When tough medicine’s needed

The Atlanta Journal-Constitution’s landmark series “Doctors & Sex Abuse” uncovered outrageous examples of medical professionals behaving unethically, criminally, or both.

The project is a difficult, but necessary read – one that we wish were mandatory for all those responsible for overseeing physician behavior. The findings unearthed, sifted through and laid out in painstaking detail by this newspaper should result in comprehensive, sweeping and methodical change across this land.

No other outcome is acceptable, given the AJC’s reporting that shows no one state or regulatory entity gets it entirely right in their approaches to investigating and acting on reports of sexual misbehavior by physicians. Admittedly, some come much closer than others.

The infuriating truth is that the medical profession, the culture within which it operates and the systems that purportedly govern practitioners have failed spectacularly and often from coast-to-coast. Lives have been badly damaged from sex abuse and it’s likely some victims have even ended their lives at least partly as a result. That landscape of destruction cries out for profound change.

Yes, the great majority of physicians conduct themselves honorably, doing admirable, health-enhancing and even life-saving work every second of every day. They serve well the lofty goals of the ancient Greek Hippocratic Oath, a 1943 translation of which includes this: “Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.”

Those who make a mockery of this oath should be held to account, but too many are not, this newspaper’s reporting shows. That must change. Yet, given the widely varying procedures, practices and standards across 50 states’ medical societies, regulatory boards and legislatures, the problem is much like a mutating disease that resists attempts to destroy it.

The AJC’s work lays out a sturdy benchmark from which to begin crafting solutions. It should be heeded by policymakers, regulators and lawmakers nationwide. On November 20, AJC reporter Carrie Teegardin wrote that, “In very state, patient protection is supposed to be the prime directive when it comes to licensing and disciplining doctors. But a 50-state examination by The Atlanta Journal-Constitution found that only a few states have anything close to a comprehensive set of laws that put patients first.”

Worse yet, when measured across five categories of laws intended to shield patients from abusive doctors, “Not a single state met the highest bar in every category the AJC examined.”

There are many problems in need of effective solutions in this area. Here are some of the most-critical issues that should be quickly addressed:

• Criminal behavior should carry consequences: Felony convictions should bar doctors from practicing medicine – period. That is not the case in too many states, including Georgia. And even misdemeanor convictions of a sexual nature should raise alarms and a high level of scrutiny around whether doctors or therapists remain fit to practice medicine. The emphasis should shift from protecting doctors' rights and land much more toward safeguarding patients.

• Laypeople need a stronger voice: Consumers should have enough seats on state medical boards to ensure that their voices carry enough weight to advocate for the public – and make a difference when push comes to shove around allegations of abuse. That means more than a token presence on these boards, which are often stacked with members likely to advocate for the medical profession. Too often such numbers can create a culture that operates at the expense of victims. The Federation of State Medical Boards, which represents regulators across the 50 states, recommends that at least one-fourth of board seats go to consumers. Only about half of the states meet that bar.

Achieving the one-fourth ratio is a good place to start, in our view, and it is worth strong consideration as to whether that base percentage should be even higher.

State legislatures should quickly consider this issue and act on the federation’s recommendations in mandating minimum consumer representation. Georgia should set an example here; its lopsided medical board has 13 doctors and only two consumer representatives. Doubling their number – to four, at least – would be a good thing for patients and the cause of transparency. Given that many sexual offenses are committed against women, boards should also be mindful of gender diversity and ensure that women make up a substantial portion of medical boards.

• Mandated reporting of suspected offenders should be required in every state. As the AJC noted, medical colleagues are often the first to notice suspicious or outright-abusive behavior. They should be required to notify medical boards of their misgivings, or observations. Doing so is not required in 20 states, including Georgia. State laws should compel such reporting, and contain real consequences for deliberate lapses. The AJC found that Iowa was among the few states that has sanctioned doctors for failing to report. Silence is the enemy of solutions here.

• Criminalize abusive behavior: Perhaps the most-astounding fact raised by the AJC's reporting is that it is often not a crime for a doctor or therapist to have sexual contact with patients. That must quickly change. Only about half the states have criminal laws prohibiting such behavior between therapists and patients. Worse yet, according to AJC reporting, only a "handful of states criminalize sex between all doctors and patients – something that is clearly forbidden by medical ethics." State lawmakers should move with speed to make such behavior a criminal offense. They could look at Delaware as a model, given that incidents there have led it to enact some of the nation's strongest patient protection statutes.

• Admit sunlight: The common regulatory practice of issuing so-called "private orders" against medical offenders imposing confidential discipline should be abolished, including here in Georgia. For the sake of public safety, actions taken to address harmful misconduct by doctors should be accessible to the general public. Only then can patients – and potential patients – have access to vital information that can both help inform their medical choices and safeguard their well-being in the process.

• Illness or crime?: There should also be renewed scrutiny on some regulators' custom and practice of viewing and handling physician sexual abuse as an illness on the part of the practitioner, and not as a potential crime worthy of investigation and punishment where the facts warrant. That fuels an environment built around self-dealing, with medical board members leaning toward protecting fellow professionals – rather than patients. As an example of this, some influential studies on treating medical sexual offenders have been done by the same therapists who profit from selling rehabilitation services to accused or reprimanded physicians. The states whose regulators use trained law enforcement personnel as part of their investigative process have it right. Lagging states should follow suit.

• Never alone: Another safeguard worth a strong, hard look is requiring that a chaperone be present during intimate patient exams of women or children.

• Reducing delays: End the practice of medical boards in some states dragging their feet until criminal proceedings are resolved – a process than can take years, allowing ample time for medical offenders to continue abusing with impunity.

This newspaper’s comprehensive foray into sexual abuse by medical professionals details a complex matrix of entrenched problems swirling around multiple systemic shortcomings and variables.

Repairing this badly broken national apparatus that too often fails to protect the vulnerable can only happen when a powerful, common symptom is recognized and addressed. And that would be indifference. As in indifference to the harm and damage wrought when physicians behave unethically, or even criminally. Indifference has led regulators to unduly focus attention and remedies on practitioners – and not patients. That loading of one side of the scales amounts to high-handed disdain for the patients that physicians are sworn to help heal. Such indifference keeps problems hidden in darkness, much as abuse occurs too often behind closed doors of examination rooms.

The indifference must end — now. The empathy and desire to heal that doctors swear an oath toward helping achieve must trump indifference. The profession, regulators, government and the public must demand no less.