Risk factors for sexual abuse in health care
The provision of health care usually involves a degree of physical proximity, which a few individuals have exploited to commit abuse.
The delivery of health care services in a range of settings and to different categories of patients can give rise to a variety of risk factors. With most industry sectors seeking coverage for sexual molestation liability, the focus is almost exclusively upon the risk of abuse involving minors. While that is obviously a key consideration for health care providers too, they also face arguably the greatest and most complex issues of risk management and abuse prevention involving vulnerable adults under their care and supervision.
The provision of health care usually involves a degree of physical proximity and contact between the caregiver and patient. In the vast majority of cases, this dynamic is handled with the greatest professionalism and sensitivity and within the parameters of informed consent. Sadly, a few individuals in the health care industry have exploited such situations to commit abuse. For example, we have seen situations where doctors have produced and retained inappropriate and intimate images of patients under the guise of treatment, or routinely undertaken inappropriate physical examinations.
Patients can feel doubtful or confused about the circumstances of their treatment, which can be compounded by the modus operandi of the abuser. For example, an emergency room doctor at a New York hospital was convicted of sexual assault against four adult female patients who he had sedated. Colleagues may also feel a reluctance to call out behaviors they have witnessed by more experienced and qualified practitioners.
Care is also often delivered in small and secluded settings, to afford patients the greatest degree of privacy and dignity possible. Even in the busiest of hospitals, patients and their care providers can frequently interact in isolated environments, where abuse can be perpetrated with a reduced risk of detection. As in other countries, the U.S. health care system has an increased emphasis on care being delivered outside acute and hospital settings. Treatment and care are very often in a patient’s own home, particularly for the management and treatment of chronic conditions. We also see the care and accommodation of the elderly taking place in smaller and less supervised settings, such as their homes. A more dispersed workforce, providing a higher proportion of care remotely and on a one-to-one basis raises concerns about a heightened opportunity for abuse, particularly where a specific individual may be visiting a patient frequently in an isolated environment. Additionally, there is less opportunity in such situations for co-workers to identify problematic behavior and raise a flag about any concerns.
The health care workforce is also increasingly mobile and there is often greater demand than supply for open positions. In some parts of the health care sector, roles can be transient and there is a risk of bad actors moving with deliberate frequency to reduce the risk of their activities or their backgrounds being detected.
The health care industry also needs to be vigilant about the risk of sexual abuse being perpetrated by patients against other patients. The issues outlined above about patients frequently being cared for in small and secluded settings can afford opportunities for abusive conduct and there are challenges in effectively supervising patients in such environments.
It is essential for employers in the health care space to appropriately screen and train employees and volunteers. Training should include notice and reporting requirements, as well as red flags to assist in identifying when a patient may be at risk of sexual abuse. This will protect both the patients and the organization from allegations or incidents of sexual abuse and should also contribute to a safer environment in the health care industry.
Christina Herald is an underwriter, U.S. executive risk at Beazley, where she underwriters for public and private company directors and officers liability, employment practices liability, fiduciary liability and Safeguard, Beazley’s sexual misconduct liability offering.
Paul Nash is an underwriter and employment practices liability (EPL) focus team leader at Beazley. He has more than 25 years’ experience and is the EPL product leader for both the U.K. and U.S. teams.
This piece was first published by Beazley and is republished here with consent.
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