Sexual Violation of Patients by Physicians: A Mixed-Methods, Exploratory Analysis of 101 Cases

Abstract

A mixed-method, exploratory design was used to examine 101 cases of sexual violations in medicine. The study involved content analysis of cases to characterize the physicians, patient-victims, the practice setting, kinds of sexual violations, and consequences to the perpetrator. In each case, a criminal law framework was used to examine how motives, means, and opportunity combined to generate sexual misconduct. Finally, cross-case analysis was performed to identify clusters of causal factors that explain specific kinds of sexual misconduct. Most cases involved a combination of five factors: male physicians (100%), older than the age of 39 (92%), who were not board certified (70%), practicing in nonacademic settings (94%) where they always examined patients alone (85%). Only three factors (suspected antisocial personality, physician board certification, and vulnerable patients) differed significantly across the different kinds of sexual abuse: personality disorders were suspected most frequently in cases of rape, physicians were more frequently board certified in cases of consensual sex with patients, and patients were more commonly vulnerable in cases of child molestation. Drawing on study findings and past research, we offer a series of recommendations to medical schools, medical boards, chaperones, patients, and the national practitioners database.

Crossing the line: Sexual misconduct by nurses reported to the National Practitioner Data Bank

“…Furthermore, some of these boards may not have developed guidelines that supplement their individual state regulations and laws concerning sexual misconduct by nurses (Clevette et al, ). In fact, it is not possible to accurately estimate the actual frequency of sexual violations in health care (DuBois et al, ). Therefore, this study can be considered as potentially capturing only a portion of the actual sexual misconduct among licensed U.S. nurses, similar to the small portion represented in NPDB reports involving physicians.…”

Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008–2016

“…In a series of recent papers, we reported results from our investigations into the three kinds of wrongdoing. In the first paper, we reported on 100 cases of IPCS (DuBois et al 2016a); in the second, on 101 cases of SAP (DuBois, Walsh, et al 2017); and in the third on 79 cases of UIP (DuBois, Chibnall, et al 2017b). In these three papers, we provide extensive details on our methodological approach.…”

“…Even when criminal charges are not brought forward, egregious cases are easy: Removing a license seems justified when it will prevent repeated serious harm to patients. The more difficult decision pertains to repeat minor offenses, which frequently precede more serious violations (DuBois, Walsh, et al 2017). Yet, the biggest obstacles to removing a physician’s license appear not to be philosophical, rather structural: There is a six-fold variance in the rates of serious disciplinary actions by state medical boards, with boards taking serious disciplinary action more frequently when they are well-funded, well-staffed, independent of state medical societies, and able to use data from diverse sources and a preponderance of the evidence standard (rather than a beyond a reasonable doubt standard) (Wolfe, Williams, and Zaslow 2012).…”

“…Though they may appear disparate, as we explain below, they involve similar dynamics. We focused on these three kinds of violations because they are among the most common causes of major disciplinary actions by medical boards such as revoking licenses (Arora, Douglas, and Dorr Goold 2014, Harris and Byhoff 2017) and, above all, in contrast say to upcoding or failures to disclose conflicts of interests, which are also violations of medical ethics, these three behaviors directly harm patients (Krause Winter 2012, DuBois, Walsh, et al 2017). The violations we studied contributed to opioid addictions and sometimes overdose deaths; emotionally traumatized patients through sexual abuse by trusted physicians; and caused physical, emotional and financial injury to patients through the performance of unnecessary procedures such as spinal surgeries that benefitted the physicians financially.…”

Preventing Egregious Ethical Violations in Medical Practice: Evidence-Informed Recommendations from a Multidisciplinary Working Group

“…Many features of the Nassar case are common across different kinds of egregious ethical violations: The violations were committed by a male, repeated, and selfishly motivated; oversight was lax or absent; and individuals who learned about the violations failed to take decisive action. 1-3,33 Accordingly, many of the actions that need to be taken to identify cases sooner and respond decisively are the same across different kinds of violations.…”