Deadly Spin (8 page)

News releases explaining what happened at an event are commonly written before the event takes place. Corporate executives go through “media training” to prepare them for speaking directly to reporters. Mock press conferences are held to give execs practice. PR staffers prepare a list of expected questions and appropriate answers for them in advance of media interviews. Few politicians and virtually no business executives write their own speeches. All good executives, like politicians, are taught the cardinal rule: Stay on message.

For many years, I was the designated media relations person, the company’s public presence, the mouthpiece for management. Mine was the face presented to the media whenever my company was in the spotlight, voluntarily or otherwise. Never—not once—did I answer questions or make statements on behalf of my employer without knowing in advance what I would say.

PR people are good at manipulating news media because they understand them. A large number of practitioners are former reporters—like Lee and Bernays (and me)—who know what kinds of stories get attention, as well as who decides what gets coverage and what doesn’t. Conversely, news outlets are increasingly dependent on public relations departments and agencies for content. As budgets drop, especially at newspapers, there are fewer reporters and fewer resources for investigative journalism. Canned information from companies is used “as is” more frequently, often without fact-checking.

In addition, PR people cultivate reporters, ostensibly for friendship or mutual benefit, but more realistically for manipulation. And in a disturbing trend, reporters can increasingly be cowed by powerful public relations reps because PR controls access to major news-makers in both business and government. I should know. For years, I was the gatekeeper to the CEO and other top executives at CIGNA. No reporter got to them except through me. I decided who had access and on what terms.

Unexpected things happen, of course, but PR people have a plan for that, too: crisis management—always in place, ready to be tweaked to fit individual circumstances, and set to be implemented on a moment’s notice. A major negative event will kick the process into gear, and if the plan is executed well, the public will eventually perceive nothing more than a company that responded quickly and honestly to a problem.

The 1982 Tylenol tragedy is a textbook example. The entire country was stunned by the news that seven people in Chicago had died after consuming cyanide-laced capsules of Tylenol. Johnson & Johnson, the maker of Tylenol, immediately worked with news media to notify the public of the potential danger. The company recalled Tylenol from all store shelves voluntarily. Behind the scenes, Johnson & Johnson’s CEO formed a strategy committee to determine the best way to prevent further deaths, and he worked extensively with his public relations staff and an outside agency to plan for the reintroduction of Tylenol in tamper-resistant packaging.

The result: 90 percent of the polled public said they did not hold the company responsible for the incident, and Tylenol sales began to skyrocket shortly after the product was back in stores. The
Washington Post
praised the firm for its performance, noting in an editorial, “Johnson & Johnson has effectively demonstrated how a major business ought to handle a disaster.”
19
The poisoning case was never solved.

In 1982, communications were primitive by today’s standards. There was no public Internet, no Twitter, and no cell phones. Newspapers, magazines, radio, and television were the only mass media. Confronting a crisis in today’s era of media overload is much more complex. Not only do companies have more opportunities to reach and influence their target audiences, but they also face greater and far more immediate criticism when they get things wrong.

A recent example is Toyota’s handling of its 2010 quality control debacle, in which more than eight million vehicles worldwide were recalled, resulting in a drop of more than 20 percent in the value of Toyota stock. The company’s early response was slow, passive, insufficient, even insulting. Toyota was lambasted for ignoring customer complaints and denying safety problems that reportedly led to more than fifteen deaths. Bloggers, not to mention late-night talk shows, had a field day bashing Toyota. Other car manufacturers, even those facing recalls of their own, basked in relief that it was the world’s largest carmaker taking the heat and losing business … to them.

Watching the Toyota crisis play out reminded me of the many times I’d been in charge of crisis communications throughout my career. When a crisis comes calling, PR people go into damage control mode. I was a fireman as well as a spinmeister, working to keep my clients and employers’ reputations from going down in flames when something bad happened.

Fortunately, I didn’t have to wear my firefighter’s hat every day. Because of my role as chief spokesman, I spent much of my time fielding questions from reporters or schmoozing with them. I was not always writing press releases or pitching story ideas. In fact, I made it clear to the company’s business and marketing people that I would not pitch a story that I knew had no news value. Instead, I worked hard to make sure that reporters saw me as a good and credible source of information about the insurance industry and trends in health care. Senior executives knew that I had developed good relationships with key reporters, and that I was able to influence what they wrote about CIGNA, which is one reason I survived several regime changes and restructurings during my fifteen years at the company.

With years of practice, I had learned how to respond with a pithy remark if I wanted to be quoted and how to “baffle them with bullshit” if I didn’t. Soon after I joined the company, a colleague gave me a framed E. B. White quote as an inside joke: “Be obscure clearly.” I became a master at doing just that.

To be a credible source for reporters, I had to spend a lot of time on conference calls and in meetings with business leaders to stay on top of what was going on. I started every Monday with three back-to-back calls and meetings, the first with the company’s lobbyists in Washington, the second with my boss, and the third with the other PR people in the company, which I called our “news desk” call. The purpose of the call was to keep each other apprised of media inquiries, pitches, and anything else we were working on for our internal “clients.” (We operated as an in-house PR agency, so we called the business people we worked with our clients.)

My staff and I also compiled a news summary every morning of all significant stories about CIGNA and the insurance industry that had appeared in the media over the preceding twenty-four hours. I never wanted any of our executives to be out of the loop or blindsided because they hadn’t seen an important story.

In addition, we wrote speeches for the CEO and other top executives and cranked out a constant stream of documents and publications, ranging from media statements and position papers to the company’s annual report to shareholders.

As chief gatekeeper, I decided who was worthy of interviewing our CEO and how much time they got with him once I’d determined the access to be in the company’s best interest. I never let in a reporter I didn’t know or have some sense of trust in. I prepared an extensive memo for the CEO each time, telling him what questions to expect and the talking points he should use regardless of what he was asked. I also included biographical information about the reporter and attached several recent stories he or she had written. I always sat in on the interviews so I could cut them short if they were going south.

I stayed in the CEO’s good graces because I never left anything to chance. I planned ahead, and I kept my cool whenever the inevitable crises arose.

So, with that kind of résumé, I certainly didn’t expect that a simple trip back home to the mountains of east Tennessee would make me lose this cool—and actually begin rethinking my life’s path as a spinmeister.

But it did.

C H A P T E R   I V

Remote Area Medical in Wise
County, Virginia

O
N
July 18, 2007, a little more than a month after the U.S. premiere of
Sicko
, former U.S. senator John Edwards (D-N.C.) made a campaign stop a few miles from where I grew up, in the southern Appalachians. A leading contender for the Democratic presidential nomination at that time, Edwards had decided to stop in Wise County, Virginia, as part of his three-day, eighteen-hundred-mile Road to One America tour, whose aim was to draw attention to the increasing number of Americans living in poverty.

I never would have known that Edwards was in the area if I hadn’t taken a few days off to visit my folks in Kingsport, Tennessee. I learned from the media there that Edwards was coming to Wise County because it was the site of a big health fair at the county’s fairgrounds. “Edwards Stops in Wise County to Address Health Care Concerns,” said the front-page headline of my hometown newspaper, the
Kingsport Times-News
. The paper made the fair sound like such a big deal—thousands of people from as far away as Ohio and Alabama were expected to attend—that I decided to go check it out.

I was attracted particularly because one of my responsibilities was to keep CIGNA’s CEO and other top executives up to speed on what the leading candidates were saying about health care reform. Another responsibility was to draft position papers and devise talking points on topics pertaining to health care reform—and one of the stickiest topics, of course, was the uninsured. In fact, I had been working for weeks on a paper that would eventually spell out CIGNA’s stance on the main problems affecting the American health care system and how lawmakers should go about fixing them. I had presented a draft of this paper to CIGNA’s fifteen-member Public Policy Council—headed by CEO Ed Hanway—shortly before my visit home.

Hanway had originally instructed me to focus the paper on the problems of the uninsured, but he later changed his mind, deciding that he wanted it to be more about what he referred to as “the real cost-drivers of health care.” He said it was still OK to mention the uninsured in the paper, but not so prominently on the front page. He also said that when I did write about the uninsured, I should emphasize the fact that most Americans had health care coverage—and not the fact that forty-five million didn’t.

Since Hanway also chaired AHIP’s Strategic Communications Committee, it was clear that his new instructions to me represented the approach the industry would be taking when the reform debate heated up. The goal would be to divert the public’s and the media’s attention from the uninsured and toward problems the insurers could insist were beyond their control. The industry’s spin, in other words, was going to be something like this: Health care costs are out of control because new treatments and technologies are more expensive than ever, the population is getting older and sicker, too many people are seeking care they don’t really need, and health care providers are all too willing to provide this care that people don’t need.

Knowing that Democratic candidates for president would likely blame insurance companies for both rising costs and the rising number of uninsured people, Hanway and the CEOs of other big companies (who controlled AHIP’s purse strings) had begun plans for a multi-million-dollar public relations and advertising campaign to try to reframe the debate, shifting the focus away from their companies. The name of this effort would be the Campaign for an American Solution.

One of the CEOs’ least favorite candidates was Edwards, who seemed to be intent on becoming the leading insurance company basher.

Sure enough, Edwards lived up to his reputation that day in Wise County. “[Lack of] access to affordable health care is a shameful aspect of a nation that should do much better by its citizens,” the candidate said during his brief stop. “How can we live with this in America?”

AMERICA JOINS THE THIRD WORLD

While Edwards talked with reporters, there were hundreds of unconnected volunteers at work around him and in the background—converting the Wise County Fairgrounds into what over the following three days would become the site of Remote Area Medical’s eighth annual expedition to the area.

Remote Area Medical (RAM, for short) is a Knoxville-based organization founded twenty-five years ago by, of all people, Stan Brock, co-star of
Mutual of Omaha’s Wild Kingdom
, a popular and long-running TV show that premiered in the early 1960s. I didn’t know anything about RAM until I read about it in the Kingsport paper on that visit.

Now seventy-four, Brock has an interesting life story—he left his family and private school behind in England when he was seventeen to seek adventure in the wilderness. He found it in Guyana, a small country then called British Guiana on the northeast coast of South America, between Venezuela and Brazil. For fifteen years, he lived and worked among the Wapishana and other Amerindian tribes there, helping them drive cattle through the country’s savannas and rain forests to steamships that delivered them downriver to be sold at market. On one of these trips, Brock was badly injured when thrown from his horse. He needed medical care, but he was forced to heal without it—the nearest doctor being twenty-six days away on foot. Brock was aware that he lived in a remote area, of course, but he hadn’t realized until then just how remote.

It was during his years in Guyana that Brock was discovered by the
Wild Kingdom
crew, while they were filming in the region, which eventually led to his TV career.

But before he left Guyana for his new and better-paying job, Brock saw several other health disasters unfold, like whole tribes nearly wiped out by illnesses that could have been easily treated back home in England. So he vowed that one day he would find a way to deliver basic medical aid to the people there and to people in other remote parts of the world. He made good on that pledge years later when he founded RAM, which began flying doctors and medical supplies from the United States to villages where he used to live. This outreach eventually morphed into a highly mobile relief force of doctors, dentists, optometrists, nurses, and medical technicians who volunteer their time to treat hundreds of patients a day under some of the worst conditions imaginable—not only in South America but also in Africa and Asia and, more recently, Haiti.

Brock first visited Knoxville when he was invited to appear there at a fund-raiser for the Knoxville Zoo soon after he left
Wild Kingdom
. He liked the area and the people so much that he decided to relocate there from Florida and make Knoxville the headquarters for his new venture.

It never occurred to Brock when he started RAM that most of his expeditions would eventually be to communities in the United States. But it soon became apparent to him that millions of Americans don’t have much better access to care—or at least to care they can afford—than people in third world countries.

It started for him one day in the early 1990s when he got a call from a social worker in one of the poorest places in the country: Hancock County, Tennessee, about seventy miles north of Knoxville. The county had just lost its only dentist, and the only hospital had recently closed because of budget problems. The social worker had heard of RAM and asked Brock if he had ever thought about doing an expedition in the United States—and if so, would he please start in Hancock County?

“I was told that dental care was one of the biggest needs,” Brock said, “so we loaded up a pickup truck with some old dental chairs and took a couple of dentists up there.” It wasn’t long before he was also taking doctors and medical equipment.

The word began to spread, and Brock was soon getting calls from other communities in the area. One of them was Mountain City, the small town in Johnson County at the northeastern tip of Tennessee where my parents were born and raised and where I had spent the first six years of my life.

Hancock, Johnson, and Wise counties have a lot in common. They are among the most remote counties in the southern Appalachians, miles from the nearest interstate highway, and doctors and medical facilities are far from plentiful. Few residents ever make it to college, and few employers are big enough to offer health care benefits.

Brock still does expeditions in Hancock County, but he stopped going to Johnson County a few years ago when his partners there decided to devote their resources elsewhere. Shortly before that, he was introduced to Wise County when a Catholic nun—who had operated a traveling medical clinic since 1980 in some of the most isolated counties in southwest Virginia—met Brock in Mountain City and persuaded him to take an expedition to Wise. He agreed, and the first Wise County expedition took place in 2000. The demand became so great that Brock decided to continue his partnership with Sister Bernie Kenny and her Health Wagon.

Sister Bernie turned over the reins of the Health Wagon in 2005 to nurse-practitioner Teresa Gardner, her longtime associate, and Gardner became the driving force behind the Wise County event, now one of the largest RAM expeditions in the United States. Over three days in July 2009, seventeen hundred volunteers contributed twenty thousand hours of time and more than $1.5 million in care, while recording more than seven thousand patient contacts.

A LIFE-CHANGING TRIP TO THE MOUNTAINS

The news coverage of John Edwards’s visit to the 2007 RAM expedition led me to borrow my dad’s old car and drive the fifty miles from Kingsport to Wise early on Friday, July 20. I’d seen a lot of health fairs over the years, some even sponsored by my employers, but never one as big or as comprehensive as the one I’d read about in the
Times-News
. My curiosity was in high gear.

The Wise County Fairgrounds covers several acres and is host to some of the area’s biggest and most popular events. The month before, it had hosted the Mountain People’s Music Fair. A few weeks after the RAM expedition, it would be the site of the Virginia-Kentucky District Fair & Horse Show.

When I arrived at about eight
A.M.
, the parking lot was already jam-packed with cars and trucks. State troopers were directing traffic on all the nearby roads, and dozens of volunteers were trying to help latecomers find places to park.

On its Web site, RAM advises people attending the Wise County expedition to come early and come prepared: “Plan for long lines. It is not uncommon for as many as 500+ people to be in line at the start of a clinic day. Remember to bring food, water and an umbrella, and expect long delays.”

Many people, I learned later, arrive the day before and spend the night in their car or a tent. On the day I was there, the first day of the clinic, eight hundred people had lined up before dawn to be sure they could get in when the gates opened at five thirty
A.M.

Because the fairgrounds are walled in at the entrance, I couldn’t see what was going on inside as I walked up to the registration desk. There were several volunteers there, but they didn’t seem to be especially busy. Except for the sounds of car tires on the gravel in the parking lot as people came and went, it was eerily quiet.

Nothing prepared me for what I saw when I walked through the gates. The contrast to the calm on the outer side of the wall was stunning. The scene inside was surreal. I felt as if I’d stepped into a movie set or a war zone. Hundreds of people, many of them soaking wet from the rain that had been falling all morning, were waiting in lines that stretched out of view. As I walked around, I noticed that some of those lines led to barns and cinder block buildings with row after row of animal stalls, where doctors and nurses were treating patients. Other people were being treated by dentists under open-sided tents. Many were lying on gurneys on rain-soaked pavement. Except for curtains serving as makeshift doors on the animal stalls, there was little privacy. And unlike health fairs I had seen in shopping centers and malls, this was a real clinic. Dentists were pulling teeth and filling cavities, optometrists were examining eyes for glaucoma and cataracts, doctors and nurses were doing Pap smears and mammograms, surgeons were cutting out skin cancers, and gastroenterologists were conducting sigmoidoscopies. Huge amounts of medications were being dispensed.