D.10 36C26126R0014 PS-05-76_VA Medical Center Memorandum Patient Rights and Responsibilities.pdf

VA Northern California Health Care System Policy Statement 05-76 February 1, 2017

RELATIONSHIPS BETWEEN EMPLOYEES AND PATIENTS

1. PURPOSE

To define appropriate boundaries in relationships between employees, staff, students, trainees, health care contractors, and volunteers, regardless of status, title or compensation arrangement and with the patients and patients' families (collectively referred to as "patients" in this policy) that we serve.

2. POLICY

Professional relationships between employees and patients must be distinct and must not co-exist with personal, intimate, social, or business relationships. Employees are encouraged to establish a warm and trusting environment for patients in order to enhance their recovery and promote satisfaction with the care and services being provided within the health care system. However, to go beyond the traditional employee and/or patient relations (even if initiated by the patient) constitutes a boundary violation.

3. PROCEDURES

a. Employee Knowledge. The employee is responsible for knowing and complying with the federal law and regulations and VA policies as well as any professional standards in his or her field.

To the degree that ambiguity exists, it is the employee’s responsibility to discuss the matter and obtain the input of the treatment team, his/her supervisor, and/or experts. The final decision as to appropriate actions should be consistent with supervisory direction by the supervisor or treatment team.

b. Expected Behavior.

(1) An employee will establish a safe and trusting environment for patients and their families. This will enhance recovery and promote satisfaction with the care and services that are being provided. To step beyond the bounds of professional courtesy and go outside the traditional patient/employee relationship may constitute a boundary violation. Employees in that situation MUST seek guidance from his/her supervisor.

(2) An employee will not establish a personal, intimate or social relationship with a patient or family to whom s/he provides or has provided direct services.

(3) An employee will not engage in business transactions with a patient, former patient or family member of a patient except where such transactions are available to the public as a whole.

Even in those instances, the price for said transaction must be the advertised price.

(4) An employee will not use his/her position to take advantage of any patient.

(5) An employee will not gain access to medical or other records of the patient for other than professional and therapeutic reasons.

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(6) An employee will not accept gifts, other than a nominal gift (as defined by the Standards of Conduct for Employees of the Executive Branch) from a patient.

(7) An employee will be aware that physical contact between patients and employees is a powerful form of interaction and should happen only when the clinical situation warrants it.

Sexualized touch is never appropriate.

(8) An employee will never assist a patient or anyone with violating or violation of VA rules and policies. An employee with a grievance about VA rules, policies or procedures should take those up directly through existing mechanisms. When an employee learns of a patient’s complaint, the employee will instruct the patient as to avenues for complaint.

(9) An employee will not engage in sexual or romantic relationships with a patient or former patient, or an immediate family member of a patient.

(10) The use of self-disclosure will be used judiciously. While some self-disclosure is appropriate in the process of providing care or services for patients, it should be used only when it enhances the professional relationship and the care of patients. Employees should keep in mind that excessive self-disclosure is believed to be a precursor to other boundary violations. Employees should also be respectful of boundaries of co-workers and refrain from giving personal information about co-workers to patients. These provisions apply even when a patient initiates inappropriate conduct. The employee is responsible for refusing the patient’s initiatives. An employee who is uncomfortable doing so should consult their supervisor or appropriate facility experts.

c. Pre-Existing Relationships. The employee must report to their supervisor (and other members of the treatment team who are responsible for the patient’s care) any pre-existing relationship with a patient (for example, a neighbor, family member, or friend) who subsequently receives direct services from any area in which the employee exercises his or her official responsibilities. In these situations, efforts may be made to minimize contact between the employee and the patient if appropriate and necessary. If the employee fails to report such a relationship and it later becomes known to management, failure to provide this required report may be grounds for disciplinary action (the post-treatment relationship should not exceed the nature and degree of the relationship prior to treatment).

d. Employees Who Are Patients. It is especially important that employees who are also patients understand the complexities of dual relationships/roles. Employees must seek consultation from their supervisor if they seek care in an area where they work or if conflicts develop between their employee and patient roles.

e. Unclear Situations. If it is unclear that a specific relationship is prohibited, the employee, or any others knowing of the relationship, must refer the situation to his or her supervisor. The supervisor will determine the action to be taken and may do so in consultation with patient’s primary provider and higher level managers.

f. Request Guidance and/or Reporting Suspected Employee Boundary Violations. Employees should contact either their supervisor or the Patient Advocate to report suspected employee boundary violations.

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g. An employee who becomes aware of behavior that appears to violate the above prohibitions must report the violation to his or her supervisor as soon as possible. That supervisor will follow the appropriate chain of command in reporting the suspected violation.

(1) Any staff member who has involved himself/herself in a conflicted social, business, or sexual relationship with a patient is responsible for demonstrating to the satisfaction of his/her supervisor, that the patient’s care is not compromised by the relationship. This requires that the employee notify his/her supervisor of any such relationship.

(2) Where the specific nature of a relationship is unclear as to whether it would be

“reasonably” expected to interfere with/or compromise the care of a patient, or if determination needs to be made on how to safeguard the patient or staff member from a potentially damaging relationship, the supervisor should be consulted. The supervisor may contact the Patient Advocate for assistance in identifying the patient’s primary provider.

(3) The supervisor will consult with the patient’s primary provider to determine whether a differential in power exists between the staff member and patient by virtue of their employment at the VA Northern California Health Care System (VANCHCS).

(4) Any employee who has direct knowledge of a social, business, or romantic relationship between a staff member and a patient that can be reasonably expected to interfere with or compromise the quality of care, civil rights, confidentiality, safety, or access to health care of that patient or other patients is responsible for immediately reporting the relationship to their supervisor, who will, in turn, follow up with a report to the staff member’s supervisor.

(5) Employees who have questions about their obligation to report a suspected violation to a licensing board must first seek guidance from their supervisor and/or Quality Management.

(6) A supervisor, upon being notified in writing of any such relationship, will notify their service chief who will initiate appropriate action through consultation with Human Resources Management Service.

(7) Employees receiving notes, expressions of affection, sexual interest or provocation from a patient or who are experiencing any difficulty in managing a relationship with a patient should immediately report this to their supervisor who will consult with the patient’s primary provider.

Additionally, the Patient Advocate may also be contacted to resolve the problem with the patient.

(8) Violations of law and federal employee conduct may additionally result in criminal prosecution.

4. RESPONSIBILITIES

a. Service Chiefs:

(1) Will assure that all employees are aware and adhere to this policy; and;

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(2) Will review and discuss any suspected violations of this policy with the employee, and report their findings to the Quality Manager to initiate the investigative process, which will determine whether patient abuse did occur.

b. Supervisors:

(1) Will enforce the intent of this policy;

(2) Will assist the employee with setting boundaries with patients as required; and

(3) Will report suspected violations of this policy to their service chief.

c. Employees:

(1) Will maintain professional relationships with patients who receive care at this Health Care System;

(2) Must report to their supervisor any pre-existing relationships with a patient (i.e., a neighbor, or a friend) who subsequently receives services from the employee's work area. The employee does not have to disclose the nature of the pre-existing relationship;

(3) Who becomes aware of a relationship that appears to be in violation of this policy will report the suspected violation immediately to the appropriate supervisor and the reporting employee will remain anonymous in so far as VA regulations permit; and

(4) Must report to their supervisor that a patient may be trying to establish a relationship other than professional or may be misinterpreting their professional relationship.

5. REVIEW, RECISSION OR REISSUE DATE

The Chief, HRMS, will review this policy for rescission or reissue within five years of the date of issue. Target review date is within five years of the date of issue (February 1, 2022). If the review is not completed within the target review date, this policy will remain active and current, until the review is completed and a new policy is published or the existing policy is rescinded.

6. ORIGINAL EFFECTIVE DATE

April 29, 2011.

7. REFERENCES

5 CFR 2635

38 CFR, Part 0, Section 0.735-11 Health Care System Policy Statement 00-40 (Code of Ethical Behavior)

8. RESCISSION

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Policy Statement 05-76, dated April 29, 2011

David Stockwell, MHA Director

RELATIONSHIPS BETWEEN EMPLOYEES AND PATIENTS