Positing her email as wanted you all to have this information.
From: Stacey Mitchell
Subject: Protocols for SA exams when health care employee is assailant?
This is a situation that everyone hates and does not want to imagine. Unfortunately, it does occur. Health care providers do assault patients. I applaud your tenacity in advocating for your patient. However, there are some considerations that must be taken into account. I am a former forensic nurse program director and administrative director for risk management and patient safety (I held these positions at the same time). So, I can see both sides of the coin and have had to discuss these very issues with system administration. At my previous employer, we had a resident sexually assault a patient who had been admitted to the hospital. This case is adjudicated, so I may speak about it. It also made national news.
When the forensic nurse was notified of the outcry, we immediately discussed the case and affirmed that this patient deserved the same quality and access to care that ANY patient would receive if they presented to the ED. So, that was not a question. Forensic nurses provide non-biased care, so that was not an issue either. The assault was documented, evidence collected, law enforcement contacted, etc...From a patient safety perspective, we moved the patient to a room closer to the nurse's station (she had to remain admitted for another day due to her health issues). Her husband spent the night and stayed in her room for the rest of her admission. The nursing staff increased their rounds. Advocacy responded. The patient was discharged the next morning.
When a patient is sexually assaulted on a hospital campus, that triggers responses from administration, patient safety, quality, risk management, and compliance, possibly HR (depending on who the hiring body is of the perpetrator). There is a lot that is occurring in the background that most staff nurses do no know. A sexual assault on campus is a reportable event to Joint Commission or DNV and the state health department. It is also a report to the Patient Safety Committee. A Root Cause Analysis (RCA) is required and the event will be investigated in a confidential manner. The information along with risk reduction strategies (fancy talk for ways to keep this from happening again) are presented to the Patient Safety Committee. The presentation is confidential and everyone who attends or presents must sign confidentiality agreements or acknowledge that the information cannot be discussed outside of the committee. Your forensic nursing note will be part of the investigation. The hospital has a right to it. You may be involved in the RCA as a subject matter expert.
The hospital's accreditation and regulatory director is responsible for the preparing for the CMS/ accreditation survey(s) that will occur. That is a given. This type of event is huge and will trigger an onsite survey from Joint Commission and the state, possibly other federal entities. Your record will be needed. The state will request it and has a right to that information. By withholding this information, there may be fines or non-conformances levied against the hospital (this could potentially impact the CMS certificate...at worst. A hospital having their CMS certificate revoked will, basically, have to close its doors). Having the forensic nurse as part of the investigation allows for education of the administrators, surveyors, etc...related to the medical-forensic exam. You could also be part of the solution and assist with devising strategies to keep this type of event from ever happening again.
Risk management has a right to your exam information as part of their investigation. These types of investigations are confidential and the information is kept securely and not shared with anyone who does not need it. Yes, they are there to protect the hospital. That is the nature of the job. However, if there are strategies that need to be implemented immediately for patient safety, your risk manager is the one who can aid in implementing them.
In the event of a criminal trial, the DA will subpoena your records, which will be entered into evidence. This occurred in the case at my previous employer. There was also a civil lawsuit (absolutely!). The plaintiff's attorney(s) and the defense will obtain a copy of your report, which will also be entered into evidence. Your report may also be subpoenaed by a licensing board. In my previous employer's case, there was a criminal trial and a civil suit. The physician, medical school (for not better screening their applicants), and the hospital were sued. That was a given. Everyone knew that was going to occur. The risk manager and/or hospital attorneys must review the information to understand what occurred and how best to respond. That may mean settling or not (depends on the circumstances of the case as each case is different).
As you can see, there is a lot happening in the background. This is a great opportunity for the forensic nurse to provide assistance to everyone involved in the numerous investigations. It's also a great way to expand your role and be the go-to person as you look at events from a forensic perspective. This is invaluable to those who know nothing about what we do. When the sexual assault occurred in our facility, our CEO did not really understand what a forensic nurse does. After this case, he was one of our biggest champions (one of the unintended consequences, but a good one).
I understand your hesitancy with releasing information. We've been taught to hold on to the records and keep them out of the medical records department so prying eyes cannot just read about your patient's worst day. This different. This information is critical to those investigations. Those departments need that information to do their jobs and they have a right to that information.
You should follow your policies for performing an exam, chain of custody, mandatory reporting, etc... I do not recommend you create a policy specifically for when a provider/staff member assaults a patient. That is a huge liability for you and the hospital. You already have policies in place. The hospital has policies in place about reporting to regulatory agencies, investigating patient safety events, etc...No need to reinvent the wheel.
I'm happy to answer any questions offline or online. I've investigated several sexual assaults on hospital campuses as risk manager/patient safety officer and as forensic nurse. I hope this helped explain the process and why other departments are asking for this patient information. My email is samitchell@tamu.edu
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Stacey Mitchell, DNP, MBA, RN, SANE-A, SANE-P, DF-AFN, FAAN
Clinical Associate Professor
Texas A & M University
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Stacey - this would make a great article!! just saying