Patient safety
Here are a just a few recent headlines involving sexual abuse or misconduct with patients:
• A physician is sentenced to 14 years for sexually assaulting patients.
• 8,000 women whose bodies may have been videotaped or photographed by a gynecologist using a pen-like camera during pelvic exams.
• A top pediatric cancer doctor is sentenced for child pornography.
• A paramedic admits to sexually assaulting an unconscious woman strapped to a stretcher.
• A radiology tech performs an unauthorized vaginal exam following a pelvic ultrasound.
• An employee describes constant sexual misconduct and assaults at an Arizona state mental hospital.
• patient.
• A prison guard is accused of sexually assaulting a female inmate in a hospital room where she was taken to have her appendix removed.
• A surgeon slaps sedated patients’ buttocks, uses derogatory terms. • A psychologist calls it touch therapy, but patients call it sexual assault.
In most of these cases, alleged or actual perpetrators are accused of taking advantage of their positions of power to sexually abuse vulnerable patients who seek medical care and treatment. These scenarios are especially serious in the public’s opinion. Instead of a masked perpetrator still can cause the kind of harm, pain, and losses that come from other types of assault, and the betrayal of trust and resulting publicity can be much more damaging to an organization’s reputation.
MANAGE THE RISK According to patient safety and risk management specialists, one of the best things a healthcare organization can do to reduce risk in all areas of patient safety is to implement a strong quality assessment and performance improvement (QAPI) program. Well-run QAPI programs safety, care quality, or security.
As part of the QAPI program, conduct an internal assessment using a
checklist or guidelines for assessing and reducing sexual abuse liability risks. Below are a few tips from the Sexual Abuse Liability Risk Assessment Tool developed by OmniSure Consulting Group that will help jumpstart the process.
68 | HEALTHCARE RISK MANAGEMENT REVIEW | Annual 2014
Assess the patient intake and education process Some patients are at higher risk than others due to prior victimization, poor boundaries, or risky behavior. Make sure you have established your facility. Assess the patient’s or client’s needs, mental health concerns, and social background for issues related to criminal conduct, likelihood of sexual aggression, or risk of victimization.
outline conditions under which a patient may be discontinued from service or involuntarily discharged. In counseling situations, educate patients about therapeutic boundaries, referencing the appropriate professional code of conduct and making clear some things are never acceptable.
In settings such as mental or behavioral health, assisted living, and
new patients or clients.
Review the employee screening and selection process Employment applications should not only question whether applicants have ever been convicted of a crime, including physical, sexual, or child abuse, they should also include a self-disclosure statement for sanctions the applicant has worked. They should also authorize the organization to complete reference and criminal background checks.
Make sure outsourced agency or independent contractors comply with
application that includes questions about criminal history and sexual misconduct.
Update orientation and training practices Prior to allowing employees to treat or work with patients, provide orientation programs with training on ethical, clinical, and legal issues surrounding boundary violations and sexual misconduct. Discuss ethics, law, risk factors, vulnerability, accountability, stages of boundary crossing versus boundary violation, warning signs, and examples of slippery slope scenarios.
Employee handbooks should clearly prohibit unprofessional
relationships with clients and outline rules for reporting dual relationships, disruptive physicians or providers, and allegations of abuse.
Require appropriate procedures and supervision Make sure to establish procedures for patient interactions with clinicians comply with federal and state regulations so that all applicable private exams or treatments are supervised or occur in the presence of a chaperone or appropriate observer.
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