Valdez (Alaska) Community Hospital has adopted new visitation rules after state regulators investigated multiple complaints that doctors had allowed their children to observe and, in some cases, assist in the treatment of patients.
"The investigators were mostly concerned about patient confidentiality and their right to privacy," says James Culley, chief executive officer of the Valdez Regional Health Authority, which operates the 15-bed hospital. "It also raised some liability issues for us."
Investigators from the state Office of Health Facilities Licensing and Certification interviewed Valdez Community's administrators and nursing staff in late June after patients complained that three of the hospital's four physicians had their children present during exams and operations. Among incidents from May and June:
n A physician allowed his teen-age daughter to assist in placing a cast on a patient's arm. The doctor turned down the offer of assistance from a member of the nursing staff.
n A doctor allowed a child into the operating room, without patient consent, while surgery was being performed.
n A doctor brought his 2-month-old and 4-year-old children into the room while performing a vaginal exam on a pregnant woman. The physician had gotten the patient's consent.
n A doctor placed his 4-year-old child on a nearby X-ray table while performing a hip manipulation procedure on a 79-year-old patient. When the child became frightened by the patient's screams, the doctor took the child from the room, leaving the patient unattended for several minutes.
Investigators were concerned that patients felt coerced and that doctors could not give their patients undivided attention, Culley says.
"We all realized that in rural areas, there are times when a physician has no choice" but to bring his or her child to work, Culley says. "But that wasn't the case in these instances. The physicians had ample time to find child care or to contact their on-call backup."
The hospital's new visitation policy requires permission from the patient, physician, nurse and administrator before an individual may enter areas such as an operating room. Visitors must also have some training in the areas of health sciences and patient rights.
Med school has gone to the dogs. Virginia Commonwealth University's new Center for Human-Animal Interaction will be one of the first programs based in a medical school to study the health benefits people derive from animal companions.
The Richmond, Va.-based center will coordinate research, such as studying the effects of pet interaction on patients with various types of illness, and provide services, such as pet-loss counseling and animal-assisted therapy for patients.
Program Director Sandra Barker, a VCU psychiatry professor who also is on the faculty of nearby veterinary college, says "certified therapy pets," such as her Lhasa apso named "H.I.," can be useful partners in patient therapy. For example, petting an animal could be part of a daily regimen for some occupational therapy patients who need to regain motor skills.
Not just any dog or cat makes the grade. Animals and their trainers must complete a certification process offered by a nationally recognized pet therapy program, such as the Delta Society in Renton, Wash.
Selling the concept of pets as part of patient therapy to doctors and administrators has its challenges. "This is an emerging field with more evidence coming to light about the health benefits of interacting with companion animals," Barker says.
She gets some strange looks when she gets on the Medical College of Virginia Hospitals' elevators with H.I., on their way to the next patient. But "I haven't really experienced resistance as much as surprise," she says.
Getting what's due them. Investigators behind the government's healthcare fraud prosecution of HCA earlier this month were awarded the U.S. Justice Department's top honor, the Attorney General's Award for Exceptional Service. Sixteen FBI agents, 13 assistant U.S. attorneys and Justice Department staff, two agents with HHS' inspector general's office, two agents with the U.S. Defense Department and an agent with the Tennessee Bureau of Investigation received the award.
"Since 1997, the nominees have led a complex multi-agency, multidistrict investigation, which uncovered a profusion of illegal activity, including fraudulent billing practices and kickbacks," U.S. Attorney General John Ashcroft said. The 1999 conviction of two former HCA executives in Florida-the only criminal convictions so far related to the investigation-has "had a major impact," Ashcroft said. Nashville-based HCA, formerly Columbia/HCA Healthcare Corp., agreed last year to pay $840 million to resolve civil and criminal fraud charges.