Addressing the Issue of Violence in Health Care Facilities

• 6/17/2010
• Author: Steven Berman
• Category: The Journal Blog
• 9560 Views
• 0 Comments
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A new Joint Commission Sentinel Event Alert, Preventing Violence in the Health Care Setting, warns that health care organizations and their patients and visitors are now confronting steadily increasing rates of crime, including assault, rape, and murder. The Alert advises that while it is imperative to control access to the facility and maintain ongoing surveillance of the grounds, administrators must be alert to the potential for violence to patients by health care staff members. The stressful environment, together with failure to recognize and respond to warning signs such as behavioral changes, mental health issues, personal crises, drug or alcohol use, and disciplinary action or termination, can elevate the risk of a staff member becoming violent towards a patient. The Alert lists 13 suggested actions that health care organizations can take to prevent violence.  I asked Kenneth W. Kizer and Beatrice C. Yorker, authors of a recent Journal article, “Health Care Serial Murder: A Patient Safety Orphan," to comment on the Alert. We welcome your own comments.

We applaud The Joint Commission for issuing its recent Sentinel Event Alert. A variety of data indeed indicates that instances of physical violence in health care settings are occurring more frequently and that such occurrences are sometimes difficult to recognize.

While the focus of our article was on the specific problem of health care serial murder, the issues and challenges, as well as the recommendations on the actions that should be taken to better address this problem, are applicable to health care-related violence in general.  In light of recent civil litigation claiming that hospitals have a “duty to warn” other hospitals if a nurse or health care employee has been suspected and/or investigated for adverse patient outcomes,¹ we suggest that health care risk management practices be reviewed and modified, if needed, so that they encourage and support hospitals and other health care organizations in their efforts to provide honest and complete employee evaluations. 

Further, covert video surveillance, a tool cited in the Alert, may be useful in health care settings, notwithstanding the issues raised by its use. Yorker concluded that covert video surveillance does not violate one’s constitutional right to privacy in situations involving patient safety and in which vigilance is expected as part of the standard of care. It has been found to be effective in deterring and preventing some types of health care harm (for example, in cases of Munchausen Syndrome by proxy).²
 
In addition to physical violence, other types of intentional health care harm, such as medical-identity theft and intended health-privacy breaches, performance of unnecessary medical interventions for financial or other nonmedical reasons, and illegal harvesting of body parts, are clearly on the rise. Hopefully, the Joint Commission will address them in a subsequent Alert.

As disturbing as it may be to think that some health care providers might intentionally harm patients, the regrettable reality is that for a variety of reasons, some do. It is time to recognize that it is too easy for rogue health care workers to commit crimes against patients. As we argued in our article, as an enterprise, health care needs to take a more proactive and concerted approach to preventing such occurrences.

References
1. In re: Charles Cullen (2010 N.J.) - Court of Common Pleas, Lehigh County #2005-C-3330.

2. Yorker B.C.: Covert video surveillance of Munchausen Syndrome by proxy: The exigent circumstances exception. Health Matrix Clevel  5:325-346, Summer 1995.