Medical boards are not consistently transparent on physician sexual misconduct, even two years after the Federation of State Medical Boards released a policy calling for such.1
Researchers reviewed medical board websites for all 50 states and Washington, DC to see how easy it was to find a list of medical board orders and case summaries on physician sexual misconduct. Twenty-four state medical board websites provided a list of orders, and 21 provided case summaries. Many licensee profiles were outdated.
There were several states with procedures in place that made finding these cases straightforward. “These states could serve as prototypes for other states who may still be developing or changing these procedures,” suggests Madeline Bruce, the study’s lead author and a PhD candidate at Saint Louis University.
From a psychology perspective, a survivor who makes a report and can see the process through to adjudication could experience a better sense of closure than a survivor who filed a report but did not see the process come to an end transparently, according to Bruce. “Providing such transparency touches upon those deeper principles of honesty in all professional interactions and doing no harm,” Bruce adds.
Yet, transparency about these cases is a balancing act. Details becoming public may need to be timed to adjudication, as everyone has the right to assumed innocence until proven otherwise. “This raises questions about the best way to communicate emergency suspensions,” Bruce notes. Case summaries and court documents would need to be redacted for any information identifying the patient-survivor, too.
When physicians with scores of sexual misconduct complaints continue practicing for many years, the obvious question is: Why was no action taken sooner? One reason is incidents often go unreported, according to Chinmoy Gulrajani, MD, associate professor of psychiatry at the University of Minnesota Twin Cities campus.
Patients may choose not to report the behavior because they are in shock, are ashamed or guilty, or fear they will not be believed due to the power imbalance between themselves and the physician. “Additionally, they may not feel confident to navigate the regulatory system to seek redressal,” Gulrajani says.
In some cases, patients may believe they misunderstood what happened. “But even when people do make these complaints, licensing boards rarely act on them or do anything to restrict the license or take it away,” says Rebecca Haw Allensworth, JD, MPhil, BA, who co-authored a paper on this topic.2
Even if a board does take action against a physician’s license, it is not always reported to the National Practitioner Data Bank (NPDB). “That reporting is less good than you would hope — but even worse is hospital reporting to the NPDB. Hospitals are obligated to report the conduct, but they often don’t,” according to Allensworth, associate dean of research and David Daniels Allen professor of law at Vanderbilt.
Allensworth says this is ethically problematic, since it suggests hospitals are putting the bottom line ahead of the safety of patients. “Hospitals might be opened up to lawsuits and might have to fire the physician who represents a major income stream for them,” Allensworth explains.
For hospitals to report physicians’ sexual misconduct consistently, Allensworth says better systems are needed. “To get hospitals to do the right thing, you need to create a system where hospitals can’t get away with not reporting without facing the blowback and PR disasters,” Allensworth says.
Even if hospital reporting improved, “to get real change you would have to change what happens at the boards,” Allensworth adds. “Even if hospitals do report it to the boards, the boards are very unlikely to do something.” Further, state medical boards are mostly comprised of physicians. “The threshold for finding a physician responsible for misconduct in these situations is high,” Gulrajani notes.
The response often is “too little, too late,” Allensworth says. “Boards tend to need a ton of evidence, and sometimes take years to act on even egregious cases.”
Boards can suspend a physician’s license on an emergency basis while determining if allegations are credible. “This shouldn’t happen over one unsubstantiated allegation,” Allensworth says. “But even with multiple accusations, it still rarely happens.”
Regardless, patients cannot access the NPDB reports. Those can be accessed only by health insurance companies and employers, such as hospitals and health systems. Typically, says Allensworth, “the only way a prospective patient could learn about a physician’s prior sexual misconduct is if the state board posted the disciplinary record on its website.”
If a physician received multiple complaints but there were no formal disciplinary charges, there would be no way for a patient to see those. In other cases, there are formal charges, but the physician might negotiate a plea agreement keeping the charges hidden from the public.
Medical boards will publish disciplinary action taken against a physician on their public profile only when the physician is found responsible for the misconduct. “However, even when a complaint is filed with medical boards, it may not lead to disciplinary action for myriad reasons,” Gulrajani notes.
For one, it is difficult to establish the facts. “Many of these situations end up being the victim’s account vs. that of the physician,” Gulrajani says. Additionally, patients may be further traumatized by the investigation process, and withdraw their complaints.
Gulrajani says medical boards should make procedures easy and accessible. Boards should consider each complaint with the utmost gravity while ensuring the accuser’s identity remains confidential. Investigators should ensure all proceedings occur in a manner that shields the patient from further traumatization. If someone files a complaint, there should be no retaliatory action. Also, boards should consider including objective, non-medical third parties in the deliberations with the patient’s permission.
“Finally, boards must foster a culture change within medicine itself that not only empowers patient victims, but also encourages other physicians to report misconduct by a colleague,” Gulrajani offers.
REFERENCES
1. Bruce MJ, Acierno R. Medical board transparency regarding physician sexual misconduct: Two years post-policy updates. J Trauma Stress 2023;36:247-250.
2. Sindhu KK, Schaffer AC, Cohen IG, et al. Honoring the public trust: Curbing the bane of physician sexual misconduct. J Law Biosci 2022;9:lsac007.
Medical boards are not consistently transparent on physician sexual misconduct, even two years after the Federation of State Medical Boards released a policy calling for such.
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