The ROI of Avoiding Bad PR

Gienna Shaw, for HealthLeaders Media, August 6, 2008

As if local patient dumping weren’t enough of a PR nightmare for the U.S. healthcare system: Now hospitals are being called out for patient dumping on an international scale.

The New York Times tells a heart-wrenching story of a 35-year-old uninsured illegal immigrant, so injured in a car accident that he is unable to care for himself. The wheelchair-bound man, who has the mental capacity of a child because of his brain injury, was sent back to the impoverished hills of Guatemala where he has only his elderly mother to care for him.

It was not the government that deported him, but a community hospital in Florida, acting on its own.

The story paints hospitals—community hospitals in particular—as uncaring, money-grubbing, underhanded, and corrupt. And the article doesn’t just focus on the Florida hospital—it gives examples of international patient dumping from hospitals across the country, including some with religious missions.

“The only people who don't realize how inhumane our health care system has become are those fortunate enough to have good insurance, or Medicare . . . or who have never run up against the wall that says, ‘You can't pay for this, so go,’ ” one reader commented.

How much does bad PR cost?
It begs the question: How much is good PR worth? Or, more to the point in this case, how much is it worth to avoid bad PR?

Martin Memorial, a not-for-profit hospital in Stuart, FL, did a lot for this patient. Not only did they save his life—twice—but when they could not find a long-term care facility that would take the uninsured 35-year-old, the hospital took him in and cared for him to the tune of $1.5 million before it leased an air ambulance for $30,000 returned him to his home country.

Should the hospital have spent another $1.5 million to avoid an article such as this one? Three million? Six? How much is enough?

Multiply those numbers by the millions of uninsured in the U.S. and the negative return on avoiding bad publicity is clear.

It seems vulgar to weigh the pros and cons of caring for a patient, of measuring the cost to the hospital’s bottom line versus the cost of bad publicity. But those within the healthcare industry know that without money, there is no mission.

Was the bad PR all that bad?
I’m not saying “there’s no such thing as bad PR.” In this case, I think, it’s pretty clear that Martin and the other hospitals named in the article got a serious whooping.

But, as usual, there’s more to the story. For example, buried in the article is the fact that the man’s legal team, comprised of a lawyer, a paralegal, a priest, and a bioethicist, visited him in his home in Guatemala and found that there was no compelling reason to return him to Florida and that his quality of life is better than it would be in a U.S. nursing home.

And, as is it turns out, many of those who weighed in on the Times article—more than 500 at last check—seemed to understand that the blame should not lie on the hospital alone.

One reader, for example, blamed the federal government and noted that the burden of paying for the uninsured falls unfairly on urban hospitals, hospitals in communities with large immigrant populations, and hospitals in poorer rural areas.

Some were outraged that the hospital had to spend as much as it did on the uninsured patient. The $1.5 million, they said, could have gone to much better use caring for those who need help right here at home.

Others pointed out that if more Americans were insured, the burden of paying for the uninsured would not fall so heavily on public hospitals.

Still others blamed the employer who hired the illegal immigrant and the driver who hit him. Shouldn’t they be responsible for the cost of his care?

Yes, some readers railed against the hospital’s insensitivity. But for the most part, they seemed to understand that there’s a schism between the ideality of charity and the reality of the bottom line. What matters most, of course, is that the hospital’s internal and external stakeholders also understand that. It’s up to the hospital to make sure they do.

Gienna Shaw is an editor with HealthLeaders magazine. She can be reached at
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