Failures of foreseeability: Risk management considerations in reducing allegations of sexual violence in psychiatric units.

This article begins with a brief discussion of findings on causal factors leading to allegations of sexual violence in health care facilities and then offers the author's account of 4 such cases that he reviewed, 3 of which occurred in psychiatric units. These cases show remarkably similar variables, especially involving decisions to allow male and female patients to commingle, the inadequate physical layout of the units, poor or absent video surveillance, and staff unacquainted with institutional policies on patient safety or refusing to enforce relevant rules. These variables arguably amount to "failures of foreseeability" that reasonably cautious health care personnel should recognize as facilitating or enabling sexual violence. As such, the proactive message of this article for health care risk management urges critical and robust attention paid to a unit's environmental/physical design as well as to performance factors among personnel so as to prevent sexual attacks and diminish the probability of malpractice actions.