Playing The Numbers: Endoscopy Center Forgets People

Since the beginning, the Endoscopy Center of Southern Nevada, which is responsible for the largest hepatitis C scare in the history of the country, has communicated a message much like it ran its practice — by the numbers.

Its message is clear. The risk is minimal to 40,000 patients who must be tested for hepatitis C as well as hepatitis B and HIV. Only six patients have been proven to be diagnosed with acute hepatitis C. Except… Except…

We’re not really talking about numbers. We’re talking about people.

Numbers don’t tell stories; people do.

My longtime friend and colleague Keith Sheldon, for example, is not a number. He’s a person. He’s also one of the many who never learned he needed to be tested because of a letter. He learned, like thousands of other patients, through the media.

“I was sitting in bed with my wife reading the Saturday paper,” Sheldon said. “At first, I didn’t think the crisis applied to me.”

It wasn’t until his wife started crying that his initial reaction, things like this happen to other people, didn’t apply. Sheldon was not only at risk, but had unknowingly put his wife at risk. And learning the center was notifying patients by letter and setting up a foundation was little consolation.

“As soon as I learned my health was at risk, I immediately made an appointment with my doctor,” he said. “He saw me the same morning … when it comes to your health, you don’t wait for red tape.”

It didn’t matter to Sheldon that he had to pay out of pocket for the test, despite promises that the center had already made arrangements with various health insurance providers. He needed answers … answers that still haven’t arrived. Because of the number of people being tested, most results will not be made readily available for seven to 10 days, which is next Monday or Tuesday at best.

“I hold the clinic’s management responsible for this disaster,” Sheldon said. “Specifically those individuals who had the day-to-day responsibility and oversight for how business was conducted.”

Recently, one doctor, who was employed at the center and asked the Las Vegas Review-Journal for anonymity because he fears "retaliation" from Dr. Desai (majority owner of the Endoscopy Center of Southern Nevada), said he left the clinic in 2000 — which places the start of the unsafe practices back to more than a decade — because he "was so depressed." He was reprimanded several times, the article says, because he was allegedly pressured to perform unnecessary biopsies, coupled with fabricated lengthy patient examinations, that could add more than $300 to a bill.

"It was so unethical," he said. "I couldn't live with myself."

As more stories surface, it seems to be that the entire practice was built on the concept of placing profits before people. By the account, it was always about playing the numbers: Reusing a single dose vial or the same syringe here and an extra biopsy there, well, it could help the clinic pay the bills.

Sheldon, who also teaches public relations and assists companies in crisis communication situations, is also mortified by the lack of empathy or apology by the center. From a business, ethical, and public relations perspective, the clinic is doing a dismal job of handling this crisis, he said.

“Rather than waste thousands of dollars on a poorly written, ill-conceived and
disingenuous full-page ad in the Review-Journal, the Endoscopy Center should have offered to pay for people to have their blood tested immediately,” he said. “ You just cannot put profit over people.”

When asked how the clinic might have responded, Sheldon offered…

“We demonstrated dismal judgment. We lost track of our mission of taking care of our patients to the best of our ability. We put profits over patients. For these transgressions, we are sorry. We pledge to make full restitution to the degree determined by the courts.”

I wholeheartedly agree. Anytime a company has surrendered all measure of professional efforts, there is nothing left to be done other than offer full disclosure, pledge full restitution, and permanently resign from the medical profession. These are not numbers; they are people — 40,000 people who are slowly learning through the media that they and their families — wives, husbands, sons, daughters — are at risk, one person at a time.

And, worse, it seems more and more clear every day that the numbers like six people infected and 40,000 at minimal risk, are designed to diminish the impact of real people, are growing every day. Dr. Desai ran six number-crunching clinics in southern Nevada. And, it has already become clear that the first clinic only offered a truncated list with 40,000 patients. Many more patients need testing.

For all of them, restitution seems obvious.

• Direct and full compensation for all testing without any fees being passed on to insurance companies.
• Free counseling for patients who are having challenges coping with the situation.
• Compensation for the pain, suffering, and anguish caused to the thousands of people put in harm’s way.
• The maximum amount paid out in medical malpractice to anyone who has to endure a shortened lifespan and risk of infecting loved ones as well as compensation to their families.
• The pledge that none of the management team will ever work in the medical profession again.

These are the only numbers we’re interested in reading about. As for the rest, it’s all about people. People you know and people who may never know if they are infected.

When handling a crisis, always put people first.

Sheldon offers up some hard but true advice for companies that abuse public or employee trust: “Would you have treated members of your family like this?”

The answer, more than likely, would be no. But we can only assume that. Other than the one-page advertisement that claimed patients should still have trust in the clinic, Dr. Desai isn’t talking.

Dangling Cookies: Alaska Airlines & Everybody

According to The New York Times, Alaska Airlines is introducing a system on the Internet to create unique advertisements for people as they surf the Web. Called retargeting by the industry, the ads will consider combined data (demographics and psychographics) from several sources to adjust the ads and ticket offers. The trade off, as always, is online privacy.

“I come from the direct marketing world,” Judy Gern, the chief executive of DesignBlox told the New York Times, referring to ads that are mailed to consumers’ homes. “And consumers should really worry about what direct marketers know, not what online marketers know.”

What Direct Mail Has Always Known.

Gern has a point. When as much as half of my time was dedicated to writing direct mail years ago, some companies would provide pretty pointed data about the people we were writing to — from the cars they drove to the magazines they read to where they preferred to take their summer vacations. With direct mail, it was not all that uncommon to present a second and third offer, increasing the opportunities for those who did not respond to the first, much like retargeting ads hope to do.

Generally, all the information was complied by magazine publishers, past direct marketing campaigns, and other survey mechanisms, with participants agreeing to answer questions upon request or for an incentive. What tends to spook people about Internet data collection is that it is comprehensive, constant, and not always clear who sees the information (or what threat that information might pose).

Privacy For Perks Is Today’s Bargaining Chip.

But marketers and network developers have noticed something else. As Marston Gould, director of customer relationship management and online marketing for Alaska Airlines, alluded to in the article: When people know that they might see an advertisement promising a $200 ticket to Hawaii, the priority for privacy quickly drops. And it takes much less than an offer that good.

In fact, for every story about consumer groups considering online privacy, there are an equal number of stories about consumers who are ready to make the trade.

What seems to be is that as long as a marketer provides a clearly defined opt-in and opt-out feature (which is where Facebook faltered on the front end), people are ready to share anything and everything about themselves. Many of them already do. The basic concept behind many personal blogs, vlogs, and even network programming like Big Brother is sharing everything with everybody.

In fact, tomorrow's consumers who are teens today, do not hesitate to share information about themselves. According to PEW/Internet study last year, they are surprisingly open.

• 82 percent of teens already use their real first names online
• 79 percent include a real photo of themselves online
• 55 percent of teens already have profiles online
• 66 percent of these profiles are limited to “online” friends
• 49 percent of them use online networks to make new friends
• 46 percent say some of their profile information is false

Teens are not alone. Their parents are happy to share information too. Most need a tiny incentive. I learned this last year after questioning tying GPS tracking to advertisements. Several people said GPS advertising went to far, until they learned it could help them find a little black dress, on sale, in their size.

Data Accuracy Remains A Question Mark.

While sometimes I consider some of the advances in consumer profiling a bit spooky, it does seem to me we are trending toward total transparency, with relatively few question marks as a marketer ...

• The randomness of “discovery” Web surfing, popularized by networks like StumbleUpon and Digg.
• The potential for savvy Web techs to game any retargeting ad structure, driving offers down so they might land the $200 Hawaii price.
• The fact that people sometimes lie on surveys and contest entry forms.

”I usually check the first box on every question because it saves me time,” one contest entrant told me. “Otherwise, entering them would take forever.”

In fact, even when consumers tell the truth, it doesn’t always mean much. One visit to a “recommended for you” list on Amazon or iTunes might demonstrate how close or, er, far away online profiling really is. And, since that is the case, one might wonder the trading privacy for perks is really as effective as we pretend it might be.

Adding Data Portability: BlogCatalog

Just days after beating MyBlogLog out of the gate with its Social Dashboard feature, BlogCatalog has moved forward to launch SocialStream, an RSS feed enabled widget that makes “lifestreaming” data portable. The widget makes it possible for BlogCatalog members to share their activity on BlogCatalog and 12 other social networks anywhere they want.

“Any network we add to our Dashboard feature can be added to the SocialStream widget,” says Antony Berkman, president of BlogCatalog.com. “It’s the next step toward putting people in more control of their data.”

Data portability is considered by many to be the next step in the evolution of social networks. While social networks have largely succeeded in helping bring people together based upon shared interests, each requires additional time to manage and update. Jimmy Guterman, editorial director of O’Reilly’s Radar Group, recently made note of this in his Social Graph Foo Report.

“So much about social networks and the next generation has been enveloped in hype … that overpromising in the short term on the data portability front could have severe public relations ramifications,” he wrote. “Data portability has to be real, not merely allowing someone to access information from social network B while inside social network A.”

The BlogCatalog widget is a step in true data portability because it takes a concept some people, like me, have been experimenting with on platforms like Tumblr and allowing bloggers to customize the content of the widget and place it virtually anywhere they want —on a Web site, blog, or even another social network that allows the addition of widgets.

Practicalities In Portable Data.

One of the tangible benefits of a social network RSS feed is that activities across social networks can now add content value to the blog. With the widget, bloggers can share discussions on other social networks; their readers can also subscribe to the widget.

At the same time, it answers some of the questions being asked by people like Lewis Green, who recently noted how much time he invests in social networks rather then his or other blogs, and David Recordon, who recently wrote about the growing challenge of social network fatigue.

By installing the widget, assuming you want to share some or all of your social network activities, people who read your blog receive updates from Amazon Wishlists, BlogCatalog, Delicious, Digg, Facebook, Flickr, Last.fm, Multiply, MySpace, Sphinn, StumbleUpon, Twitter, and YouTube.

Berkman says they will continue to add more social networks. Originally, the BlogCatalog Dashboard started with connections to nine social networks. It now includes 12. Berkman said what is most exciting for him and his development team is to assist bloggers in helping their material become viral.

“It will help friends and blog readers find out if you Digg an article so they can Digg it too,” says Berkman. “This makes it easier to navigate the Web and increases the likelihood that something will go viral because it appears wherever people share their widget.”

The widget also solves a challenge for bloggers with multiple blogs. Many of them would invest hours of time writing about their social activities on several blogs. The widget can be installed on all of their blogs, which would allow them to write a post on one blog, include the link on a social network like Twitter, and then seed their post across all of their blogs via the widget.

What’s next? It’s hard to say. Speed to market has never been an issue for a fast-moving social network like BlogCatalog. To give just one small example: Despite working with BlogCatalog as a communication consultant, I found out the BlogCatalog team was launching the SocialStream widget just a few hours prior to the announcement.

It didn’t even have a name when I received the call. That is an amazing contrast to something that many companies would have discussed for months. Fortunately, several years of political experience has made rapid response a second nature skill set. Only political campaign teams move as fast.

Repeating Milgram: Endoscopy Staff Behavior

In 1963, Stanley Milgram gave the world a glimpse into obedience by publishing the results of his experiment in the Journal of Abnormal and Social Psychology. I learned about the study in college.

The experiment, conducted at Yale University, tested how much pain one participant would inflict on another, provided the participant inflicting the pain would relinquish responsibility to the person they perceived as an authority.

Although the experiment was staged (the person enduring the pain was a actor) and no one was injured, Milgram found that 65 percent of participants would administer an electric shock of what they believed to be 450 volts. Even more surprising, not one participant refused to administer shocks before the 300-volt level, despite several switches clearly marked “danger: severe shock” and the actor complaining of chest pain, banging on the wall, or dropping silent.

With light to moderate prodding, an authority figure in the experiment was able to convince the participant to deliver electric shocks. Some would protest, but continue to “shock” the actor nevertheless.

Understanding Obedient Staff Behavior.

Understanding Milgram’s experiment was followed by strip search prank call several years ago. It was not an experiment. It involved a caller claiming to be the police and instructing fast food managers to strip search employees. In more than 70 reported cases, managers surrendered personal responsibility to an authority figure, becoming like a puppet, and demanded employees remove their clothes.

By comparison, the notion that staff at the Endoscopy Center of Southern Nevada would blindly follow the instruction of administrators to reuse vials of single-dose medicine would likely take less surrendering of responsibility to a higher authority, especially one who had served on the board of the Nevada Board of Medical Examiners.

Why? Proximity to the authority figure. Perceived level of authority. Assurances of a minimal risk. Other nurses already practicing the procedure. And on. And on.

It the only answer for people still wonder why they didn’t stop the practice at the Endoscopy Center of Southern Nevada. Objectivity was sacrificed in favor of perceived acceptance. As one CDC officer reported it: the center’s practices to be so obviously dangerous that it was like “driving the wrong way down the freeway.”

I feel the same way about the center's crisis communication plan. It's like watching a horror show of a horror show, where you watch the next victim stumble up stairs with a flashlight.

The latest update: The Las Vegas Metropolitan Police Department and county prosecutors opened a preliminary criminal investigation. These investigations join inquiries by the FBI and the Nevada attorney general’s office.

Add to all this news an endless stream of sources being tapped by the media, including a very telling and almost incoherent interview with the center’s recently hired third-party crisis expert. Somebody forgot to tell her she wasn't a spokesperson.

Employees Need To Learn To Say No.

Comedian George Carlin includes it in his bit. He says people are too fat and happy to question authority. He's right. It happens all the time.

Even on social networks, it's obvious people blindly follow perceived authority figures, sometimes even participating in a “pile ons” just to be accepted. There is no concern for facts. Most online diatribe can be traced back to obedience and acceptance. It happens everywhere in places all over the world, places just like the Endoscopy Center.

There is only one lesson, and more employees could learn it:

• Th nurses could have complained to the administration that the practices were unsafe, refused to perform them, and demanded correction.
• Upon administrative insistence, the nurses could have told the center to correct its practices or report the incident to county health officials.
• Upon insistence or further inaction, the nurses could have resigned and immediately reported the infractions to county health officials.

Three simple steps could have protected thousands of people from being at risk of hepatitis B, hepatitis C, and HIV. Unfortunately, no one was up to the task. In all the world, only a mere 10-25 percent of people would have been willing to step up to the plate, depending on the country where they were raised.

Skirting Apologies: Endoscopy Center Not So Sorry

On Friday, the Las Vegas Review-Journal reported that the city of Las Vegas shut down the Endoscopy Center of Southern Nevada. After waiting until six patients had completed treatment, all employees were asked to leave the building and the doors were locked.

As mentioned last week, the Endoscopy Center of Southern Nevada was using single dose vials of medication, some of which had become infected with hepatitis C, a potentially fatal blood-borne virus, more than once. Hepatitis C is not the only potential infection that could have been spread; some fear hepatitis B and HIV could have also infected patients, some as far back as 2004 or earlier.

In what appears to be an effort to "control communication," the Endoscopy Center of Southern Nevada, which has declined to comment to any media outlet, did not seem short on words this Sunday. They ran a full-page advertisement in the Las Vegas Review-Journal.

The advertisement, designed to mimic an "open letter to the public" with the headline “Open Letter to Our Patients and the People of Southern Nevada,” smacks as a near-exact carbon copy of an ill-advised communication disaster attempted by Jack in the Box several years ago. Somebody must have missed that case study. It did not work then. It will not work today.

Dr. Dipak Desai offers sympathy but no apology.

“Recent events at the Endoscopy Center of Nevada of Southern Nevada are causing great concern to our patients and the community at large.”

This opening line says it all. It is so obviously written to mask where the responsibility might reside. This was not an accident. The responsibility lands squarely on the medical director and presumed "letter writer" of the advertisement.

In fact, according to the Las Vegas Review-Journal story referenced above, clinic staff has already told health investigators that they knew this technique fell well below accepted medical practices and was dangerous. However, they say they were ordered by administrators to engage in the practice anyway. So they did. The ad continues…

”First, I want to express my deepest sympathy to all our patients and their families for the fear and uncertainly that naturally arises from this situation. The trust we have spent for years building in this community has been challenged by the discovery that some of our patients may have been exposed to blood-borne diseases at our facility. In cooperation with the Southern Nevada Health District and other health agencies and officials, we have carefully reviewed our procedures and implemented the changes they recommended.”

Despite the near admission in the third sentence, there is no direct admission (despite mounting testimony) or any apology whatsoever. Clearly, the aim is an ill-advised attempt to position the crisis as an accident while once again attempting to leverage "trust" that patients placed in the clinic while they were "unknowingly" placed at risk by what seems to be a very "knowing" staff. The ad continues…

“We are also working with third party payers to be sure all our patients who need to be tested are, and that the costs are completely covered.

For those who are uninsured, a foundation is being set up to cover the cost associated with their tests. You will learn more about this in the days to come.”

It amazes me that any company or organization would attempt to promote the argument of denial, despite the fact that the clinic is already proven responsible for the infection of several patients. In addition, the attempt to portray itself as a good public citizen by setting up a foundation reminds me of post-crisis measures employed by Jack In The Box, which they only implemented after sustaining a loss of $20 to $30 million.

The ad continues with another paragraph, first thanking the health district for bringing the problem to the Endoscopy Center of Southern Nevada’s attention and continued clarification that the clinic did not spread the disease to patients one way as has been reported, but another erroneous way all together. As if that matters. The ad closes…

"At the same time and without making excuses, I think it’s important for the public to know that the chances of contracting an infection at our center from 2004 though June 2007 were extremely low. Of the six cases reported, it appears one exposure took place in July 2007 and five on Sept. 21, 2007. Regardless, if you were a patient at our facility, I encourage you to get tested.

Thank you for allowing me to share these thoughts with you.”

The six cases mentioned were those that prompted health officials to conduct an investigation, and not the results of 40,000 tested. Worse, this closure attempts to use the number of confirmed infections as a tool toward exoneration, as if six patients who have been confirmed infected are less significant when compared to the 40,000 that have yet to be tested.

What it also neglects to mention is that health officials are also concerned, however, that even more patients could have been infected prior to 2004 when the clinic operated under a different name. Not everyone is taken by these controlled statements. As expected, one local law firm, Craig P. Kenny & Associates, ran a full-page advertisement in the same section. Its advertisement encourages patients to contact the firm to discuss legal action.

While heroes are seldom found during a crisis, there is one clear hero in Las Vegas. Quest Diagnostics, which is completely unaffiliated with the Endoscopy Center, is the first business to offer to test patients for free. The offer from Quest Diagnostics to provide this community service came after the Endoscopy Center was slow to offer the same and after another health care provider, one that sent overflow patients to the Endoscopy Center, shrugged off any responsibility.

As shocking as it seems, the Endoscopy Center of Southern Nevada has not made any mention of how it intends to compensate those patients who have been infected nor has there been any comment that seems to demonstrate remorse or empathy. So far, it seems they are content to play the numbers and control an uncontrollable message.

Causing Crisis: Health Clinic Spreads Virus

Sometimes a crisis communication checklist is not enough. The Endoscopy Center of Southern Nevada is attempting to apply some practices, but the message is failing to resonate. I’m not surprised.

This is the largest hepatitis C scare in the history of the country.

The Endoscopy Center of Southern Nevada was reportedly using single dose vials of medication, which had become infected with hepatitis C, a potentially fatal blood-borne virus, through their initial use and were used again. Hepatitis C is not the only potential infection that could have been spread.

The Southern Nevada Health District is asking some 40,000 patients who had procedures requiring injected anesthesia at the clinic between March 2004 and January 11, 2008, to contact their primary care physicians or health care providers to get tested for hepatitis C as well as hepatitis B and HIV. Given the transient nature of Las Vegas, it is nearly impossible to tell how many of these patients have moved out of the area or have been living with an infection for years.

The reality and gravity of the situation is severe enough that the statement released to the media by the Endoscopy Center of Southern Nevada fails to exhibit even a basic understanding of crisis communication, considering the severity of the issue.

“On behalf of the Endoscopy Center of Southern Nevada, we want to express our deep concern about this incident to the many patients who have put their trust in us over the years. As always, our patients remain our primary responsibility and we have already corrected the situation.”

Obviously not. If patients were the primary responsibility, this would have never happened. How could anyone even think such a statement was appropriate to include as a patient care message during a press conference that addressed wrongdoing of the worst kind — reusing single dose vials is widely known to pass infection.

The statement goes on to say things like “In addition to our corrective actions, we are on a mission to maintain the trust our patients have had in us during our years of service to southern Nevada.” They must be joking. And, unbelievably, they attempted to play the legal counsel card — pending class action suits already being organized and a criminal investigation — to limit their comments and refuse to take reporters’ questions. Unbelievable.

If you break off communication with the media during a severe crisis, they will have no alternative but to seek other sources. Every media outlet covering the story is doing exactly that.

According to the Las Vegas Sun today, several doctors unaffiliated with the Endoscopy Center of Southern Nevada have surmised that the clinic appeared to put profits ahead of patient care, directing staff to cut corners in order to accommodate the high volume of patients. The procedures were performed by certified nurse-anesthetists, with apparently no one at the practice willing to step up and say what they were doing was wrong.

These practices continued until the Southern Nevada Health District identified six cases of hepatitis C, five of which stemmed from the Endoscopy Center of Nevada. While the center continues to stress that the actual risk of anyone being affected by this is extremely low, it seems to be little consolation for the individuals. Elected officials are already calling for the removal of the clinic’s license.

This crisis has already been mishandled to the point of no return.

In such extreme cases, one might ask if the clinic is worth saving. While this could be debated endlessly, I’d rather focus on what they did wrong from a communication standpoint, which made this unrecoverable.

They are attempting to apply a truncated crisis communication formula frequently employed by public relations professionals who have little real world experience. Worse, they are being selective in which ones they are using — the statement doesn’t even include an apology, possibly for fear of admitting criminal negligence.

Look, crisis communication is a process and not a formula. You can come forward, apologize, explain the incident, address corrective measures, seek outside consult, promise it will never happen again, and perhaps demonstrate some measure of empathy (I was told the owner appeared empathetic at the press conference) all you want. But it won’t change gross negligence.

What the crisis communication team needed to consider.

• The clinic needed to come forward sooner and explain precisely what occurred and why it occurred, regardless of potential civil and criminal cases. If the crisis was caused by placing profits before patients as some speculate, an admission is appropriate.

• The clinic needed to apologize, at minimum, to the five people likely infected with hepatitis C by its procedures and offer immediate restitution. It further needed to voluntarily pay for a proactive location and testing of all 40,000 patients as well as family members that may have been affected as a result.

• The clinic needed to maintain an open door policy to address all concerns and questions from the media and other stakeholders, regardless of personal jeopardy, as personal and public safety remain at risk.

• The clinic needs to verbalize empathy, sympathy, and embarrassment over its procedural practices without any trite statements revolving around preserving patient trust and promises that it will never happen again. It would seem more logical for the clinic to voluntarily dedicate 100 percent of its resources to the crisis.

• Dipak Desai, medical director and majority shareholder in the practice, needs to step forward as his own spokesperson and promise to step down immediately after overseeing restitution to the victims. Desai also needs to fully cooperate with all investigations and help determine which doctors and nurses were engaged in these procedures or knew about the procedures but neglected to speak up.

All this should have already happened. However, it did not. Given the severity of the crisis and the initial handing, it’s likely this will be unrecoverable. And frankly, despite placing it in the living case study slot, maybe that is for the best if it does not recover.