Hospice Patients Alliance: Consumer Advocacy


While the business of health care continues to struggle to find ways to meet the needs of all health care recipients, all of us in the health care industry must realize that not providing appropriate care is not the answer, even though many agencies choose this line of "increasing profits" as a "quick fix" to their financial concerns. The question is no longer: "which hospital, agency or institution would dare to violate such basic patient rights as the right to essential services delivered according to the standards of care in the industry?" ...the question now is, "which hospital, agency or institution is the exception and actually is providing essential services according to the standards of care in the industry?"

Saving money by under-staffing, under-medicating, under-serving patients, "looking the other way" (to maintain physician referral sources), and not informing patients of all treatment options or services has become quite common. While one institution may not violate all standards, all the time, in all locations or departments, it is likely to violate one or more standard in a department or location, consistently from time-to-time! And even more alarming, the administrators of our hospitals, agencies and institutions are consciously choosing to create situations which they know will result in the violations of the standards of care.

Intentional and knowing violations of the standards of care are simply and absolutely unacceptable! If health care providers such as physicians, nurses, social workers and therapists do NOT speak up in order to assure quality care, and do NOT force a halt to the changes now occurring, there will no longer be a health care system as we know it. In almost any setting, health care professionals will not be able to practice consistently on an ethical basis and still retain their jobs. What this means is that there will be times when each health care professional will be confronted with a situation in which they will be forced to "look the other way" or compromise the standards of practice for their profession. And if they don't, they won't have a job any longer.

In fact, the current reality of health care often punishes the ethically concerned practitioner while rewarding those who look the other way and work the system, for their own benefit. There have been many journal articles detailing the ineffectiveness of many professionals' efforts to improve the quality of care at their place of employment. Some staff may report problems "up the chain of command" as we're all told we're "supposed to do," and find no action taken by executive management to correct the problem. In those cases where management does nothing to correct a glaring problem, the problem is most likely consciously known and accepted by the executive management as a "necessary" result of administrative decisions taken by the corporate Board of Directors to bolster profit margins or please shareholders (if a for-profit corporation).

Betraying the trust of our patients in order to personally prosper is a despicable violation of everything our licenses stand for. Patients and families put their trust in the health care professionals and deserve our very best.

If you have real ethical dilemmas at your employment, ask yourself why you entered this profession; review your profession's code of conduct, review your legal responsibilities to your patients, and be willing to take a stand for your patient's rights. However, take a stand intelligently and protect yourself and your license as well. While some professionals simply quit and "move on" to another facility, the current reality is such that you may simply be changing one problem employer for another. Health care agencies are not hesitant to violate standards of care that involve you!

If you do try to attempt to correct the situation, you may find it helpful to follow some of the following general guidelines: Get legal advice if you believe there is some illegal activity going on. Actually going to the trouble of paying for and asking an attorney before you do anything may actually be the least expensive path. Even though attorneys are expensive, paying for an hour or two of advice can save you much heartache...and this is not advice on how to bring a lawsuit that we're suggesting. You need to know what your rights as an employee actually are and what your employer might actually do, regardless of what your "legal rights" are. Employers often circumvent "legal" protections to employees by making other "arrangements." They can try to find ways of creating "trouble" for you or making it more desirable for you to resign. You will have to decide whether or not you wish to actually do anything. What you decide will say much about your own character and strength of convictions.

If you do decide to work on correcting a situation at your workplace, document exactly what the situation really is: what the patient expressed, what the family may have stated, what the patient's need is, what your assessment is, what others stated and/or did, what supervisors instructed you to do...all of these are important aspects of protecting yourself and your license. Remember that the chart is the record, legally, of what happened or did not happen. If you don't chart your concerns and don't tell others, you have nothing to support your perception of the situation. Write down your own notes about your concerns and keep a dated and signed copy at home.

Make sure to communicate your concerns to other co-workers. If you don't tell anyone else except your supervisor, you may find yourself illegally terminated for some "trumped up" charge that has no bearing in reality. If you make your concerns known in front of many co-workers, retaliation will be less likely to happen and you will be more easily able to prove any retaliation, if it occurs. If you have a union, speak with your representative. If not, speak with your professional organization's ethics committee and legal advisors. Make your assessment known to your supervisor.

Whether a nurse, physician or social worker, there will be times that the "institution" may try to exert influence on you, against your professional judgment about what is the correct course of conduct. We all need to be more active in advocating for patients' rights and staff's rights as well.

If you observe health care fraud or other types of criminal activity, you are legally obligated to report this to the Federal Office of the Inspector General and other agencies. Although you can make a report by phone, it is recommended that you make any report in writing, by certified return-receipt U.S. mail. Always keep copies of any documentation you have access to which can provide evidence about the violations occurring. While you can't keep charts, you can keep correspondence or postings, e-mail or announcements. You can make anonymous and confidential reports if you're afraid of retaliation, but you'll need to include enough information to adequately describe exactly what's going on, for the agency to correct the problem. Do NOT believe "advice" from fearful co-workers who tell you to "keep quiet or they'll shut down the facility." It is highly unlikely that reporting criminal activity is going to threaten your employer with being "shut down." Rarely do agencies get totally shut down, however, white-collar criminals do go to jail for their crimes...and they are criminals! As a citizen and licensed professional, and for the patient's welfare, do the right thing and report to the Federal government.

A word of caution is also in order here. If you report to your State's division of licensing and certification, don't expect confidentiality and don't expect the State to always "do the right thing." There's a lot of administrative corruption in local State governments and the political connections may be unbelievable until you've tried to make a complaint. Any health care agency that is fairly large and respected in your community is going to have Board members and others who "know" somebody at the State level. Sometimes the State will "look the other way" to protect political "friends." It's a case of the business "network" protecting its own. Employees are not part of the political "network." Employees who violate the rules can get nailed to the wall, but employers rarely do, unless they're not "connected." This is not the time to be naive!

Some useful resources are the ethics committees or legal advisors of the following:

You can also check our section on "Links to other useful resources."

If you have questions about hospice, we hope that you will take the time to visit the hundreds of pages at our website, read our Guide to Hospice Care and visit our resources and links section (with hundreds of vital resources listed).

Hospice Patients Alliance affirms that all human life is inherently valuable and that the role of hospice nurses, physicians and all other staff is to alleviate suffering and provide comfort for the sick and dying without sanctioning or assisting their suicide. A death with dignity allows for a natural death in its own time, while doing everything possible to assure relief from distressing symptoms. Hospice Patients Alliance works hard to promote quality hospice care throughout the USA. If you would like to support our mission, we hope you wille consider supporting our mission through a donation. Hospice Patients Alliance is a 501(c)(3) charitable nonprofit corporation and your donations are deductible to the full extent allowed by law.

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