What can a practice do when a patient harasses a staffer?

A column about keeping your practice in good health

By Victoria Stagg Elliottis a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009. Posted Nov. 14, 2011.

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Doctors generally know that they risk legal action against a practice if a physician or employee complains about sexually suggestive or racist remarks from another doctor or employee and nothing is done.

But physicians might not realize that they face the same risk if they don't deal with complaints about a patient who frequently leers at a receptionist or utters racially offensive remarks to a medical assistant.

"Employers have more authority over the employees to discipline or terminate them," said Christina Stovall, director of the Human Resource Service Center for Odyssey One Source in Euless, Texas. But they can't throw up their hands about customers or patients harassing staff. "It's still your practice," she said. "There can still be repercussions."

Employee legal action because of inappropriate touching, sexual comments or racist remarks from patients falls under Title VII of the Civil Rights Act of 1964. The legal system could label a chronic, unaddressed problem of this kind a "hostile work environment."

Damaged staff morale, reduced productivity and high turnover are more likely if the situation is left untackled. Harassment even may increase health care costs. A study in the Aug. 25 Ergonomics correlated an increased risk of neck pain among employees who faced intimidation from any source in a workplace. Unwanted sexual attention increased the risk of neck pain in female employees. A study in the July-September Journal of Addictive Diseases indicated that people subjected to chronic harassment were at higher risk of problem drinking.

"If this isn't addressed, eventually your top performers are going to get sick of it and they are going to leave," Stovall said.

Experts say practices need written policies and training for employees. Policies should include how to defuse or minimize potentially uncomfortable situations. This is considered especially key for medical practices, because harassment could come with the job. Some patients may not be in full control of their words or actions because of mental illness, dementia, medication or other health issues.

"The employer has an obligation to make sure the working environment is safe and that employees are not exposed to problems that an employer can truly prevent," said Mary Ruth Houston, a partner and specialist in employment law at Shutts & Bowen in Orlando, Fla. "And education can make employees feel a lot more comfortable when they are harassed or put in a position where they are subject to inappropriate contact."

Devising a policy

The first step is to write a policy. It can be similar to one addressing harassment among staff, and it should have means for reporting problems with anyone who does not work at the practice, including patients and outside vendors. The policy should state that employees will not be subject to retaliation for reporting. Any report should be investigated, with information gathered from all witnesses.

"Employees need to know that their report about the situation is going to be confidential and there will be no retaliation," said Richele Taylor, an employment attorney at Fisher & Phillips in Columbia, S.C. "And once you determine how serious the situation is, you can talk to the patient and get the patient's side of the story."

This policy also may be communicated to patients and others who come into the practice.

Practices need to develop response strategies if a complaint is filed and harassment has been established. Solutions may vary. A question to consider is whether someone, possibly the physician, will point out inappropriate behavior to a patient.

"You can let them know that that is not the way we do things here," Stovall said. "Sometimes people are not even aware that what they are doing is offensive to someone or made someone uncomfortable."

Other questions to contemplate: Should the issue be discussed with a family member or caregiver? Are there subtle ways to steer a patient's behavior in an appropriate direction? Under what circumstances will a staffer be permitted not to work with a patient? Is it possible or necessary for at least two people to always be in a room with some patients?

But the goal is not just to reduce the risk of a lawsuit or low employee morale. Practices want to avoid discharging a patient for inappropriate behavior. That comes with its own challenges, although it sometimes may be necessary. If this step is taken, practices need to ensure that a patient is referred to another practice, records are made available and care is not disrupted. Some states may require minimum notification.

"If any patient engages in behavior of any kind that is disruptive, you can always discharge the patient from the practice," said Stacey Gulick, an attorney and partner at Garfunkel Wild in Great Neck, N.Y. "But the practice has to be sure that it doesn't violate any rules regarding patient abandonment." (See correction)

Victoria Stagg Elliott is a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009.

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