The Death of Number 215 continued

The story of the death of Paul Douglas Hawks, 56, of Tampa, Florida, at the Lahey Clinic was buried in the Burlington Hyperlocal section of Boston.com, along with news of neighborhood real estate deals and progress in repaving a section of Route 128.

Paul Hawks, who walked into the lobby of the Lahey Clinic under his own steam on a mission of mercy, was wheeled out the back door under a sheet marked Property of Tufts Medical School. He is buried in Hillsboro Memorial Gardens in Tampa, Florida. The notes on his online guest book  from Lorraine Hawks, his wife of 35 years, are heart breaking:

“Our first Valentine day apart. I will miss the flowers, cards and chocolates you would always have for me. You never, ever forgot. I miss you.”

“My darling husband a year gone already i know your happy up there I love and miss you every day.” 

“Yesterday would have been our 36th wedding anniversary.  I feel so lost with out you, It is so hard being without you…  I will always love and miss you.”

Lorraine will tell you, though, that “there is no heart more broken than the hearts of Paul and Charlotte, the parents.”

Falling down an elevator shaft or being eaten by sharks is a stunning, rare tragedy. What happened to Paul D. Hawks was entirely preventable—even predictable—given the recklessness involved; a criminal combination of arrogance and negligence, de facto if not de jure.  And, while medical tragedies are certainly stunning when it happens to you, they are not at all rare. People are needlessly killed and injured by American medicine every day.

You just don’t hear very much about it.

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Part One:  Positive and Short Lived

 
 

Paul D. Hawks

 
 
 
 
     Here’s Paul Hawks, age four, in what could pass for a publicity still from the matinee adventures of a boy and his dog. He was born in Montgomery, West Virginia. It’s a little town which, as they’d say in The New York Times, is hard by the Kanawha River. The town’s website reports that “Montgomery is the home of West Virginia University Institute of Technology and Technical College. Also located in Montgomery are two major banks, Montgomery General Hospital, Brown’s Chevrolet and many other local businesses.”

It says something about the town that they still have an eponymous general hospital, and it’s ironic that Paul Hawks would die in a hospital so far from humble as the one where he was born. His father worked the coal mines, and decided when Paul was 5 years old that the future had to be better and brighter on the sunny side of the earth’s surface, and so he moved his brood to Tampa. And for the most part, the family did flourish in the sunshine and Paul in particular developed by all accounts into a person who strove in his life to reflect goodness and light.

* * *

There they were at the Cracker Barrel off I-4, having decided to let someone else deal with the kitchen work on Thanksgiving 2009, Lorraine and her husband and sons with dessert menus and a steaming fresh round of  coffee. They had just gotten the word from CHARLENE that the chocolate pecan pie had been eighty-sixed when Lorraine’s cell phone rang.

It was her sister from New Hampshire. She took the call outside. Out in the parking lot with the smokers,  steam rising after the passing of the afternoon sun shower, a rainbow feel in the air, she asked her sister what the word was, which was that her sister’s husband needed a liver transplant. Lorraine commiserated with her sister for a time and then went back into the restaurant through the Cracker Barrel gift shop. She figured bad news would keep, and said when she sat back down that she’d tell them all about it later on. But her husband made her spill the beans, and Lorraine laid the situation out as she understood it, that her brother-in-law’s liver was failing fast and that his only hope was finding a suitable donor. “I’ll get tested,” her husband said.

And just like that, Paul Douglas Hawks had 179 days left to live.

* * *

If, after having just volunteered to split one of your vital organs with a sick brother-in-law because that’s the kind of guy you are, you decide upon sober reflection to check out the website of the hospital where the sacrifice is to take place, you will be reassured. All the stories on the Lahey Clinic website have happy endings. Lap-Band® surgery, for example, has transformed the lives of Fran and Dave. They each lost 100 pounds, so now both of them can fit into a single pair of their former pants. There’s Richard, the retired and respectable working man who is smitten with Lahey’s multidisciplinary approach to care. And Becky, who after years of silent suffering, finally got her life back because Lahey solved her incontinence problem—and good for her for going public.

And then there’s Bill Brennan’s liver transplant story, which started out innocently enough:

“Independence Day weekend of 2008 brought more than fireworks for Pembroke, Mass., resident Bill Brennan. Like many of us do in the summer months, Bill decided to mow his lawn.”

Just a regular guy from Pembroke—until one day he tries to crank up the old Briggs & Stratton and his liver conks out.

“Bill was rushed to a Boston hospital, where he stayed for several days. He was diagnosed with end stage liver disease, or ESLD, a condition that requires liver transplantation. One of the liver specialists on his medical team told him he was living on borrowed time and should start getting his things in order. Fortunately, a different doctor on Bill’s medical team was also a doctor at Lahey Clinic, and he brought the case to the attention of Lahey’s transplant team.”

So there is,  apparently,  this doctor on a team of doctors at a hospital in Boston who is unaware of the advent of organ transplantation, and he told poor Bill Brennan that next July 4th, he’d be working the wrong side of the lawn. Good thing there was a moonlighting Lahey doc on the team who was better informed and well connected.

“I’m so lucky I had these people at Lahey. Right off the bat, they were amazing. They knew my story before I even met them. I can’t tell you what that feels like when you’re so sick. They’re not only the Lahey team; they’re my team.”

You can’t buy publicity like that. Well, actually you can, but more on that later.

“In April 2009, Bill came to Lahey for evaluation to see if he qualified for their transplant program, which would increase his chances of getting on the national liver transplant waiting list. By closely following the transplant team’s guidelines, Bill was put on the UNOS liver transplant waiting list in late July, an event he compares to winning the marathon. But he still had another marathon to complete: waiting.”

Bill’s waiting-on-a-liver-to-stay-alive marathon was a grueling one. It was July, 2008 when they rushed him to the hospital and told him that his number was up, but his new team at Lahey couldn’t work him in for an appointment until April, 2009. Nonetheless, Bill was eventually judged to be a fit recipient, and for Christmas that year, he got a new liver.

It’s just one success story after another at Lahey.

* * *

And it was all started by a man with a vision:

“Frank Lahey, who founded the Clinic back in 1923. His idea was simple: a team of specialists all under one roof, who talk to each other in order to provide the best care for patients. Today, Lahey remains a shining model of this multispecialty approach, and people like Richard, who can’t stay away, are the proof.”

Lahey, a shining model of modern medicine, although you’ve got to wonder about patients like Richard who just can’t stay away from a hospital.

* * *

Frank Lahey left another model for modern medicine, one that is not so shiny. It turns out Doc Lahey was one of the prominent physicians who was assuring the American people in 1944 that Franklin D. Roosevelt was hale and hearty enough for yet another four year term. This while FDR was stoking his blood pressure to extremis with Chesterfields, dirty martinis and Lucy Mercer, all in the thick of a raging world war.

So when FDR finally blew a gasket and died shortly after the election,  Doc Lahey was not surprised. He’d written a CYA letter to be placed in the permanent record—right after his public affirmation of Roosevelt’s likely longevity—for when the public finally found out the truth: “As I see my duty as a physician,” he wrote for posterity, “I cannot violate my professional position nor possible professional confidence, but I do wish to be on record concerning possible later criticism.”

Frank Howard Lahey, MD, didn’t want to be criticized for telling one of the biggest, fattest lies of the century. He wanted to justify his actions, presumably on the grounds of having a larger duty.

And that spirit of behind-the-scenes ethical dexterity continues at Lahey to this day. While the name Lahey Clinic evokes notions of honor and idealism and trust, the institution is on familiar terms with certain officials at the United States Department of Justice, occasionally paying hefty fines while not admitting guilt to various schemes to defraud taxpayers.

As news, these stories are easily handled in the PR department. For one thing, it’s fairly common, and people are not surprised. It’s a story more for insiders, and plays out mostly in the business press—business as usual. The hospital just clams up, citing perpetual litigation. (The accounting department takes it in stride, with the cost of lawyers and government fines being built into the overhead.)

Explaining how a perfectly healthy person died in a hospital, however, is a PR situation that requires some expertise. To protect the franchise in a case like that, it pays to maintain strength in the public relations bullpen. This is where Steve Danehy’s Experience comes into play. Steve, according to his LinkedIn profile,  held the title of Director, media relations Lahey Clinic  at the time of  Paul Hawks’ death. He orchestrated the institution’s response, and his achievements should serve to disabuse members of the press of the notion that their field is immune to manipulation.

Among the highlights of his tenure at Lahey are some pretty impressive feats (bold in the original):

• Successfully minimized the fallout from a Boston Magazine investigative feature story alleging unethical conduct between Lahey physicians and the medical device industry. • Developed and implemented the strategy behind publicly announcing the first death of a live liver donor at Lahey Clinic in more than ten years. Extensive national media coverage was positive and short-lived. • Initiated relationship with Lahey’s local community newspaper resulting in weekly free publication of health columns from Clinic physicians. • Leveraged long-term media relationships to kill two different local television news stories that would have seriously damaged Lahey’s brand.

With a portfolio like that, you could write your own ticket at any major medical center in the country, or better yet, go on to become Senior Manager, global media relations for R&D at Pfizer, Inc.—which is what Steve did.

The Boston Magazine “investigative feature story” that was successfully manipulated for minimal impact was titled There Will Be Blood and Money. The piece, written by Francis Storrs,  ran in the May 2010 issue and was little more than a hatchet job on a whistle blower. The story concerns cardiologist David Gossman, who worked for Lahey until one day he wondered out loud why the hospital was still  passing out Medtronic Endeavor heart stents after safety concerns had been been raised. The answer is, of course, that the hospital was not really just passing them out, it was selling them to make a lot of money and curry favor with the world’s largest medical device company—despite the fact that people were getting hurt.

Dr. David Gossman was summarily fired, escorted off the premises. His reputation and career were destroyed.

He sued.

To hear Francis Storrs tell it in There Will be Blood and Money, Gossman’s messy fall from grace is a sad story all right, but Dave Gossman had it coming. The article begins with a line that Steve Danehy might have written himself. “One of the world’s best hospitals sits just off I-95 in Burlington…” So much for objectivity.  In the piece overall, there was just enough scrutiny of Lahey’s version of events to provide a veneer of legitimacy. Otherwise, it’s clear that Lahey is the victim and Gossman is the villain in this story. Storrs writes:

To some observers, the episode seemed like a classic whistleblower case: A trusted employee threatens to expose an unethical deal, only to have his company fire him in retaliation. That was exactly how Gossman portrayed the situation when he filed a lawsuit against the hospital and two of his former colleagues last October…”

But just who is this Gossman anyhow? And why’s he trying to tarnish the image of “one of the most highly rated cardiology departments in the country?”

For many of those involved with the Lahey Clinic… the episode revealed an altogether different story line — one that suggested Gossman’s motives for suing had little to do with ethical concerns. In fact, in the weeks and months that followed the firing, there proved to be almost nothing that anyone involved in the dispute could agree upon, except maybe this: that when big business and cutting-edge medicine intersect, it’s almost impossible to tell where patient interest ends and self-interest begins.”

* * *

It’s not almost impossible to tell where patient interest ends and self-interest begins.

I can tell you right now: big business and cutting-edge medicine intersect in the big corner hospital office of Dr. Richard W. Nesto,  41 Mall Road, Burlington, Massachusetts. Richard Nesto was calling the shots when the hospital kept using the Medtronic Endeavor stent—even though he and other doctors knew that people were going to get hurt. Nesto and his cronies made sure Gossman was summarily drummed out of civil society for exposing hypocrisy and corruption at Lahey.

When The Wall Street Journal’s Tom Burton asked Steve Danehy about the whole mess, Denahey said he was not going to litigate the matter in the press, but did add that Gossman, up until then a fair haired boy at Lahey, “repeatedly demonstrated himself to be unsuited to the kind of collegial practice” that exists at the organization.

The Japanese have a saying: “The nail that sticks out is the one that gets hit in the head.”

* * *

There was certainly a lot of collegial practice going on in Lahey offices in the hours, days and weeks after Paul Hawks died. The docs and the administration rallied ’round the brand and closed ranks around the construction that Paul’s death was a rare and tragic thing, a bizarre sort of mishap that couldn’t be helped… a tragedy all around, really. Which it is, except that the person who died did nothing to invite this tragedy, was lured to this tragedy under false pretenses, and the persons who arranged the circumstances under which the tragedy occurred are fighting vigorously to deny all responsibility and would, if they could, go on with their lives and further their careers as if this thing had not happened, while the survivors of the tragedy are left to lonely struggles to live and to pay their bills—without any real acknowledgement of the devastation they were dealt.

Developed and implemented the strategy behind publicly announcing the first death of a live liver donor at Lahey Clinic in more than ten years. Extensive national media coverage was positive and short-lived.

Lahey doctors had killed a person and gotten a burst of positive media coverage. That’s how Steve Danehy made it to the big leagues in his profession.

This is the first installment of this article__________________________________

 

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