Nursefriendly.com: Abuse Documentation

Showing posts with label Abuse Documentation. Show all posts

Sunday, March 20, 2011

Felony Child Abuse Conviction, Made Possible Thanks to Nurse's Documentation.

See also: Medical, Legal Nurse Consultants, Clinical Nursing Case of the Week, Clinical Charting and Documentation, Nurses Notes, Courtrooms, Disability, Discrimination, Employment, Expert Witnesses, Informed Consent, Medical Malpractice, Nursing Practice Acts, Pensions, Search Engines, Torts and Personal Injury, Unemployment, Workers Compensation, Workplace Safety:
Each week a case will be reviewed and supplemented with clinical and legal resources from the web. Attorneys, Legal Nurse Consultants and nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material.

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Summary: Child abuse is a "reportable" crime. This means when a healthcare worker suspects in the course of their duties that a child has been abused, it must be reported. Procedures are in place in hospitals and other facilities for the reporting of abused children. In this case, it was the expert documentation of a child's statements by a nurse, physician and field agent that made the conviction of an abuser possible.
The mother and child entered the Emergency Department passing on the way an investigator for the Illinois department of Family Services. The child gave a history of "being kicked by a cow." When initially questioned by the physician and nurse with the mother present this "story" was maintained.
"There are behaviors that children who have been victimized exhibit:
Hyperactivity, Depression, Changes in eating habits, Changes in sleeping habits, Difficulty at bath time, Difficulty at bed time, Regression in behaviors, Bed-wetting, Self destructive behaviors, Increase in accidents, Moodiness, Talking nonsense, Bad dreams, Social difficulties, Fall behind in school, Plays violently with dolls, Hurts animals, Lies
Although from time to time, children normally experience some of the above, consistent or prolonged problems should be brought to the attention of a trusted professional, such as a doctor or therapist."2
Physical examination of the child would reveal extensive bruising and obvious signs of being beaten. The physician commented on this to the child. The obvious signs of abuse were evident on the patient's face, buttocks and down the backs of both his legs. These were carefully documented in his chart by both physician and nurse.
"All states require certain professionals and institutions to report suspected child abuse, including health care providers and facilities of all types, mental health care providers of all types, teachers and other school personnel, social workers, day care providers and law enforcement personnel. Many states require film developers to report."3
When questioned in private, the child gave a different history. He reported that it was not a cow, but in fact his Stepfather that had hit him and hit him repeatedly.
The child stated that he didn't want to tell the truth initially with his mom present. He stated his mother had witnessed the beating. She brought the child to the hospital but "had watched and would not help."
When it was clear that the physician and the nurse "already knew" how he had been hurt, the truth was offered. His complete statement was documented in the nurse's notes. The chart would be later offered for admission into evidence.
When the case went to trial, the defense argued that the child's testimony was "unreliable." They further pointed out that the nurse's observations were "hearsay."
Questions to be answered:
1. Were the nurse's observations of physical trauma and charted statements by the child valid and admissible as "evidence."
2. Did the fact that the child "changed his story" make his testimony unreliable?
When the case went to court, the hearsay testimony was "allowed" over objections by the defense. The Stepfather was convicted of a Felony offense.
A medical chart including nurses notes have long been recognized as legal records. The documentation of the child's physical condition and statements clearly indicated an abusive situation.
In reviewing the child's statements and the situation, it was decided it was unlikely his statements were "made up." It was noted that "typically" children are afraid to tell the truth about an abusive situation in the presence of close family that may be involved. The fact that the child told a different story when 'the parent" was not around made it more likely that she was allowing it to occur.
When the testimony was combined with physical evidence of abuse, it simply could not be dismissed. In all, the Family Services Investigator present, his supervisor and the nurse were allowed to testify.
It should be noted that it was the thorough documentation of the incident by the nurse that made the case. Often testimony by "witnesses" can be dismissed or invalidated by an opposing attorney. Clear and concise documentation in a medical chart by a nursing professional carries much more weight. In this case they spelled out, in detail, what was seen, what was said and actions that were taken. Sometimes this is not the case.
"When an injured patient seeks legal advice about filing a medical malpractice lawsuit, the attorney's first task is to review the medical records. The attorney is looking for specific acts of negligence and at the overall quality of the record. The strongest medical malpractice lawsuits are based on well-documented, specific acts of negligence. In most cases, however, the negligence is inferred from documented and undocumented events."4
While the evidence in this case was overwhelmingly suspicious of abuse, any suspicious circumstances by law must be reported.
If the child came and was treated no action might have been taken. If it was repeated, the family could have sued the hospital for not acting on suspected child abuse!
Related Link Sections:
Abuse: Domestic, Physical, Verbal Links
http://www.nursefriendly.com/nursing/directpatientcare/abuse.htm
Clinical Charting and Documentation, Nurses Notes
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm
Medical Legal Consulting Nurse Entrepreneurs
http://www.nursefriendly.com/nursing/ymedlegal.htm
Sources:
1. 39 RRNL 12 (May 1999)
2. Cain, Linda. April 24, 1996. Child Sexual Abuse. Retrieved June 13, 1999 from the World Wide Web: http://www.commnet.edu/QVCTC/student/LindaCain/sexabuse.html
3. Smith, Susan K. June 6, 1999. Mandatory Reporting of Child Abuse and Neglect. Retrieved June 13, 1999 from the World Wide Web: http://www.smith-lawfirm.com/mandatory_reporting.htm
4. Richards, Edward P. Medical Records as a Plaintiff's Weapon. Retrieved June 13, 1999 from the World Wide Web: http://plague.law.umkc.edu/Xfiles/x188.htm

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Send comments and mail to Andrew Lopez, RN
Created on June 13, 1999

Last updated by Andrew Lopez, RN on Monday, February 28, 2011

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Thursday, March 17, 2011

Emergency Department Nurse Verbally Abused, Physician History Well Documented

See also: Medical, Legal Nurse Consultants, Clinical Nursing Case of the Week, Clinical Charting and Documentation, Nurses Notes, Courtrooms, Disability, Discrimination, Employment, Expert Witnesses, Informed Consent, Medical Malpractice, Nursing Practice Acts, Pensions, Search Engines, Torts and Personal Injury, Unemployment, Workers Compensation, Workplace Safety:

Each week a case will be reviewed and supplemented with clinical and legal resources from the web. Attorneys, Legal Nurse Consultants and nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material.

For a free subscription to our publication:
Please send a blank e-mail to: clinicalnursingcases-subscribe@topica.com

Summary: Official tolerance for verbal abuse and sexual harassment is approaching zero. It is clear that both are still prevalent in healthcare settings today. Enforcing and reporting instances of abuse are critical to an end being put to the situation. In this case, a physician had a "history" of verbal abuse in the facility involved. It was the documentation of previous events that made formal action and administration of a suspension feasible.

The physician berated the nurse for the way in which one of his patients was being handled. He accused the nurse of "not doing her job" and giving the patient substandard care.

Specifically, he admitted making the statement that the nurse "Should get off her ass and that she was a wrench in the works, she was obstructing patient care."1

"Rothschild says that physical abuse is more publicly recognized than verbal abuse, the latter is just as potent a force in a person's life. Verbal abuse might not inflict the same bruises and scars that physical abuse does, but it does not occur without leaving its own marks."2

This was not the first time this type of verbally abusive statement had been made by the physician. Complaints had been made and formally documented about his outbursts.

These attacks had been occurring with sufficient frequency to merit formal written warning by the hospital's Credentialing Committee.

This instance represents the exception, rather than the rule regarding abusive behavior on the job.

"The continued low profile of verbal abuse could be attributed to the idea that it is a subtler form of abuse and therefore more likely not to be taken seriously, Kesden says. "If you don't inflict a wound on someone, it is easier to be passed off."

Often, abusive behavior was learned by the abuser in childhood and cannot be overcome without therapy.

"If a person is raised in a house with verbal abuse ... there is a good chance he will bring that into a romantic relationship," Kesden said.

The first step in acknowledging a verbally abusive relationship is to admit that there is a problem. "The abuser has to recognize what he is doing," Rothschild says."2

Regardless of a behavioral pattern's origin, when it occurs on the job, toleration or inaction can set a dangerous precedent. By not taking action on the spot or when safety allows, the stage may be set for future occurrences.

The physician's abusive and harassing behavior was clearly identified and reported.

"Harassment

Discriminatory harassment includes verbal or physical conduct designed to threaten, intimidate, offend, demean, or coerce; and may impair an employee's ability to do his or her job. Harassment may take on many forms such as:

gestures, or physical acts

slurs

taunting

verbal abuse or epithets

comments or jokes

displaying derogatory objects, cartoons, posters, drawings, or pictures

Harassment may also be any unwelcome or offensive conduct relating to an individual's race, color, religion, ancestry, national origin, sexual orientation, sex, age, disability, veteran status, political ideology, or other protected characteristics."3

Prior to the above outburst, it had been made clear that any further abusive behavior would result in a suspension of privileges at that hospital.

When the incident was reported, a suspension was handed down of no more than 30 days. The physician appealed the suspension internally. The decision to suspend was affirmed.

When it was clear that the suspension was going to be upheld, the physician filed suit against the hospital. The hospital filed for and was granted summary judgement to dismiss.

The physician appealed.

Questions to be answered:

1. With documented evidence of abuse and previous warnings of future consequences, did the physician have grounds to appeal the decision?

2. In light of the history of abuses, did either the Credentialing Committee or the court arbitrarily or without merit decide that a suspension was appropriate?

To initiate filing a suit, typically no legitimate grounds are needed, just an attorney that will take the case. It can literally be done at will. It can be called "frivilous." It is a basic and constitutionally guaranteed right.

The physician regardless of his chances of succeeding had a right to appeal a decision that will deprive him of the right to practice. A suspension would directly affect his ability to earn an income from consulting/treating patients.

The appeal could have been filed to make a point. This could also have been done to further harass the nurse who would be called in to a deposition and subjected to interrogatories.

It is common for an individual to attempt to delay hearings that will result in a license suspension or revocation. Whether the physician was looking to "buy time," further harass the nurse or if he actually thought he could "get off," procedures to do so are in place and available.

The likelihood of the decision being overturned, was slim.

It was to the nurse's advantage in this case that previous actions had been taken. It was not the first time that abusive practices by the physician had been documented.

It is vital, that when a pattern of behavior is emerging that action be taken to document it. If a nurse or patient or member of the healthcare team is abused, it needs be reported.

Frequently, abusive behavior is not.

This case example occurred in the Emergency Department. It can happen in any unit or setting.

The Association of Operating Room Nurses offers the following guidelines:

"The best thing to do about a surgeon's abusive behavior is to confront the surgeon at the time the abuse occurs. This does not mean, however, that you should interrupt the surgical procedure. Immediately after the patient is out of the OR, confront the surgeon and let him know that his behavior is unacceptable and that you will not tolerate it. Tell the surgeon how the abusive behavior makes you feel.

Offer a comment, such as

When you berate me as you did during the surgical procedure, I feel very uncomfortable and distracted. This interferes with my ability to provide you the assistance you deserve.

Inform the surgeon that you will confront him immediately should another incidence of abusive behavior occur. Also inform your supervisor of the surgeon's abusive behavior, your confrontation with the surgeon after the surgical procedure, and your plan for continued confrontation. If the surgeon's abusive behavior occurs again, continue to confront this behavior each time it occurs. Consistency is essential. In addition, you should file a formal complaint to the medical staff committee through the appropriate channels in your facility. Finally, if this does not stop the abusive behavior--and as a last resort--you can press charges for slander and/or sexual harassment, if there are sexual tones to the abuse"4

Verbal abuse is both damaging and demeaning and treated similarly to sexual harassment in the workplace. If you feel you have been the victim of any type of abuse, you need to be aware that rarely will it "just go away."

Whether it is a personal relationship or "on the job," the likelihood of a person changing their ways or stopping an abusive behavior is poor.

"SOLO emphasizes that the quicker a woman decides to get out of an abusive relationship, the better. Verbal abuse only escalates, like physical abuse, and the longer a woman stays in such a relationship, the deeper her self esteem sinks and the harder it is to get out of the relationship."2

It is a difficult situation for both the individual and coworkers that might be hesitant to step in. It's crucial then for the individual to discuss the situation with a supervisor or someone they feel comfortable with.

A fatal trap to avoid is making excuses for the abuser. Phrases like "I deserved it" or "I made him angry" are common responses to abuse and are patently false. There is never any excuse for abuse in the workplace or at home.

"Women do a lot of convincing to themselves, rationalizing about the relationship," Kesden says. Many women often try to justify the abuser's actions."2

A sad fact is that often abuse is occurring at home as well. It compounds the problem and can be disabling when the problem is encountered at work.

The sooner action is taken, the sooner formal proceedings can be set in motion. Taking initial action does not guarantee an immediate solution. It may cause the abuse to escalate initially

This can deter many from reporting a situation in the first place. It is this first crucial step that makes corrective action possible when there are recurrences.

Depending on the environment, pressure may be put on the nurse or physician to "make the problem disappear." An administration may or may not be intimidated by the fact that physicians are sometimes viewed as the "money makers" of the hospital. In this case, they were not.

Regardless of the cause or abuser, one outcome is inevitable.

If the problem is not dealt with, it will not go away. It may signal to the abuser that it is "ok" to abuse if it is demonstrated that he can get away with it. If no resistance is encountered it literally gives free license to pick other "victims." It opens the door for abuse to get progressively worse.

The question you need to ask is this. "If I'm getting abused today, how much worse can it get? Who will it be tomorrow?"
Related Link Sections:

Abuse:
http://www.nursefriendly.com/nursing/directpatientcare/abuse.htm

Emergency Department Nurses on the Nurse Friendly
http://www.nursefriendly.com/nursing/directory/spec/ed.html

Psychiatric Nurses on the Nurse Friendly:
http://www.nursefriendly.com/nursing/directory/spec/psych.html

Sources:

1. RRNL 4 (September 1998)

2. Munoz, Rachel. No date given. Student.com. Verbal Abuse Scars. Retrieved June 6, 1999 from the World Wide Web: http://www.student.com/article/verbalabuse

3. Francis Hutchinson Cancer Research Center. 1995. Personnel Policy and Procedures Manual, Section 3-2. Harassment/Sexual Harassment. Retrieved June 6, 1999 from the World Wide Web: http://www.fhcrc.org/admin/hr/pppm/p0302.htm

4. Association of Operating Room Nurses. September 1997, Volume 66, Number 3. Clinical Issues. Retrieved June 6, 1999 from the World Wide Web: http://www.aorn.org/JOURNAL/997/Septci.htm

The Uniform Resource Locator (URL) or Internet Street Address of this page is
http://www.nursefriendly.com/nursing/clinical.cases/060699.htm

Send comments and mail to Andrew Lopez, RN

Created on June 6, 1999

Last updated by Andrew Lopez, RN on Monday, February 28, 2011