A lot of media folks have been calling the Institute asking for our opinion on what happened at Walter Reed Hospital. There appears to have been repeated and gross violations of the patient rights of distinguished veterans as well as the rights of their advocates.
We have issued a press release clearly stating our position on the issue. The Washington Post reporters Dana Priest and Anne Hull first broke the story last Tuesday. Their report focuses almost entirely on the conditions of the physical plant. A still more troubling piece appears in the March 8th edition of Newsweek.
Dan Ephron and Sarah Childress' piece in Newsweek reports on what amounts to repeated and gross violations of patient rights in patient care. Fundamental rights of patient self-determination and informed consent were totally disregarded by VA medical and administrative personnel on a routine basis. It's bewildering that war-injured, distinguished veterans would return home to face such mistreatment and disrespect.
There was a complete breakdown in communications, both at the clinical and adminstrative levels of hospital operations. The Ephron and Childress piece seems to single out the nursing staff (as usual!), but the violations of patient rights indicates a systemic problem implicating administrators, doctors, nurses and even the hosptial chaplaincy.
Singling out individual healthcare professionals, like individual nurses, simply will not wash. The problems of a failure to communicate, conflict between providers and patients, and medical error require a systems approach in addressing patient rights.
Values, belief and attitudes must be addressed along with behavioral competencies and organizational systems and sub-systems.
All of us in health care ethics have the utmost respect for the VA's clinical ethics function. The VA has put a lot of money where its values are in funding a top notch, comprehensive ethics program. However, it now appears to all that the VA has not adequately integrated that clinical ethics function into the operations of Walter Reed at the hospital bedside.
We have called on Congress to conduct a thorough and complete investigation into the circumstances that led to such a gross violation of patient rights. Congress should not stop with the VA.
What happened at Walter Reed is a microcosm of the state of the delivery of health care in hospitals across the United States. Fragmentation of care, uncoordinated care, invariably leads to a breakdown in communications and, eventually, to medical mistakes. A failure to communicate is violation of the most fundamental patient right: the right to informed consent.
While the violations may not be as aggregious as what occurred at Walter Reed, nonetheless patients and their families daily experience the violation of their rights at the hospital bedside in the delivery of health care.
People may say 'this could never happen to me,' but instances of the violation of patient rights like this happen everyday across this country to patients and their families. Unless and until we address the problem of miscommunication/failure to communicate, they will continue to do so.
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