Joint Commission issues rules designed to stop bad behavior by doctors

Anne Zieger — Thu, 10 Jul 2008 12:38:52 -0400

The Joint Commission has issued a safety alert announcing new requirements for preventing intimidating behavior by doctors. In its statement, the Joint Commission noted that physician threats, outbursts and the use of condescending language, among other behaviors, can make nurses afraid to challenge doctors when they're concerned about potential problems. This can lead to increased medical errors, the group said. (Readers of this publication have all heard tales of, for example, wrong-side or wrong-organ surgery that went ahead because Dr. X wouldn't listen to nurses.)

Nurses who feel bullied aren't just afraid to challenge doctors they feel are making mistakes. They may even be afraid to call them with routine questions, which can lead to patient care problems, researchers have noted. Worse, nurses may make mistakes themselves, due to stress, after having a particularly stressful encounter with a bullying doctor.

However, the Joint Commission hopes to reduce these incidents dramatically. By next year, hospitals will be required to have codes of conduct and processes in place for managing inappropriate behavior by medical staff, including a policy specifically defining acceptable and unacceptable behavior. If they don't, the penalties will be stiff. Hospitals without appropriate anti-bullying systems in place could lose their all-important Joint Commission accreditation.

To learn more about the Joint Commission's ruling:
- read this Associated Press piece
- read the Joint Commission statement

NY woman dies on floor of public hospital

Anne Zieger — Tue, 01 Jul 2008 21:59:44 -0400

In a case strongly reminiscent of the death of a Los Angeles woman at the now-closed King-Harbor hospital, a New York City woman died writhing on the floor of an area public hospital while staff ignored her condition. The patient, 49-year-old Esmin Green, had already been waiting in the emergency department of Kings County Hospital for 24 hours at the time of her death struggle. Early in the morning, she fell face down on the floor and was left there for over an hour while security and other staff members failed to react. (Their inaction--and Green's death--were captured on a hospital surveillance tape.)

Green, who was waiting to be admitted to the hospital's psych unit, didn't get any care until someone on the medical staff was brought over by a patient in the waiting room. She had been committed to the psych unit due to symptoms of psychosis and agitation. In reality, the length of stay she faced in the ED is not that unusual, nor is it unusual for the patient to have been left without psychiatric support during her wait, but having her medical symptoms ignored until she died is obviously another issue entirely.

In the wake of the death, six staff members have been fired. Meanwhile, the New York City Health and Hospitals Corporation, which runs the facility, is investigating whether staff members attempted to cover up the incident. Green's medical records contain notes suggesting that she was ambulatory during the period when the video shows her dying on the floor.

To learn more about this incident:
- read this Associated Press article

Related Articles:
LA officials grapple with hospital death
Study: Psych patients face especially long ED waits

Medical Staff

Joint Commission issues rules designed to stop bad behavior by doctors

NY woman dies on floor of public hospital