Crisis Management: A Transplant Tragedy and the Response: Crisis response
Before we talk about how Duke University Medical Center publicly handled the “botched” transplant surgery that ultimately killed Mexican teenager Jesica Santillan, let’s first agree on this. If your organization makes a mistake that contributes to the death of a child, you deserve the wrath of the media and public. That’s the price for such a grievous error. While I did not work with Duke, I did participate in two other cases where children died. One involved a hospital and the other an institution that cares for kids. Media coverage briefly flared in the former and lingered as a firestorm in the latter. Nothing weakens the stomach more than preventable loss of young life. Jesica’s family and supporters are sick at heart, but the people at Duke Hospital must be thunderstruck. Saving life is their job and they didn’t.
So how did Duke manage this tragedy in the public eye? I think the hospital did well. (Friends in the medical community have disagreed with me, and some news stories have criticized the hospital.) The overriding impression left with me, and most Americans, in my opinion, is that Duke made a catastrophic mistake and accepted responsibility for it. When I read and watched news stories of the breaking events in the national media, almost one-third to one-half of their content involved Duke’s CEO William Fulkerson saying 1) his institution failed, 2) he apologized, and 3) corrective steps were already in progress.
What else could you do? The chief of a premier medical institution bit the biggest bullet of all. He admitted the mistake, made no excuses, didn’t duck behind a press release or lower-level functionary, and appeared before reporters. Fulkerson stepped up and took it. (This unshrinking acceptance of fault reminded me of Swissair’s CEO who, after one of his jets crashed and killed 229 people, ordered his lawyers to leave him alone so that he could go do the right thing.) Once you publicly admit guilt, there is nowhere else to hide. As they say, “The only question left is how many zeroes will be on the check you write.”
Still, there were missteps in my opinion.
First and most dangerous was a lag between the initial public rumblings that something went terribly wrong and the hospital’s response. The hospital played a dangerous game of saying nothing for three days. Fortuitously – probably because the delay was over a weekend – news of both the transplant blood-type matching error and the apology seemed to hit the national press simultaneously. Duke is lucky that this did not blow up in its face during those 72 hours. (By the way, I do not subscribe to the notion that Duke should have publicly announced its mistake the day it happened. Doctors and hospitals make errors, deserve the chance to correct them, and should not routinely blow the whistle on themselves unless public health or public trust demands it and confidentiality permits it.)
Secondly, the follow-through with the media seemed occasionally ragged. The family or its representatives would make allegations Duke sometimes would not immediately tell its side and accusations would linger. (Was Jesica taken off life-support too quickly? Was no outside medical opinion permitted? The hospital eventually disputed both.) Of course this was lose-lose for the hospital. How do you debate people grieving a child who died in your care? Duke provided three interpreters and a priest to try to ensure the family understood its actions, and issued timelines for events, but I wonder how much grief, anger, and linguistic confusion inhibited communications in those ugly final days.
For a long time – longer if lawsuits linger – Duke University Medical Center will be linked with this tragedy. Ultimately the hospital’s contrition and reputation will prevail. Public and press distraction with war might speed that process. But Jesica Santillan will still be gone.