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GOOD PATIENT CARE REQUIRES CYA ANTIDOTE
Journal of Healing – Nov. 8, 2006

To the alphabet soup of dreaded diseases (HIV-AIDS, ALS, MS, TB, etc.), let’s add CYA, which seems to be infecting the health care system itself.

CYA? For those unfamiliar with the acronym, it refers to occasions when you are likely to receive a well-deserved kick to your derriere, so you Cover Your A--.

I found symptoms of CYA all the way through a front-page story in the Seattle Post-Intelligencer last week. It was an appalling account of how a nursing home aide, charged with raping a totally paralyzed stroke patient, managed to work in health care institutions for 13 years despite a repeated pattern of sexually aggressive conduct, firings and even an arrest record.

The story documented how, when the system doesn’t work, it screws up grandly. The aide managed to bounce from job to job, hospital to nursing home. While he now awaits extradition from Pennsylvania to face charges in Seattle, and while the victim and her family cope with unspeakable trauma on top of tragedy, the folks in charge are busily pointing fingers at each other.

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THE FIRST hospital to fire him – after he sexually harassed female patients – reported to the state only that he had engaged in “inappropriate comments.” Patients claimed physical aggression. Nevertheless, the hospital spokeswoman contends the report should have been a “red flag” to the state. The state’s response is the usual: “We don’t have the resources to investigate every single complaint.”

When the next hospital was checking references, Hospital A did not report that the man had been fired, only confirming the dates of his employment. Hospital B hired him and subsequently fired him.

The nursing home executive where the rape allegedly occurred insists that “Patient safety is our utmost priority.” Empty words when in the next breath she blames others who should have been “more diligent about proper reporting.”

We all know what’s going on here. CYA is symptomatic of a national virus, SMSU (Somebody Might Sue Us).

I’m not forgetting that the real culprit is the accused rapist. But that’s not good enough. There are few experiences more heart-wrenching than turning a vulnerable loved one over to the care of an institution. I’ve been there. It takes a near-desperate leap of faith to believe that strangers will treat your loved one with as much respect and tenderness as you would.

Families are not interested in suing if things go wrong, although sometimes that is a last-straw act of desperation. We’re interested in health care providers who are strong and tough enough to accept responsibility and turn things right again.

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THE STORY about the rape victim hit me hard in the gut because her injuries were the same as my husband’s following his stroke 13 years ago: totally paralyzed, unable to speak, and fully cognitive.

During the months that my husband was hospitalized and in rehab, I or a family member stayed with him every day. Not everyone can do that, and not even we could maintain a 24-hour vigil.

One morning when I arrived at the rehab, John’s doctor was waiting for me. During the night two aides had harassed John while cleaning him. His roommate, a dear man dying of brain cancer, overheard and reported them. The doctor could have covered it up, but he apologized and explained how the aides would be disciplined.

There’s talk, as a result of the rape case, of new laws to protect patients. Laws don’t protect patients, people do. When the system works, it’s because people fend off the CYA disease with a time-tested antidote, DWR: Doing What’s Right.

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