Column: D-H fails COVID-19 communication test

By Maggie Cassidy
Valley News Editor

Dartmouth-Hitchcock recently launched regular video briefings about the new coronavirus and its arrival in the Upper Valley, and when D-H President and CEO Joanne Conroy joined Chief Clinical Officer Ed Merrens for a Facebook Live event on March 5, Conroy, in response to a question from the public, said her role was to “communicate, communicate, communicate.”

This assertion struck me as remarkable, given how unforthcoming the institution has been right from the start in providing even basic information about its role in this situation. Perhaps this reticence stems from the fact that the first three confirmed cases of the new virus in the Upper Valley have links to D-H: the first two patients are employees, and the third patient had contact with the second at church services before the latter manifested symptoms. But the fact remains that the public interest demands more candor than D-H has mustered so far.

Don’t take my word for it, though; judge for yourself.

On the morning of Feb. 29, a Saturday, the Valley News heard from a person who does not work at Dartmouth-Hitchcock Medical Center about a potential COVID-19 case there, a tip that demanded urgent follow-up.

“We got a tip that there is a possible COVID-19 case at DHMC, someone who had recently traveled to Italy,” news editor John Gregg emailed to two Dartmouth-Hitchcock spokespeople and a spokesperson for the New Hampshire Department of Health and Human Services at 9:20 a.m. “I’m told it’s not confirmed, in part because there may be no test kits on site, but that it has been reported to the (Centers for Disease Control and Prevention). Is this the case, or a similar scenario?”

Dartmouth-Hitchcock spokesman Rick Adams wrote back at 11:42 a.m.: “We are actively screening for potential cases of COVID-19, as well as a number of other respiratory illnesses, at all of our clinical sites. At this time, D-H has had no positive cases of COVID-19 and no pending tests for the illness.

“We continue to discuss potential cases with New Hampshire Department of Health and Human Services, which is coordinating with the CDC on any testing that is needed,” Adams continued. “Questions about testing or about any patients who may currently be under observation should be referred to New Hampshire DHHS.”

New Hampshire DHHS spokesman Jake Leon added a few minutes later: “To follow up on Rick’s email, I can confirm that no one in New Hampshire is being tested for COVID-19 at this time.”

In fact, sometime prior to the previous evening, Feb. 28, a DHMC employee who lives in Grafton County sought care at the hospital’s ambulatory care center. He had recently traveled to Italy, which had been identified as a hotspot of the new coronavirus, and he was showing symptoms consistent with COVID-19.

This man, and his potential for COVID-19, were on the medical center’s radar.

Dartmouth-Hitchcock instructed him to self-isolate, which he did not do. Instead, he attended an event that night for Tuck School of Business students at The Engine Room in White River Junction. About 100 people turned out, including, we’re told, D-H medical residents.

Late on Saturday, according to an email that D-H subsequently sent to staff, samples were taken from the patient. Tests for more common respiratory illnesses such as influenza or the common cold came back negative on Sunday, March 1, and the case was referred to the state for further testing with the goal to rule out COVID-19, according to D-H. (Also on Sunday, the second patient — who was not yet showing symptoms and not yet known to be a possible case — came into close contact with the third at a morning church service in West Lebanon.)

On Sunday night, at 10 p.m., Dartmouth-Hitchcock sent that email to its 13,000 employees alerting them to the potential COVID-19 case, but failed in its obligation to communicate with the general public about a potential public health incident. The Valley News only learned of it when a source provided the email the next morning.

The decision to release that alarming update without communicating with the press, which works on behalf of the public, raised the very real potential for that information, and misinformation arising from it, to spread haphazardly. In doing so, D-H failed to make itself available to answer questions, both from Valley News journalists and from the members of the public who turn to us for accurate information in appropriate context.

On Monday, March 2, the Dartmouth-Hitchcock employee’s tests came back as “presumptive positive” for COVID-19, and D-H distributed its first news release on the issue. (Those results were later confirmed positive by the CDC. He was ordered by state officials to isolate at home, per a court order, which we have asked to see.)

Over several days, the Valley News asked Dartmouth-Hitchcock three times to explain how its response to our initial inquiry on Feb. 29 squares with the information we later learned about the first patient’s activities on Feb. 28.

The third time, I additionally asked Jennifer Gilkie, vice president of communications, how the response squares with Dr. Conroy’s goals of communication and transparency as D-H responds to COVID-19.

On Monday night, March 9, Gilkie offered only this: “At that point (Adams’) response was accurate at the time he made it. As I am sure you understand, this Public Health Incident is a very fluid one.”

The incident is certainly fluid, and the providers on the front lines are no doubt working very hard to keep their patients and the Upper Valley at large safe and healthy.

Nevertheless, D-H’s response to the initial inquiry was so fluid that it failed to communicate important information to the public. To accept it, you have to agree with D-H’s definition of “pending tests,” which I’m left to infer is strictly limited to samples collected and submitted — and excludes imminent testing of a person exhibiting symptoms, who recently traveled to an outbreak hotspot, and who made D-H sufficiently concerned that he was told not to go out in public.

Importantly, this is not the only way in which D-H has come up short in its communication.

It has declined to say what role the two employees with confirmed cases play at the medical center, even though several sources have identified the first patient as a medical resident and the Vermont health commissioner identified him as a “physician trainee,” which we understand to include medical residents, interns and fellows.

D-H has also declined to say how many of its health care providers have been told to stay home because they came into close contact with the first patient (D-H refers media to the state, and the state refers media to D-H), and if it’s a significant number, how D-H is adjusting its staffing in response. It has declined to give insights into its resources, such as isolation rooms and ventilators, and has even refused to specify how many residents it employs, although it told us Dartmouth-Hitchcock Health has more than 1,800 providers across its locations.

D-H has said that patients have not been exposed to the two employees who tested positive; that all appropriate steps are being taken; that it is exploring alternative remote-work options for non-clinical staff; and that its incident command team is constantly evaluating its capacity in the hospital and where changes may need to be made.

Spokespeople assert that answering questions about the first patient’s job would violate federal health privacy laws (better known as HIPAA) as well as their own policy against discussing personnel issues. Significantly, perhaps, they have not answered what part of that federal law would be violated or how specifying his role at the hospital would make him identifiable.

Surely whatever D-H’s interests are in refraining from discussing personnel matters must be weighed against the public’s need to understand the facts, which in turn is the only way to ensure continued trust in the community’s health care leaders.

It’s worth noting that not all medical centers are so wary of journalists’ inquiries. Look no further than Boston, where Massachusetts General Hospital allowed a reporter and photographer from The Washington Post significant access to report on its preparations for COVID-19, including frank assessments from the hospital about its challenges.

The Valley News conceives its mission to be providing readers with accurate information and insights; informing them of the risks and suggested precautions without inciting unnecessary panic; engaging them on questions they want answered and giving voice for them to share their experiences; and holding our community’s leaders accountable.

I am sure D-H is getting many of the same concerned phone calls and emails as we are here at the paper. We published a survey on our website Tuesday night asking for the public’s input to guide our coverage. Many readers’ questions have centered around D-H’s specific COVID-19 response plans, and the first D-H employee’s actions.

“That was just so very wrong,” one person wrote.

D-H has the opportunity to set it right, by being candid, dealing in facts and answering questions.

Maggie Cassidy is editor of the Valley News.