To Err is Human

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Hoag Hospital’s decision to ban elective abortions has raised many questions. This column examines one of them: Why the massive failure in communication between the Board and its doctors and the community?

Good health care depends upon clear communication. According to a report from the Institute of Medicine, “medical errors in hospitals account for as many as 98,000 deaths each year[,] with good communication an essential factor in preventing such errors.

Although Hoag’s decision does not involve a patient on an operating table or in ICU, I see the decision and the way it has been handled as a medical error with deeply troubling consequences.

 –The breakdown started after the Board announced its affiliation with St. Joseph Health Care Systems with the assurance that Hoag’s Women’s Health Institute would continue as it was. Several weeks later, the Board announced that it would no longer permit elective abortions. The decision took Hoag’s OB-GYNs by surprise — the Board had changed course without letting them in on the process. Poor communication.

 –According to Board president Robert Braithwaite (as quoted in the June 16 issue of the Daily Pilot), the Board based its decision on a “pretty careful review of all the facts and considerations.” Two surgeons near retirement age did most of Hoag’s abortions. The Board believed that better care was available through Planned Parenthood and the UC Irvine Health’s Women’s Options Center. If those facilities can staff competent abortion providers, why can’t Hoag? Did the Board consider recruiting? Instead it made a policy shift, prompting some of its OB-GYNS to protest in a letter to the Daily Pilot.

 –The Board insists that St. Joseph did not exert pressure. The Board may be technically correct in saying that St. Joseph’s said nothing, but then it didn’t have to: The mere existence of the pending affiliation with a Catholic hospital provided covert pressure. When people said as much, the Board reiterated its original stance. Good communication practices suggest that when your message isn’t received as credible, you re-evaluate.

 –Instead, Hoag ran a newspaper ad showing a woman in yoga pose on the beach. The copy read, “At Hoag, women and their families have a loyal health partner dedicated to helping them manage their health needs and live fuller, more rewarding lives.” The ad was off-key. A “loyal health partner” does not suddenly eliminate the emblematic heart, elective abortion, from its range of reproductive care. And I took the message as, “Mellow out.” I can tell you that many of us in the community are not in the mood for yoga right now – as I write this a protest rally outside Hoag is being organized for Thursday, June 20.

 –Particularly troubling is the Board’s apparent indifference to the greater implications of its decision. Did it not grasp that elective abortion is a highly charged political and religious issue? For this reason the Board should have increased communication with its doctors and the public throughout the process. Right now the Board comes across as unyielding. And this is the pity: the Board consists of people who have dedicated their lives to the health of our community. When I raised the concern that Hoag’s obstetrical patients might now be subject to Catholic hospitals’ policy of refusing to abort to save a mother’s life with Dr. Allyson Brooks, the executive medical director of Hoag’s Women’s Health Institute, she was adamant: “I want to go on record that will never be an issue at Hoag. Our physicians are taught and trained and pride ourselves on taking care of the mother’s life.”

At least the Board remains willing to talk, while Dr. Richard Afable, the head of the Covenant Health Network that oversees Hoag and St. Joseph, St. Joseph and the Roman Catholic Diocese of Orange are “unavailable for comment,” according to the Daily Pilot. (I’ve had no success in reaching them either.)

So it’s imperative that Hoag’s Board admits that it’s human — it erred — and revisit the decision, with the participation of its doctors and the community. It is the essential and proper first step in rebuilding the trust the hospital has lost.

Jean Ardell can be reached at [email protected]

 

 

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