What the Texas Ebola case teaches about crisis communications

The way Texas Health Presbyterian Hospital Dallas and its parent system Texas Health Resources handled, and in some cases mishandled, their public relations response while treating the first Ebola patient diagnosed in the U.S. provides communications lessons for other providers who might find themselves in the eye of a similar crisis-induced media storm.

Texas Health initially said staff miscommunication was responsible for doctors not knowing the patient, Thomas Eric Duncan, had recently been in Liberia, a hot spot of the current Ebola outbreak in Western Africa. But last Friday, it issued a statement blaming an electronic health record workflow issue for the oversight, only to rescind that statement Friday night.

In the absence of details from the hospital, and following Duncan's death, allegations of racism in his treatment surfaced, as well as the charge that Duncan's lack of health insurance may have played a role in his inappropriate release.

Responding to the allegations, Texas Health issued a statement Thursday denying accusations that Duncan was treated differently, stating he was provided the “most appropriate and available medical interventions” by healthcare staff.

“Our care team provided Mr. Duncan with the same high level of attention and care that would be given any patient, regardless of nationality or ability to pay for care,” the statement read. “In this case, that included a four-hour evaluation and numerous tests. We have a long history of treating a multicultural community in this area.” Texas Health is continuing to review the chain of events that led to Duncan being sent home the first time he came to a Texas Health emergency department, it said in a statement Friday.

Experts say errors in information dissemination can be common in times of crisis, when an organization may be trying to get information out as fast as possible to satisfy a barrage of queries from media outlets and others concerned about the event.

But on occasions when new developments may occur daily, if not hourly, it is imperative to have all the facts before releasing details in order to avoid the risk of losing public trust in the hospital's ability to manage an emergency, said Fraser Seitel, a partner at public relations firm Rivkin & Associates, which specializes in crisis management.

“The problem with Dallas was that it was a brand new thing, it was a huge incident, and they stumbled out of the gate,” Seitel said. “In a crisis, the first impressions mean a lot.”

Crisis experts agree that healthcare providers must get organized, know all the facts, and to be forthcoming with the public by providing as much detail as possible as early as possible.

It is also important to communicate what safeguards are being put in place to ensure the incident is not repeated. Daily briefings to the media, such as the ones held by Texas state health officials in the current case, as well as the Centers for Disease Control and Prevention, help reduce the likelihood of wrong information being reported, Seitel said.

“Every hospital, every healthcare facility and every medical practice should sit down and take a look at the things that they deal with, and ask themselves 'Could this happen here?'”, said Larry Smith, a senior consultant for the Institute for Crisis Management. “They should be prepared to be straightforward in the simplest way.”

Seitel acknowledges that developments can occur during a crisis that necessitate updating or retracting previously released information. But it is because of such flux that it is crucial for an organization to know the message that it ultimately wants to convey to the public, he said.

“It seems that, in this case, they fired out quickly to disseminate the news, which they understood was of national and international concern, but they fired out too quickly when they didn't have all of the facts,” Seitel said. “What happens then is you wind up saying things that you have to retract.”

Questions also still remain about the events that led to Duncan's release from Texas Health Presbyterian Hospital Dallas Sept. 26, despite Duncan informing healthcare personnel of his recent travel to Liberia, one of three African countries most affected by the worst outbreak of the virus ever recorded. Duncan was brought back to the hospital two days later when his condition worsened, and placed in isolation, where he remained until his death Wednesday.

Testifying before a state senate health committee Tuesday, Texas Health Presbyterian Hospital Dallas Chief of Critical Care Dr. Gary Weinstein did not provide lawmakers with an explanation as to why Duncan was discharged, saying that the results of a full review were forthcoming.

“The events preceding his current admission are being thoroughly reviewed,” Weinstein said. “The results of that review will be made available once they're compiled.”

Weinstein did not provide a timeline to lawmakers as to when the results of the review might be released.

The communication situation in Dallas played out very differently than a similar incident earlier this year in Indiana involving a healthcare facility suddenly faced with the prospect of treating a patient suspected of having a another type of deadly infectious disease.

In April, when a man who had flu-like symptoms was examined at Community Hospital in Munster, Ind., hospital staff were able to quickly identify him as having Middle East respiratory syndrome, or MERS, the first case of the deadly illness diagnosed in the U.S.

A rapid response that included daily communication updates to the media on the patient's condition, how he came to the hospital, and what healthcare personnel were doing to ensure public safety all helped to lessen community concerns over the facility's ability to effectively contain the spread of the disease.

In response to requests for comment, Texas Health Friday issued the following statement:

“Texas Health Presbyterian Hospital Dallas continues to closely review and evaluate the chain of events related to the first Ebola virus diagnosis in the United States. At the same time, we have made changes to our intake process as well as other procedures to better screen for all critical indicators of Ebola virus. In addition, Spohn Memorial in Corpus Christi today reached out to us about our experience and learnings. We briefed them and will continue to make our professionals available to any health system diagnosing potential new cases of Ebola.

“The nurses, doctors and team who cared for Mr. Duncan, as well as the entire Texas Health Presbyterian Hospital Dallas community, grieve his death. We are committed to providing the best possible care to every patient we see, and to sharing our experiences and learnings in managing this insidious disease with the broader health care community.”

Follow Steven Ross Johnson on Twitter: @MHsjohnson