The Federation of State Medical Boards on Saturday is expected to adopt sweeping reforms that, if put into practice, would be a death knell for a pervasive culture of coddling and forgiving doctors who sexually exploit patients.
The federation’s house of delegates will vote in a Zoom meeting on a massive overhaul of its guidelines on handling physician sexual misconduct. A 14-page document adopted in 2006 — which mostly characterized abusive doctors as mentally impaired and in need of rehabilitation — would be replaced by 30 pages calling for boards to turn offenders over to police, to fine hospitals and fellow doctors who don’t report sex abuse, to stop issuing private orders or warnings to abusive doctors, and to remove barriers that discourage victims from filing complaints, among other reforms.
“We focused much more on the survivor and public protection,” said Patricia King, a Vermont primary care doctor who chairs the federation’s Workgroup on Physician Sexual Misconduct. “The public deserves to understand and have all the information possible that is used to justify regulatory decisions. So the transparency in understanding our decisions is critical.”
King and the panel of physicians from across the country began their study in 2017, after The Atlanta Journal-Constitution's groundbreaking 2016 investigation found that thousands of doctors across the nation had sexually violated patients, and that even the worst offenders, some with hundreds of victims, were given passes by medical regulators. In 2017, the AJC took another look at the issue and found that little had changed. Those stories, and an investigation by The Indianapolis Star on disgraced former USA Gymnastics physician Larry Nassar, resulted in more victims speaking out and public pressure for protecting patients.
Many of the reforms proposed by the panel address the AJC’s findings about how the system fails to protect patients.
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Several reforms aim at transparency. The panel recommends against vaguely-worded public orders that don't spell out sexual abuse — often the results of negotiations between board attorneys and better-funded attorneys representing doctors, the AJC's investigation found. In addition to calling for the end of private agreements in cases of sexual misconduct, the panel also calls for sharing information with medical regulators in other states and for boards to make details of investigative findings and disciplinary actions available on their websites. If legislation is needed to do that, boards should work to achieve those changes, the draft says.
Legislation also may be needed to remove time limits on reporting sexual violations and to ensure that medical boards have sufficient authority to conduct their investigations.
The draft also says medical boards should be mindful that having an abusive doctor take an educational class is no assurance that patients will be protected. What’s more, the draft says that even a single case of sexual misconduct can be sufficiently egregious as to warrant revocation of a physician’s medical license. The AJC investigation found that doctors found to have sexually violated patients often were able to keep their licenses by taking a “boundaries” class, and that some doctors were given repeated chances to stay in practice.
The federation can’t dictate to medical boards how to police the profession in their states, but the FSMB guidelines set national standards, with boards often incorporating the language into their own rules and policies.
Some patient advocates who read the draft are skeptical that state boards, which are dominated by doctors, will take such a hard stand. Marian Hollingsworth, who often testifies on patient safety issues to the Medical Board of California, said she wishes the guidelines gave a more clear directive about notifying law enforcement when a patient accuses a doctor of a criminal act, such as sexual battery or assault.
The proposal says that boards don’t have to report to law enforcement if the victim doesn’t want that.
“I think they’re soft-pedaling that,” Hollingsworth said. “They don’t want to make it mandatory, because then all the doctor lobby groups will rise up and scream that they’re not being fair to the doctors.”
As the panel has been studying the issue for the past three years, more horrific cases of doctor sex abuse have come to light. In Michigan, former athletics teams doctor Robert E. Anderson, who is now deceased, sexually assaulted patients over decades. Lawsuits accuse the university of knowing about his conduct but allowing him to continue in his role.
In New York, Dr. Reginald Archibald apparently preyed on thousands of children at Rockefeller University Hospital over decades.
In California, gynecologist George Tyndall at the University of Southern California abused female patients for decades. Earlier this year, the university agreed to pay $215 million to settle a class action case involving more than 18,000 women.
Georgia Composite Medical Board member Alexander Gross, a Cumming dermatologist who sits on the federation work group, said the board has already formed a committee to work on incorporating the new guidelines into its own rules and policies. That process requires approval from the Attorney General’s office and the governor, along with public notice and a hearing, and takes three to four months.
Other recommendations, such as fining hospitals and heath care systems that fail to inform the board of sexual abuse, will require legislative action, and the committee has begun talking to lawmakers, Gross said.
Financial support will also be needed for some of the reforms, said Stephen Seeling, former executive director of the South Carolina State Board of Medical Examiners and a member of a patient advocacy coalition, Medical Board Roundtable. “You’re talking about recommendations of expediting sexual misconduct investigations,” he said. “You’re talking about having special panels and specialized investigators. You’re talking about educating board members and giving them training on implicit bias. All these things cost a lot of money.
“The only way this even has a snowball’s chance in hell of getting done,” Seeling said, “is if somebody subsidizes it.”
These are highlights of the proposed Federation of State Medical Boards guidelines for handing physician sexual misconduct:
- Sexual assault should be reported to law enforcement immediately, except in cases where reporting would contravene the wishes of an adult complainant and non-reporting in such an instance is permitted by applicable state law.
- The use of private agreements or letters of warning in cases involving sexual misconduct is inappropriate because of the importance of disclosure for public protection and data sharing with other state medical boards or medical regulatory authorities from other jurisdictions.
- State medical boards should have the ability to levy fines against institutions for failing to report instances of egregious conduct … Results of hospital and health system peer review processes should also be shared with state medical boards when sexual misconduct is involved.
- Findings of even a single case of sexual misconduct are often sufficiently egregious as to warrant revocation of a physician's medical license.
The Atlanta Journal-Constitution began publishing its investigation into doctors and sexual abuse in 2016, exposing a nationwide scourge of doctors raping, molesting and seducing patients, yet being allowed by their peers to continue seeing patients. Previously, no one had accurate data on doctors and sexual abuse, but the AJC’s series revealed it happens far more than anyone had acknowledged. The AJC continues monitoring the issue, with about 4,500 names currently in a database of doctors who have faced accusations of sexual misconduct since 1999.