Saturday, November 11, 2017

Privacy Violations: A patient's experience

Privacy Violations and how I dealt with them
by 'Still Standing'

(Moderators' note: This poster did not want to be personally identified to protect all concerned.  Although we do not favor this policy, his real identity is known to us, and we have permitted it as we have done on rare occasions before.)

I had a bad Patient Privacy experience at a VA Clinic and filed the complaint copied below. I prefer not to list the City or individual names, mostly out of respect because they have responded favorably to my complaint. The word Facility is the name of the VA Clinic, and the other Italicized words are similar substitutions. The medical procedure was in late August 2017.
VA Facility Outpatient Clinic August, 2017
Dear Ms. Patient Experience Chief:
I am registering a complaint of people in my procedure room who had nothing to do with my procedure. Four times during my procedure the door was opened and people not part of my procedure were allowed to enter. This involved seven or more people. My privacy was invaded and my sense of modesty disregarded.
On The Day, a little before 8 AM I checked into Clinic C at the Facility VA for a scheduled colonoscopy at 9. My name was soon called and a woman introduced herself as Nurse. She said she would be monitoring my status during my procedure.
Nurse led me to the procedure room and closed the door. There was a bathroom off of the procedure room where Nurse gave me the necessary directions: Take off all your clothes and put them in this white bag. Put on this gown, it opens in the back. And put on these booties, you can wear your socks under the booties if you want. Nurse then left and closed the bathroom door.
When I came out of the bathroom the procedure room door was open and four or more people were standing in the procedure room, near the door, talking to each other and also talking to Nurse. There was also one or two people in the hallway who seemed to be involved with the people in the room and not walking by. The people in the room were dressed in green scrubs and scrub caps. One of the women in the scrubs made eye contact with me. Those people seemed to hurry wrapping up their conversations and left in a minute or two. The door was closed.
Nurse helped position me on the gurney and asked me if I wanted a blanket. I said I did and she left to get one. A man came in dressed in green scrubs and a hair net. He introduced himself as MedTech and said he would be assisting the Doctor during my colonoscopy. Nurse returned with the blanket. Doctor Last Name came in and introduced himself and said he would be conducting my colonoscopy. Soon the Doctor and MedTech were involved with their preparations in front of an instrument table.
A man came in dressed in civilian clothes, he walked up to MedTech and the Doctor and said “I had a great weekend, and yes, I can afford to retire in Reno.” He went on to tell them how he and his wife investigated real estate options in Reno. Evidently being in a good school district will raise the cost of buying a home, and that might not be a good value if you don’t have school age children. He also talked a bit about social and entertainment options that were readily found. Surely there must be even more to do if we just had time to look around.
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This man was quite happy and excited. He walked around the foot of my gurney and around the left side to a stool beside my head. While walking he looked into my gurney and strongly avoided making eye contact. He sat on the stool and told his friends that he and his wife also went to a city just outside of Sparks to look at a retirement community and at the general real estate market there. Evidently the retirement facility was nice but they didn’t imagine themselves involved with the social activities there. He said that 20% of the residents do not participate in those activities and so that community might work out for them after all. I could tilt my head up and left and look at him while he was talking. He avoided eye contact. When I looked toward Nurse she had turned her back. MedTech and the Doctor were facing this man and talking with him and they did not look at me. This man and his wife thought this little town outside of Sparks had a lot of potential and they looked forward to finding out more about it.
After ten minutes or so, I wasn’t wearing a watch, this man left. His exit path followed ninety percent of the perimeter of my gurney, during which time he did not make eye contact. I believe he is a staff member of VA Facility but I don’t think he is a member of the medical staff. He may not work in that building. If my procedure had required me to be exposed during his visit, then he would have had full view of my nudeness while he was visiting with his friends.
This man probably entered the room without knowledge of the exact procedure being performed, because he went there to visit his friends where they work: he wasn’t there to watch a colonoscopy per se. If I was there for a different procedure which required me to be fully exposed, this man would have been permitted to stay in the procedure room and have a full view of me. I do not know if he would enjoy having a full view of me, and I do not think that whether he would enjoy it or not is relevant. What is relevant is my sense of privacy. I do surrender my privacy for a medical procedure, but only to a medical staff involved with my immediate medical issue.
If an opposite gender patient had been in that room, and was exposed during her procedure, then that man would have a full view of her as long as he chose to stay and visit his friends. And I am not concerned that myself or other patients “have something” that this man or other VA staff “have not seen.” I realize that nude men and women have been seen before. I am concerned that I am required to be nude in front of people for no medical reason.
If that opposite gender patient had been sedated, or if I had been sedated, then “What the patient doesn’t know won’t hurt them.” Well, I disagree. Patients are affected by how the staff views them. When the staff views the patient as someone whose rights can be easily taken away from them, then the patient loses some humanity in the eyes of the staff.
Current VA Facility PRACTICE (not written policy, but practice) is disregard of patient privacy and modesty. Look at my experience, this cannot be a one-time oddity. This must be an environment. For various employees at the VA to have access to disrobed patients, without a medical reason, is disgusting. And when the patient is sedated it becomes creepy.
Returning to my procedure, there were two additional times when someone entered the procedure room. I believe it was the same man both times. He was dressed in scrubs and wore a scrub hat. He went to cabinets to put things in the cabinet and take things out of the cabinet. He made eye contact and offered a smile. I appreciated that.
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My procedure was completed soon after 9. I asked Nurse and MedTech about the man who talked so much and was not a part of the procedure. They looked at me with dull faces and said nothing. Is patient privacy a taboo subject?
As a patient, I surrender all Authority over my privacy of self and over my genital modesty when I enter a medical situation that requires it. When I surrender this Authority the medical staff cannot only take over this authority, they must also take the Responsibility that goes with it. The medical staff taking this authority from me is responsible to be a good steward of my privacy and modesty. The VA Facility medical staff holds my privacy and modesty in utter contempt.
This has got to change.
First, patient privacy cannot be a taboo subject. Patient inquiries cannot be stonewalled.
I received a procedure follow up phone call from TelephonePerson. She said she was sorry that people were allowed into my room who were not involved with my care. She told me there is an existing policy that only attending nurses and doctors are allowed in patient areas. I am sure she is right. I want to see copies of these existing policies. Perhaps these policies can be added to the Patient Bill of Rights. If VA Facility takes my complaint seriously, then I need to be copied on emails and reports about my complaint. There has to be an educational process to change this environment. I need to be informed about that educational process. This has to change.
Patient name and contact info.
I filed my complaint two days after the event. I looked up the Patient Advocate office at the Facility but the phone numbers listed were out of order, due to office renovations. I ended up calling the head of the department, Ms. Patient Experience Chief, whose office is at Headquarters in a Distant City, but I think I would have gotten the same response and results if I had started with the local Patient Advocate. I did enjoy talking the with the Department Head and at the time believed my case would be better handled by starting with her.
After ten days I got a letter from the Lab that the polyps discovered during the procedure were not cancerous. From that letter I also got the names and titles of Nurse and MedTech. I looked them up in the medical staff directory. A few weeks later I returned to the directory and their names were gone.
Two weeks after my letter I got a phone call from the Case Manager for GI Services, whom I will refer to as CaseManager. Mr. CaseManager was very encouraging and said there was an evidence of an
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environment problem with patient privacy before my complaint. He asked if he could send my complaint to interested parties, with my name and contact information. I consented.
That same day I got a phone call from Doctor LastName who thanked me for my feedback. He identified two problems: first that the patient was not sedated and second that the conversation was better suited for the break room. He assured me the man in street clothes (I said civilian clothes in my original letter) was the highest skilled nurse in the GI Department. He stated further that no one outside the GI Department is allowed in that area. He said that in every hospital and clinic there are people going in and out of procedure rooms that are not involved in the procedure in that room but they are medical personnel pursuing medical work in other rooms close by.
Remembering lessons I learned reading this blog and its’ articles, I addressed him by his title and last name and was relaxed when I spoke respectfully to him. I complained that the nurse had turned her back on me and that she and the technician had stonewalled me and that I had been generally treated with contempt. The Doctor responded that he takes care of the procedure and the support staff takes care of the patient. He would not directly address my question of whether friends would often drop in during times when the patient was sedated; in fact, everyone I talked to denied any knowledge of that one way or the other.
Three weeks after my complaint the CaseManager said the GI Department Chief had come from Headquarters, for the department monthly meeting, and had someone read my entire complaint to the whole department. They said that procedures had not been followed and the larger issue was that the patient should always come first. They had discussed incorporating my issues into on-going training.
I eventually talked to the Nurse Manager of the GI Department. She said they were installing signs outside each procedure room that would indicate when the room was in use, and also installing curtains in each room, three feet in from the door. If a staff person needs to get something out of the room, or to talk to another staff person in the room, then they will make that request and so forth, from behind the curtain.
In talking further with the NurseManager she confirmed that the invasion of privacy I experienced would never happen to a female veteran; because they have two important safeguards built into their system. One is the female veteran patient can request and receive a same gender health care team. Secondly, the female veteran is always accompanied by a medically credentialed, same gender attendant. NurseManager explained that the attendant would have stopped anyone who was not involved with the patient from entering the room. She was very proud of the service and respect they provide for the female veteran but acknowledged that it was not available for the male veteran due to personnel issues, all the men health care workers had been replaced with women; there were not enough men left to provide same gender care or accompaniment.
I left my conversation with NurseManager with a lot implied but unspoken. I was ready to take what victory I had and go. I also enjoyed talking with her in a respectful way and told her I considered the issue resolved, which she was glad to hear


Joel Sherman MD said...

This article calls into attention a frequent privacy violation to which we have not given much attention. The presence of an unnecessary person in the room during a medical or surgical encounter may range from blatant as in this case, with a person chatting about their personal issues to relatively trivial or accidental. The intruders usually are medical personnel but they could be industry types or even non medical 'observers.' Either way complaints are justified and I commend 'still waiting' for speaking up.

Dany said...

I will echo Dr Sherman's comment in appreciation of the poster still waiting's initiative. Perhaps not the complete victory expected but still, it looks like his complaint got some traction... And some changes are being implemented. Nice job!

Of course, and perhaps this is the cynic in me speaking, we're still a long way away from being treated equally with regard to privacy and/or modesty, as evidenced by the fact that this VA clinic seem oh so proud of what they are doing to protect their female patients. And yet...


Still Standing said...

Thanks for the kudos and comments, Dany.
I have since sent a second letter to the Patient Experience, this time requesting a same-gender medical team for my upcoming prostate biopsy. To schedule this I got two phone calls from two different women at the VA (there was a snafu and it had to be rescheduled, hence the second phone call) and both times asked for a same-gender team. Both times they asked me to repeat what I'd said and from their voice they implied there was something wrong with me and that no one else ever asked for this.
One week after my letter I got a phone call from Patient Advocate honoring my request. The Patient Advocate said he simply went to the department and asked, and they said sure. He said I would get a formal letter stating the care I would receive. When I asked, he said it was rare, in his knowledge, for a man to make this request.
I am going to pursue this issue of the women who make appointments not acting on requests from their male veterans, and not even recording the requests. The statement that it is rare for men to request same-gender care is probably not true. The women in scheduling just tell them 'no' and leave it at that.
I commend the Patient Experience department for acting and honoring my request.
After I have gone further with my issue with the scheduling department, I will tell you how that went.
- Still Standing

Anonymous said...

They are explicitly giving different levels of care based on gender by their own admission. That seems like a textbook discrimination case. Maybe consult the ACLU?

Still Standing said...

It is a textbook discrimination case. It is not ethical to have two standards of health care based on gender. Still, The Affordable Care Act excludes Prostate Cancer Screening or treatment, and still charges men and women the same. I saw a segment on TV news about a woman concerned that she couldn't finish her breast cancer treatment if there is a change in the ACA. I don't see anything on the news about the men denied cancer treatment.

Legal action is a step much larger than I want to take. I haven't thought about it. Also, the ACLU involvement. I know they do get involved in small, local actions like mine. Everything they do is not national.

It is probably the only option that will change the system.

Anonymous said...

Regarding the ACLU, your case is actually not a small, local issue. There is a policy that is clearly illegal and discriminatory. Your case is just one example of it. This is actually a big deal because it is happening across the board with many men. If it's too much to fight I get it and I don't want to pressure you or guilt you. I just have the opinion that it's not a small case. That said, I am not an lawyer.