After he fondled patients, exposed himself and traded drugs for sex, Dr. David Pavlakovic easily could have lost his medical license – or faced criminal charges.
Instead, Pavlakovic was placed in therapy. He was allowed to return to practice. And he didn’t even have to tell his patients.
The way Alabama handled Pavlakovic’s case reflects a growing trend: Medical regulators are viewing sexual misconduct by doctors as the symptom of an impairment rather than cause for punishment, a national investigation by The Atlanta Journal-Constitution has found.
Regulators and therapists say sexually abusive physicians can be evaluated and restored to fitness with as little as a three-day course on appropriate doctor-patient “boundaries.” Some cases may warrant inpatient care, where mental health treatment may include yoga and massage.
Increasingly, private therapists, rather than regulators or police investigators, try to unearth the extent of a doctor's transgressions, the Journal-Constitution found as part of a broad investigation of sexual misconduct by physicians. The newspaper's full report is at doctors.ajc.com.
The Journal-Constitution reviewed public disciplinary orders for 2,400 physicians accused of sexual misconduct with patients since 1999. The AJC found that, with rare exceptions, all of the 1,200 who are still licensed were ordered to undergo treatment, training, or both.
After receiving accusations against Pavlakovic, Alabama’s medical board sent him to Atlanta-based Behavioral Medicine Institute for evaluation. The board eventually found the doctor guilty of inappropriate sexual behavior with patients, suspended him for almost a year and fined him $10,000. But it also adopted the treatment center’s recommendation that he be allowed to practice if he attended therapy, took a lie-detector test twice a year and met other conditions. Prosecutors dropped a criminal case.
Pavlakovic and his attorney declined to comment.
Therapists who run treatment programs say physicians must meet high standards to return to practice.
“And justifiably, rightfully so,” said Philip Hemphill, who for more than a decade oversaw a program for troubled professionals at Pine Grove Behavioral Health and Addiction Services in Mississippi. “I mean, they’re entrusted with the public safety, which is different than other people.
“But they still should have an opportunity for intervention and monitoring,” Hemphill said. “They still have the ability to practice. It’s not all of who they are. That aberrant behavior is not the entire person.”
Faced with complaints that a doctor has sexually violated patients, boards investigate and often order a psychiatric evaluation before deciding what, if any, action to take.
A physician who isn't found to be afflicted with a serious mental disorder might be directed to take classes on maintaining proper boundaries with patients.
Physicians who commit more serious infractions and have complex and ingrained psychiatric disorders may have to enroll in more intensive treatment programs.
The Sante Center for Healing in Argyle, Texas — its slogan: “miracles happen on the hill” — offers group therapy and individual sessions to restore professionals suffering from what it calls any addicted disorder.
Sante also provides yoga as well as equine therapy.
Doctors in treatment are encouraged to honestly discuss their misconduct and to accept blame. Consequences, however, are limited.
After treatment, therapists’ assessments of whether a doctor can return to practice without endangering patients carry a great deal of weight.
In California, Dr. Esmail Nadjmabadi took two boundary-violation courses and a professionalism course after he was accused of watching young female patients undress and of touching their genitals. One victim was a high-school-aged girl who came to him because she had a sore throat.
When Nadjmabadi sought permission to resume his practice, an administrative law judge noted the doctor had been “evaluated and found fit to practice by three experts.”
“He has undergone a brief course of psychotherapy and gained insight from it,” the judge wrote. “But most importantly, (Nadjmabadi) has changed and matured.”
California’s medical board concurred. It reinstated his license in 2015.
Nadjmabadi and his lawyer did not respond to messages from the AJC.
The entire focus on rehabilitation can go too far, some regulators say.
Some doctors’ conduct is so outrageous, said Idaho Board of Medicine Chairman Robert Ward, that it doesn’t matter how much they are rehabilitated. They should not be returned to practice. “They’re using their position of power to do something they could never do in any other position,” he said. “It’s irrevocably harming those people.”
Despite the widespread reliance on treatment programs, little data exists on their effectiveness – in part because so many cases are handled in secret, from start to finish.
Dr. Gene Abel, who founded Behavioral Medicine Institute in Atlanta and is regarded as one of the most successful practitioners, has claimed a recidivism rate of only 1 percent among those he treated. Key to his success, Abel said: monitoring the physician after he returns to practice, requiring chaperones with patients, and administering periodic lie detector tests to assess his compliance.
“We follow the physician forever,” Abel said. “Or at least five years.”
Abel once testified it was inevitable that one of his cleared patients would someday re-offend. At the same time, he said he had never heard of that happening with any Georgia doctor who completed his program.
With treatment, Abel testified, “the recidivism possibilities for that individual drops to zero.”
This testimony came in 1999 on behalf of Donald Taylor, an anesthesiologist accused of sexually abusing patients, including a 16-year-old girl. Abel testified that Taylor had been treated and was safe to practice. Georgia’s medical board let Taylor keep his license.
Years later, in 2013, a patient alleged in a lawsuit that Taylor hugged, kissed and touched her at appointments starting in 2010, and they later had oral sex in his office.
The medical board suspended Taylor and ordered him back to treatment. Little more than three months later, the board allowed him to practice again.
Taylor did not return the AJC's phone calls or email messages seeking comment.
In Taylor’s case and in virtually all others reviewed by the Journal-Constitution, efforts to rehabilitate doctors who violate their patients exclude a key figure: the victim.
In thousands of medical board orders, it was rare to see any mention of the harm suffered by abused patients. Whether they received treatment – or whether they had an opinion on reinstating the doctor – was almost never taken into account.
Reid Finlayson, who runs Vanderbilt University’s Center for Professional Health, which offers a three-day boundaries course, said the question of bringing a victim into the program, so that the doctor might understand the impact of his violations, is “a little awkward.”
The way sexual abuse cases unfold, Finlayson said, “it just gets to a point where forgiveness is very, very difficult.”
Patients who have experienced sex abuse by doctors are skeptical of the treatment approach.
“The damage they do to a family, or a woman, going on to the rest of her life, is just irreparable,” said Marilyn Nowak, who was abused by her psychiatrist decades ago and says the damage has lasted a lifetime. She now volunteers in a network that helps other victims.
“If you send these doctors for rehabilitation — I’m sorry but that’s not enough for what they do to you,” Nowak said. “They should pay for that.”
Related story: No Report, No Justice -- Even in some extreme cases of doctor sexual misconduct, medical regulators may not report suspected crimes to police – and laws in most states don't require them to do so. Even when there are mandatory reporting laws, boards may not report.
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