Compelling, Concise, Targeted: Writing Samples by Jana Moore
Pew Charitable Trusts Pamphlet
Red Cross of Southeastern Pennsylvania
The Children’s Hospital Newsletter
Penn Medicine Donor Brochure
American Friends Service Committee
Project on Medical Liability in Pennsylvania News Release
National Board of Medical Examiners News Release
The Rev. Beth Stroud Fact Sheet
Although most materials produced by non-profit organizations have an underlining goal of raising funds, one group — the direct appeal — must clearly establish the need and the reason the organization stands uniquely qualified to meet it. Direct appeals also must subtly appeal to the donors’ egos by including them in the elite group that knows how to tackle the problem.
The two samples — a pamphlet for Pew Charitable Trusts and the introduction of a case statement for the Red Cross of Southeastern Pennsylvania — fit the criteria.
Pew Charitable Trusts Pamphlet: The Investment in Kids Partnership
The children are our future.
The statement is repeated often and believed by most. Yet few truly understand the profundity or the repercussions in today’s world.
As the global economic competition expands and intensifies, we are falling behind. More than 20 percent of U.S. workers are functionally illiterate and innumerate. Our rate of productivity growth has slipped, and the burden of debt on the next generation has skyrocketed.
Will our children be equipped to overcome these challenges? American youngsters now lag their foreign counterparts in math and science. Less than half of the African-Americans and Hispanics entering college earn a degree in six years. And the United States has the highest child poverty rate of the 20 developed countries belonging to the Organization for Economic Cooperation and Development.
Logic points to one imperative: For the country to flourish, our children must thrive.
Nascent research indicates that an investment in children translates into an investment in our nation’s economy, but not enough information exists to convince policy makers to focus on youth. To guide the debate, The Pew Charitable Trusts and Robert Dugger of Tudor Investment Corp. are turning to farsighted donors to join the Investment in Kids Partnership to build the evidence that will help secure our country’s economic health.
Path to Productivity
The path to productivity starts early: Of 50 children experiencing problems reading in the first grade, 43 will still be struggling three years later. These same children are at the greatest risk of dropping out, committing crimes and failing to find productive work. Researchers have identified demonstrably effective ways to intervene, yet the United States has never made children a high priority, partially because no direct economic benefit has been established.
When a link is established, policy makers take action, as our experience with preschool education proves. Using a study showing that early education produces a rate of return of about 16 percent a year — far more than traditional economic development projects — advocates have lobbied successfully to bolster pre-kindergarten programs across the country.
Children need more than early education to help them succeed, but little research exists to tie other programs to economic benefits. The Investment in Kids Partnership will give us that evidence.
Gathering Hard Evidence
If we receive the support of donors, we will start the project by documenting the economic value of healthy, productive children; identifying at least three major interventions with proven positive rates of return; and determining the impact of the programs on workforce productivity and economic growth. Given the current federal fiscal crisis, we also will examine creative ways to finance the investments, looking for effective public, nonprofit and for-profit partnerships in other areas as examples. The final phase of research will focus on ways to communicate the results effectively and to insert the information into the policy debate at the state and federal level.
If the research indicates the need for an aggressive public education and advocacy campaign, we will expand the partnership into a second stage, implementing a communications strategy. A third stage will involve identifying opportunities to change state and national policy.
Two advisory boards will guide the project; one will include major donors and other business and policy leaders to offer advice on overall strategy, and the other will include researchers to help develop the agenda, assess the findings and provide guidance on the quality of the data.
The facts and figures paint a sobering picture of our future unless Americans of wisdom and foresight step forward with innovation. The Investment in Kids Partnership is a long-range plan for a long-range problem that will have profound effects on the economic health of the United States. We ask all Americans interested in the future of our country — and our children — to join us.
Introduction to the Red Cross of Southeastern Pennsylvania Case Statement:
Answers to Questions
Just hours after jetliners exploded into the World Trade Center, they began to appear, the haunting posters showing smiling men and women above simple pleas: Have you seen my husband? My sister? My father? My daughter?
Those posters tore at the heart of each and every one of us who saw them on television or in the newspapers.
Frank Donaghue, the director of the Red Cross of Southeastern Pennsylvania, saw them in person, when they were fresh, just hours after the towers buckled and crashed. A veteran of far more fatal disasters around the world, Donaghue felt the pain of uncertainty behind the posters on a personal, emotional level. And a thought began to crystallize: Americans will understand if the American Red Cross isn’t prepared this time; they won’t understand if we aren’t prepared again.
What if terrorists attack the Limerick nuclear plant?
What if extremists pump poison into the steam system?
What if terrorists spray smallpox in Philadelphia?
Two years ago, intelligent, thoughtful people would have scoffed, calling the scenarios preposterous. Today, we fear our imaginations cannot even conjure the worst that could occur.
The American Red Cross Southeastern Pennsylvania Chapter knows the answers to the “what if” questions. Frank Donaghue and his team know they would need to help house and feed 32,000 evacuated from around Limerick, help deal with the death or illness of thousands from poison gas, and provide supplies to help quarantine every person exposed to smallpox.
Volunteers would fan out to reconnect families, find care for victims’ children, house the homeless, feed the hungry and minister to the traumatized both spiritually and mentally.
With the lessons of September 11 still unfolding, the Red Cross team a year ago began building its forces to handle emergencies of a magnitude not seen in Pennsylvania in almost a century. The culture changed overnight to a finely tuned operation planning for contingencies not before considered.
The Red Cross bolstered the volunteer ranks, strengthened communications systems, and devised response plans. Staff members never considered for disaster duty signed up for extensive training. Mental health services, so pivotal in the New York crisis, took on an urgent priority.
On every front, the American Red Cross Southeastern Pennsylvania Chapter prepared for a massive disaster within its financial realities. But no one — not Frank Donaghue, not Philadelphia Fire Commissioner Harold B. Hairston, not United Way President Christine James-Brown — believes the Red Cross has gone far enough.
To become truly prepared, we need to:
· Strengthen communications systems, both telephone and computer.
· Stand ready to shelter 32,000 people.
· Strategically recruit and train 2,800 new volunteers.
· Develop stringent security provisions.
· Establish a human services 2-1-1 hot line.
To give our area the security so central to the Red Cross mission, we ask all civic-minded leaders to help us raise $6 million to prepare for the largest Philadelphia-area disaster that federal agents consider probable. Even if our hopes come true, and the American Red Cross in Southeastern Pennsylvania never faces a disaster involving 32,000 people, this initiative will improve our efficiency and effectiveness in the 900 disasters we face each year
Our plan has the potential of touching each and every one of the 3.2 million people in Southeastern Pennsylvania. It will give you and your loved ones the security that comes only from thorough preparation and planning.
Donors want to see stories of substance, not puff pieces. The following samples — from projects for The Children’s Hospital of Philadelphia and the University of Pennsylvania — fit that criteria.
For The Children’s Hospital of Philadelphia, Jana produced a quarterly newsletter that focused on research and development through the eyes of the people helped. The newsletter generated numerous donations, including a gift in the seven figures, and made the hospital’s achievements much better known, even among close associates.
To celebrate the end of a $650 million campaign at the University of Pennsylvania Medical Center and Health System, Jana produced a 56-page booklet that focused on the groundbreaking work there and the motivation behind the gifts that made the campaign so successful. Researchers and donors alike requested extra copies of the booklet.
I took both projects from conception through production. I based the copy on interviews and extensive research.
The Children’s Hospital Newsletter:
Rare Disease Changes Family Overnight
Just back from her freshman year at Kenyon College, Courtney Braun left her parents’ Delaware home with a smile in May 1995 and headed out for an evening at the movies.
A few hours later, Miss Braun lay writhing on her parents’ bedroom floor, crying out for a way to end the pain in her head. The family’s puzzled pediatrician sent them to Children’s Hospital of Philadelphia, where doctors instantly diagnosed Miss Braun’s illness: meningococcal meningitis and septicemia. Calmly, and with great compassion, a nurse sat the Brauns down to give them the news: Courtney probably will die within two hours.
The combination of meningitis and septicemia strikes fewer than 1,500 Americans each year, mostly college freshman who live in crowded dormitories and children. The meningitis sent an infection into Miss Braun’s spinal cord and the fluid surrounding her brain, threatening to leave her with brain damage; the septicemia sent a toxin racing through her body, breaking down the walls of her blood vessels, slowing her circulation to a virtual standstill and starving her major organs of oxygen.
Only 20 percent of the people who contract both diseases survive, and the vast majority end up with serious brain damage or the amputation of their legs and arms.
Laboring Against Hope
Mary and Wilson Braun watched their comatose daughter helplessly as doctors crowded into her room. “There must have been 22 doctors, and not a single one thought she would survive,” Mrs. Braun says. “But not a single one stopped trying to save her.”
Russell Raphaely, M.D., who established the nation’s first pediatric intensive care unit at Children’s Hospital, suggested a radical procedure never before attempted at The Hospital: filling her body with 22 liters of fluid. Theoretically, the 70 pounds of liquid would jolt Miss Braun’s circulation system, but it also would endanger her major organs.
As their daughter became bloated beyond recognition, the Brauns began their 24-hour vigil, catching catnaps in a room no bigger than a closet. “For 2½ weeks, it was one trauma after another,” Mrs. Braun says. “She was as close to death without dying as anyone could be. But we knew she sensed the love and devotion around her; when you spoke to her, she rubbed your palm gently.”
Devotion Astounds Family
Courtney Braun returned home to recover almost two months after entering The Hospital. The ordeal damaged her kidneys but also inexplicably sharpened her intelligence, strengthened her memory and honed her artistic abilities, which she now uses as a fashion designer.
“What got to us was the compassion, the utter devotion of everyone at Children’s Hospital for what they’re doing,” Mrs. Braun says. “By saving Courtney, they saved all of us.”
Six months later, the family showed its appreciation with a $10,000 gift, one of many to come from two foundations in Mrs. Braun’s family, the Arguild and the Laffey-McHugh. A later gift of $150,000 helped rebuild the ICU and $25,000 went to the fetal surgery program. The largest amount — $100,000 for research and $500,000 toward establishing an endowed chair — benefited the department of nephrology, a specialty that became increasingly important to the family as Miss Braun’s kidneys failed and she received one of her mother’s during a transplant in 1997.
“The family’s gifts began because of the care they received at The Hospital,” said Steven M. Altschuler, M.D., the CEO and president at Children’s Hospital. “But as they became more familiar with other work here, their interests grew and their generosity spread. This is a testament to our work. It’s also a testament to the family.”
The Brauns believe they now belong to a relay team focused on keeping Children’s Hospital in the forefront. “If there hadn’t been donors before us, Children’s Hospital wouldn’t have the high-tech equipment and the medical talent that saved our daughter’s life,” Mrs. Braun says. “It’s our turn now.”
Hope Emerges for Babies with Diabetes, Hyperinsulinism
The babble of Alyssa Donaldson, so like the happy sounds of any healthy 7-month-old baby, belies the weeks she spent threaded with IV lines, screaming for the sugar her tiny body could not absorb.
From birth, her parents, Donnie and Rebecca Donaldson of Ceres, Calif., knew something was seriously wrong with Alyssa. After spending 11 days hospitalized with low blood sugar, she grew progressively worse at home, sleeping only in 20-minute spurts and twitching uncontrollably.
“We had no idea what low blood sugar meant or what it should be,” says Mrs. Donaldson.
Into a Surgeon’s Hands
San Francisco doctors ultimately diagnosed Alyssa with hyperinsulinism, which means the beta cells of her pancreas secreted too much insulin. Hyperinsulinism is the flip side of diabetes, which is caused when the pancreas secretes too little insulin. On the advice of Alyssa’s doctors, her parents took her to The Children’s Hospital of Philadelphia. There, she benefited from the hospital’s world-renowned surgeons, endocrinologists, radiologists and pathologists who are refining an operation that can cure babies with hyperinsulinism.
Financed by the endowment behind the hospital’s Baker Endowed Chair in Diabetes, the team performs the procedure as often as 11 times a year, while most hospitals might see one case a year.
In a best-case scenario, the surgery cures babies of the illness, which affects 200 to 300 children born annually. Beyond that immediate goal, researchers study the diseased cells removed during surgery in hopes of perfecting drug treatment for both hyperinsulinism and diabetes.
“These are very precious samples, because there aren’t too many patients who go to surgery,” says Bryan Wolf, M.D., the new pathologist-in-chief in the Department of Anatomic Pathology/Clinical Laboratories.
Dr. Wolf studies the isolation and transplantation of islets, cells that produce insulin and regulate blood sugar. Researchers ultimately hope to cure Type I diabetes, in which the body destroys islets, by transplanting healthy islets into patients. Wolf hopes that by studying the isolated beta cells, the Hospital researchers will better understand the malfunction so they can better target drug therapies.
“We have individuals from different backgrounds, and we’re working together as one team to solve the problem. That’s our strength,” Dr. Wolf says. “By joining forces, we hope to be able to find an answer.”
Charles Stanley, M.D., holder of the Baker Endowed Chair and division chief of Endocrinology, says the hospital hopes to use the endowment to develop a method for genetic diagnosis of children born with hyperinsulinism. Genetic diagnosis will allow physicians to determine with greater accuracy and speed which babies have the best chance of being cured.
Currently, surgeons must walk an excruciatingly fine line, and the stakes are high. As Stanley says: “If you don’t take out enough pancreas, you don’t control the low blood sugar. If you take out too much, you’re going to cause diabetes.”
The Hospital’s researchers also are exploring the genetic engineering of beta cells to manipulate them for better insulin secretion.
Realization of a Dream
The Baker Chair is named for Stanley’s mentor and former chief of the Division of Endocrinology. Dr. Baker founded the hospital’s Diabetes Center for Children and dreamed of establishing an endowed chair in pediatric diabetes. When Dr. Baker died before realizing his goal, $500,000 from the Lester and Liesel Baker Family Foundation, $500,000 from the Department of Pediatrics and $500,000 from friends, family and others who wanted to pay tribute to Dr. Baker helped complete the chair funding.
Using the money from the Baker chair, Dr. Stanley is working with Dr. Wolf’s lab and other diabetes investigators to study isolated beta cells from patients like Alyssa.
“Surgery is very invasive, but there are other ways of understanding why the cells make too much insulin. We need a model to be able to study that,” he says. “By joining forces, we hope to be able to find an answer.”
Penn Donor Brochure:
Finding the Genetic Switch
It’s the children who break Fred Kaplan’s heart.
The Penn physician is the world’s foremost expert on fibrodysplasia ossificans progressiva and a related disease he and his colleagues discovered, progressive osseous heteroplasia. Slowly but surely, FOP and POH entrap patients in a personal prison by turning their muscles, tendons, and ligaments into bone. The episodes can start with something as benign as a bump or a vaccination; after a few weeks of excruciating pain, a patient will wake up one morning unable to move his neck or his shoulder or his hip. The children with FOP know that one day they will awaken encased in a second skeleton.
“It’s a torturous disease for the children, the families, and for orthopedic doctors who are accustomed to seeing children improve,” Dr. Kaplan says. “It’s nightmarish to think a child could have movement of a joint one day and wake up another never able to move it again.”
It’s a nightmare that one donor, with nothing but empathy to connect her to FOP, wants to see end and that another donor confronts every day in his young son.
Diane Weiss met Dr. Kaplan while he was treating her mother for a condition unrelated to FOP and became interested in his research. In honor of her parents, she established the Isaac and Rose Nassau Professorship of Orthopaedic Molecular Medicine in Orthopaedic Surgery with Dr. Kaplan as the first incumbent. The second donor came to Penn when his son began developing lesions that no other doctor could diagnose. He went on to establish an FOP fund and to work tirelessly to build it through contributions from relatives and colleagues.
“As devastating as the diagnosis was, knowing about the Penn program helped us cope in some way,” the donor says. “I started the fund because 20 years from now, when my son is confined to a wheelchair, I want to tell him we’ve done everything we could.”
Penn doctors have seen 220 FOP patients from all parts of the world. “The more patients we see, the more we understand, and the more valuable the research becomes to the community,” Dr. Kaplan says. “These gifts have allowed us to take our research on a global scale, to pursue many more clues than we could do if we didn’t have these resources.”
The team’s research ultimately could have ramifications for many skeletal diseases, including arthritis, bone cancer, and spinal cord injuries. For Dr. Kaplan, the focus remains on FOP and POH.
“The clock is ticking for these children. It’s our job to find out how the bomb is wired and disarm it. Hopefully, we will be able to reverse the damage, but the main thing is to find the genetic switch and turn it off.”
Bridging Past and Future
The $1 billion that Alzheimer’s disease will cost Americans this year pales next to the emotional cost the disease wrings from families. In the next decade, scientists say, this struggle will end. Researchers are close to developing treatments and possibly even vaccinations to counter the disease, and Virginia M.-Y. Lee, M.B.A, Ph.D., Hom’93, stands at the forefront of this research.
Dr. Lee, co-director of Penn’s Center for Neurodegenerative Disease Research, and her colleagues began developing a method for monitoring the effectiveness of different treatments last winter, shortly after she was named the first recipient of the John H. Ware 3rd Endowed Professorship in Alzheimer’s Research. Within months they discovered a way to get past a complicated physical barrier to allow doctors for the first time to see the effects of Alzheimer’s on a living brain.
“The Wares’ gift was extremely timely,” Dr. Lee says. “This research would not have been possible without it.”
The family of John H. Ware 3rd, founder of American Water Works in Voorhees, N.J., knows the pain of Alzheimer’s. Mr. Ware suffered from the disease for eight years until his death in 1997 at the age of 88. Mr. Ware’s wife, Marian, his children, grandchildren, and the family’s Oxford Foundation established the chair as a tribute to Mr. Ware, a 1930 Wharton alumnus who served as a U.S. congressman and a university trustee.
“The gift is a way to bridge the past and future,” says Paul Ware, president and chairman of the Oxford Foundation. “Dr. Lee and her team will make breakthroughs, and the quality of life will be improved for people who have never heard of Dr. Lee or John Ware.”
Pushing the Frontier
In six years, the Center for Bioethics has grown from ground zero into a world-renowned resource for those grappling with today’s challenges in medicine. Government leaders and medical professionals turn to the center for advice on issues ranging from transplants to human experiments. The director, Arthur Caplan, Ph.D., leads the federal government’s advisory committee on blood safety. And the center’s Web site (www.bioethics.net) receives up to 350,000 hits a week.
The center’s prominence attracted Robert L. Hart’s attention. Mr. Hart, a Floridian with no previous connection to Penn, became interested in bioethics when his father, Emanuel, became ill. To honor his father’s memory and strengthen the center, he created the Emanuel and Robert Hart Chair of Bioethics through a charitable gift annuity.
“We have many, many more ethical questions today than we had 50 years ago because of our success in medicine, and rapid development always creates confusion,” Dr. Caplan says. “Is it acceptable to do stem cell research? Is cloning OK? Should we make an artificial life form? These questions have profound moral implications that we, as a society, must confront.
“Bioethics is always controversial, and there is a danger of offending someone at every turn. Private gifts give us a secure base and allow our faculty to push out to the frontier when foundations and federal grant makers aren’t there yet.”
When Albert M. Kligman, GA’42, M’47, GME’51, headed for the University of Pennsylvania 60 years ago, he left a household depleted by the Depression and bewildered by a son’s desire to go beyond high school. Without a penny to spend on his education, he found the financial support he needed to earn his medical degree and three other degrees at Penn and to go on to become an internationally renowned research dermatologist. Dr. Kligman and his wife, Lorraine Kligman, Ph.D., a research professor in the Department of Dermatology, knew what they wanted to do when they heard about the Welsh Challenge — they established the Albert M. Kligman, M.D. and Lorraine H. Kligman, Ph.D. Scholars Fund.
“What chance do these inner-city kids have today to even dream of being able to pay the $32,510 that tuition and fees cost each year? And some of these kids are so bright, so idealistic; I stand next to them in the lab and wonder if I could compete today.
“I have been handsomely rewarded for my work, and my life has been very satisfying. I feel morally obligated to give back. But it’s so much more than that. I’m helping select winners, students who wouldn’t have that chance. It gives me great joy. I’m getting back far more than I give.”
Successful op-eds establish the writer as an expert and present a point of view through logic but very, very rarely blatantly promote an organization. In the days after the Sept. 11, 2001, attacks, Director Mary Ellen McNish of the American Friends Service Committee wanted to submit an op-ed to newspapers throughout the country but offered no suggestion about the specific subject matter, only general messages she wanted expressed. Through extensive research, Jana came up with the Marshall Plan analogy (long before it commonly appeared) and details of the Blair plan.
American Friends Service Committee Op-ed:
A Marshall Plan for the 21st Century
By Mary Ellen McNish
With Europe’s economy in smoldering ruins, with thousands of people homeless and starving, with the governments close to collapse, U.S. Secretary of State George Catlett Marshall stood at a lectern at Harvard College <editor: CQ> in 1947 and delivered what many consider the most transforming speech in modern history.
“Europe’s requirements for the next three or four years of foreign food and other essential products are so much greater than her present ability to pay that she must have substantial additional help or face economic, social and political deterioration of a very grave character,” Marshall said.
For the next four years, the United States helped Europe devise a strategy for recovery and contributed the equivalent of $93 billion in aid to the continent’s rebirth.
A component of humanitarianism rested at the heart of the Marshall Plan, but the prime U.S. motivation was far more self-serving: Economic turmoil and political instability in Europe would undermine U.S. security and prosperity.
Today, the resentment born of the United States’ approach to foreign policy and the crushing poverty and repression found in much of the world represent a threat to our security as grave and concrete as we have ever seen. Today, we need a modern Marshall Plan to address the inequities that offer significant risk of leading to more murder and mass destruction in the United States.
Practicing What We Preach
When explaining the motivation of the murderous fanatics who attacked the United States Sept. 11, President Bush and many of our nation’s editorial writers explained: They are jealous of our freedoms. If we believe this, then we need to ask what we have done to help foster freedom and prosperity throughout the world.
The United States speaks as the world’s biggest champion of democracy yet supports some of the Middle East’s most repressive regimes, creating a moral chasm that enrages moderates as well as fundamentalists.
Many of the disaffected come from Saudi Arabia, where the United States helps oppressive rulers stay in power in exchange for use of a highly strategic military base. With the United States’ help during the cold war, the Taliban came to power after routing the Soviets from Afghanistan; the Afghans now live in heart-wrenching conditions. And the Iraqi people, already oppressed by Saddam Hussein, suffer dire depravation from economic sanctions and U.S. bombing for crimes they never committed or condoned.
The world might look much different if the United States let respect for freedom and equality guide foreign policy.
A Marshall Plan for the 21st Century
Just as personal introspection has accompanied the fear and aching loss most Americans have felt since Sept. 11, the United States must reach to a far deeper and more lasting level to address this security threat than a $40 billion military “solution” will allow.
When Secretary Marshall spoke to the Harvard class of ’47 more than a half-century ago, he called on Europe to devise its own recovery plan, saying unilateral decisions by the United States would be arrogant and ineffective. The breakdown in longstanding enmities since Sept. 11 gives the United States an unprecedented opportunity to help transform the world again in Marshall’s spirit — by offering meaningful humanitarian and economic aid without foisting our own culture on other nations.
Less than a year ago, Prime Minister Tony Blair’s government in Great Britain released a detailed blueprint to help countries reach a sound balance between good social policy and good economic policy (http://www.globalisation.gov.uk/). The 15-year plan, designed to bring the benefits of globalization to the world’s poorest people, offers concrete proposals for cutting extreme poverty in half, establishing universal primary education, fostering equality for women and helping other countries devise development strategies.
For the sake of our security we can no longer ignore the plight of others. The Blair blueprint offers the Bush administration a solid starting point for a new Marshall Plan that will involve all developed countries as partners against poverty. In Secretary Marshall’s words: “Our policy is directed not against any country or doctrine but against hunger, poverty, desperation and chaos.”
Mary Ellen McNish is general secretary of the American Friends Service Committee, an international Quaker organization committed to social justice, peace and humanitarian service. The AFSC accepted the Nobel Peace Prize on behalf of Quakers in 1947, the same year the United States introduced the Marshall Plan.
Jana strongly believes in following strict journalistic principles in writing news releases and fact sheets for reporters. She also follow the age-old guidelines of making the releases interesting and relevant, not always easy with complicated information.
Below is a news release for the Project on Medical Liability in Pennsylvania and another for the National Board of Medical Examiners on a public opinion poll Jana designed and commissioned to generate publicity (the story received widespread coverage from outlets ranging from The New York Times to NPR). The third item is a fact sheet in the case against The Rev. Beth Stroud, a Philadelphia Methodist minister prosecuted by the church for living in a committed relationship with another woman; the case attracted worldwide attention.
Project on Medical Liability in Pennsylvania News Release
Report Identifies Reforms to Address Malpractice Crisis
Independent Initiative Recommends Face-to-Face Mediation,
Frank, Open Communication About Medical Errors
PHILADELPHIA — A new report issued by an independent initiative outlines procedures that could ease the state’s malpractice insurance crisis while improving patient safety and benefiting relatives, doctors and hospitals.
The report — from the Project on Medical Liability in Pennsylvania, an initiative financed by The Pew Charitable Trusts — notes that ineffective communication is the primary reason patients and families sue. Citing extensive research, the report recommends open, meaningful communication by health professionals about medical errors and mediation to avoid costly lawsuits.
The paper comes as Pennsylvania hospitals struggle to comply with a precedent-setting 2002 law requiring them to explain to patients or their relatives the circumstances and repercussions behind serious health complications or deaths caused by medical errors.
“These recommendations are designed to create a culture that supports candor, the free exchange of information, fair outcomes for patients and physicians and improved patient safety,” said Professor Carol Liebman, an expert in mediation at Columbia Law School who co-wrote the report with Chris Stern Hyman, a lecturer at Columbia and partner in the Medical Mediation Group LLC.
The cost of medical malpractice insurance in Pennsylvania has spiked, and physicians in high-risk specialties have moved, closed their practices or retired, particularly in eastern Pennsylvania. At the same time, doctors and hospital officials fearful of lawsuits generally have shied away from candor, often enraging patients and relatives by offering only barebones explanations of errors and stonewalling. Research shows this situation creates a vicious circle: Anger often motivates patients or survivors to file medical malpractice suits.
The report, issued by the initiative’s Demonstration Mediation Project, recommends four measures:
· Provide communications training to doctors and administrators.
· Create a team of communications experts from within the hospital to help plan meaningful conversations with patients and relatives and to provide emotional support to health-care providers involved in errors.
· Offer legitimate apologies when appropriate.
· Use mediation sessions that bring patients or relatives together with health-care professionals within months of when the problem occurs.
“Lawsuits take four or five years to resolve,” Hyman said. “The costs — emotional and financial — are debilitating for both sides. The type of mediation that we recommend, where both sides get together to reach a settlement, not only results in fair compensation for patients or families under a much quicker timeline, but it also can bring changes in hospital procedures to improve safety, a result no court could order.”
The medical profession long has recognized communications as a weak point among doctors — the organizations overseeing the medical licensing exams added a complex segment last year to test students’ communications skills. In addition to defensiveness, the report says, the problem often rests in health-care professionals making assumptions or taking a patient’s words at face value instead of trying to determine the true meaning behind a statement. Frustration and anger on both sides result.
The report recommends two-day training sessions to familiarize health professionals with the complexities of meaningful communications. During the sessions, they learn how to formulate the right questions, to avoid defensiveness and to express concern about the issues at the center of a patient’s statements, all techniques that tend to diffuse anger by making a person feel respected and understood.
But the training is not enough, the report says, because deaths or serious problems created by health-care professionals rarely occur, meaning doctors receive few opportunities to keep skills sharp. Instead, a team of hospital employees adept at communications should meet with the doctors and administrators involved in an error to anticipate questions and concerns, to formulate explanations that laymen can understand and to determine the best way to support the patient or family. A team member needs to accompany health-care professionals meeting with relatives to make sure they are heard and to identify any patient safety problems that need addressing, the report says.
The authors acknowledge that the third recommendation — offering a legitimate apology — holds risk, because all but two states allow plaintiffs to use doctors’ statements as evidence.
“But the risks need to be weighed against the benefits,” Liebman said. “There is growing research evidence that apologies reduce litigation, save money and have great benefits for patients, families and the health-care provider who made mistakes.”
At the crux of the recommendations lies mediation, a technique already practiced by a handful of hospitals, including the Drexel University College of Medicine in Philadelphia. In all cases, the proceedings are voluntary. They remain confidential, meaning nothing said can be submitted into evidence, and patients unhappy with the results retain the option to go to court.
In most cases involving malpractice mediation, the two sides rarely meet to negotiate: The mediators shuttle from side to side, usually focusing only on financial issues. The sessions occur long after the error to give each side a chance to prepare a case.
The report recommends a far different approach. In this case, the two sides meet face-to-face and the mediator helps them gain understanding, asses the strength of their positions and reach a settlement together. Both sides have the opportunity to ask questions and to express feelings.
Without the need to gather “evidence,” the session can occur within months of the error instead of years. And because the medical professionals hear the survivors’ concerns and complaints, improvements to hospital procedure can result.
“Unlike the other approach, this type of mediation goes beyond financial terms,” Hyman said. “When mediators encourage the participants to include other provisions such as staff training to avoid similar errors or a memorial lecture, both sides may feel that the resolution has given meaning to a tragic event,” Hyman said.
For the report, Liebman and Hyman spent two years reviewing extensive research on medical errors and their effects on survivors as well as health-care professionals. The authors also conducted training sessions and in-depth interviews at three hospitals and two mediation sessions at one.
The $3.2 million Project on Medical Liability in Pennsylvania (http://medliabilitypa.org/ ) was designed to provide policy makers with objective information about the medical liability system; to broaden participation in the medical liability debate to include new constituencies and perspectives; and to focus attention on the relationship between medical liability and the overall health and prosperity of the commonwealth.
National Board of Medical Examiners News Release
Americans Overwhelmingly Support New Medical License Test;
Field Trials Show Fairness, Reliability of Test
PHILADELPHIA, PA — An overwhelming majority of Americans consider good clinical and communication skills critical for physicians and believe students should pass an examination that tests these skills before receiving their medical licenses.
Two-thirds of Americans also believe state medical boards should add the exam to existing licensing requirements even if it costs students $1,000, according to a poll by Harris Interactive®..
As part of the licensing process, medical students have not been tested on their clinical skills — their ability to gather information from patients, perform a physical examination and communicate their findings — since 1964, when concerns about objectivity ended tests involving real patients.
The board overseeing the United States Medical Licensing Examination, or USMLE, voted Jan. 17 to begin requiring students to pass a new clinical skills exam that has undergone 15 years of testing for fairness and objectivity. The USMLE board considers the exam an issue of public safety: Poor clinical and communications skills have been linked to a higher incidence of malpractice suits, lower treatment compliance by patients and decreased patient satisfaction.
The two organizations sponsoring the USMLE plan to implement the clinical skills exam in 2004. It will be required for medical students starting with the graduating class of 2005. The exam will be administered in five cities at a cost of about $1,000 to students.
Unlike the other components of the USMLE, which rely on multiple-choice questions and clinical case simulations administered by computer, the clinical skills exam involves one-on-one personal encounters in a clinical setting.
During field trials last year in Philadelphia and Atlanta, 858 students from seven U.S. medical colleges examined 10 “standardized patients,” lay people trained to act like patients. After each 15-minute exam, students had 10 minutes to record pertinent history and physical examination findings, list diagnostic impressions and outline any plans for further evaluation.
The field trial results prove the test can be administered reliably and fairly in multiple centers and in different regions of the country, according to Dr. Donald Melnick, president of the National Board of Medical Examiners®, which develops the USMLE and co-sponsors the exam.
The Harris Interactive survey of more than 1,000 adult Americans, conducted Dec. 12 through Dec. 16, 2002, shows that 97 percent consider clinical skills very important or extremely important when selecting a physician; 87 percent want to see students pass a clinical skills exam before receiving their medical license.
The poll was commissioned by the Federation of State Medical Boards®, which also co-sponsors the USMLE.
Performance data for international medical graduates who took the same test in the same centers as the U.S. students participating in the pilot exam were also utilized in studying the exam’s characteristics. Since 1998, graduates of foreign medical schools who want to enter post-graduate training programs in the United States have faced a clinical skills test administered by the Educational Commission for Foreign Medical Graduates®, or ECFMG®.
Under standards established by ECFMG, about 83.3 percent of the international graduates passed. The results mirror the performance of international graduates in previous years, when all tests were administered in Philadelphia.
American students who took the exam as part of the field trials performed at about the same level as the international students whose native language is English. No specific scores for Americans were released because the participating medical schools required their fourth-year students to take the exam but did not grade them on the results. The USMLE has not yet established a pass/fail cutoff.
“We need a national standard so the American public knows their physicians enter practice with core competencies,” Dr. James Thompson, Executive Vice President of the FSMB, said. “This exam will establish that standard.”
Medical schools vary greatly in the emphasis they place on clinical skills. In a survey of students participating in the field trials, 4 percent said they had never taken a history or conducted a physical examination under the watch of a faculty member, and 20 percent said they had been observed only two or fewer times.
Just over half of U.S. medical schools require students to take a comprehensive clinical skills exam before graduating, according to data published by the American Medical Association.
All state medical boards require physicians to pass a national medical knowledge examination before receiving a license.
(For more information about the survey and field tests, visit www.usmle.org/news/cse.htm.)
The Rev. Beth Stroud Fact Sheet
The Rev. Irene Elizabeth Stroud’s Case
The Rev. Irene Elizabeth Stroud
The Rev. Irene Elizabeth (Beth) Stroud, 35, joined the First United Methodist Church of Germantown in Philadelphia as an associate pastor July 1, 1999. She oversees the youth programs and preaches; until she was stripped of her credentials in December 2004, she also offered communion and performed baptisms and wedding ceremonies. Previously, she served as associate pastor of West Chester United Methodist Church. She earned her undergraduate degree from Bryn Mawr College in 1991 and a master’s of divinity degree from Union Theological Seminary in New York in 1996. Under the process in place at the time, she was ordained as a deacon in the Eastern Pennsylvania Conference of the United Methodist Church in1997 and became a full member of the conference in 2000.
The process that led to the church charges against Stroud started April 27, 2003, when she told the congregation about her relationship with Chris Paige, 33, a consultant to small businesses and nonprofit organizations. They have lived together for almost five years.
In April 2003, Stroud told the congregation in a letter and a sermon that she is a lesbian living in a committed relationship with Paige.
In reaction to the announcement, the eastern Pennsylvania bishop started a process that led to a formal charge of engaging in “practices declared by the United Methodist Church to be incompatible with Christian teachings.” A trial was held on Dec. 1-2 at Camp Innabah, a United Methodist camp and retreat center in Spring City, Pa., about 30 miles north of Philadelphia. The presiding judge, retired Bishop Joseph H. Yeakel of Smithsburg, Md., refused to allow Stroud’s team to argue that the law violated the church’s constitution, forcing the 13 ordained United Methodists serving as jurors to consider only whether she was a “practicing homosexual.” The jurors voted 12-1 to convict Stroud; they voted 7-6 to strip her of her credentials.
Stroud took the case to the United Methodist Church’s Northeast Jurisdiction Committee on Appeals, which held a hearing April 28 outside Baltimore. The appeals committee could examine only whether the charges and the circumstances of the case had violated church law, not whether prohibiting “practicing homosexuals” from serving as clergy represented a just law. The next day, the committee — composed of four ministers and five lay members — ruled 8-1 that grave errors existed in the case. The ruling overturned the conviction and required the church to reinstate Stroud’s credentials, though she has elected not to perform the sacraments before the final ruling this fall.
The committee’s logic (see www.umc.org for the full ruling) centered on two facets: The church’s failure to define two terms — “status” and “self-avowed practicing homosexuals” — and the phrase “because homosexuality is incompatible with Christian teaching.” The church appealed the ruling to the Judicial Council, the United Methodists’ rough equivalent to the U.S. Supreme Court. The Judicial Council will hear Stroud’s case Oct. 27 in Houston; a ruling is expected within days.
The case represents a rarity in the United Methodist Church. Since 1940, the Judicial Council has heard only 12 trial appeals.
The Rev. Jim Hallam, minister at Lima United Methodist Church in Lima, Pa., and Alan Symonette, an attorney who serves as a lay leader at Stroud’s church, the First United Methodist Church of Germantown, will represent Stroud before the Judicial Council. The Rev. Tom Hall and attorney Robert Shoemaker Jr. will argue for the church.
The Book of Discipline, which outlines the laws of the United Methodist Church, says “because homosexuality is incompatible with Christian teaching, self-avowed practicing homosexuals are not to be accepted as candidates, ordained as ministers or appointed to serve” as pastors. The church’s constitution prohibits discrimination of any kind based on “status.”
As the appeals committee noted, the Judicial Council in previous cases has found the terms “self-avowed practicing homosexuals” and “status” vague and ordered the General Conference — the church’s rough equivalent to the U.S. Congress — to explicitly define the terms. The conference, which meets every four years, has failed for almost a decade to follow the council’s orders. This failure, the appeals committee said, robbed Stroud of due process in the case.
Stroud’s team argues that, according to accepted definitions, “status” refers to a condition beyond a person’s control, and homosexuality, according to all current medical research, fits the definition.
The second main point of church law in the case centers on the phrase “because homosexuality is incompatible with Christian teaching.” Stroud’s team argues, and the appeals committee agreed, that the phrase constitutes a doctrine under United Methodist law because it makes a pronouncement about the essence of Christian teaching. The United Methodist Church requires a constitutional amendment or an explicit declaration by the General Conference to add a new doctrine to church law. Neither has occurred.
Stroud’s side also argues that the ban on homosexual clergy runs counter to other Methodist laws. The Book of Discipline says: “Inclusiveness means openness, acceptance and support that enable all persons to participate in the life of the church, the community and the world. Thus, inclusiveness denies every semblance of discrimination.” In addition, it says sexuality is “God’s good gift to all persons,” homosexuals are “individuals of sacred worth,” “God’s grace is available to all” and “certain basic human rights and civil liberties are due all persons.”
In reaction to an acquittal in a similar case, the Judicial Council ruled a year ago, without addressing the doctrine controversy, that the church finds homosexuality incompatible with Christian teachings and reaffirmed the church’s ban on the ordination and appointment of gay and lesbian pastors. The council did not consider whether the prohibition on ordination of homosexuals violates the church constitution.
In March 2004, a jury acquitted the Rev. Karen Dammann of Ellensburg, Wash., of “practices incompatible with Christian teachings” for living with another woman in a committed relationship. In a statement, the jury said, “We searched the Discipline and did not find a declaration that ‘the practice of homosexuality is incompatible with Christian teaching.’ ” Instead, the jury cited references in the Discipline to the “sacred worth” of homosexuals and the church’s abhorrence of discrimination.
The Judicial Council ruling and the addition of the words “declared by the United Methodist Church” in the formal charge against Stroud precluded her from using the reasoning that led to Dammann’s acquittal.
The church has filed only one other case against a homosexual minister. The first United Methodist trial involving homosexual issues was held in 1987. The church convicted the Rev. Rose Mary Denman, a lesbian minister in New Hampshire; she later wrote a book about her struggles with the church.
First United Methodist Church of Germantown
The 210-year-old First United Methodist Church of Germantown, which straddles one of Philadelphia’s wealthier areas and one of its poorer, attracts a diverse congregation of almost 1,000 members. Long known for social activism, the congregation belongs to the national United Methodist movement Reconciling Ministries Network, which advocates the full inclusion of gays and lesbians in church life.
The church is part of the Eastern Pennsylvania Conference of the United Methodist Church, which encompasses 498 churches with more than 138,000 members in 16 counties.
United Methodist Church
The United Methodist Church, which traces its founding to 1744, is the third largest denomination in the United States. The church claims 8.3 million members in the United States and about 1.5 million members in other countries. The controversy over homosexuals has divided the church for three decades.
Links of Note
First United Methodist Church of Germantown: www.fumcog.org
The Rev. Irene Elizabeth Stroud’s defense: www.bethstroud.info
Eastern Pennsylvania Conference: www.epaumc.org
United Methodist Church: www.umc.org
Reconciling Ministries Network: www.rmnetwork.org