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A Case Study in How Not to Handle Sexual Abuse in Healthcare

Doctor walking in a hallway

How an organization responds to sexual harassment or abuse plays an important part in its success with creating an environment hostile to these damaging transgressions. In the case of one healthcare organization, Hacienda Healthcare, a limited response when a leader was found guilty of harassment led to subsequent disaster.

Hacienda Healthcare is a long-term care hospital in Arizona that takes care of patients who are unable to function outside the hospital, either due to significant physical problems or lack of consciousness. In December 2018, a female inpatient in her late 20s, who had been in a persistent vegetative state for 14 years, gave birth unexpectedly. This situation received public attention and eventually was featured in a television report after a facility nurse contacted the Emergency Rescue and Response Unit in Maricopa County. How the organization responded created even more problems.

How Not to Respond

Several days passed before a spokesperson for the organization responded with a statement that Hacienda had been in business for 50 years, during which it consistently provided high quality, specialized care for patients. This statement was non-responsive in terms of the event that occurred, and insensitive to the family and the patient herself. It's important to understand the legal obligation and mandatory duty to report abuse, both on an institutional level and for individual healthcare employees and clinicians. Bringing attention to this situation required going outside the institution.

An Environment That Turned a Blind Eye to Abuse and Harassment

Local newspaper and TV research revealed a 12-year old history of staff complaints about sexual harassment by the longtime CEO of Hacienda healthcare, as well as allegations of financial fraud. In that early instance, Hacienda’s Board of Directors sent the CEO to required counseling and had him attend training sessions. Records show, however, that they continued to award him raises and bonuses. We often think of sexual abuse and sexual harassment as separate issues requiring separate policies. Very often, tolerance of one is likely to coexist in an organization with tolerance of another. A case like this, where senior executives are alleged to have engaged in sexual harassment with no repercussions, creates a permissive and even negligent atmosphere. For healthcare, not only does it mean patients are less safe, but it means employees are not comfortable reporting abuse, because they have no confidence that anything is going to happen as a result.

No One Spoke Up

At Hacienda, many people were caring for this victim on a regular basis; , She had to be bathed, dressed, fed, and cared for in myriad ways. It is hard to imagine that not one of those staffers providing care noticed she was pregnant. The likely truth is that though people were aware, they decided not to say anything—the treating physician, nurses, or anyone else. This situation emphasizes the importance of a reporting mechanism to be in place so that people with concerns can raise them in an anonymous way.  Most healthcare organizations are supposed to have a compliance hotline as the foundation of an anonymous and confidential reporting process.

Confidential Reporting Was Not Available

Even after the media reports of the surprise pregnancy and delivery, Hacienda didn't hire a lawyer for another three weeks. In addition to other responsibilities, an organization needs to have a crisis management plan. Even now, the organization’s website does not list a compliance officer. In the past, the compliance officer at Hacienda was a nurse who also had a full-time job as a supervisor—it's unclear that she had any training or knowledge of her compliance role. After three months of investigation, Hacienda found out that the patient was raped by a nurse. The organization is still in business, after a change in Board composition and replacement of all senior management.

This blog post is the fourth in a series based on the HealthStream webinar, Fostering a Safe and Secure Workplace, led by James Sheehan. Sheehan is currently Chief of the New York Attorney General's Charities Bureau, which oversees compliance and regulation of the nation's largest charity sector. Prior to this role he was the New York City Human Resource Administration's first Chief Integrity Officer overseeing audit investigation and data analysis for the nation's largest social services agency. He has additional experience as New York State's first Medicaid inspector general, overseeing the country's first mandatory compliance program. He also was an assistant and associate U.S. Attorney in the Eastern District of Pennsylvania, where he developed a nationally recognized program working with whistleblowers under the False Claims Act.

Download the full webinar here