Identity mix-up shows need for good PR but not new risk policies

Teen-age girls misidentified after car accident, wrong parents notified

The story got a lot of media attention because it sounded like a cruel twist to every parent’s nightmare: The hospital calls two sets of parents after their daughters are involved in a car accident, but the grim reports get mixed up. The surviving teen’s parents are told she is dead, while the dead teen’s parents are told she survived.

How could such a huge mistake occur at a respected medical center? Does it mean there is a serious flaw in the hospital’s procedures?

Even though everyone involved admits it was a horrendous mistake that only compounded the families’ grief, the error may not be the lawsuit magnet it first appears. Sources tell Healthcare Risk Management that, like many highly publicized hospital errors, the identity mix-up may not result in lawsuits against the hospital. Nevertheless, they also say there are lessons to be learned about how such a high-profile incident should be handled to lessen the damage.

Risk managers and hospital administrators often are so mortified by such incidents that they try to stick their heads in the sand and just hope the reporters will go away, says Greig Coates, MD, JD, an attorney with Mithoff and Jacks law firm in Austin, TX. His experience on the clinical side of health care, and now as a malpractice attorney, has exposed him to many cases in which administrators missed the opportunity to step in front of the cameras and stick up for themselves.

"I don’t recall anyone from risk management at the hospital trying to explain the incident publicly when it first happened, but I really think that would have gone a long way toward minimizing the damage," he says. "There’s a natural tendency to just be quiet and not say anything, but that can hurt you when you really didn’t do anything wrong."

Particularly in this case, an aggressive response to the situation could have defused some of the initial criticism, Coates suggests. The initial news reports sounded outrageously bad even to risk management professionals because everyone could relate to the idea of being told, in error, that one’s teen-age daughter did or did not survive an accident. But when you hear more of the hospital’s side of the incident, some of that knee-jerk criticism seems unjustified.

The incident occurred on Nov. 26, 1997, when a pickup truck collided with another pickup truck carrying six young people. Two best friends from Franklin, TN, 14-year-old Tiffany Moshier and 16-year-old Tiffany Getty, were among five airlifted to Vanderbilt University Medical Center in Nashville. The other passenger died before being airlifted, and one of the others died at Vanderbilt. The other two were treated for injuries.

The identification problem occurred with the two girls named Tiffany. Exactly how the identities got switched is still being argued by everyone involved, but Vanderbilt spokesman John Houser says it appears the mix-up began when a relative of the other pickup driver incorrectly identified the girls for a police officer in the emergency room, and that information was related to the hospital staff. The relative had said he knew both girls.

While they were similar ages and both white, Tiffany Moshier is small with dark hair while Tiffany Getty was blonde and a few inches taller. Both girls suffered some facial trauma in the accident, but Houser says Tiffany Moshier’s face was not disfigured or bandaged. They had no identification on their bodies at the time of the accident.

The girls’ families were notified of the accident, and Tiffany Moshier’s parents were told she had died. Tiffany Getty’s body had been sent to Williamson Memorial Funeral Home in Nashville, where the funeral director told Tiffany Moshier’s parents they should not view the body immediately because the girl’s face was severely disfigured. The funeral director planned to repair the face as much as possible before the viewing.

But when the funeral home returned the dead girl’s clothing and jewelry to the parents, they commented that something didn’t seem right. They didn’t recognize the clothing or jewelry, and they commented that she must have switched clothing with someone before the accident.

Meanwhile, Tiffany Getty’s family was sitting at what they thought was their daughter’s bedside in Vanderbilt’s critical care unit. For four days, no one raised any questions with the hospital staff about the girl’s identity, Houser says. The girl was on a breathing tube, so she could not speak even though she was conscious for part of the four days. When the breathing tube was removed, she shocked everyone in the room by explaining that she was Tiffany Moshier, not Tiffany Getty. Unknown to her, her death announcement had appeared in that day’s The Tennessean newspaper.

Risk manager says hospital not at fault

While sympathizing with everyone involved and admitting the mistake had tragic consequences, the hospital’s executive director of risk and insurance management, John McCauley, JD, says the initial investigation has not revealed any fault with the hospital’s system of identifying patients. "So far, we don’t see any indication that this mistake happened because our policies and procedures were ineffective," he tells HRM. "It was a tragic mistake, but it looks like it was just a very unusual situation that can’t be blamed on our policies and procedures."

The hospital is continuing to review how the mistake occurred and whether any systematic improvements can be made, but McCauley says he has been dismayed by the slant of the media coverage following the incident. All of the blame has been focused on the hospital, he says, and that is an injustice to the people who worked so hard to treat the accident victims.

"People tend to overlook the fact that we managed to life-flight five teenagers that night and save at least one of them," he says. "That’s no small accomplishment, and it shouldn’t be negated because there was an unusual mix-up that, from what we can tell, was not a result of any shortcoming by us."

And that is exactly the kind of comment that Coates, the malpractice attorney, says could have helped the hospital deflect some criticism immediately after the accident. It is entirely possible that similar comments were available to the media and not used, but Coates says the lesson is still the same: When your facility is being abused in the media and you don’t think you deserve it, get out there and defend yourself.

"If I were a risk manager, I would talk about how there was this whole mangled car full of purses and IDs and they were effectively useless because the two principals had facial trauma," he suggests. "I’d state flatly that we were much more interested in saving their lives than establishing their identities, and the identity didn’t change how we treated them. And if you want to take us to task for concentrating more on saving their lives than identifying them, so be it."

Families didn’t spot ID problem, either

Coates also points out how surprising it is that the families did not question the girls’ identities. That’s especially relevant when considering the potential liability of the hospitals, he says. The hospital spokesman says Tiffany Moshier’s face was slightly swollen and partly obscured by a breathing tube and a cervical collar, but she did not have the severe facial disfigurement that prevented the easy identification of the dead girl.

The Getty family’s inability to recognize that the girl was not their daughter is crucial in assessing how much the hospital is responsible for the misidentification. Though the hospital has not been sued for the mix-up, the Moshier family has retained Nashville attorney James Omer Jr., JD, to pursue legal remedies. Omer tells HRM that he still is trying to figure out just where the identity mix-up began and who might be responsible for the emotional distress that resulted. He says it’s possible the family will sue Vanderbilt University Medical Center, but he also notes that risk manager McCauley has been helpful in providing medical records and explanations.

Coates says the hospital’s potential liability in a lawsuit would depend on just how the mix-up occurred, among other things. If it’s true that a police officer provided the mistaken identity to the hospital staff, that could diminish the potential liability because it’s reasonable to trust information from a police officer after a traffic accident. But if Coates were defending the hospital in a lawsuit, he says he probably would zero in on the fact that the two families could not identify the girls.

"It would be difficult to prove that complete strangers should have picked up on the differences in their appearances when the parents themselves saw the girls over the course of several days and couldn’t do it," he says. "Part of talking about what folks did wrong is talking about what they should have done right. If you can’t prove that this hospital should have done something differently, you don’t have much of a case."

Besides, the situation is so unusual that it could hardly be anticipated, the lawyer says. For the identities to be confused as they were, you must have two patients admitted at the same time, of at least similar appearance and ages, both unconscious, with no identification on their bodies. Even then, the mistake will be temporary and of minimal consequence unless the families themselves compound the error by failing to recognize their children.

The only similar and somewhat more likely situation would be a surgeon coming out of the operating room and telling the wrong parents their son or daughter died on the table, Coates says. But that requires much more actual carelessness than the Vanderbilt mistake, he says.

"In terms of liability, the key can be the reasonableness of the situation," he says. "A surgeon who gets the name wrong will have a lot more explaining to do than the staff in a trauma situation where even the families are mistaken."

In addition, state laws can make lawsuits difficult to press in cases alleging the infliction of emotional distress. Many states require that the plaintiff show the defendant intentionally caused the emotional distress, so it would not be sufficient just to show that the girls’ parents were harmed by the identity mix-up.

Don’t rush to change policy

McCauley, the risk manager at Vanderbilt, tells HRM that administrators are considering policy and procedure changes that would make it even less likely that such a mix-up could occur again. Even though there is no indication that existing policies and procedures were at fault, McCauley says Vanderbilt will want to do anything possible to avoid repeating the experience.

Coates agrees that there probably is no need to change typical hospital policy and procedures based on this one tragic incident, and he says there certainly is no need to write a special policy on identifying trauma victims. That would be overkill, he says, but he also predicts Vanderbilt will do just that. "Given this experience, it will look really bad for them if it happens again in the future and they can’t show that they investigated, devised a solution, and implemented it. It will be an unnecessary addition to the procedures manual and mainly just a legal maneuver, but it’s understandable that they will have to do it."