affairs for the Harristown Hospital and Health System (HHHS), in response to his ringing Blackberry. He didn’t recognize the number that flashed on his small screen. However, the area code of 404 indicated the call was from the Atlanta area.  

It was 8:30 on a Monday evening, and he was in the middle of watching an episode of House, MD. The mythical Princeton Plainsboro Teaching Hospital didn’t have much in common with HHHS, and he was aware that most medical staff at HHHS found the show ridiculous, particularly the main character’s ethics, or lack thereof. Dr. House would have lasted no longer than a day on the staff of any real hospital, they asserted, regardless of whether he could save lives no one else could, all within a 43-minute timeframe plus commercials.

Reflexively, Roemer hit the pause button on the remote and took the call. Probably nothing that was needed of him that would be on the eleven o’clock news, he judged. Most of those calls involving a request for him to do a taped interview occurred during the early afternoon, for transmission back to the studio for editing in time for the six o’clock broadcast.

Roemer was proud of the fact that he made himself available 24/7 and was accessible to reporters working on deadline. While his smartphone might ring occasionally during the middle of the night, those times were rare. A former beat reporter for a South Carolina daily, he enjoyed the excitement of working with the media, particularly when he was sought out by television stations to appear live to comment on a breaking story. Health care was a broad, high-profile topic that would find itself often as a lead story in some context in the Harristown Morning News, and the television news, as well.

During the five years Roemer had served as the chief public relations professional of HHHS, he had developed substantial expertise on topics ranging from medical conditions and their treatment to the complexities of hospital finance and accounting. He had visions of returning to reporting, but he was also getting spoiled by the high salary and substantial fringe benefits and privileges of working in a corporate environment with staff and other resources to help him do his job. Whoever said working in the nonprofit sector guaranteed a low salary didn’t know what they were talking about.

Occasionally, at the urging of his wife, he would turn off his Blackberry during “family time” and return any calls he received later. The advanced technology of the smartphone kept him connected, but he recognized that there was also a cost to being available day or night to not only reporters, but to his small staff and his superiors at HHHS. Unlike many other nonprofit organizations, this organization did not go to “sleep” after traditional business hours, although the pace may have appreciably diminished. There was a baseline of 8 a.m. to 4:30 p.m. office hours in the administrative floor of HHHS, with meetings, press conferences, production of the weekly newsletters, and preparing flashy briefing books for upcoming board meetings, filled with eye-catching graphics. But after business hours, the hospital remained a beehive of activity, with newsworthy developments periodically occurring in the evening, throughout the night, and on weekends, as well.

Other than perhaps the CEO, Roemer was the public face of the Health System, and that telegenic face had to remain clean-shaven because of the possibility that it would be on the other side of a camera with minimal notice.

It was Roemer’s responsibility to keep the public educated and happy, and to have a positive association with the name of HHHS. Although generally no news was good news, Roemer proactively engaged the local media in covering aspects of hospital activities that would put it in a positive light. HHHS was an important pillar in the community—a respected player in the city’s economic and social future, and second only to the state university as the largest employer in the city. It had a brand name to protect, and Roemer was its key frontline defender.

Despite its first-rate reputation, HHHS was in a constant competition for patients, who had a choice when deciding which among the three major acute care facilities in Harristown to patronize. (There had once been six hospitals in the community, but a series of mergers had resulted in HHHS absorbing three others in the 1990s.) Increasing market share was a key component of HHHS’s strategic plan, and additional funds had been allocated to Roemer’s department based on the premise that good public relations could improve that statistic, as well as improve its overall net revenue.

Despite its nonprofit status, improving net revenue was the principal focus of every management decision. The hospital typically charged its patients exorbitant fees for every procedure, as did the other two hospitals in the community. However, few patients paid the regular fee schedule; most charges were reimbursed by negotiated payments from private and government insurance. Even these rates were substantially higher than costs, so that treatment of nonpaying patients could be cross-subsidized. By state law, nonprofit hospitals were permitted to make a profit, but any net revenue over expenses was required to be funneled back for the hospital’s charitable purposes. Those charitable purposes, of course, included investing in the most advanced technology, increasing staff salaries, and providing substantial perquisites to those who worked there, including the use of a Skybox at the NFL Stadium at the Sportsplex across town.

Roemer had attended several games seated in this box, enjoying a lavishly catered lunch and actively participating in the advocacy and fundraising carried on there directed at invited guests, such as the State’s congressional delegation and potential donors. As a reporter, he had been able to purchase tickets to only a single Atlanta Falcons pre-season game during his five years at the paper, and he had paid for those seats himself.

In addition to his other responsibilities, Roemer was also part of the team of staff who decided which programs and activities would receive financial sponsorship of HHHS, with several million dollars available annually to support concerts, youth sports, museums, the Harristown Marathon, and other events that would help the community and provide more visibility and name recognition for HHHS. He really enjoyed this aspect of the job, using the Health System’s money to benefit community groups.

Roemer’s face had become familiar to TV viewers as a result of on-camera duties such as explaining the changing medical status of a celebrity admitted to the facility, updating the public about a train derailment that sent scores of injured to the hospital, or decrying a recent government report documenting an increase in the uninsured.

During one week two summers earlier, he had been a constant guest on all three local newscasts in the Harristown media market following a car accident involving the Mayor of Harristown. Mayor Hawkins had suffered a heart attack while at the wheel of his city-provided Honda Accord, careening into a telephone pole. Shortly after the accident, Roemer had appeared live from the scene of the accident, with five microphones thrust into his face, and reported that Mayor Hawkins was in stable condition, but that his Honda Accord was better described now as a Honda Accordion. People still stopped him to this day to express their appreciation for that quip.

In his position, there were a number of other opportunities he had to educate the public. It was not unusual for him to be stopped on the street and recognized as a celebrity himself. He was trusted by reporters, although he certainly provided a spin on his comments that was flattering to his employer. No one would have expected anything else.

Now that he had built up a good reputation as a straight shooter, reporters came to him for both on the record and off the record comments. He liked his job. He liked being a part of the decision-making as part of the management team that ran the hospital, even though that was not a formal part of his job description. Most of the Vice Presidents, along with the President and CEO, had been there only a few years, and he felt that they valued the institutional memory he brought along with his common sense about how the public and other stakeholders might respond to consequences of a decision.

More than a few times, his advice prevented the management team from taking action that might have been a disaster. Today, however, he had been frustrated that the CEO and Vice Presidents failed to recognize the seriousness of their decision with respect to one particular sensitive matter involving a young surgeon, who was fired for attempting to perform an operation while heavily intoxicated. In this case, the doctor had been partying late into the night, but had been on call. When he responded to a page to come in to perform an emergency appendectomy, operating room nurses had complained that he was not in any condition to operate. Fortunately, another surgeon was available to fill in, and the patient had a normal procedure, unaware of the situation that might have put her at serious risk.

This was the second time the doctor had had a problem with alcohol interfering with his duties. The Medical Director had no second thoughts about firing him, and did so. However, the doctor knew that being fired for alcohol abuse would make it virtually impossible for him to be hired at another hospital. So, this doctor threatened to go public with allegations of gross negligence on the part of hospital staff, resulting in the deaths of two patients the previous year, unless the HHHS complied with a series of demands.

Apparently, hospital staff had participated in a cover-up involving a medical error. In that case, two children had been provided with lethal doses of heparin, a commonly used blood thinner, by hospital personnel. A similar medical error had made the national news in 2007 when a child of actor Dennis Quaid had barely survived such an overdose. The error was compounded by a defect in the package labeling, which failed to distinguish adequately between the weak dose administered to children and the standard dose administered to adults, which was 1,000 times more potent. After considering whether or not to disclose the medical error to the children’s parents, the hospital staff had decided to simply explain to the families of the victims that the two patients had died from causes unrelated to injecting these kids with a lethal overdose. And it had issued strict verbal instructions to all staff involved in the incident to keep their mouths shut about what happened.

What the surgeon now demanded was that the hospital would have to provide him with a letter of recommendation and agree not to disclose to anyone outside of the hospital management that he had been fired or the reasons why. Second, the hospital would have to provide him with a severance payment of $500,000, which would automatically become $5,000,000, payable at the rate of $500,000 each year, if anyone in the hospital violated the first provision.

The management team had met that afternoon to decide whether or not to approve the agreement.

Roemer was hearing this story for the first time today, and he was uncomfortable. Had he been in charge, he would not have covered anything up. He would have explained the error and let the chips fall where they may. His experience was that many people understood that errors are made by professionals in all fields, although the consequences of errors in the medical field are certainly more serious than, let’s say, allowing a ground ball to go through one’s legs during a baseball game. But unlike a baseball game where the mistake is seen and understood by everyone in the stands, medical errors often occur without anyone knowing about them other than the staff. And the consequences can be fatal for the patient. There is a huge incentive for the staff to keep mistakes they make from the patients and their families, avoiding a lot of unpleasantness in addition to civil liability that can amount to millions of dollars in any single case.

At an afternoon meeting, where this situation was discussed among a small group of management with the chief counsel present, the team had decided to minimize the hospital’s potential exposure and accept the surgeon’s offer. Roemer had been the sole dissenter, arguing that the hospital should acknowledge its mistakes, suffer the consequences of being accountable for its mistakes, and not give in to what he perceived was blackmail. The chief counsel had been neutral on the decision, although she did point out that in the event this doctor was hired by another hospital and was involved in a similar incident, the fact that HHHS failed to take appropriate action rather than covering it up could make HHHS potentially liable.    

Roemer was moving up the ladder in leadership of the Council of Hospital Public Relations Professionals, in line to become its next chair. The Council had an ethics code, which Roemer took seriously. Among the provisions of this code was an obligation to be accurate and truthful in representing the interests of one’s employer to the public, as well as an obligation to serve the public interest. In Roemer’s twelve years as information officer, he had never knowingly lied to the media or the public about a professional issue. He knew that this would be severely tested if anyone ever raised the issue of either the medical error cover-up or the agreement HHHS management had just agreed to make with the terminated surgeon.

Although the decision made at the meeting made Roemer uncomfortable, it certainly wasn’t the first time that decisions made at the highest levels of HHHS were inconsistent with his personal and professional values. However, he recognized that he was not the boss, and that overall, HHHS, despite some flaws, was operated in a manner to serve the public. And he never lied about anything, although he occasionally would tell a reporter that he was not free to comment on a particular situation.

With the TV paused, Roemer listened to the voice at the other end of the line.

“Hi, this is Steve Barton. I’m with the Associated Press in Atlanta, and I am working on a story for AP about HHHS. I’m calling with a couple questions. We are working on a story involving problems with the blood thinner Heparin, which had some problems relating to contamination, as well as overdosing. One of our sources referred us to your hospital, which apparently ran into a problem with heparin overdoses last year. While researching this, we came across a story of a surgeon from HHHS who was terminated today for attempting to operate on a patient while impaired with alcohol, and found out that there was some relationship between these two incidents, which we are not clear about. Can you clarify some of this for me? I understand that you were at the meeting today at HHHS where this was discussed….”

Discussion Questions:

1.    How should a public relations professional deal with any conflict between the principles of one’s professional ethics code and the exigencies required to represent the interests of one’s organization?

2.    Is Roemer obligated to talk to the reporter about the meeting? How should he respond?

3.    What boundaries should individuals have between their personal lives and professional lives?

4.    Is there anything unethical or otherwise inappropriate about HHHS having a Skybox for entertaining VIPs?

5.    Was the decision to agree to the terms of the surgeon appropriate? What other options did the management of HHHS have?

6.    If a staff member of a nonprofit is fired for misconduct, is it ethical not to take steps to inform any potential future employer of that staff member that the person has engaged in misconduct?

7.    Could the hospital management have had any other options other than firing the surgeon?

8.     Compare and contrast two very different types of charities that may be headquartered in the same neighborhood, such as a hospital and a food bank.

Note: This case originally appeared in “The Nonprofit Management Casebook: Scenes From the Frontlines.”