Acts of patient abuse and neglect are committed in every aspect of society. Gone are the days when acts of torture and humiliation were committed in dark, dungeon-like basements. Today incidents of patient abuse and neglect are reported with alarming frequency and committed by people of varying backgrounds, levels of education, and cultures. These reports have become so commonplace that one wonders if sensitivity to the topic of patient abuse and neglect has become just as trite.
When citizens and legislators neglect to advocate for the funding which ensures patient care and protection, are we guilty of patient abuse and neglect? How blameworthy is the individual who turns a blind eye; the non-compliant agency or provider; and the congressman or congresswoman who are not advocates for patient care systems?
The Legalities of Abuse
The Federal Register defines abuse to include “any act or failure to act which was performed, or which was failed to be performed, knowingly, recklessly, or intentionally, and which caused, or may have caused, injury or death to an individual with developmental disabilities.” Harassing, assaulting and doping (beyond Federal laws and State regulations), or any act which may cause “immediate physical or psychological harm” to a patient is also prohibited. View the rule at frwebgate.access.gpo.gov.
Patient Population
Patients, depending on the facility in which they are housed and the severity of their ailment, range from in-patient or out-patient clients in short-term or long- term medical or residential facilities. The people most often exposed to abuse and neglect include the elderly, children, the mentally retarded and developmentally disabled. The indigent, homeless and patients within the prison population also suffer abuse and neglect. Most of the members of these populations receive Medicare and Medicaid funding for services.
Reported Cases of Abuse in the U.S.
Various regions of the U.S. report incidents of patient abuse and neglect in the media. In Florida, a psychiatric therapist strikes and verbally abuses his minor male patient during a therapy session. Imagine seeking psychiatric treatment for a child, only to see his therapist curse and strike him about the head and face. Who was it that said “physician, heal thyself?”
In 2007, a North Carolina state hospital lost Medicaid and Medicare funding after a 50-year-old patient was left unattended and unfed for 22 hours. Proceeding investigations later exposed staff priorities that cost the patient his life: “playing cards, socializing and dancing”.
In a North Carolina prison, an incarcerated, debilitated cancer patient suffers unnecessarily. Medical students are called to the bedside of a dying inmate when they are restricted by security from removing him without the proper paperwork. The request to notify his family of his condition and rapidly deteriorating status is denied.
Klein’s article “Care is Care No Matter Where” describes horrific treatment of incarcerated women 10 years ago. One HIV patient complained of discomfort and progressive pain. She was ignored for over 32 hours, and died two days later.
Factors of Abuse and Neglect
Various factors exist in society which fosters patient abuse and neglect. Since 2003 reports of nursing home abuse have been rampant as testimony by the Massachusetts Nursing Association attests. In 2004, the Executive Director of the organization reported a decline in the quality of patient care. She attributed the degeneration to understaffing, low wages and lack of employee benefits.
Today background checks play a major role in patient care. In her McKnights article, author Liza Berger claims a three-year pilot shows states which require background checks have lower incidents of patient abuse. Furthermore, Berger notes that nearly two-thirds of “prohibited” providers are not tracked in federal databases.
Such federal tacking systems include the National Provider Indentifier, the Centers for Medicare and Medicaid Services (CMS) database. The system is used to identify healthcare providers using a 10-digit number which assists them in billing Medicare and Medicaid for services rendered. According to the CMS website “the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty”. See more information at http://www.cms.hhs.gov/NationalProvIdentstand/.
Patient Obstacles in Government
Patients who are Medicare and Medicaid recipients face the greatest challenge for advocacy in government. Open Secrets, a watchdog database which provides extensive data about lobbying activity reveals that when an issue is of little or no importance to a special interest group, industry or organization, lobbying for the issue is unlikely.
A search of the Open Secrets database shows the issue of Medicare and Medicaid has remained at the bottom of the “Top Issues” list for a number of years. Never rising beyond the 7th spot, the funding which provides healthcare and other benefits to the vulnerable population has taken a back seat to transportation, trade and defense issues since 2001.
Factors, reported cases of abuse and legislative obstacles contribute to the the mystery of patient abuse and neglect in America. Can the mystery be solved?
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