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 harm a patient, so it is set up so that patients almost never are able to bring criminal charges.
“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.
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 - which is
impossible for any physician to do. 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 or to
investigate it. However, state medical boards accept criminal complaints and
dismiss them for lack of evidence – which is what happens when an agency has
neither the capacity nor the will to find such evidence, nor the legal
authority.
The police should include on their list that another reason
not to file charges is that the police also usually do not have the will to do
meaningful investigations of crimes in medicine. They may go to the person who
committed the crime and be shown that the records "prove" that nothing
unusual happened. These are records that were created by the person who
committed the crime. They also will consider as evidence the testimony of anyone
complicit in the commission of the crime. Then the will police apologize for having interrupted the
criminal caregiver's
busy day, leave and dismiss the case.
But it is a rare patient who is able to get the police to go
that far. Normally, the police just won't let the charges be filed 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 that’s how they were incurred. 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.
The singer Meatloaf 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.
However,
When our systems fail to acknowledge the problem of
intentional harm, let alone do anything about it, they are not systems adequate
to 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, healthcare
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.
Healing Dangerously
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 more overt, even when it is a caregiver
lashing out and brutally beating a patient
It is critical to have the stories of these victims in order to put faces on the problem. Bare numbers do not enable the public to think about it. Predatory crime
in medicine needs to have a face put on it or the public 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.
Criminal 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 blame 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 lets
put aside blaming the bad people in their midst 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) Healthcare 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.
There are statistics on how often crimes are committed by healthcare workers
against patients, but medicine chooses to ignore them.
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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
healthcare 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, speaking about a doctor who had intentionally disabled a patient,
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 OutRemember 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 healthcare worker who sins against patients versus how much good that healthcare 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 work
that helps others. 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 healthcare worker radiates out
to effect many people for a long time.
Besides, 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 healthcare 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 nameIt 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.
He who passively accepts evil is as much involved in it as
he who helps to perpetuate it.
He who accepts evil without protesting against it is really cooperating with
it."
- Martin Luther King, Jr.
Sexual abuse of males
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