Sexual abuse of people with intellectual disabilities in residential settings: a 3-year analysis of incidents reported to the Dutch Health and Youth Care Inspectorate.

OBJECTIVES: To explore characteristics of sexual abuse within residential settings for people with an intellectual disability and to map out measures undertaken and improvement plans made by healthcare organisations after sexual abuse. DESIGN: Descriptive analysis of reports about sexual violence against persons with an intellectual disability submitted to the Dutch Health and Youth Care Inspectorate by healthcare organisations. SETTING: Residential settings for people with an intellectual disability in The Netherlands. SELECTION: 186 incident reports submitted to the Inspectorate between January 2017 and December 2019 were included. RESULTS: 125 incident reports concerned sexual abuse by fellow clients and 61 reports concerned sexual abuse by professionals. Client perpetrators were predominantly male whereas almost 30% of the abusing professionals were female. The majority of the perpetrating professionals were unlicensed professionals. Clients who committed sexual abuse were mostly relocated to another residential setting. Most healthcare organisations invested in education and training for employees instead of improving the sexual education programme for clients after an incident of sexual abuse. If there was a strong suspicion of sexual abuse by a professional, resignation followed in most cases. In just two cases, the perpetrating professional was reported to a warning registry. CONCLUSIONS: A small amount of the perpetrating professionals held a licensed profession, which makes it challenging to address this form of sexual abuse through healthcare regulation. It raises the question why warning registries are not engaged more often after alleged sexual abuse. Constantly relocating abusing clients might endanger the (sexual) safety of clients in these new environments. Previous literature suggests that adequate sexual education regarding social skills and sexual behaviour is very effective for the majority of clients who commit sexual abuse. Healthcare organisations could take up a more prominent role in this to ensure safety for their own clients and for clients residing elsewhere.

Disciplinary law and neurosurgery: a 10-year analysis of cases in the Netherlands.

OBJECTIVE: Neurosurgery is historically seen as a high-risk medical specialty, with a large percentage of neurosurgeons facing complaints during their careers. The Dutch medicolegal system is characterized by a strong emphasis on informal mediation, which can be accompanied or followed by disciplinary actions. To determine if this system is associated with a low overall risk for medical litigation through disciplinary law, the authors conducted a review of disciplinary cases involving neurosurgeons in the Netherlands. METHODS: The authors reviewed legal cases that had been filed against consultant neurosurgeons and neurosurgical residents under the Dutch disciplinary law for medical professions between 2009 and 2019. RESULTS: A total of 1322 neurosurgical care-related cases from 2009 to 2019 were reviewed. Fifty-seven (4.3%) cases were filed against neurosurgeons (40 first-instance cases, 17 appeal cases). In total, 123 complaints were filed in the 40 first-instance cases. Most of these cases were related to spine surgery (62.5%), followed by cranial surgery (27.5%), peripheral nerve surgery (7.5%), and pediatric neurosurgery (2.5%). Complaints were filed in all stages of care but were mostly related to preoperative and intraoperative care. CONCLUSIONS: The risk for medically related litigation in neurosurgery in the Netherlands through disciplinary law is low but not negligible. Although the absolute number of cases is low, spinal neurosurgery was found to be a risk factor for complaints. The relatively high number of cases that involved the sharing of information suggests that specific improvements-focusing on communication-can be made in order to lower the risk for future litigation.