Was anyone else besides me disturbed by the news last week from a state veterans’ home in Hastings? Three officials have been placed on leave, and the facility is under investigation following allegations that residents, as well as some employees, may have been threatened with retaliation for complaining about the care.
The obvious question here, namely whether this is a common situation, was further fueled by a listing in the Sunday Minneapolis Star Tribune of Minnesota nurses who have had their license revoked this year for misconduct. Among them was a nurse who owned a home health agency in Plymouth and who is alleged to have given substandard care to a patient who filed a complaint about her.
Two instances don’t make a pattern, nor do they suggest these are anything other than isolated cases. But they’re concerning for the way they reveal an issue that’s rarely talked about openly in health care: the subtle and not-so-subtle ways health care workers can intimidate, bully or harass patients who might be perceived as troublemakers or just plain difficult.
It’s not clear how often this happens. I’d venture to guess the majority of health care professionals don’t behave this way, and most reputable institutions don’t tolerate it. Yet it does occur, as demonstrated by this recent entry on an infection control online message board, written by a nurse whose father experienced retaliation after expressing safety concerns while undergoing dialysis. She wrote:
Retaliation against patients comes in all sizes and all forms. This can be overt or covert – from staff rolling their eyes to a clear verbalization – telling the patient and/or designated advocate (family member) – never ask that question again, never question what I (staff) am doing.
She describes in chilling detail what happened when her 85-year-old father registered a complaint about a staff member in the dialysis unit who used contaminated gloves:
The staff retaliated against my father with such behaviors as staring and glaring at him, walking by him when he was receiving treatment and making little laughing noises, pulling in other staff to act the same way which resulted in many staff not being very nice.
Then there’s the nurse in Colorado Springs who was fired after being pulled over for speeding and complaining to the police officer, “I hope you are not ever my patient.” The story generated more than 350 comments on the New York Times website. Although the vast majority of the readers sided with the nurse, others were blunt about the implied threat. “I’ve worked in hospitals for 30 years and reviewed thousands of medical charts. Sadly, nurses do sometimes exact revenge – keeping a patient waiting for pain medicine, ignoring the call light for extended periods of time, bad-mouthing the patient to others on the health care team,” one person wrote.
From someone else:
Anyone who has ever been hospitalized with a critical health condition knows how vulnerable a patient is to accidental or intentional mishaps perpetrated by hospital staff. She’s the one who escalated the encounter, by hinting at the power she levies as a cardiac nurse. Sounds like a threat to me.
On the whole, it appears that retaliation by health care providers against patients is rarely reported. Patients and families are often reluctant to complain for fear of making the situation worse, especially if they aren’t in a position to seek care elsewhere. Retaliation also is somewhat fueled by perceptions and can be difficult to prove. (“We didn’t deliberately delay the patient’s pain medication. We were busy!”)
Doctors, nurses and other health care professionals are vulnerable themselves to retaliation if they report unsafe or substandard care. It’s not unheard of for them to be harassed or fired. In one of the more egregious cases, two nurses at a 15-bed county hospital in Texas lost their jobs and were charged with a felony after they blew the whistle on a staff doctor who they believed was endangering patients with unsafe care. They sued for damages and won, but the emotional cost of fighting this battle must have been enormous.
It has been fairly well documented that disruptive behavior takes place in the health care work environment. Health care is probably no better or worse than many other workplaces, but the stakes clearly are much higher when patients’ lives are on the line. Retaliation is one form of this behavior, so perhaps it’s not too surprising that at times it spills over into the staff’s interactions with patients. But it’s both unethical and against the law, and whether it’s directed at patients or staff, it shouldn’t be happening. Period.
Photo: Wikimedia Commons