Through special arrangement with Taylor & Francis, AJOB posts its editorials on bioethics.net. This essay and the articles it references are also available on the publisher website.
by Carrie Teegardin & Lois Norder
An investigative reporter at The Atlanta Journal-Constitution was researching a prison doctor with a troubled history when he decided to page through some other disciplinary folders on the state medical board website. One of the first names he clicked on was Dr. William Almon. The Georgia physician’s file revealed that he had repeatedly faced allegations of sexually violating vulnerable female patients. The records showed that he was accused of abusing a suicidal soldier, jail inmates, a mentally ill woman, and a child of 14 years. In each case, however, this doctor was effectively given a pass. Almon held onto his white coat, in spite of the allegations, and is still fully licensed to practice medicine in Georgia today.
The disturbing facts of this case prompted further investigation by the newspaper and eventually gave life to the most extensive investigation ever conducted of physician sexual misconduct in the United States. The Atlanta Journal-Constitution’s “Doctors & Sex Abuse” series, which was launched in 2016, has uncovered more than 3,500 cases of sexual misconduct by physicians across the nation since 1999. In just the past 2 years alone, more than 450 doctors were brought before medical regulators or courts for sexual misconduct or sex crimes. The series also revealed that many—if not most—cases of physician sexual misconduct remain hidden.
The project made its point, in part, because the research was so exhaustive. Reporters had to search through 100,000 public disciplinary records from 50 states and the District of Columbia to find and study those involving sexual abuse. But the power of the series rested in the tiny, shocking details of the individual cases that demonstrated a disturbing tolerance for sexual abuse of patients by the medical establishment.
Take Dr. Ashok Alur. The Kentucky doctor was examining an infection on a patient’s abdomen when he told her she had sexy underwear and then rubbed her and placed his mouth on her genitals. The patient pushed him away and went to police. “It was so beautiful,” the doctor explained later, “I couldn’t resist.” He was allowed to stay in practice, even though the medical board’s review also found problems with his prescribing and clinical skills.
A California psychiatrist also stayed in practice after grabbing a patient’s breast out of her bra and placing his mouth on it. He then exposed himself and ejaculated on her hand. A Missouri doctor kept his white coat, too, after he asked a woman badly injured in a sexual assault if she liked being tied up during sex, whether she was easily stimulated, and whether she liked being urinated on. He then told the patient he was being aroused.
Delaware pediatrician Dr. Earl Bradley eventually lost his license and ended up in prison. But that was only after Bradley spent 15 years raping, molesting, and sodomizing a generation of pediatric patients. Bradley didn’t get away with it because he was never accused or suspected. In fact, Bradley was accused of abuse at least eight times over his career. He was only stopped when police found 13 hours of his assaults that he had recorded on video.
The Atlanta Journal-Constitution found that Bradley’s case was hardly an anomaly. In fact, it epitomized the medical culture that ignores, enables, and excuses sexual misconduct by physicians across the nation. If anyone doubted that more than one serial predator in a white coat could get away with abusing children for years, Dr. Larry Nassar’s history closed the case. As one Nassar victim after another told her story, the nation was schooled in how predatory doctors abuse patients in exam rooms and how the medical establishment and cops may ignore those who try to sound an alarm.
In recent months, the public has learned about other physicians who violated patients over decades. Thousands of children may have been victims of a New York endocrinologist. More than 450 women have accused a University of Southern California gynecologist of molesting them. Dozens of athletes have come forward to report an Ohio State University doctor.
Dr. James M. DuBois and his coauthors conclude, in their study published in this journal, what The Atlanta Journal-Constitution’s reporting has also found. “At present, the balance of moral considerations has favored the fair treatment of physicians over the protection of patients,” they wrote in “Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008–2016.”
The Atlanta Journal-Constitution’s reporting tried to explore why the system was more concerned about doctors than patients when handling sex abuse cases and how that view played out when complaints were lodged against doctors. A desire by physicians to rehabilitate their colleagues is part of what drives the system, the newspaper found.
An Alabama regulator was honest about why medical boards keep some sex abuse cases confidential and send doctors to treatment. Doctors, he explained, are different. It’s expensive to train doctors, and they’re needed, he said, especially in rural areas of America where the doctor shortage is critical. “The resources that have been poured into that education almost demand that you try to salvage that physician—if it’s possible,” he said. The Atlanta Journal-Constitution found that medical regulators regularly fail to alert law enforcement when a doctor may have committed a sex crime, even when they have a legal requirement to do so. Instead, regulators routinely refer doctors to treatment centers after they are caught rubbing their genitals up against patients, molesting them in the guise of exams, or enticing vulnerable patients into sexual relationships. That’s a stark contrast to how others are treated when sexual lines are crossed. The Atlanta Journal-Constitution found some rehabilitation programs have a spa-like environment with yoga and equine therapy. And while physician health programs may pave the way for doctors to return to practice, no good data exist on how many of the doctors repeat as sexual abusers.
Some state medical boards discipline doctors in private, which is another factor that tilts the process away from patients’ rights. That means a patient or even a future employer may have no idea that the doctor had been the subject of previous medical board action. In North Carolina, for example, a doctor had been subjected to a series of private letters and private agreements with medical boards over allegations of sexual misconduct that ranged from inappropriate hugging to sexual assault. Those private actions became public only after the doctor petitioned for reinstatement after giving up his license after another allegation. It’s rare that these private actions come to light. But when it happens, usually after a doctor reoffends, it can demonstrate that even serious allegations are often handled privately.
Georgia demonstrated its secrecy and forgiving nature in the case of Dr. Jacob Ward. After a female patient accused him of molesting her, he was arrested. Georgia allowed the doctor to keep practicing in spite of the criminal matter, requiring him to go to treatment and use a chaperone when seeing female patients. Later, after he pleaded guilty, public files in the criminal case revealed that two other patients had made similar charges against Ward, 4 years earlier. The medical board handled those allegations by sending the doctor a confidential letter expressing its “concern regarding exams and patients of the opposite sex.”
Even in states that don’t allow private orders, The Atlanta Journal-Constitution found that patients may not be able to discover whether their doctor may be a threat. Boards may make no mention of pending criminal charges. Some states post vague orders that may only cite a legal code or have obscure language that says a doctor was being sanctioned for a “boundary violation” or “unprofessional misconduct.”
While patient protection is supposed to be the prime directive when it comes to licensing and disciplining doctors, a 50-state examination by the newspaper found that only a few states have anything close to a comprehensive set of laws that puts patients first. Minnesota bans doctors from practice if they are convicted of felony sex offenses. Most states have no such ban, and it’s not unusual for doctors to get their licenses back after getting out of prison. State laws also set out who gets to serve on the medical licensing board. Iowa is rare in requiring gender balance. In most states the boards are dominated by male doctors. Half the states do not give consumers a strong voice on medical boards. Some states don’t even require criminal checks before licensing a doctor—a step that is routine for almost any job application, even babysitting. The 50-state ratings recognized one state for having the strongest protections: Delaware. That state changed its laws to try to tilt the balance in favor of patient protection only after the horrifying case of Earl Bradley, the pedophile pediatrician, came to light.
One reason that sex abuse among physicians has only recently been recognized as a problem is because there are many barriers to gaining information and conducting research on this topic. We applaud Dr. DuBois and his coauthors for their recent work on this topic. We’d like to see more. The “Doctors & Sex Abuse” series, which was a finalist for a Pulitzer Prize and the winner of many other awards, devoted the resources to make it clear that physician sexual misconduct is a serious issue that has damaged thousands of patients. The problem has now been exposed. But the actions needed to address this problem have not yet come. Lawmakers need to examine their slate of laws and the membership of their medical boards. Medical schools need to add training on this topic to their curriculum. Medical societies and associations need to acknowledge this problem and exert leadership to deal with the problem, instead of denying that it exists or minimizing it. More research on this topic will help offer a path toward change that will help shield another generation of patients whose lives were forever changed when a trusting professional violated them. One patient who was sexually assaulted by an Oregon doctor while she was under anesthesia described how vulnerable patients can be when they submit to a physician’s touch: “I keep going back to the ‘Do no harm’ aspect of the Hippocratic oath,” the patient said. “I mean, I couldn’t move. I was completely at the mercy of whoever was there, and it turned out that the person who was there was a serial predator.”