DALLAS — October has not been kind to Texas Presbyterian Hospital.
Ever since the first Ebola patient to be diagnosed in the United States arrived at the Dallas hospital late last month, the facility has waged an uphill battle of public relations.
"Presby" as it is affectionately known, immediately became a symbol of how healthcare providers in the United States may be unprepared to handle the virus that has killed nearly 5,000 people in West Africa.
Now, the hospital, which received close to the national average scores in most categories when it was last reviewed by the Department of Health and Human Services, is trying to convince the nation that it remains a safe, competent place. And it is doing so largely through social media.
Facebook and Twitter posts — mostly with the hashtag #PresbyProud — began sprouting up on Oct. 2. Some of them appear to be heartfelt expressions of anger, wounded pride, and mutual support on the part of individual members of the hospital staff. But other posts feature high production values and are heavily branded with the hospital's logo — which, as The Guardian reported, suggests a coordinated public relations campaign.
Burson-Marsteller, the New York-based public relations firm retained to handle the media firestorm surrounding the hospital, told BuzzFeed News that the hashtag was started independently by an individual member of the hospital staff and that there was "no coordinated effort" to use it.
Whatever the provenance of the hashtag, the posts provide a window into a hospital in crisis. Presbyterian stands to lose millions of dollars if it cannot regain the confidence of the public. It also faces a potential labor conflict, as disgruntled members of its non-unionized workforce appeared to have reached out to National Nurses United, the largest health care worker's union in the United States.
But even though the story's protagonists have taken to the internet to voice their concerns, in real life they remain stubbornly silent.
BuzzFeed News reached out for comment to more than a dozen nurses at Presbyterian — in person, over the phone, and through social media. Every one declined requests for comment. The hospital's public relations office also did not return requests for comment.
All of which raises the question of who, exactly, is #PresbyProud?
It all began on Sept. 25, when Thomas Eric Duncan, who had just arrived in Texas from Liberia, showed up at Presbyterian's emergency room complaining of a fever — and was soon turned away.
Duncan returned to the hospital on Sept. 28, with worsened symptoms. Two days later, the Centers for Disease Control confirmed he had Ebola.
Suddenly, media from around the world began lambasting the hospital for failing to admit a man whose symptoms and travel history marked him as a prime candidate to have a contagious disease that can kill up to 70% of those it infects.
It mattered little that Presbyterian's emergency department is not actually run by the hospital, but by an outside contractor, as the Dallas Morning News reported. The hospital and its staffers became scapegoats.
From that point, the situation only got worse. On Oct. 8, Duncan died of the disease. Four days later, one of the nurses who cared for Duncan tested positive for the virus. The CDC immediately blamed her and the hospital for not following safety protocols designed to protect health care workers treating Ebola patients, further damaging the hospital's reputation.
Less than a week later, on Oct. 15, a second nurse at the hospital was diagnosed with Ebola. Revelations that the nurse had traveled on an airplane after having been in contact with Duncan, potentially exposing dozens of people to the virus, only increased the scrutiny of the hospital's employees.
That very same day, a powerful union threw its weight into the game.
Saying a number of nurses had come forward to denounce unsafe working conditions at Presbyterian, National Nurses United published a scathing report accusing the hospital of putting the nurses in physical danger.
"The nurses strongly feel unsupported, unprepared, lied to, and deserted to handle the situation on their own," the NNU report said.
Whether the CDC was right, and Presbyterian's nurses had not followed protocols, or NNU was right, and those protocols had not been around in the first place, the hospital looked as if it was unprepared.
Presbyterian attempted to defend itself, saying in statements that the NNU's allegations did not "reflect actual facts learned from the medical record and interactions with clinical caregivers" and that the nurses had followed CDC protocols and become infected anyway. (The CDC has since amended its safety guidelines for people treating Ebola patients).
The infected nurses were sent to other facilities known to be more experienced in treating infectious diseases like Ebola. Amber Vinson was transferred to Emory University Hospital in Atlanta; Nina Pham was sent to the National Institutes for Health facility in Maryland.
Presbyterian has routinely refused requests from BuzzFeed News and other news organizations to provide more information about the Duncan case and the subsequent infections. Even general questions about the record-keeping system have been ignored — or are indefinitely "under consideration" for a response — and the strategy seems to primarily include offering as little information as possible.
Despite the hospital's denials, the criticisms by the NNU and the CDC had a predictable result: People do not seem to want to be treated there anymore.
The toll the crisis has taken on the hospital was clear on Tuesday when, at lunch time, the cafeteria was mostly empty. Later, a nurse who was walking the halls — and eating pizza that another staffer brought in as a morale-booster — confirmed to BuzzFeed News that the hospital was less busy, though she declined to give her name or provide details. And outside, empty parking spaces are now the norm.
"I don't think there are as many people there now," Aaron Dunn, who regularly visits the hospital with his pregnant wife, told BuzzFeed News late last week. "Maybe people don't want to be around there right now. There was a little bit better parking."
Some physicians also privately acknowledged that patients are staying away from the hospital — a cardiologist recently told the Dallas Morning News that his department has seen visits decrease 60 or 70% since the crisis began.
The financial health of the hospital, which has yearly revenues of about $600 million, could suffer from the crisis even in the long run. Shortly after the crisis began, Moody's Investor Services downgraded the long-term creditworthiness of the hospital's parent company from "positive" to "developing," the Dallas Morning News reported.
#PresbyProud began appearing online shortly after Duncan was diagnosed with Ebola, when the hospital began facing intense criticism.
The hashtag's origins are mysterious, but it appears to have started on Twitter on Oct. 2, barely two days after Duncan was admitted to the hospital and almost a week before his death. The first person to use it in the context of the Ebola crisis — as opposed to as a celebration of the Presbyterian faith — appears to have been a Texas woman named Paula Miller.
According to Topsy, a Twitter analytics site, the hashtag has since been used some 850 times — a measly number compared with a hastag like #handsup, which served as a rallying cry for the Ferguson protests against police brutality and was used tens of thousands of times. A good number of those tweets came from official hospital accounts or from those of top managers.
But on Facebook, many of the posts appear to be sincere efforts on the part of Presbyterian staff members to support one another through a time when strangers are questioning their competence. A community page called Presby Strong and Proud, for example, has 2,639 likes and is dedicated to provide a "POSITIVE support system" for the hospital's staff.
"So I wake up this morning to the news of the new diagnosis," began a post published on the page last Thursday, the day after Amber Vinson became the second nurse to test positive for Ebola. "I am both saddened and angry. It is ok for us to feel sad, disillusioned, disappointed, and even angry. It is more important now that we continue to be strong and support each other, our family, our coworkers, our friends, and ourselves. No one knows what really went on in that room with Mr Duncan, all of this is new to us. Just remember that at this point we can not change the past."
In another post tagged #PresbyProud, this one from Monday, a health care worker named Jessica Williams published a collage of photos of Vinson on her personal page.
"She is thorough in everything she does, compassionate to everyone she cares for, and a remarkable individual," Williams wrote in the post. "She is a wonderful nurse that followed the rules given to her from a higher power. I love her from the bottom of my heart, and it hurts that people believe they have the right to judge her."
But other posts using the hashtag on Facebook, Twitter, and YouTube, many of them posted using official hospital accounts, seem designed as a direct response to the allegations brought forth by National Nurses United. Although the posts have high production value, they seem designed to give the impression that the health care workers they feature are speaking for themselves.
In a YouTube video posted on the hospital's channel and tweeted from accounts bearing the hashtag, three nurses wearing #PresbyProud pins say that the hospital did its best to care for Duncan and insist that they are proud to work at Presbyterian.
"My name is Amy McCarthur, and I am always Presby proud and Presby strong," one of the nurses say in the video. "I love my team!"
The upbeat tone of the video and other posts like it paint a very different picture from the allegations detailed in the NNU report. Charles Idelson, a spokesman with NNU, dismissed the hashtag as an orchestrated campaign to create the illusion that nurses support the hospital's management.
"You have to understand that this is a non-union hospital," Idelson told BuzzFeed News. "We have heard that nurses have an understandable fear of retaliation if they express a different point of view. This calls into question the campaign that has been orchestrated by a PR firm in consultation with hospital executives."
When asked whether NNU was actively trying to organize the health care workers at Presbyterian, Idelson simply said that the union "invites nurses in every non-union hospital in the U.S. to join our organization" and declined to comment further.
The Presby nurses seem unwilling or unable to discuss the situation themselves. Late last week, BuzzFeed News approached several nurses in the hospital's cafeteria. Most refused to say anything at all, though one curtly added that "we do our job and do it well. We don't want you here."
On Tuesday, two nurses — who were standing near a display of posters and cards from other hospitals — said they were touched by the outpouring, but quickly added that they weren't permitted to speak to the press.
In fact, members of the nursing staff have only publicly spoken out once: During a news conference held outside the hospital on Monday. At the conference, Dr. Cole Edmonson, the head of nursing management at Presbyterian, read a set of prepared remarks insisting that #PresbyProud was not the creation of the hospital's communication staff.
"We are a proud family. We know we need to reaffirm the public's trust in us," Edmonson said at the conference. "We ask that they stand with us today."
Nurses Chantea Irving and Juile Boling followed Edmonson, both reading prepared statements that they held in quivering hands. They were flanked by dozens of other nurses, most of them wearing blue scrubs.
After the remarks were over, members of the press shouted questions, including asking the nurses if they felt safe at the hospital. Edmonson merely shook his head, and all the nurses turned their back to the cameras and filed back into the hospital.
Nicolás Medina Mora is a reporter for BuzzFeed News and is based in New York.
Contact Nicolás Medina Mora at email@example.com.
Jim Dalrymple is a reporter for BuzzFeed News and is based in Los Angeles.
Contact Jim Dalrymple II at firstname.lastname@example.org.
Got a confidential tip? Submit it here.