Eastern Health: a Case Study on the Need for Public Trust in Health Care Communications

Journal of Professional Communication 1(1):149-167, 2011 Journal of Professional Communication Eastern Health: A case study on the need for public trust in health care communications Heather Pullen★ Hamilton Health Sciences, Hamilton (Canada) A R T I C L E I N F O A B S T R A C T Article Type: The reputation of a large health care organization in Canada’s east- Case Study ernmost province, Newfoundland/Labrador, was shaken by a three-year controversy surrounding decisions made by leaders of Article History: the organization not to disclose that errors had been made in one of Received: 2011-04-10 its laboratories. For breast cancer patients, the presence or absence Revised: 2011-08-04 of hormone receptors in tissue samples is vital since it often changes Accepted: 2011-10-25 the choice of treatment — a choice that can have life-or-death implications. Although Eastern Health learned of its errors in May 2005, Key Words: it was not until five months later, when media broke the story, that Health Communication the organization started informing patients. In May 2007, court Crisis Communication documents revealed that 42 percent of the test results were wrong Information openness and, in the interim, 108 of the affected patients had died. This case Newfoundland study reviews the impact on Eastern Health’s reputation and high- Public Relations lights the communication issues raised by the organization’s reluc- tance to release information. © Journal of Professional Communication, all rights reserved. etween 1997 and 2005, 383 women in Newfoundland/Labrador may not have received appropriate treatment for their breast cancer. At least 108 of them passed away by March 2008, when public hearings into the controversy began. B These women were failed by a health care organization that did not provide modern, accurate laboratory testing. This testing should have found that their tumours were being “fed” by hormones — an indication that would have made them candidates for anti-hormone drugs that may have slowed down the pro- gression of their disease, and perhaps saved their lives. Instead their hormone receptor tests came back negative and other, possibly less effective, treatment options were chosen. The laboratory errors were made by the Eastern Regional Health Authority (also known as Eastern Health), which is the largest regional health authority in -149- jpc.mcmaster.ca ★Corresponding author. (Heather Pullen) Email: [email protected], Twitter: @HJPullen ©Journal of Professional Communication, ISSN: 1920-685. All rights reserved. See front matter. Pullen, H., Journal of Professional Communication 1(1):149-167, 2011 Newfoundland/Labrador, serving a population of 290,000. External audits of the Eastern Health laboratory conducted as early as 2003 identified that it was not up to standard, and training and quality control were serious issues. De- spite these troubling findings, it was not until 2005 when a patient’s husband requested that his wife’s tissue sample be tested a second time that the scope of the problem was discovered. Eastern Health decided to retest 1,013 patient samples and more than one third of those came back as positive for hormone receptors, when previously they came back as negative. What turned this track record of errors into a crisis was Eastern Health’s de- cision not to go public about its mistakes. Instead, they decided to inform patients one at a time, as individual results became available. As word spread, however, patients and their loved ones started pressing for more information and media picked up the story. A swirl of controversy followed as Eastern Health responded to accusations that it failed to release information in order to protect its reputation. In 2007, the provincial government appointed a Commis- sion of Inquiry on Hormone Receptor Testing. That Commission, led by Justice Margaret A. Cameron reported its findings in 2009. Background Newfoundland/Labrador together form one of Canada’s ten provinces. A former British colony, they were the last province to join Canada, voting to do so in 1949. Despite the geography and distance that separate Newfound- land/Labrador from the rest of the country, its 500,000 citizens benefit from the same governmental commitment to universal health care that is fundamental across Canada. That commitment is to prepaid coverage for medically neces- sary health care services for all citizens. The institution that is the topic of this case study, Eastern Health, is the largest regional health authority in Newfoundland/Labrador providing care to a population of 290,000 in thirty communities. Eastern Health is also the province-wide referral centre for advanced health services. Eastern Health was formed on April 1, 2005 with the merger of seven health organizations. It employs 12,000 people who work at more than eighty hospitals, health care centres, long-term care facilities and community care sites. Eastern Health’s major facilities include seven acute care hospitals and the Dr. H. Bliss Murphy Cancer Centre. Financial challenges may have contributed to the circumstances that this case study is examining. In 2005, with a significant debt on its books, the Newfound- land/Labrador government introduced a number of efficiency initiatives in- cluding reducing the number of health authorities from fourteen to four. Con- sequently, in its early days, Eastern Health faced two big challenges: imple- -150- jpc.mcmaster.ca Pullen, H., Journal of Professional Communication 1(1):149-167, 2011 menting the merger successfully, and meeting government targets for cost sav- ings. Methodology The period of time covered by this case study is from June 2003 when a pathologist first raised concerns about the quality of Eastern Health’s hormone receptor testing, to March/April 2008, the initial stage of the Commission of In- quiry’s hearings. During those years, the crisis went through several stages in- cluding1: • Retesting of some tissue samples and notification of some affected patients (2005); • The filing of a class action suit against Eastern Health and the organization’s attempt to re-establish the reputation of its laboratory services (2006); • Revelation through court documents that more patients were affected than Eastern Health first reported — followed by establishment of the Commis- sion of Inquiry (2007); • Testimony before the Commission of Inquiry (2008). Primary research sources for this case study were: proceedings and other documents of the Commission of Inquiry, media coverage, and an interview with the president of the Newfoundland/Labrador chapter of the Canadian Public Relations Society. Analysis of stakeholder response Patients and families Before this crisis began, Eastern Health had a strong reputation, and despite negative publicity from the lack of disclosure chronicled in this case study, patients and families remained loyal. A number of patients who went public with their stories talked about how grateful they were to their caregivers at Eastern Health. For example, Dr. Robert Deane, whose wife Peggy passed away in Au- gust 2005 after losing her battle with breast cancer, voiced his support of East- ern Health staff: “I know they’re understaffed, underpaid, overworked, under 1 Details in Appendix 1. -151- jpc.mcmaster.ca Pullen, H., Journal of Professional Communication 1(1):149-167, 2011 appreciated and I hope Eastern Health doesn’t dump them” (Newfoundland and Labrador, 2008, March 25). Gerry Rogers, another patient, spoke at the In- quiry about the responsiveness of her oncologist, Dr. Kara Laing, prior to Octo- ber 2005: “Dr. Laing has always been totally accessible to me and has just given me such wonderful care and has always been open to answer any of my ques- tions or queries” (Newfoundland and Labrador, 2008, March 25). Eastern Health employees Employees of Eastern Health represent another group of important stakeholders in this case study. A review of the organization’s reaction begins with the revelation in 2003 that the laboratory was not working up to standard. The fact that laboratory staff did not share this with the organization’s administra- tive leaders is surprising. An important operational issue such as this one — which also had capital implications because new equipment was needed — would typically be raised at a senior level. Because it wasn’t, one must question the degree to which the staff members involved are committed to a corporate culture of openness and accountability, where corporate culture is defined by Schein (as cited by Leavitt, 1989) as: […] the pattern of basic assumptions that a given group has invented, discovered or developed in learning to cope with its problems of external adaptation and in- ternal integration — a pattern of assumptions that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems (p. 278). We can infer from the failure of laboratory leaders to share the shortcomings of their facility with Eastern Health leaders that the organization’s culture did not value openness and accountability. Without a reliable and well-entrenched blame-free culture, patient safety priorities are unlikely to be met. Staff and physicians need to feel that they can come forward to identify safety issues without the risk of discipline and with confidence that steps will be taken to address the issue. At Eastern Health, this lack of an open and accountable culture not only undermined patient safety - it put the organization’s reputation as a caring institution at risk. As Cravens and Goad Oliver (2006) point out, “employees are not only central to the creation of corporate reputation, they are es- sential in preventing a reduction in or loss of reputation” (p. 295). -152- jpc.mcmaster.ca Pullen, H., Journal of Professional Communication 1(1):149-167, 2011 Eastern Health senior leaders Amongst all the stakeholders, the senior leaders at Eastern Health held the most accountability.

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