"Prosecutors who cannot rely on statute or contract can still prevail if a health care provider's indifference to the risk of harm amounts to either criminal negligence or recklessness" : (http://ispub.com/IJLHE/5/1/5237). There has been disquiet from the medical profession concerning the proposed Criminal Prosecution of Medical Negligence- adding to the current opportunities for civil action. However, from where I stand / observe ( 10 years as an allied health professional) - dealing with embedded and enculturated abusive behaviour appears to be problematic under current legislation. As a priority , the non-reporting of abusive behaviour by colleagues should become sanctioned legally - this would do more than any single legal action against an abuser to reverse and challenge institutionalised treatment of patients and carers that is / should be reqgarded as "illegal" --either under civil or criminal law.

No one has replied so far . I ask you again -Why is abusive professional behaviour ignored in healthcare situations? However good the medicine and application of theory and science - if it is delivered against a backdrop abusive behaviour by medical teams - ther may well be poor outcomes

There are many reasons that abuse and neglect are not reported in healthcare settings. First, in many cases even when abuse is reported there are no consequences or limited consequences to the perpetrator. In many cases, there are informal consequences for those who report abuse, such as being shunned by other staff members and sometimes there are formal consequences where action is actually taken against reporters of abuse. Second, the exposure of abuse typically reflects badly on the entire healthcare facility and team, not just on the perpetrator. As a result, in many cases supervisors and administrators actually try to cover abuse and neglect or willfully ignore it. Third, there are so many rules, requirements, and often unrealistic standards that most healthcare professionals, and even the best ones, run afoul of some rules. As a result, everyone's "hands are dirty" and this makes it difficult for anyone to report their fellow workers. These are just a few of the many reasons. From experience, in child protection, I believe that mandated reporting would be helpful, but in fact, these laws have not been very effective in child welfare. There is little evidence that they are critical in who reports, and there are rarely prosecutions under these laws.

Thanks Dick - peer pressure to do nothing or to respond negatively to colleagues who report abusive behaviour and poor standards of care are recognisable characteristics of this scenario. Your insightful repy make me realise I am asking the wrong question and that it is a mere reflection of the real issue : how do we reverse and challenge embedded harmful behaviour in healthcare settings much more effectively, given that inertia is not an alternative. I do have radical proposal, given that healthcare settings are large enough very often to be described as communities in themselves. The misplaced assumption is that healthcare communities are essentially benign: my assertion is that they are self evidently not ( your comments suggest this too). Could it be then that liberals, who make up the bulk of healthcare professionals ( I am one) have been unable to accept the fact that ALL communities require policing. I do not mean by more regulation - but by enforcement similar ( perhaps exactly like) to what you or I would expect if we see some drunk vandalising a phone booth or urinating in a public place

Mike, I think it is a delicate balance. Yes, policing is necessary, but heavy-handed management that does not respect healthcare workers can actually make the problem worse. Staff who are threatened or abused by more powerful administrators displace their frustration and anger toward vulnerable patients. Most of my research career focused on abuse of people with disabilities particularly with in educational and healthcare settings. Power inequities, inherent in the system and sometimes necessary, foster abuse. Empowerment of the potential victims provides counter-control and policing is one way to even the playing field a bit if done properly.

Of course you are right - after all - who polices the police. A more organic approach would be to empower those who are powerless ( those on the receiving end of care as well as those who feel intimidated by colleagues). One concern I have is that some behaviours lead to patients failing to get the care they need at the time they need it - leading more to a sin of ommission than an actual "crime". A recent example of this was brought to my attention by the spouse of a patient with a progressive heart and lung condition, who had delayed taking action to manage the symptoms his wife was experiencing for a month due to the hostile and unhelpful "help-line service" run by the nurses. This cruel indifference was hardly remarked on by her team and when raised as an issue worhty of comment- resulted in my being shunned by two of the nurses: the team leader at last conceded that re-training might help- but only after a clearly implied message that I should stop rocking the boat.