PR pros see crucial missteps in hospital's hep C response

Two dozen lawsuits already filed in relation to case

Ask a public relations person to name a company that adeptly handled a major crisis, and chances are the conversation will come around to Johnson & Johnson.

In 1982, J&J's Tylenol was the best-selling painkiller in the United States, with a 37 percent market share. But in the fall of that year, someone swapped bottles of Extra-Strength Tylenol that had been laced with potassium cyanide with bottles on supermarket shelves, leading to seven deaths in the Chicago area.

Following news reports of the poisonings, J&J took out advertisements warning consumers not to ingest the painkiller, used the media to issue a national alert and issued a nationwide recall, which cost it more than $100 million.

The company's swift action helped Tylenol to regain its market share — and rebuild its brand as a trusted consumer product.

"How they managed it was to hit it head-on, and to be very quick and upfront and truthful — or appear to be," said Laurie Storey-Manseau, principal of Hopkinton-based communications firm StoreyManseau LLC. "They looked at the crisis at hand and said, 'Our first priority are the people who are using Tylenol.'"

How to respond to a public health crisis has been a challenge for Exeter Hospital since May, when the 116-year-old facility discovered four of its patients had tested positive for an identical strain of hepatitis C — with the only known link between the cases the hospital's cardiac catheterization lab.

Since the discovery, the total of infected patients has mounted to at least 31. A hospital employee — called a "serial infector" by the U.S. attorney — has been arrested and charged with stealing drugs intended for patients.

The outbreak, which is the first such case of its magnitude in New Hampshire, has garnered significant media attention, both locally and nationally.

Largely that's because of the seriousness of hepatitis C, a viral, often asymptomatic disease with no known cure that leads to swelling of the liver and can cause cirrhosis and liver cancer. According to the Centers for Disease Control, Hepatitis C kills more Americans every year than HIV.

So how has the hospital communicated in the wake of the outbreak of a potentially life-threatening liver disease?

Not well — at least according to Robin Schell, a partner of the nationally known Rye-based public relations firm Jackson Jackson & Wagner, who wrote in an email to NHBR that the hospital "did not do a good job following the basic rules of crisis communication."

Charlie Perkins, former executive editor of the Union Leader, put it a bit more bluntly in a June 14 post on Twitter: "Exeter Hospital's past successes always outweighed its inept public relations. Not this time. Stonewalling the Hep C crisis is a disaster."

But Scott Tranchemontagne, president of Bedford-based Montagne Communications, was slow to judge the hospital.

"For any institution like that, people think it's easy to just go out and say what happened," said Tranchemontagne. "At the end of the day, having done this type of crisis communication for clients for many years, it's never as easy as it seems. There are always mitigating factors."

The case first broke publicly on May 31, when the hospital and the state Department of Health and Human Services announced the four known cases and the hospital's plan to begin testing all patients who had been treated in the lab since the previous August.

Two weeks would pass before the hospital's CEO, Kevin Callahan, would make a public apology for the outbreak. It came a day after Dr. José Montero, the state's public health director, said the likely source of the infection was drug diversion by a hospital employee. (Drug diversion usually occurs when an employee injects himself or herself with medications intended for patients and refills the syringe with a saline solution, which is then reused on the patient.)

On June 14, alongside Dr. Richard Hollister, the hospital's chief of medicine, Callahan apologized on WMUR-TV, saying, "We've disrupted people's lives." The following day, he sat down with the Portsmouth Herald, reiterated the apology, and expressed his hope that the hospital would remain viable in the face of mounting lawsuits.

He also pledged that if the hospital were to be found responsible for the outbreak, it would shoulder the costs of treatment for the patients affected.

Aside from those two interviews, he has not spoken with other media outlets about the case. Debra Vasapolli, a spokeswoman for the hospital, declined to comment for this article, citing the ongoing investigation.

Typically in a case so serious, "your spokesperson will be someone from the top of the organization who will be very visible," said Schell of Jackson Jackson & Wagner. "They haven't gotten across the message that they're sorry or done a good job of outlining the steps they are taking to ensure something like this doesn't happen again.

"In fact, the CEO's apology "might have come a little too late," said Brett St. Clair, a partner in the Concord-based public relations firm Louis Karno & Company, though he acknowledged the complicated position in which the hospital has found itself in. "It's easy to be the Monday-morning quarterback in my situation," said St. Clair.

Getting the timing of an apology right is a "very difficult judgment call to make," and one that someone will always criticize as being either too early or too late, said Tranchemontagne. As a general rule, though, he recommends to clients not to hide "or go in a bunker."

"What most people want in a situation like this is for someone to be accountable. Unfortunately for the leader of an organization, somebody has to be the face.

"Undoubtedly for Exeter Hospital, how much it has been allowed to say publicly has been hampered by two factors: the ongoing investigations — being done by the state, the U.S. attorney and the hospital itself — as well as the potential legal ramifications that can accompany too much disclosure.

Already two dozen lawsuits have been filed in relation to the case.

Often, when walking that PR tightrope, legal concerns outweigh messaging in order to protect the bottom line, said Tranchemontagne.

"That's the fine line that they walk — they want to appear to be accountable, yet from a legal perspective they have to protect their interests by not accepting too much responsibility," said Tranchemontagne. "I've been in those situations, where as a PR consultant, I might be advising a client to say X, yet the legal team is advising the client to say Y, so you have to reconcile those needs — and sometimes the legalese trumps the communications.

"For that reason, St. Clair said it's important for an organization to at least make an expression of empathy early on if it cannot to offer an outright apology.

"Expressing empathy and concern is something that they perhaps could have done better" at Exeter Hospital, he said.

Even if an organization is not at fault, it's important to acknowledge early when people have been harmed because it helps to diffuse their anger, said Peggy Gonder, owner of Gonder Public Relations in Westminster, Colo.

Gonder followed the 2009 case of Rose Medical Center in Denver, the last such case of a major hepatitis C outbreak in the U.S. There, a surgery technician was found guilty of drug diversion and received a 30-year-jail sentence in 2010 after infecting 36 patients with the virus.

Gonder said that since that occurrence, Rose's reputation has rebounded in the community, in part because of the hospital's quick response to the crisis.

Some of the things that she praised Rose for doing Exeter has also done — establishing a section on its website dedicated to hepatitis C resources and reaching out to all the patients who were directly affected. And in the case of Rose, there was some public sympathy for the institution itself, because in some ways it was seen as a victim too, she said: "it was something that happened that to some extent they had no control over."

Dealing with crises over which he has no control is basically Martin Murray's job. As head of communications for Public Service of New Hampshire, Murray has been the utility's top spokesperson during the four biggest storms in the utility's history, all of which happen to have occurred in the last four years: the ice storm of December 2008; the wind storm of February 2010; Tropical Storm Irene in 2011; and the freak Halloween snowstorm, also in 2011. All of those storms left hundreds of thousands of homes and businesses without power, in some cases for more than week.

While the storms are certainly not analogous to what happened at Exeter Hospital, Murray said some of the crisis-management lessons learned are universal to any organization in crisis mode.Being responsive is one — particularly early, as the crisis unfolds, even if it means just admitting to not knowing much.

"Those events really reminded us that people appreciate the communication, even if you don't yet have the answer that they're seeking," said Murray. "So acknowledging the situation, acknowledging the questions, and providing assurance that you'll stay in touch as the situation evolves pays dividends."

Assuming the hospital is able to remain viable in the face of mounting lawsuits, Gonder said she thinks Exeter Hospital can follow Rose's lead and restore its reputation, particularly since it has been a community institution for so long.

"You don't just view a crisis with the lens of what's going on now," she said.

In his interview with WMUR, Callahan expressed similar optimism: "I cannot believe that one or two criminal actions can so damage the trust of the tens of thousands of people that we've cared for every year."

Rebuilding its brand should be possible for the hospital, but it can't be done until all the investigations are completed and facts are known, said Tranchemontagne. And, he acknowledged, while "it's easy for people on the outside to point to potential negligence or lack of oversight, it's possible that a situation like this can happen."

"I guarantee you this — every other hospital in New Hampshire is saying to themselves, 'There but for the grace of God, go I,' because this stuff can happen — and obviously it did in this case."