Over the past 24 hours a story has begun circulating that a pharmacy accidently dispensed methotrexate to a pregnant woman (see below). The drug is used for chemotherapy and to terminate early-stage pregnancies. The woman could eventually lose the pregnancy or deliver a child with birth defects.
The pharmacy has issued a “sincere apology” and has pledged to cover all medical expenses. The pregnant woman says sorry won’t cut it, has hired a lawyer, and is not talking anymore.
So, did sorry not work? We need to understand more about the case.
From where I sit, my gut tells me the pharmacy needs to be saying and doing more. Simply offering help with medical expenses sounds cold. Even if God willing the child is born with no defects, this dosing error has turned this pregnancy into a nightmare. Could you imagine waiting seven to eight months to learn if your precious child is impaired? Talk about torture. Quite frankly, this is an area where a lot of organizations still struggle with disclosure…they say “sorry” and pledge to help, but either the pledge is insufficient and/or not specific enough. The follow through is lacking and aggravates the situation and actually builds the fire as opposed to dousing the flames.
I think the pharmacy needs to be more aggressive in their pronouncements. They need to talk about covering all injuries – financial/medical and emotional – caused to this woman, her baby, and her family. Even if the lady refuses all phone calls, letters, e-mails, etc, her lawyer or the public will never be able to say they didn’t care or want to own up to their responsibilities. As we say, disclosure, at the minimum, is about building a rock solid defense. Take away the plus factors.Another problem: “We understand the anxiety this has caused and the difficulty of Ms. Silva’s situation.” Yes, the pharmacy actually said this (see story). Ouch. No, they don’t understand. This might be another reason the woman has lawyered up and is not talking anymore. Clumsy statement. Try this: “We can only imagine the pain she and her family are experiencing….” See the difference?
Going forward, the pharmacy is really going to need to think of creative and meaningful ways to own this error. Name a safety training series after the mother and child? Involve the mother/family in some meaningful ways? Etc, etc. Bottom line is the resolution shouldn’t simply be a check…the situation demands much more.
Hey, don’t forget to register for our first ever open Sorry Works! Training Seminar on March 22nd, being hosted by the Hospital Association of Southern California.
Sincerely,
- Doug
Doug Wojcieszak, Founder, Sorry Works
618-559-8168 (direct dial)
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Perhaps the pharmacy could ask her what she needs and what they could do to help, and then actually listen to her response — which might very well be long, angry, and initially imprecise. Keep listening. Then do the best they can to meet those needs.
Sounds like they’re trying. I got, “We’re sorry you were dissatisfied with your experience.”
I have been a subscriber to your blog for quite a while and believe in what you are trying to accomplish. Most of your missives are on point and accurate, and we can learn something valuable from your observations. This evaluation seems to be less thoughtful, blaming the organization for what you consider to be a poor/inadequate response. It is my opinion that to judge what this pharmacy chain is doing/saying based on what is in the press is short-sighted, at best. There are probably a number of things in the works at this time to assist the involved party (now a claimant) that the general public isn’t and shouldn’t be privy to. Organizations can wait until they have a well-formulated response and risk being accused of a delayed response time, or can put forth a good faith first response (with more to come) and be judged harshly, as you have done in this instance. Maybe it would be prudent to wait until more of the picture is revealed before rushing to judgment? It seems you throw fuel on the fire and scare well-intentioned people off with blogs like this one, rather than being thoughtful and articulate, as your past blogs have been. Your insight and thoughtful consideration of most situations is impressive – this one is not. I hope this will not be the tone of future case reviews. It would be a shame to see your purpose and mission be sacrificed on the altar of sensationalism and harsh criticism.
ADB,
First, thank you for responding. I always appreciate feedback, even tough critiques such as yours.
Second, thank you for the kind words about past blogs/newsletters, and I’m sorry this one didn’t meet your expectations.
Let me walk through your critique for the benefit of you and the rest of our audience. You raise a lot of interesting & new points that are valuable.
You mentioned that maybe/perhaps more is going on behind the scenes with this case then we are privy to. Also, you indicated its kinda like a dammed if you do/dammed if don’t scenario because organizations either get all the facts first and be accused of dragging their feet, or they get out of gate quickly and people like me criticize them for not doing enough.
You might be right – the pharmacy may be doing more, lots more. So, why not tell it? The pharmacy is fighting a two front battle: 1) possible litigation from the pregnant woman and 2) an enormous PR hit with the media and public. The organization and its risk and legal as well as PR departments need to be on their toes with this case. I’m sorry, but saying “we’ll cover all medical expenses” and nothing broader does come off cold – both to mom and her legal team as well as the public. As I wrote, even if the child comes into the world unharmed, there is an enormous emotional toll on the mother and family that is readily apparent right now. Shouldn’t need due diligence to figure that out.
Furthermore, this is one of those rare cases that has slipped into the media….and not only does that fact have enormous PR/image consequences, it has also bearing on the potential litigation. You have to assume the woman, her family, friends, and attorney are carefully reviewing every press clipping. Working with this assumption, I would want to hear/read more than we’ll cover “medical expenses.” It would have been better to give something broader such as “We are going to take care of all the financial and emotional harm created by this mistake. This woman and child will be cared by our company.” Not only is that a good statement for mom and her lawyer to read/hear, but it will also rebuild confidence with the public and media.
Possibly the harshest part of my criticism was concerning the statement “we understand the anxiety this has caused and the difficulty of Ms. Silva’s situation.” The pharmacy broke a cardinal rule of disclosure: Unless you have personal experience that is exactly on point with the victim’s experience, no, you don’t understand. Saying so can be very offensive and, again, fan the flames as opposed to dousing them. Simply say “we can only imagine how this feels, etc.”
In closing, I felt the need to jump on this story not for sensationalism, but for two reasons: 1) Head off the critics who will say sorry doesn’t work (they’re still out there!) and 2) address the problems organizations have with following through appropriately after “sorry.” Lots of well-intentioned organizations struggle with how to handle patients and families after the sorry, and I wanted to use this high profile case to teach and get people thinking.
Thanks again for your comments, and thanks for listening to me.
Sincerely,
- Doug
Doug Wojcieszak, Founder
Sorry Works!
618-559-8168 (direct dial)
Mr. Wojcieszak.
I fear you’ve missed the point. So have your commentators. “Sorry” has to be personal. A SINGLE PERSON, the professional pharmacist, made an awful error that affects A SINGLE PERSON, Ms. Silva (and her baby, of course, and her family). Forget Safeway. It’s a huge corporation, and while it’ll get hurt, badly, it and its stockholders will survive. Legal fictions don’t apply. Safeway didn’t make the error. Even though the legal fiction says it did. Even though it’ll pay the bills. (Or its insurer will.)
Where in all this is the human dimension? I don’t blame Ms. Silva for “lawyering up”. Faced with this public response, I would do that too. No doubt because I would do this, Safeway won’t be asking my advice, but here it is:
First of all, the offending pharmacist must be involved. If the lawyers say, Oh, no, it’s admitting fault,” well, how can anybody deny it? Even mitigate it” Res ipsa loquitur. If he/she needs coaching, given the inflammatory flap that’s not only allowed but encouraged by the oafish way Safeway’s handled its oh-so-legally-neutral public pronouncements, fine. But the clear, simple message that Ms. Silva and her lawyer and the public should be hearing is, “I screwed up and I’m sorry. I CAN begin to imagine what you’re feeling, and I don’t blame you for feeling it. You should be. Of course it’s too late to make a difference for you, but we’re looking very hard to find out how to keep this from happening again, and why it did happen to you. But that’s for later. I just want you to know I’m sorry and embarrassed. I want to know what we can do to help you and your baby get through this, no matter what. Safeway will help with the money part. But I made the mistake. It’s something I’ll never do again, and I’ll carry it with me ’til the day I die.” That’s sympathy. That’s contrition. And that’s what Ms. Silva wanted.
Doesn’t change the result. Doesn’t lessen the pain. Doesn’t mitigate the outcome. But doesn’t worsen it.
Even as cynical as I am, I’d believe that. I don’t doubt the pharmacist is emotionally wrecked. In this case, fine: it’s as it should be. Pity we can’t see it. Want to know more? Of course. But we know enough to judge the image right now.
Safeway qua Safeway should shut up. After all, why would a corporate vice president of risk management or the head of the legal department care about this beyond what’ll happen to the bottom line? Corporations aren’t people; they don’t have hearts; they don’t feel sorry.
Back the pharmacist’s sincere contrition, accept the facts, make a manageable promise of financial support, don’t seem to quibble and nitpick about claims. And fix whatever failsafe procedure failed.
This is a matter of absolute liability. It’s going to hurt the corporation; it’s going to hurt the pharmacist, personally, professionally and possibly financially. But this is pouring gasoline on the fire.
I concur with Dr. Kahn because I have handled vulnerable populations. Harm reduction may be the best to do but it is authentic.
Please understand that mothers of young children are probably the most challenging. Either way, in three decades of practice I’ve come to understand how personal communication is essential.
When we have novices caring for challenging situations, we need to support their negative communications. In my opinion, that novice criteria would include the majority of fresh MDs/RNs/NPs/PAs & PharmDs. So the provider will influence what level of collateral communication should occur. For instance, Dr. Kahn stated that we “don’t quibble”. That is very well put and listening is something we learn as we gain confidence. So quiet reflection or one word acceptance statements like “yah” may be the most sincere approach.
Perhaps America has been believing its own propaganda too much (i.e., pervasive free-market advertising). I ask, Could it be that we’re too quick to treat business entities as having actual style, creativity, “cool”ness and integrity – and even emotions – of their own?
The truth is that these are human traits! And deep down, when we’re in personal distress and we need to receive human empathy, we just know that it just won’t suffice if it comes from a corporate entity. That’s a “person” by legal fiction only. Hearts know the truth.
I think there is a difference between intellectually understanding how a patient might feel after this kind of error vs. understanding it in the depths of your gut. Although most people can empathize with this patient, it doesn’t mean they’ve truly internalized how she must feel.
In the world of apology, I think we need to realize that people who’ve had firsthand experience with medical harm often have a deep, interior sense of what it really means to say you’re sorry, and that they can be very quick to recognize when an apology might sound canned or facile. It doesn’t mean that only those who’ve walked the walk can make a valuable contribution to the discussion. It’s just that they’re coming from a different place – it’s like the difference between a soldier coming home from Afghanistan and the neighbors and coworkers who can intellectualize about what combat must have been like but not truly understand the reality.
If we’re ever going to make progress on helping health care providers say they’re sorry, I think we need to be able to dissect real-life cases from time to time. People who are trying to learn often crave examples. Why did a particular apology work? Why did it fail? In this case, the apology clearly failed; what were the dynamics that might have contributed to this?
At times there’s going to be disagreement; at times it’s going to be uncomfortable. But I’d like to think it helps everyone learn more when there can be an honest discussion. For years it’s been something that no one really talked about, and look where that’s gotten us.
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