Thursday, May 28, 2015

"Who died?"

Well, that was fun.

A local hospital caught in the middle of a serious botulism incident requested assistance from our regional PIO network. I offered to help.

It was day two of the situation, and the hospital PIO and marketing staff realized they could use some mutual-aid, so they asked that a notification be sent via our messaging software.I threw my hat in the ring for a shift on day three.

First, some of you may have seen coverage of this, as CNN and various affiliates across the country chose to run it. The scenario in a nutshell is that people attended a church potluck, and shortly thereafter some of them developed signs and symptoms that were diagnosed as probable botulism.

A traditional luncheon could harbor foodborne illness
When I arrived in the morning to begin my shift, representatives from various hospital departments were present, and we engaged in a planning meeting and situation status report. I learned that there had been dozens of patients who had been processed through the emergency department who could trace their commonality to the potluck. That conclusion didn’t come together immediately, but was the result of some “CSI-type” investigatory work that is part of the lifestyle of infectious disease docs and epidemiologists. That morning, there remained four in ICU and one under observation. The rest had been either discharged or transferred to other hospitals.

Some investigation confirmed botulism was involved
One patient had died, and the media had discovered an obituary notice they suspected was her. That became the first public information crisis of the day, with reporters calling and pressuring the hospital to confirm these were one and the same.

This was the first interaction I had with the command and general staff, and the lead PIO asked what my fire department EMS experience had been with this kind of situation. My suggestion was to defer this duty to the county coroner. They were running the death investigation, and not being a health care provider, were not required to follow the regulations of the Health Information and Patient Privacy Act.

As with all things HIPAA, this didn’t sit well with the media. My experience has been that they HATE this legislation, because it puts a legal stranglehold on what was formerly a much easier task for them. (I was at a PIO symposium one year where members of the media panel begged those of us present to help them get this law rescinded.)

What is most bothersome in my view is the way journalists couch their phrasing to imply that health care providers have a choice in the matter. They will often state that “hospital/EMS officials would not release the patient’s name or condition”, implying we have a choice and are thumbing our noses at them. Sour grapes, I say.

The media calls continued. I suggested to the lead PIO that she contact the coroner and request they expedite confirmation that the person in the obit and the patient who had died at the hospital were one and the same. When the coroner’s staff expressed initial reluctance, I asked the lead PIO if she thought it would help to have the physician acting as incident commander make a personal call to the coroner. (Note: The hospital could also have asked the family if it was okay to release the name.) The coroner’s office further stated that there was no autopsy planned, but that the death remained “under investigation” pending lab results.

This first crisis resolved, the lead PIO then left the room to work on prep for a story by the local newspaper about the support being given to the affected families by the hospital chaplain.

Dan Kochensparger
Public Information Officer
Upper Arlington, Ohio Fire Department

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