Deadly Spin

by Wendell Potter

  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

  ON 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 comp
any 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 r
eal 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.

  I didn’t realize until later that the New York Times had sent a reporter and a photographer to the Wise County expedition. The headline on the eight-page spread in the paper’s magazine summed it up well: “Patients Without Borders: What Do the Uninsured in America Do When They Need Health Care? Some Turn to a Volunteer Medical Group That Was Set Up to Provide Free Services in Third World Countries.”

  In the article, Brock noted that despite the expedition’s three-day span, hundreds of people are turned away every year, and that the medical needs of the people who come for free care far outstrip what the volunteers can provide. He said, “There comes a point where the doctors say: ‘Hey, I gotta go. It’s Sunday evening, and I have to go to work tomorrow.’ ”

  Brock estimates that by 2010 about twenty-six thousand volunteers for RAM had treated more than three hundred thousand patients during six hundred expeditions in the United States and abroad. Because the need for the services that RAM and its volunteers provide shows no sign of abating, Brock is trying to raise one million dollars to expand the organization’s capabilities. He hopes to use the money from RAM’s “Reach Across America” campaign to, among other things, buy and operate another airplane to fly volunteers “anywhere we’re invited.” One of the planes RAM currently uses, which Brock himself flies, is a DC-3 used by the U.S. Air Force in Europe during World War II.

  As I took in the scene at the Wise County Fairgrounds, I realized that the folks in those lines and animal stalls could have been my relatives or my parents’ neighbors. I could tell from their faces that they were people with whom I shared cultural roots, but who—for whatever reason—simply hadn’t had the good fortune to land a high-paying job and a cushy office in a Philadelphia skyscraper. Quite unexpectedly, this spur-of-the-moment outing was starting to feel personal and even spiritual—and I didn’t consider myself to be much of a spiritual kind of guy. It was clear to me at that moment that I was having an epiphany.