Most disturbing sex abuse case in healthcare history

Sexual abuse cases have torn through institutions such as The Pennsylvania State University in recent years, and the state of Delaware is grappling with what is being called the most heinous case of sexual exploitation in healthcare in history. A pediatrician is serving 14 life sentences plus 164 years, and the hospital is facing multiple lawsuits, including a class action lawsuit that could involve as many as 7,000 patients.

The healthcare industry is ripe for more such lawsuits, some observers say, and risk managers should act quickly to reduce the risk and protect children in their care.

Beebe Medical Center in Lewes, DE, is struggling through a legal tangle even though none of the child sexual abuse is alleged to have occurred at its facilities. The convicted pedophile once worked as chief of pediatrics at the hospital. The lawsuits allege that Beebe employees and administrators should have detected signs that he was abusing children or that they suspected something was wrong but did not take adequate actions. The abuse took place at the pediatrician's clinic, in an annex next door to the hospital.

Hospital spokesperson Kelly Griffin tells Healthcare Risk Management that the hospital is committed to a mediation process that should resolve the lawsuits over the next three to six months. Until that time, she says, administrators cannot comment further. She notes, however, that the hospital has responded to the crisis with several significant improvements to reduce the risk of sexual abuse in its facilities, including a policy that provides for a chaperone to be present during physical contact with a child or anyone else who might be vulnerable.

Hospital's credit rating lowered

The hospital was drawn into the case of 58-year-old Earl B. Bradley, MD, who was convicted in June 2011 of 24 counts, including first-degree rape, second-degree assault, and sexual exploitation of a child. Prosecutors charged that Bradley raped or assaulted more than 85 young children under his care over several years.

The class action suit was approved by a Delaware judge in April 2011. It allows victims to combine dozens of civil lawsuits against Beebe and three physicians accused of failing to report suspicions of misconduct. Attorney Bruce Hudson, JD, who represents many of the victims, released a statement saying that class action status would require contacting up to 7,000 former patients for possible inclusion. At that time, Beebe Vice President Wallace Hudson issued a statement saying the hospital supported the class action lawsuit as an orderly way to address the numerous lawsuits the hospital faced. The hospital had acknowledged earlier that the lawsuits resulted in credit agencies lowering its credit rating.

Lessons to be learned from case

The extent of Bradley's crimes and the viciousness of his abuse has led many to call his case the most extreme example of sexual abuse in healthcare. But he is not alone. In the past 10 years, dozens of doctors have been accused of abusing hundreds of children, and many of those cases took decades to uncover.

As in other cases, many of the allegations against the hospital and physicians who worked with Bradley concern people not acting or acting insufficiently on their suspicions about his behavior. This case will create a higher expectation for healthcare professionals and employers, says Linda Ammons, JD, associate provost and dean of the Widener University School of Law in Wilmington, DE.

Ammons was asked by the governor of Delaware to conduct an independent review of the Bradley case in 2010. Her report found many faults in the Delaware healthcare system and Beebe Medical Center's actions, offering 70 recommendations for improvement. "We absolutely will have lower tolerance for people saying they just didn't know. They should have known," Ammons says. "Because of this case and other cases, the liability risk is even greater for hospitals that don't do what they ought to do. The question won't just be what did you know, it will be what should you have known, based on everything that has happened so far."

The Bradley case is probably the "most heinous" case of sexual abuse in healthcare, says Grena Porto, RN, MS, ARM, CPHRM, principal with QRS Healthcare Consulting in Hockessin, DE, and former president of the American Society for Healthcare Risk Management (ASHRM) in Chicago. The details of the Bradley case produce clear lessons for risk managers, she says. The first is that when any type of abuse is suspected, employees must report it immediately and administrators must act aggressively, she says.

"The problem here was that everyone had suspicions, and no one did anything about it," Porto says. "The doctors and nurse who worked with him said, 'Yeah, we called him the pedophile doctor,' but nobody acted on that. Some people reported their suspicions, but in the end, the administrators and the authorities didn't do anything to stop him, and more babies were raped."

Too often, Porto says, administrators refer abuse allegations to peer review rather than the police.

Hospitals at high risk

Sexual abuse of children can happen anywhere, but healthcare facilities offer unique opportunities, says Julie Logan, president and CEO of Darkness to Light, a national non-profit dedicated to the prevention of child sexual abuse, based in Charleston, SC.

"Perpetrators are drawn to places where they can have access to children, especially private access, and that can be more of a risk in hospitals," Logan says. "They also are drawn to situations where they can have a trusting relationship with the child and the parents, and that can be a healthcare environment as well."

Bradley, for example, took children to a separate room without their parents for examinations, and parents allowed it because they trusted him, Logan explains. Risk managers should implement policies that prohibit such behavior and require others to report violations, she says.

The facts emerging from the Bradley case do not entirely surprise Frederic G. Reamer, PhD, a professor at the Rhode Island College School of Social Work in Providence. Reamer is the author of two books on crime, and he has been a member of the Rhode Island Parole Board for 20 years. Reamer says it is common for people to see warning signs about abusive behavior but to do nothing, or do too little.

"Once these offenses come to light, it is not unusual to hear co-workers comment or testify about concerns they had over a period of time, like odd or suspicious behavior, poor job performance, or impairment," he says. "Colleagues sometimes worry about blowing the whistle because of their concern about destroying a career, defamation, or the anxiety and stress involved in reporting a co-worker to authorities. I think healthcare professionals would do well to include the subject of professional impairment — warning signs, predictors, correlates, and how to respond — during in-service training."

Recognizing and reporting impairment is important because it can go hand-in-hand with sexual abuse, he explains. "Nearly all of the offenders I have worked with over the years manifest very troubling evidence of very troubled lives," Reamer says. "Common correlates and precursors include major mental illness like bipolar disorder and clinical depression, substance abuse, trauma histories such as being victimized themselves as children, social isolation, and dysfunctional interpersonal and intimate relationships."

Ammons urges risk managers to learn from the Bradley case and to study the recommendations in her report and Beebe's improvements. "It's unfortunate that this particular episode happened, but I think out of this tragedy we have developed some very good recommendations," she says. "If those are implemented and expanded upon, I think we can prevent a lot of tragedies for individuals and reduced liability or hospitals and healthcare facilities. I admonish people to pay attention and do what you need to do."

Porto calls on risk managers to always err on the side of caution when it comes to protecting patients, especially children.

"In all of these sex abuse cases, the organizations were all about protecting their doctors," she says. "Where in your mission statement does it say you're there to protect physicians? You're there to protect patients."

Sources

• Linda Ammons, JD, Associate Provost and Dean of the Widener University School of Law, Wilmington, DE. Telephone: (302) 477-2162.

• Julie Logan, President and CEO, Darkness to Light, Charleston, SC. Telephone: (843) 965-5444. Web: http://www.d2l.org.

• Grena Porto, RN, MS, ARM, CPHRM, Principal, QRS Healthcare Consulting, Hockessin, DE. Telephone: (302) 235-2363. E-mail: gporto@qrshealthcare.com.

• Frederic G. Reamer, PhD, a professor at the Rhode Island College School of Social Work in Providence. Telephone: (401) 456-8042. E-mail: freamer@ric.edu.