'How I tweeted my way out of spinal surgery'

Technology consultant and blogger, Sarah Cortes, used Twitter to escape a hospital she claims tried to intimidate her into unneeded spinal surgery.

The post describes a failure that is significant in light of the ongoing national debate surrounding health care reform and economics. Beyond health care, the role of social networking makes this failure a valuable case study for the enterprise.

Technology consultant and blogger, Sarah Cortes, went by ambulance to Robert Packer Hospital, a facility located in rural Pennsylvania, after she suffered a serious spinal fracture. The story takes an unusual turn because Cortes says Twitter helped her escape from the clutches of hospital staff whom, she claims, tried to intimidate and coerce her into accepting unnecessary spinal surgery.

On her blog, Cortes writes that Packer, "tried numerous maneuvers over 48 hours to hold me there against my will." She continues [bullet formatting added]:

[The] tactics included:

  • Threats that my insurance would not pay any expenses if I did not accept their treatment. My bill was already in the many thousands of dollars, they informed me.
  • Intimidation that if I did not stop resisting their treatment I could be paralyzed
  • Impeding my communication with Boston doctors by needlessly limiting my phone access. Thank God for Twitter and iphones.

Cortes believes Packer wanted to perform the surgery to help boost its accreditation statistics. From Cortes' blog:

With a fractured spine, but otherwise excellent health and no medical problems, Packer staff, upon learning I had top-of-the line health insurance, prepped me for immediate “reconstructive spinal surgery” and a lengthy recuperation in Pennsylvania....

Packer staff insisted I still needed immediate spinal surgery. [S]ympathetic nurses quietly mentioned I was one of few patients who had any form of health insurance and tried to help me obtain release. “This is about the money,” I thought. Not just the money, they said. Rural trauma centers need to keep up their numbers of severe cases like mine to maintain their accreditation. I was beginning to get the picture.

Facing immediate surgery and not wanting to remain isolated and far from home, Cortes asked her Twitter followers to provide names of neurosurgeons in her native Boston. This strategy was successful, according to her blog:

Frustrated, alone, immobilized, and cut off from the rest of the world, I turned to Twitter and asked again for neurosurgeons. The names of top doctors at MGH [Massachusetts General Hospital] came back.

[T]witter helped save me from entrapment and unnecessary surgery in rural Pennsylvania, and that I still feel lucky to have escaped unparalyzed....Twitter helped me get the word out to the outside world what was happening to me.

In the end, Cortes left Packer for treatment in Boston, where doctors treated her successfully without surgery. A week after the accident Cortes remains mobile, with treatment consisting of a torso brace that she must wear for four months.

Serious allegations. I spoke with Cortes to discuss the gravity of her charges against Packer Hospital. Cortes stands firm, telling me:

I would not take back anything and there is a lot more I did not discuss. There is nothing I would take back.

To help substantiate her claims, Cortes forwarded me an email she sent to Paul Levy, CEO of Beth Israel Deaconess Medical Center [BID] in Boston. That email thanks Levy for the responsiveness of Beth Israel staff, including neurosurgeon, Dr. Paul Glazer, while Cortes was trying to escape Packer Hospital. From her email:

Throughout the night of August 19, staff at that rural hospital struggled against BID's Dr. Paul Glazer to prevent my transport to BID. His persistence, professionalism and caring when receiving my multiple, persistent emergency late-night calls helped me escape the nightmare of unnecessary spinal surgery as I lay helpless, immobile, and far from home.

While researching this story, I discovered that Cortes deleted the twitter messages she made while at Packer. I asked why she removed these important artifacts, which helped document her situation. Cortes responded by email:

I deleted the tweets regarding my spinal fracture just before I addressed a group at Harvard on an unrelated subject. Everywhere I went people asked me, "What happened to you?" and wanted to talk only about my back brace. I was concerned that my injury was overtaking my professional identity, and realized the personal and somewhat urgent-sounding Tweets in my feed fed that preoccupation. So I resolved to end attention to my injury. I concealed my brace under my clothes before the talk, and deleted the tweets.

Although Cortes deleted her tweets, Alex Howard, an editor at TechTarget, where Cortes works as a freelance contributor, remembers the Twitter messages. In an email, Howard told me that Cortes tweeted:

Trapped in hospital in rural Pennsylvania, fractured spine. Need a neurosurgeon in Boston

Packer Hospital response. Packer provided the following statement in response to my request for comment:

Due to the constraints of HIPAA law, officials at Robert Packer Hospital are unable to address or comment on the care provided to patients without their permission. The hospital takes very seriously any and all feedback about the care provided by its physicians and staff. However, there is one misperception in Ms. Cortes' account that can be clarified publicly: the hospital does not base treatment on a patient's ability to pay. The implication that hospital would keep patients against their will because of the insurance coverage they have is an unfair and unwarranted characterization of the facility and its staff.

ZDNet's Editor-in-Chief, Larry Dignan, notes that HIPAA regulations offer an easy out for Packer to avoid addressing specifics:

The hospital cited HIPAA in its thin response to Cortes’ claims. Here’s the question: Should privacy procedures be waived by a patient’s actions, say updating Twitter or Facebook during a surgery?

[N]evertheless, I’d like to see a point-by-point rebuttal from the hospital to Cortes’ allegations. Transparency should be both ways.

THE PROJECT FAILURES ANALYSIS

This situation raises difficult and uncomfortable questions about patient rights, hospital obligations, and the process by which economic incentives drive treatment decisions. Equally, it challenges us to evaluate a patient's perception of health care against views held by providers. Although these issues are emotional and compelling, this blog must remain focused on strategic, technology-related implications for the enterprise.

Enterprise 2.0 tools, such as Twitter, have rapidly emerged as a mainstream form of communication among consumers. This creates two key ramifications for the enterprise.

Established information protocols are breaking down. Social networking causes a balance of power to shift from the enterprise to its customers. Customers don't care about an organization's internal communication hierarchies, and can use tools such as Twitter to pool information in ways that bypass traditional information chains and channels.

As I discussed in a recent post, no organization can afford to ignore the significance of this change:

[C]onsumer-oriented influence groups can rapidly go viral for, or against, any organization or government, extreme reputation failure sometimes occurs with almost astonishing speed.

In this case, Cortes circumvented traditional medical referral processes to locate an "accepting neurosurgeon" with one hour. Cortes says her doctor said it is typically "impossible" to achieve this feat so quickly.

Transparency is inevitable. Social networking tools enable consumers to rapidly form ad hoc collaboration groups and solve problems in ways that would have been almost impossible only a few years ago. Transient social collaboration, based on customers pooling their wisdom and collective intelligence, creates greater transparency regarding the activities and actions of organizations in which they take an interest.

Ultimately, this transparency will force organizations to improve their processes and increase responsive to customers. Successful organizations recognize that every customer is a potential broadcaster reporter. Packer Hospital learned this lesson the hard way.

-------

My take. Sarah Cortes experienced a situation at Packer Hospital that she found highly negative and deeply distressing. Although we have scant evidence aside from her own words, Cortes' impressive background adds weight to the credibility of her arguments.

Although failure takes many forms, the human element is virtually always a common denominator. In this case, it appears that unspoken agendas drove action and decision-making. And that's why this post fits well into the Project Failures blog.

What do you think about all this? Please share your thoughts in the talkbacks!

[Dr. Paul Glazer did not respond to two requests for comment. Image from iStockphoto.]

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