title: Accusations that hospital staff have abused pediatric patients.
abstract: OBJECTIVE
  Study objectives were to describe a hospital Child Protection Team's (CPT) efforts to develop and implement a protocol for systematic evaluation and management of accusations that hospital staff have abused pediatric patients, and to learn how to avoid problematic patient encounters and cope with existing accusations.
  
  
  METHODS
  This study reports on a retrospective series of cases from one pediatric hospital between 1982 and 1996. It includes a survey of national children's hospitals' experience from 1990 through 1995.
  
  
  RESULTS
  After initial complaints to our hospital's CPT, it became apparent that procedures were inadequate to protect the safety of patients and rights of the accused. A protocol for reporting, evaluation, and management of accusations was developed and implemented by the CPT. Thirty-four accusations of abuse of children by staff were reviewed. Seventeen of the physical abuse cases included bruising, fractures, rough handling, and verbal abuse. Eighteen sexual abuse complaints included touching and sexual statements. Complaints were substantiated in 23% of the accusations, and a third of the identified staff members were fired or resigned. Child victims had a high frequency of chronic illness. They and their families frequently had histories of prior abuse, mental illness, and social disarray. These factors made children more likely to become victims of real abuse and to misinterpret standard hospital procedures as abusive. All service areas of the hospital and types of hospital staff were accused of patient abuse.
  
  
  CONCLUSIONS
  Few children's hospitals have formal protocols for internal management of or training programs to avoid complaints. Institutions and their staff who care for children should anticipate abuse complaints, train them in risk reduction methods, and develop accusation management plans.
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine and the Child Protection Team of the Children's Hospital & Medical Center, Seattle, USA.
authors.forename: K W
authors.initials: KW
authors.lastname: Feldman
authors.forename: C
authors.initials: C
authors.lastname: Mason
authors.forename: R P
authors.initials: RP
authors.lastname: Shugerman
mesh_terms: D002648:Child; D002649:Child Abuse / Q000517:prevention & control / Q000706:statistics & numerical data*; D002654:Child Care / Q000592:standards*; D002673:Child, Hospitalized / Q000523:psychology / Q000706:statistics & numerical data*; D003625:Data Collection; D006776:Hospitals, Pediatric / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D016134:Organizational Policy; D005791:Patient Care / Q000592:standards*; D010564:Personnel, Hospital / Q000592:standards; D011369:Professional-Patient Relations; D011567:Psychiatric Department, Hospital / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017751:Safety Management / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology; D014861:Washington / Q000453:epidemiology