Marriott Rivercenter San Antonio, Texas Oct. 13-16
orexcellence.com

Lessons Learned From the Death of Joan Rivers
There are many lessons we can learn from the death of celebrity Joan Rivers during what was supposed to be a routine endoscopy. Her death has increased media and public scrutiny of patient safety outside the traditional hospital setting. In addition to reviewing the known facts surrounding Ms. Rivers's death, nationally recognized patient safety expert Kenneth P. Rothfield, MD, MBA, CPE, will outline steps outpatient facilities should take to ensure the highest standards of safety. Register at orexcellence.com to see Dr. Rothfield, the chief medical officer of Saint Vincent's Healthcare in Jacksonville, Fla.

To a drug addict or a sexual predator, the operating room must be like the candyland of opportunity, a personal playground, temptation at every turn. All you need is some alone time with the drug vials and the anesthetized patients to get your fix, to feed your habit and to get your jollies. Of the taboo topic of sexual assault, you say Never in my OR! But we're not just talking about the criminal acts you'll find in our editorial archives — Surgical Tech at Military Center Faces Allegations of Fondling 3 Women, Nurse Charged with Sexually Assaulting Patients Under Anesthesia, Surgeon Pleads Guilty to Sexually Assaulting Patients. We're also talking about the subtle smuttiness that's silently condoned, like these creepy examples our readers shared with us:

• The hands of the older male CRNA lingering a little too long while placing EKG leads on young female patients.
• Pre-sedating patients who are having cosmetic procedures and leaving them to lie naked on the OR table, surrounded by only male providers.
• An anesthesiologist French kissing a post-op patient as she's emerging from anesthesia.
• A surgical tech taking pictures on his cell phone of an exposed patient.
• A surgeon exposing the breasts of a woman undergoing a laparoscopic abdominoplasty. The circulator covered the patient's breasts with the gown, but the surgeon pulled the gown up and said, "Leave them uncovered because I like breasts."

We could go on, but you get the point. You might deserve to get punched in the nose for such acts of perversion, but you won't get prosecuted. So who'll protect your powerless, unconscious and vulnerable patients from the predators? You. And here's how.

1. Remove the one thing that predators need: opportunity. Like syringe stealers, sexual predators will look behind both shoulders to make sure no one's watching before they abuse their victims. "I believe an underlying personality trait of infallibility and or perversion must be present," says Sean Hintz, CRNA, of Benton, La. "It can happen in the open, but I suspect it's done mostly surreptitiously."

Never leave a patient alone in the OR or in PACU with a solo member of the opposite sex, and ensure that a same-sex nurse attends to every patient at all times.

"Many of my younger co-workers see it as old-fashioned, but I adhere to the principle of a same-gender person as the patient being on the surgical team," says an RN.

"The standard of care for an anesthetized patient should be 2 clinicians present," says a facility manager. "Two people are less likely to collude and commit a sexual offense than 1 person. A patient in a vulnerable state should never be left alone, and no one with common sense about their legal liability and license should ever want to be alone with a vulnerable patient."

2. Realize human nature. Some people are predatory by nature, and sometimes a level of depravity simmers just beneath the calm surface. As Dan Simonson, CRNA, MHPA, of Spokane, Wash., says, "There are factors in our genetic inheritance going back to our predatory past that play into it."

So why tempt fate by putting a surgical team member alone in a room with an anesthetized patient who's none the wiser? All it takes is to leave the patient alone in the OR with the anesthesiologist or scrub tech for a minute while the circulator readies for the next case.

"We must act to prevent this from ever occurring to our patients — and the best way to do it is to make sure there is no opportunity," adds Mr. Simonson. "The predators that walk among us must be kept at bay."

Remove opportunity and realize human nature.

"Shining a bright light in the corners makes the crawly things scatter," says Jane Taylor, MSN, RN, a clinical instructor at The Catholic University of America in Washington, D.C.