​A risk manager recently asked ECRI Institute for help identifying and managing risks with a situation dubbed their "waiting room philanthropist," in which the widow of a cancer patient periodically visits the waiting room of the hospital's outpatient oncology clinic and hands out $100 bills to everyone in the waiting room. The woman is not herself a patient. The hospital knows when she is coming but does not announce her presence. She does not enter treatment areas or visit inpatient areas.

In our response, ECRI Institute notes that the woman's efforts and generosity are laudable. There are, however, several risks to consider.

If word gets out that a person periodically comes onto hospital property with at least several hundred dollars in cash, she and the hospital could be targets for robbery. Short of robbery, people may try to take advantage of the situation in other ways, such as by planning to show up when they think she might be there.

Oncology waiting rooms can be emotional places. Although many people in the waiting room would likely appreciate the woman's gesture, some people could become annoyed, possibly even angry. Perhaps they don't want to be bothered, or don't want people to know they have cancer—it could be someone the philanthropist knows personally, a celebrity, or anyone, really—and therefore object to the presence of someone who has no clinical need to be there. There could be other reasons as well. Whatever the reason, a potentially emotional reaction could lead to a tense situation in the waiting room.

Premises liability issues may come into play as well. Legal statutes that exist under property law (e.g., business invitee, licensee) may govern what duty of care the property owner owes to this individual, in the event that she should slip and fall or be injured on the premises, of if someone is annoyed by her action and lashes out.

If the woman hands out money while sick with a contagious illness, patients could be unnecessarily exposed. Although the organization could ask the woman not to visit when sick, it would not eliminate the risk: for some illnesses, including the flu and stomach viruses, people can be contagious before they realize they are sick. This is a particular concern in oncology areas because infectious diseases can be serious for cancer patients, who are often immunocompromised.

The hospital may wish to have a conversation with the woman to develop a plan for moving forward.

One potential solution is to propose another way for the woman to channel her generosity. Maybe she would be interested in establishing a fund to support cancer patients and their families or donating to an existing fund. A fund could serve one or a variety of purposes, depending on how the organization and the woman would like to structure it. For example, the money could go toward defraying medical costs for patients who have financial need, purchasing nonmedical necessities for patients, purchasing comfort or fun items for patients and families, or some other use.

Establishing a formal channel for her financial contributions could have more benefits than simply addressing the risks outlined above. It may allow more people to benefit than the ones who happen to be in the waiting room when she arrives, and others could contribute to the fund. If the hospital decides to pursue this idea, present it as a positive new initiative inspired by her generosity. The fund could even be named in honor of her husband.

Instead of or in addition to contributing to a fund, she may be interested in volunteering at the hospital (with the understanding that she could not give money to people through her volunteer role). Alternatively, she could direct her philanthropy to outside organizations that support cancer patients or cancer research. There may be other ways she could contribute.

If instead the organization decides to allow her to continue to hand out money, it should take steps to address the risks discussed above. Examples include the following:

• Ask the woman to reduce the predictability or frequency of her visits, if necessary, to reduce the risk of robbery or people simply taking advantage of her generosity.
• Give her a copy of the visitor policy to ensure there are no misunderstandings about the parameters of her conduct and timing of her visits.
• Advise the woman not to visit while ill or within a certain time frame of being ill (consult with infection control personnel regarding appropriate time frames). Ask the woman to perform hand hygiene before and after handing out the money.
• Consider whether staff activities in accommodating these visits detract from patient care or other operations.
• To reduce the risk of premises liability claims, assess and optimize the safety and security of the environment.
• Develop contingency plans in the event that the woman's efforts attract public attention—through local news media, for example. Consider risks that could arise, such as an increased risk for robbery, and create strategies to address those risks.

The recommendations contained in Ask HRC do not constitute legal advice. Facilities should consult legal counsel for specific guidance and develop clinical guidance in consultation with their clinical staff.