Physicians Disciplined for Sex-Related Offenses
By betraying and exploiting their patients’ faith, confidence, and vulnerability for their own gratification, physicians who engage in sexual contact with their patients inflict immense damage on their victims. In fact, this behavior is similar in many ways to incest, as physicians are trusted caretakers. When physicians put their needs ahead of the physical and psychological needs of their patients, they are abandoning their role of a protector of the patients’ interests, just as a parent who sexually abuses his child can no longer be considered a trusted guardian.
The dangers of physician-patient sexual contact were recognized in the Hippocratic Oath in the 4th or 5th century B.C., but over 2,300 years later this awareness is not always acted upon by the medical profession or the legal and disciplinary structures that regulate physicians. Indeed, it was not until the 1970s and 1980s that professional medical associations clearly stated that sexual activity between physicians and patients was unethical. Similarly, the disciplinary and legal systems have increased their attention to this issue in the last two decades. Over this time period, state medical boards have increasingly issued policies on sexual misconduct, and their trade organization, the Federation of State Medical Boards, adopted a report in 1996 to further aid in discussion of this issue. The first state law criminalizing sexual contact between a psychotherapist and a patient was passed in 1983 in Wisconsin, and at least 12 more states have passed such laws since that time.
Although the recently accelerated attention to and concern about physicians who sexually exploit their patients is commendable, it must be accompanied by action, in the form of holding offending physicians accountable, if it is to have any meaning. Since most of the agencies responsible for disciplining physicians are deficient in their policing of all kinds of offenses, it is probable that the majority of physicians committing sexual offenses are never apprehended, and that those who are caught are inadequately penalized. If this is the case, the fact that sexual misconduct in the abstract has been increasingly condemned is inadequate, for individuals guilty of these offenses are protected by the insufficient oversight of the medical profession.
Purpose and Methodology of the Report
In order to determine to what extent physicians who are guilty of sex-related offenses are held accountable for their actions by the agencies that regulate the medical profession, this report uses Public Citizen’s Health Research Group’s national database of disciplinary orders against physicians to analyze the frequency and severity of disciplinary actions taken for sex-related offenses. In this analysis we include all orders which are sex-related, whether or not they explicitly involved a patient, as a physician who commits sexual misconduct of any type violates the social trust necessary to the physician-patient relationship. The characteristics of the physicians against whom these orders were taken are also analyzed in order to gain an improved understanding of who commits sex-related offenses.
Frequency and Severity of Discipline
In the years 1989 through 1994, the number of disciplinary orders per year we identified as being for sex-related offenses increased from 47 to 162, a 3.4-fold increase. In these same years the percent of all disciplinary orders that were sex-related increased from 2.1% to 5.2%, a statistically significant 2.5-fold increase (p<.0001). In 1994, the year with the highest rate of disciplinary actions taken against physicians, 0.023% of physicians were disciplined for sex-related offenses.
The severity of discipline has not changed significantly from 1989 through 1994. The percent of orders by state medical boards that included a revocation or surrender of licensure decreased from 47.2% of all sex-related orders to 36.2% in this time period, while the percent of orders in which the most serious action was suspension or emergency suspension, restriction or probation, or other, non-serious, actions, increased. None of these changes is statistically significant. The percentage of disciplinary orders containing a revocation, surrender, and/or suspension was significantly higher for sex-related offenses than for non-sex-related offenses (71.9% vs. 42.8%, p<.0001).
While 44.4% of physicians who were disciplined for sex-related offenses lost their licensure through revocation or surrender, the most serious action taken against 26.3% of these physicians was suspension or emergency suspension, while another 19.6% had their license restricted or put on probation, and 9.6% had other, non-serious, actions taken against them. In addition, a substantial number of disciplined physicians had multiple actions taken against them, and some had more than one serious action imposed.
Of the physicians who were disciplined for sex-related offenses, 39.9% are currently licensed to practice in one or more of the jurisdictions which originally disciplined them. In addition, another 9.2% have one or more of their licenses in suspended status, indicating they could eventually practice.
The number of orders taken by individual state boards per 1,000 MDs for sex-related offenses from 1989 through 1994 varies from 3.3 to 0, and the number of MDs disciplined for sex-related offenses in those years also ranges from 3.3 to 0.
Characteristics of Physicians Disciplined for Sex-Related Offenses
Physician specialties (analyzed for MDs only) overrepresented among physicians disciplined for sex-related offenses were psychiatry (27.9% of those disciplined compared to 6.3% of all MDs), child psychiatry (2.5% compared to 0.8%), obstetrics/gynecology (12.6% compared to 6.1%), and family/general practice (20.3% compared to 12.4%) (all p<.0001). Conversely, MDs in the specialties of internal medicine (9.0% compared to 18.9% of all MDs), pediatrics, anesthesiology and general surgery were significantly underrepresented among MDs disciplined for sex-related offenses (all p<.006). Psychiatrists have progressively made up a smaller proportion of disciplined physicians between 1989 and 1994 (39.4% to 21.6%), while family and general practice physicians have, in the same time period, made up an increasing percentage of the total physicians disciplined for sex-related offenses (9.1% to 24.5%). Other specialties have remained a relatively constant proportion of disciplined physicians.
The age distribution of physicians disciplined for sex-related offenses at the time of the first sex-related disciplinary action was significantly older than that of the physician population as a whole. The distribution for disciplined physicians peaks in the 45-54 age category, with 32.6% of physicians disciplined for sex-related offenses belonging in this category, whereas the overall age distribution reaches its highest point in the 35-44 age category, with 32.7% of physicians. Physicians disciplined for sex-related offenses are significantly more likely (p<.0001) to be involved in direct patient care, and significantly less likely to be participating in post-graduate education (p<.0001) or non-patient care activities (p<.0156).
Analysis of the proportion of physicians disciplined for sex-related offenses who were board certified, as well as the proportion of these physicians who practiced in metropolitan areas, revealed that these physicians are not statistically different from the physician population as a whole in these characteristics.
Although the rate of discipline for sex-related offenses appears to be increasing, both in absolute terms and as a proportion of all discipline, not enough discipline is being done. The incidence of discipline, with at most 0.023% of physicians being disciplined for sex-related offenses a year, would result in only 1.2% of physicians being disciplined in their lifetime (assuming a 50 year career). This rate is inadequate given the prevalence of physicians guilty of sexual misconduct, which has been estimated conservatively at 3.5% to 13% of all physicians. Further, the severity of discipline is not only inadequate, with less than a half of the physicians in our database having an action of revocation or surrender taken against them, and almost 40% of disciplined physicians continuing to be licensed to practice in one or more of the jurisdictions which originally disciplined them, but also stagnant, with no significant changes in the severity of discipline occurring from 1989 to 1994.
Although physicians disciplined for sex-related offenses are significantly more likely to practice in certain specialties, to be involved in direct patient care, and to be older, they are not otherwise significantly different from the physician population. Thus, there is no identified profile of sex- abusing physicians which can be used to identify these unethical practitioners.
What Can Be Done?
The disciplinary system must better protect patients from physicians guilty of sex-related offenses by aggressively identifying and sanctioning physicians who have violated the public’s trust in this manner. In order to accomplish the necessary improvement, regulatory agencies must correct general deficiencies in their structures and policies, through such mechanisms as being more aggressive in searching out guilty physicians and immediately sanctioning physicians disciplined in other jurisdictions. Changes specific to sex-related offenses must also be implemented, such as having clear and well publicized sexual misconduct policies, and protecting a victim’s identity during the investigation and hearing.
In order to ensure that physicians identified as having committed a sex-related offense are adequately disciplined, disciplinary agencies must apply the only sanction guaranteed to protect patients–removal of the physician’s right to practice. Rehabilitation, monitoring, and license restrictions are all insufficient to protect the public from physicians who may continue to commit sex-related offenses. If the use of these penalties for physicians disciplined for sex-related offenses is to be curtailed, more consumer representation on medical boards is required to counteract the overly lenient perspectives of many physicians when judging their colleagues.
The legal system, medical profession, medical education system, and the public also all have a role in protecting patients from physicians who commit sex-related offenses. For example, all states should have criminal laws similar to that recently passed in Idaho, which defines any act of sexual contact between a patient and a medical care provider as “sexual exploitation by a medical care provider.” A comprehensive movement, which incorporates all these facets of society in concert with the disciplinary system, has the potential to protect patients by decreasing inappropriate behavior through education and accountability and by ensuring that those physicians who do engage in this behavior are identified and disciplined.
1. All states should adopt statutes that include sexual offenses as a specific cause of action for discipline by medical boards.
2. Regulatory agencies must adopt policies which prohibit any sexual contact between a physician and current patients, as well as any contact with former patients which relies in any way on the power imbalance established in the physician-patient interaction. Sexual contact between psychiatrists and any current or former patients should be forbidden.
3. State medical boards need to be more severe in their penalties against physicians who commit sex-related offenses. The vast majority of these offenders should have their licenses surrendered or revoked and never be allowed to practice medicine again. A small minority, whose relatively milder offenses warrant separate consideration, may eventually be returned to practice, provided the state boards implement specific and rigorous plans for reintegration and surveillance.
4. At least 50% of the members of each disciplinary board should be well-informed and well-trained public members, who have no ties to health care providers, selected based on a history of advocacy for patients.
5. Regulatory agencies should ensure that victims’ identities are protected at all times, including during the complaint process, the investigation, and the hearing.
6. All members of state boards should undergo training in the issues involved in sexual misconduct by physicians and how to be sensitive to the victim’s needs. The first contact a victim has with the disciplinary system should be with a person who has been specifically trained in conducting these interviews.
7. Civil and criminal legislation, including that providing for mandatory reporting, should be passed in all states. These statutes should model themselves after the Idaho statute in defining sexual exploitative relationships as including all sexual contact between any health care provider and their patients.
8. Educational programs in medical schools, residency programs and in continuing medical education should emphasize the vulnerability of the patient-physician relationship, and the responsibility of physicians to protect patients from sexual abuse, both in their own practice and by reporting offending colleagues. These programs should especially target those specialties which are believed to have a higher rate of offense, such as psychiatry, obstetrics & gynecology, and family practice.
9. Sexual exploitation by physicians must continue to be brought into the public eye by the media, the profession, and the victims in order to raise public consciousness and continue the pressure for regulatory and legal reform, including the full public disclosure of disciplinary records.
Physicians Disciplined for Sex-Related Offenses
Published: June 1997
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