A single, unusual death in a hospital can sometimes put it into a crisis management mode, so one can imagine the intense situation when a small facility experiences dozens of such deaths in one year.
The reason is simple enough: When a healthcare provider is accused of misdeeds, misdiagnosis, or flat out murder, the public sits up and takes notice.
While such occurrences are rare, they seem to happen at least one a year in this country. This happened in 1995 at Vermillion County Hospital in Clinton, Ind., a 50-bed facility serving a small rural retirement community. In the early '90s, Vermillion's death rate in their four-bed Intensive Care Unit averaged about 27 patients each year, but in 1994 the ICU deaths topped 100. The crisis - and the hospital's reputation - is still in the spotlight thanks to recent lawsuits surrounding the case and network newscasts rehashing the incidents.
Did the hospital's management ring the alarm bells? Evidently they did, but far too late, according to state officials.
Although an investigation by the county sheriff was already underway in March 1995, concerned nurses at the hospital mailed anonymous letters to Indiana's news media warning of an "angel of death" among them.
They alleged that a licensed practical nurse named Orville Lynn Majors may have been responsible for as many as 135 ICU deaths in a 22-month period between 1993 and 1995. Records show he worked every shift where a fatality occurred.
"I know it doesn't look good on paper," Majors recently told "NBC News". "But it doesn't make me nervous because I know I've not done nothing wrong."
Today he stands accused by the community of mass murder. But despite a $1 million investigation by Indiana law enforcement investigators in the two years since the story broke, Nurse Majors has not been charged with any crime. He now wants his suspended nursing license back and has filed lawsuits against the state and the hospital for character assassination.
Sources in Indiana who have been involved in the case indicate the sword of responsibility lay feebly in the hands of Vermillion's former President and CEO John F. Ling, who was repeatedly warned by ICU nurses that something was terribly wrong in their ward. Only after seeing the high numbers of ICU deaths in 1994 did hospital administrators finally contact law enforcement in early 1995.
This has been an horrific tragedy for the community and the hospital, where admissions dropped in the first year of the crisis by up to 80 percent in spite of Majors' dismissal from duty. Additionally, the state department of health fined Vermillion $80,000 for lax management procedures in connection with the case, and accreditation by the Joint Commission of Healthcare Organizations also was yanked.
The day the story broke, the hospital turned to Myra Borschoff, a public relations expert from the Indianapolis-based firm, Borschoff Johnson & Co., to handle initial crisis communications with both the media and the hospital staff. Borschoff said the staffers were confused, angry, and were being bombarded with hard questions from friends, family and the national news media. "What went wrong at Vermillion County Hospital?" they were asked.
"My job was to keep the wolves at bay and to try to keep the lines of communication open internally with a very demoralized staff," said Borschoff.
Larry Smith, a senior consultant at the Institute for Crisis Management, Inc. in Louisville, Ky., said, "Such crises can be nightmares because many hospital attorneys do not realize that these cases are usually decided in the court of public opinion long before they reach a court of law."
Borschoff agrees. "Lawyers have a tendency to want to clam up with the press...they didn't want anybody [at Vermillion] to answer any questions, and that was not the right approach."
Smith says that the media can be used to communicate with the public, which in turn helps restore confidence in the hospital. But before a hospital in crisis-mode faces the TV news cameras, management needs to get as much factual information on the situation as possible.
"You have to be like reporters and get the facts," said Smith.
Smith advises his clients to follow the example set by Borschoff, who prepared a statement to be read by Vermillion's CEO at a news conference.
"The CEO should voice compassion for the victims and promise to cooperate with the authorities," and then hand over the day-to-day task of media and community relations to a knowledgable spokesperson, Smith said.
Both Borschoff and Smith stressed the importance of providing the media with honest, factual information as quickly as it comes in because it helps to build public support. "When I was a reporter," said Smith. "I wanted to talk to somebody who could answer all of my questions when I asked them."
Initially, part of Vermillion's struggle with crisis management is that it did not have a plan in place to deal with potential public health emergencies.
Practice What You Plan
Shea Davis, Quorum Health Group's director of communications, recommends that each of the 18 hospitals her company owns have a crisis management plan for unexpected situations that could become local or national news.
"They don't just need a general plan, they also need to practice it," said Davis. Additionally, CEOs, CFOs, CNOs, department heads and hospital spokespersons need a shortened version of the crisis management plan that contains phone numbers for media and hospital staff, general hospital/corporate statistics, and names of hospital management.
In a 1989 case similiar to the tragedy at Vermillion County Hospital, Daniel Drake Memorial Hospital in Cincinatti, Oh., made national headlines when a nurse admitted to and was subsequently convicted of killing 24 patients.
Like Vermillion, Drake Hospital was operated by the county, which eventually cleaned house and replaced their staff with physicians from the University of Cincinatti. The hospital has also been renamed and is now a model of financial success.
In mid-1995, Vermillion expedited negotiations with Union Hospital in Terra Haute, Ind., which signed a five-year leasing agreement with Vermillion's board of directors. This agreement effectively ended the involvement of the hospital's administrators, who were replaced.
Union's director of public relations, Lorrie Heber, assumed the same role for the troubled hospital in December, 1995. "Union has a strong reputation [in this part of Indiana]," Heber said. "When we took over Vermillion, the community literally cheered the news."
Like Drake Hospital in Ohio, Vermillion County Hospital no longer exists at least in name. It is now called West Central Community Hospital (WCCH).
And the infamous ICU "death ward?" Gone forever. The Joint Commission also re-accredited WCCH unconditionally for three years starting in January, 1997.
Heber says the kinds of problems Vermillion County Hospital faced can only be solved with a long-term investment in community relations. "It isn't done with ad campaigns. It's done with a personal touch, by reaching out to the community," she said. (Myra Borschoff, 317/ 923-2300; Larry Smith, 502/584-0402; Shea Davis, 800/ 233-1470; Lorrie Heber, 812/ 238-7000)