Wednesday, January 18, 2012

A communications primer on the Amelia Rivera case

Update: The family has agreed to meet with hospital officials next week.

Acknowledgement. Empathy. Action.

It’s a well-known prescription for corporate crisis communications following an error.

Since we weren’t in the Children’s Hospital of Philadelphia room when a doctor told parents whether their child was eligible for a kidney transplant, we don’t know what transpired.

We do know that two parents left that meeting with the understanding that their daughter, Amelia Rivera, was being denied a life-saving kidney transplant because she had mental retardation and what was perceived as a 'diminished' quality of life.

At a minimum, the hospital needs to acknowledge to the family that a terrible miscommunication took place and meet with the family until they understand clearly the hospital’s position.

A 2011 white paper by the Institute for Healthcare Improvement notes that the number one priority for outreach following serious adverse events is the patient and family. While this event didn’t cause the patient harm, I would argue that it harmed the parents. Certainly mainstream media coverage has turned the event into a serious one for the reputation of the hospital.

“Who is the organizational 24/7 contact person for the patient and family?” is first on IHI's adverse event checklist (you have to register at IHI to access this).

According to Sunday Stilwell, the blogger who organized the petition that over 27,000 have signed in favour of Amelia receiving a transplant, contact with the hospital has been minimal.

Stilwell says the family was contacted by the hospital on Sunday with a request for a meeting to discuss Amelia’s case, but the hospital hasn’t followed up that call to book the appointment.

In the meantime, CHOP has posted about its transplant criteria on its Facebook page:

CHOP does not have any criteria which exclude patients from being considered for transplant solely on the basis of their cognitive status.

What I took from this statement was that cognitive status is a factor in the evaluation process, but not the only factor.

Later we read:

CHOP does not disqualify potential transplant candidates on the basis of intellectual abilities. We have transplanted many children with a wide range of disabilities…

At this point, we still can’t ascertain how cognitive status fits into the evaluation process. What are all of the factors considered, and how much would developmental delay weight a child against receiving a transplant?

In the same Facebook message: We are also taking action to review all existing policies to make sure that they reflect the core values we live by, including our deep commitment to not discriminate in any way.

It’s good to hear that they are reviewing their policies to make sure they’re not discriminatory.

If in fact what the parents took from their meeting is incorrect, the hospital needs to express empathy to the family for the pain they experienced based on this miscommunication. According to one news report, the family did receive an apology by phone on Sunday.

Then the hospital needs to work with the family to come up with a clear plan to prevent future misunderstandings when this kind of transplant information is conveyed.

If there was no miscommunication, the hospital has different issues on its hands.

Either way, the incident has got people talking about the ethics of transplant eligibility for people with intellectual disability, and that is obviously a good thing.

Dr. Art Caplan, a bioethicist writing for MSNBC online sums it up beautifully: …"Children with intellectual disabilities do not appear on transplant waiting lists with the frequency that should be expected…There are reasons why anyone with an intellectual or physical disability might not be considered a good candidate for a transplant. But those reasons, to be ethical, have to be linked to the chance of making the transplant succeed. Otherwise they are not reasons, they are only biases."


Hi Louise - do you have any updates about this very important story? Has CHOP stepped up and responded in a more appropriate way?

Hi Sue -- I don't have an update. The petition has over 35,000 names signed. The parent organizing the petition said the family is meeting with CHOP this week but doesn't know when. Will keep you posted if I hear anything!