Crime in Medicine
At least as far back as Thomas Hobbes it has been recognized that no matter how pure or "good" someone is, he or she still can be a violent, selfish human being. Except, apparently, in medicine, according to those running that establishment as though no caregiver ever would intentionally harm a patient, so it is set up so that patients almost never are able to bring criminal charges.
In any large group of humans there are sociopaths and psychopaths. The crime rate in medicine keeps being swept under the table. It is the first thing from which patients should be protected - the caregivers who commit crimes against their patients.
“Where else but in medicine do you find men and women who never admit a mistake?"
- From "The Doctor Factor," an essay in "The Woman at the Washington Zoo" by Marjorie Williams
The legal issues don’t really matter. The police won’t let the patient file criminal charges anyway. The list of reasons they give is creative, and apparently endless, but it includes not wanting to “criminalize” medicine (I’m not going to write the paragraph of problems with that statement). It includes telling the patient that there won’t be any witnesses, no matter who saw it, so that there is no point in filing. Police have told patients that if there were any witnesses, they would stick together and testify for each other against the patient – and that is what happens. Police have told patients (and will argue such points endlessly) that if an event happens in medicine it is civil and not criminal – which is what I mean by creative, and wrong. No one has drawn a red line around medicine saying that within that circle criminal law does not apply.
What the police tell patients even includes simply saying that they are not going to let the patient file charges no matter what (see Kashyap).
It Can't Happen Here
Before reaching that point, what they say can include telling the patient that before they can let the patient file charges, the patient must have some physician verify that the injuries were caused by the person the patient claims caused them. (When they wheeled John F. Kennedy into a hospital in Dallas did the physicians look at his wounds and say, "Oh, yeah. We can see who did this." It is not something that physicians can do except in extremely rare cases. And even when they can, if the criminal is a physician, they won't They stick together.)
It includes telling the patient that no district attorney would pursue it so it would be a waste of time no matter how good the case is. It includes telling patients that if it happens in medicine it is the jurisdiction of the medical board – which is less creative but equally wrong. The police are the only people with the legal authority to accept a criminal complaint and to investigate it.
However, state medical boards do accept criminal complaints even they do not have the facility nor the authority to do anything about them. Then they dismiss them for lack of evidence – which is what happens when the people running an agency have a conflict of interest that motivates them to adopt policies and habits that defeat patients no matter how much evidence the patients might have.
Patients are not much better off taking it to the police anyway. The police usually do not have the will to do meaningful investigations of crimes in medicine. They have been known, when forced to, to go to the health care professional who committed the crime, be shown records in which there is no mention of the crime, accept that as proof that nothing happened, and then disimiss the case based on that. These are the records created by the person who committed the crime, and who is a member of the profession that almost never makes a record even of a simple error.
The police also will consider as evidence the testimony of anyone complicit in the commission of the crime. Then the police will police apologize for having interrupted the criminal caregiver's busy day, leave and dismiss the case.
People, including the police, have so much faith in members of the medical community to be honest, and have been exposed to so few stories about how routinely they are not, that there is no overcoming it with common sense and evidence.
But it is a rare patient who is able to get the police to look at records and talk to anyone about them. Normally, the police just won't let the victim file charges in the first place.
The Will of the Caregivers
Patients who try to report crimes in medicine rarely get to. But there is nothing that coalesces a medical community more solidly against a patient than suggesting that someone in their community committed a crime. Try to get injuries treated when they were caused intentionally. Even if they believe the patient, no one wants to create a diagnosis that could be used as evidence in a grievance or suit against anyone else in medicine (all suits and grievances are frivolous in their eyes).
Interestingly, there does not appear to be anyone in medicine who is aware of this. To them, if the police will not let patients file charges, that is proof that all those charges are frivolous.
Meatloaf, the singer, said he knew OJ. He had played golf with OJ. He knew OJ could not have committed that crime. People in medicine "know" that about caregivers they never met.
When our systems fail to acknowledge the problem of intentional harm, let alone do anything about it, they are not systems adequate for policing less sinister problems. If medicine really was interested in the well being of patients, they would understand that this is the first and most basic problem in patient safety. But they don't.
There is a parlor trick I have played on physicians. I ask them what the crime rate in medicine is. As I ask I reach for my wallet and take out a piece of paper. When the physician says, "What do you mean 'Crime Rate' in medicine?" I show the piece of paper from my wallet on which is typed, "What do you mean 'Crime Rate' in medicine?"
That is putting them on the spot more than I like to so I don't do it often, but it continues to be a useful gauge of how out of touch with patients caregivers are.
"We can't reorganize medicine just because of something that happens so rarely"
When you mention the crime rate in medicine, health care professionals brush it off as being too rare to bother with. Would we accept it from the police if they brushed off rape that happened in the parking lot of the police station because that happens only rarely? Or any other crime?
On what do members of the medical community base the notion that crime in medicine is so rare in the first place? On the basis of the fact that so few criminal charges are filed with the police?
Henry Pontell, a professor of Criminology and author of books about white collar crime, said that someone with the highest pedigree intentionally hurting people is a lot more damaging to our social structure and our institutions than the actions of a common criminal. Think of how corrosive it is to civility and faith in our institutions and the willingness of people to function within normal decorum. But our medical community doesn't think it is worth bothering with.
I have asked physicians what they would recommend a patient do after being assaulted by a physician. To them it is a no-brainer. "Call the police." When I try to explain that patients who have tried that have failed to get help from the police, physicians don't believe it.
I should create a list of the things physicians choose not to believe. It's a list of the most important things you could know if you honestly cared about the well being of patients.
If you live in a safe suburb, medicine might be the most dangerous place you go in terms of people being able to commit crimes against you with impunity. The statistics on the crime rate in medicine are known, and yet the people charged with doing something about it respond as though there is no problem.
People tend to judge the likelihood of occurrences of events in terms of how readily instances of it come to mind. A cognitive rule-of-thumb for it is known as the "availability heuristic." We don't think in terms of statistics. We think in terms of stories. The stories need to be known in order for the community to think about problems.
Part of the problem with crimes committed in medicine is the fact that the crimes often are committed by very smart people who know what they can get away with. They can cause physical harm that is slow to develop. For instance, damaged blood vessels take years to become entirely clogged. An angry surgeon merely has to injure blood vessels now to disable someone in the future. The consequences are not sudden like an injury from a gun shot is, but are just as life-ruining.
But even when it is overt, even when it is a caregiver lashing out and brutally beating a patient, characteristically none of the witnesses will risk their careers by doing or saying anything. They move on silently, following normal protocol by not discussing it among themselves, which helps defeat an institutional memory of the even being created.
It is critical to have the stories of these victims known by them and everyone else in order to put faces on the problem. Bare numbers do not enable people to think intelligently about it. Predatory crime in medicine needs to have a face put on it or the everyone will continue to allow health workers to persuade them to dismiss the facts uncritically.
There are a few such stories elsewhere on this site (like James Burt), and more on the web, but there also needs to be discussion of theory.
The Routine Activity Theory of crime is one that should be discussable with regard to crimes committed against patients since it emphasizes situational factors which give rise to criminal opportunity rather than blaming individuals. That fits in with the current vogue in patient safety discussions that blames systems or institutions or environments or anything other than the people who commit the crimes.
Currently, in spite of all the testimony and statistics to verify that surgeons and nurses commit criminal acts against patients, the subject is treated by health care as though it is not worthy of discussion. For instance, one of the lines most often repeated by patient safety advocates is: "We don't believe people go to work to to a bad job," as though there never had been a serial killer or a pedophile in medicine. So for a moment lets indulge their fantasy about there being no bad people in their midst and their fantasy about no one going to work to do a bad job and just deal with the Routine Activity Theory of Crime.
Any patient safety effort that does not begin by addressing the problem of crime against patients ignores the most fundamental problem
Routine Activity Theory says that crimes occur when three conditions are present:
1) a suitable target is available
2) there is no guardian to prevent the crime
3) a likely and motivated offender is present
1) Patients are easy targets. They are trusting and nearly helpless, like children, and have almost no ability to respond to crimes committed against them. They don't know who to turn to to find out. There is no number to call to get an advocate. If you think a victim can get help by calling a lawyer, first read elsewhere on this site about how unlikely it is for victims to get lawyers. (Do we want lawsuits to be the only option anyway?) And then consider the fact that lawyers do not sue criminals. They defend them. You cannot get a lawyer to represent you in a criminal matter. The only person who can bring a suit for criminal activity is a district attorney. The only thing for which a patient can get a lawyer to sue are civil damages.
Injured patients, as a rule, can find no advocate
2) Health care workers virtually never report each other, which means there is no guardian. This is one of the chief components creating the climate in which it is possible to get away with so much of what goes wrong in medicine. People in medicine unite against patients. They protect each other, not patients. The only forthcoming witness will be the patient and there is no one for that patient to tell. Also, if the patient tells the wrong person, even if it was only one single person the patient can be sued. We know of risk management departments who persuade patients they can be sued even for complaining to the police. Which is not true. You have the right to complain to an authority. But most patients don't know that.
3) It is not uncommon for someone in medicine to want to do something he or she shouldn't. Unnecessary operatons for profit? Lust? Competitiveness? There are lots of reasons. Bbut medicine chooses to believe that the reasons do not exist and the issue is not important.
It might be that nothing can be done to make it so that patients are not easy targets. But something needs to be done to provide guardians for patients and a system that will respond to it when patients report having been victimized. Other health care workers never will do this job. They even are in denial about its needing to be done. So is the society as a whole. One lawyer, when told about a doctor who had intentionally disabled a patient in a burst of anger, brushed if off by saying that he is sure that the surgeon does a more good than harm.
So the lawyer gets to be judge and jury and dismiss it on that basis?
Wrongs Radiate Out
Remember the point of the movie It's a Wonderful Life with Jimmy Stewart? The angel shows him all the good that would not have been done if Jimmy Stewart hadn't lived to help all those people. If Jimmy Stewart had been a patient who was disabled intentionally he would not have done all that good. When measuring how much damage is done by a health care worker who sins against patients versus how much good that health care worker has done, you have to measure all the good that would have been done by patients but that wasn't done because their lives came to be about surviving the injuries, rather than about going out into the world to do good.
Their families also do less good work as more of their time and attention is absorbed by the injured family member. The damage committed by health care worker radiates out to effect many people for a long time.
That aside, how do you measure the agony of a patient who no longer provides for his/her children, has a marriage fall apart, and becomes a recluse after sins committed by a health care worker? How can any amount of good done elsewhere make up for that? Especially when the sinner has multiple victims?
Having MD after your name
should not be like having 007 after your name
It is not a license to kill. It is not a get-out-of-jail-free card. It is not acceptable for civilians to play judge and jury by making assumptions about whether or not the sinner should be reported because of rationalizations like being sure the sinner must do more good than harm. When a crime is committed, the right, legal and moral thing to do is bring it to the criminal justice system.
Crimes committed in white collar settings, like hospitals and banks, are not well understood or appreciated. Most white collar crime is not one on one. It is not someone saying to a person, "I am going to commit harm specifically against you." Except in medicine where it often is. In medicine it is more likely to be what a street thug does to an individual than most white collar crime. But in medicine they have so many layers to hide behind - expensive lawyers, the ability to destroy evidence, loyal witnesses, the great facade, etc. Evil people find a good home in medicine.
Books for further reading on the subject:
Healthcare Crime: Investigating Abuse, Fraud, and Homicide by Caregivers by Kelly M. Pyrek
Workplace Violence edited by
Vaughan Bowie, Bonnie S. Fisher, and Cary Cooper
Has a section about staff who abuse those in their care.
Both of those books are rather expensive. I'm on the lookout for more reasonable texts that still are available.