Published Jun 7, 2005
Has anyone on the board ever had a patient sexually assault another patient while being in a locked, inpatient unit? How was the situation handled by your superiors?
I have worked in psych over 20 yrs and never yet had that occure. Not, that is, if you are talking about a full blown rape. I have never worked anywhere so poorly supervised that a pt yelling for help would be ignored. Certainly we have had male patients who were inappropriate with females. That is a theraputic issue and it is the attending physician and the treatment teams responsiblity to put measures in place to deal with that. If they fail to do so it is a malpractice issue.
People do not surrender their civil rights just because they are psych patients. The victim has every right to seek legal recourse. That would include criminal prodeedings against the perp and civil against the institution. Since the perp is a psych pt he has a ready made insanity plea. The police are reluctant to "waste time" on a case that they know will be thrown out of court. That does not mean it is a waste to file the complaint, it just will not likely result in a conviction. It does develop a "paper trail" that can help keep an offender off the streets.
Since I am a nursing supervisor I will tell you what I would expect to have done. The nursing staff should report the event to the doctor on call as soon as they are aware of it. The event and all known details should be documented in the patient's medical record by the staff with the most immediate knowledge. The victim should be given appropriate medical attention, with evidence gathering by a trained professional. Here that would mean sent to the local ER. I'm pretty sure that rape is a manditory reporting type event in the emergency medical system. An incident report should be filed through the internal institutional system. I would forward that to our director of nusing through my supervisor. Since I am the night supervisor here, I have been requested to alert all interested parties by e-mail when anything really odd happens, so I would do that too.
The incident was not a full blown rape. It was forcible female-to-female sodomy. With this in mind, would you still have the same response?
I, too, have not encountered anything that would be considered "rape" in my many years in psych, just consensual sexual activity between clients, but I would consider anything that could be described as "forcible" to be a criminal issue in addition to a clinical/treatment issue. In addition to all the internal responses outlined by CharlieRN, I would certainly offer the alleged victim the option of reporting to the local police and pressing charges.
I have been in many situations where police came to a psych unit to take statements and gather evidence related to other, non-sexual criminal allegations (typically, client-client assault). While it's certainly not their favorite thing to do, and it may well be difficult to obtain a conviction under the circumstances, it is their job to investigate allegations of criminal activity.
You may also have an obligation to report the situation you describe to your state healthcare licensing/enforcing board. The rules are different in every state, but in my state, the state mental health client rights rules would require that you report the incident, and state psych surveyors would do an on-site investigation to see whether the incident and your facility's response afterwards involved any lack of compliance with state rules/regs for your facility. If the facility didn't report it and we (I have been a surveyor with that agency in my state for the last several years) found out later about the incident (say, the alleged victim or a family member complained to us about it) the facility would automatically be in trouble with us for not having reported it at the time. But that varies greatly from state to state.
Yes this has happen on a locked unit where I worked approximately 13 years ago. It was in the VA. One male raped another male room mate. The incident took place in a span of perhaps 15-20 minutes, between rounds. The room mate punched the other man in his face, crushing his cheekbone. He then proceeded to hold his hand over the others mouth, throw him across the bed & sodomize him. The agressor then returned to bed. The victem promptly came to staff & reported the incident, also stating that he was unable to call out for help as the agressor had covered his mouth. I immediately phoned the doc on call both medical & psych, my supervisor & the VA police- it is a federal facillity & thus a federal crime & charge. They came & took the agressor to federal prison for quite a long while as this is a felony assault. When questioned by the police the agressor freely admitted to raping & punching his room mate, he was angry with him b/c he keep slamming the door to the bathroom & turning on the lights in the room...the agressor had no previous history of sexually inappropriate behavior. & carried a Dx. of Paranoid Schiz.
In short, yes. The key word is "forcible". That makes what has occured an assault. That is a criminal offense. Also it is a primary failure of the institution to provide a safe environment. The patient or her guardian has grounds to sue. The only defense the institution has is to aggressively pursue the case. Trying to sweep it under the rug makes it worse.
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