New Public Citizen Study Examines Physician Sexual Misconduct

Health Letter, April 2016

Azza AbuDagga, M.H.A., Ph.D.

Horror woman behind the matte glass in black and white. Blurry hand and body figure abstraction
Image: Joe Techapanupreeda/Shutterstock.com

There is a long-standing prohibition against physician sexual misconduct in medicine:

“I will come for the benefit of the sick, remaining free of . . . sexual relations with both female and male persons.” — The Hippocratic oath, fourth century B.C.[1]

The Council on Ethical and Judicial Affairs for the American Medical Association has determined that it is unethical for a physician to have a romantic relationship or sexual contact with a current patient, and that a sexual relationship with a former patient is also unethical if the physician “uses or exploits trust, knowledge, emotions, or influence” derived from the prior physician-patient relationship.[2]

In addition to violating a fundamental tenet of the medical profession, physician sexual misconduct inflicts severe — and often lasting — emotional pain and suffering on patient victims, and endangers their medical care.[3],[4],[5],[6],[7],[8]

This exploitative behavior, according to the Federation of State Medical Boards, “may be verbal or physical, and may include expressions of thoughts and feelings or gestures that are sexual or that reasonably may be construed by a patient or patient’s surrogate as sexual.[9]

On Feb. 3, Public Citizen’s Health Research Group published a research study in PLOS ONE on physicians who have been reported to a national database due to sexual misconduct. Since our 1998 study — which was limited to disciplinary actions taken by state medical boards against physicians for sexual misconduct — this is the first study to provide recent national information on this important public health problem.[10]

This study used data from the National Practitioner Data Bank (NPDB), the only national repository that receives reports of disciplinary actions taken by state medical boards or by hospitals or other health care organizations against health care providers. The NPDB also receives reports about malpractice payments made by malpractice insurers on behalf of health care providers.

Our findings[11]

A total of 1,039 physicians — most were over age 40 — had at least one NPDB report related to sexual misconduct during the study period (Jan. 1, 2003, to Sept. 30, 2013).

Of those physicians, 786 were disciplined solely by state medical boards. In nearly 90 percent of cases, the disciplinary actions taken by the boards in response to physician sexual misconduct were serious in nature— such as revocation, suspension or restriction of the medical license. In contrast, the boards took such serious actions in approximately two-thirds of cases related to other types of physician offenses. Similarly, approximately two-thirds of the sanctions taken by hospitals and other health care organizations against physicians with sexual misconduct offenses involved revocation or suspension of physicians’ clinical privileges in the health care organizations. In contrast, only 52 percent of such actions were taken against physicians with other types of offenses.

Information regarding the victims of physician sexual misconduct was available only in incidents that led to malpractice payment reports. These reports showed that nearly 90 percent of these victims were female. Nearly half of them were 20 to 39 years old. In contrast, less than a quarter of the victims in other incidents leading to malpractice payment reports were in this age group. “Emotional injury only” accounted for the majority (82 percent) of the types of victim injury in malpractice payment reports related to sexual misconduct, compared with just under 2 percent of reports for other physician offenses. Over 80 percent of the sexual misconduct incidents that led to malpractice payment reports occurred in the outpatient setting. In contrast, only about 40 percent of the malpractice payment reports related to other physician offenses occurred in this setting.

State medical boards fall short

Our study revealed that of the 253 physicians who were reported to the NPDB because they had engaged in sexual misconduct that led to sanctions by hospitals or other health care organizations, or to a malpractice payment, 177 (70 percent) were not subsequently disciplined by state medical boards for such misconduct. This finding is concerning because the NPDB provides state medical boards with access to all reports filed by hospitals, other health care organizations and malpractice insurers for physicians. In addition, hospitals and malpractice insurers also send copies of their NPDB reports directly to the appropriate state medical boards, as mandated by the federal law that established the NPDB.[12]

This inaction is not new. Medical boards did not take disciplinary actions against more than half of the physicians who were subjected to serious sanctions by hospitals and other health care organizations due to negligence or incompetence from 1990 to 2009.[13]

Without state medical board action, transgressing physicians can still practice and hurt more patients. If they have been sanctioned by one hospital, they can pursue work at another one if their medical licenses remain valid.

The tip of the iceberg

While our study revealed important new information, it only scratches the surface of physician sexual misconduct in the U.S., considering that sexual misconduct appears to be a common reason for physician discipline by licensing authorities in other countries (such as Canada).[14] In contrast, physicians with sexual misconduct reports accounted for only 1 percent of the total physicians reported to the NPDB in our study.

Several factors may contribute to the underreporting of and inaction regarding physician sexual misconduct. Many patients likely do not report violations of this nature due to embarrassment or fear of not being believed. Physicians also are unwilling, in the majority of cases, to report sexual misconduct by their colleagues.[15] Of patients who do file complaints against health care providers, “nothing happened” to the alleged perpetrator in 55 percent of cases, according to a study.[16] Attorneys are typically reluctant to pursue malpractice claims with little prospect for substantial damage awards. In sexual misconduct cases, which mostly involve emotional injury, the case may result in small damage awards.[17]

We see our study as a continuation of Public Citizen’s push to enhance physician accountability and patient safety. Therefore, the concluding remarks of our study called on medical boards to improve how they act on information related to physician misconduct in order to better meet their obligation to protect the public. Additionally, we urged the entire medical community to increase its efforts to prevent physician sexual misconduct and to be aggressive in reporting and disciplining physicians who engage in such misconduct. Particularly, we asked for more stringent state legislative oversight of medical boards to ensure that all physicians who have committed sexual misconduct face appropriate medical-board disciplinary actions for any cases of sexual misconduct.

Measures you can take to protect yourself

When you choose a health care provider or institution, look for one that provides a chaperone upon patient request. Having a third party present during physical exams and procedures can discourage any misconduct. In any interaction with a physician or health care provider, if anything does not feel right to you, do not let it proceed. Always trust your instincts. Remember that when it comes to your body, you are always the one in charge.

In the event that you or someone you know has been a victim of sexual misconduct by a physician, we recommend that you file a complaint with the appropriate state medical board. State boards are required to investigate all complaints. If the sexual misconduct occurred in a hospital or other health care institution, you should contact the medical director of that institution to file a complaint as well.

References

[1] Edelstein L. The Hippocratic Oath: Text, translation and interpretation. In: Veatch R, ed. Cross cultural perspectives in medical ethics: Readings. Boston: Jones and Bartlett; 1989:6-24.

[2] Council on Ethical and Judicial Affairs, American Medical Association. Sexual misconduct in the practice of medicine. JAMA. 1991;266:2741-2745.

[3] Eichenberg C. Sexual assaults in therapeutic relationships: Prevalence, risk factors and consequences. Health. 2010;2(9):1018-1026.

[4] Disch E. Sexual victimization and revictimization of women by professionals: Client experiences and implications for subsequent treatment. Women Ther. 2006;29(1-2):41-61.

[5] Disch E, Avery N. Sex in the consulting room, the examining room, and the sacristy: Survivors of sexual abuse by professionals. Am J Orthopsychiat. 2001;71(2):204-217.

[6] Luepker E. Effects of practitioners’ sexual misconduct: A follow-up study. J Am Acad Psychiatry Law. 1999;27(1):51-63.

[7] Fahy T, Fisher N. Sexual contact between doctors and patients. BMJ. 1992;304(6841):1519-1520.

[8] Pope KS. How clients are harmed by sexual contact with mental health professionals: The syndrome and its prevalence. J Couns Dev. 1988;67(4):222-226.

[9] Federation of State Medical Boards of the United States Inc (2006) Addressing Sexual Boundaries: Guidelines for State Medical Boards. http://library.fsmb.org/pdf/grpol_sexualboundaries.pdf. Accessed February 26, 2016.

[10] Dehlendorf CE, Wolfe SM. Physicians disciplined for sex-related offenses. JAMA. 1998;279(23):1883-1888.

[11] AbuDagga A, Wolfe SM, Carome M, Oshel RE. Cross-sectional analysis of the 1039 U.S. physicians reported to the National Practitioner Data Bank for sexual misconduct, 2003–2013. PLOS ONE. 2016;11(2):e0147800.

[12] Health Care Quality Improvement Act of 1986 (1986). Public Law 99–660, Title IV. 42 USC Sec. 11134(c).

[13] Levine A, Oshel R, Wolfe SM. State Medical Boards Fail to Discipline Doctors With Hospital Actions Against Them. 2011. https://www.citizen.org/sites/default/files/1937.pdf. Accessed March 23, 2016.

[14] Alam A, Klemensberg J, Griesman J, Bell CM. The characteristics of physicians disciplined by professional colleges in Canada. Open Med. 2011;5(4):e166-e172.

[15] Gartrell N, Herman J, Olarte S, Feldstein M, Localio R. Reporting practices of psychiatrists who knew of sexual misconduct by colleagues. Am J Orthopsychiatr. 1987;57(2):287-295.

[16] Bouhoutsos J, Holroyd J, Lerman H, Forer BR, Greenberg M. Sexual intimacy between psychotherapists and patients. Prof Psychol Res Pr. 1983;14(2):185-196.

[17] Shepherd J. Uncovering the silent victims of the American medical liability system. Vanderbilt Law Rev. 2014;1(67):151-195.