Health

CA Data Suggest ‘No Progress’ in Sex Misconduct in Medicine

An analysis of data from the Medical Board of California shows that complaints about sexual harassment and abuse by physicians are on the rise in that state.

But one advocate claims the problem is not isolated to California. Esther Choo, MD, interim executive director of Time’s Up Healthcare, told Medscape Medical News that the occurrence of such misconduct hasn’t increased but that it is steadily high.

“In medicine, it’s been pretty well documented that we’ve made no inroads” against sexual harassment and abuse, she said.

“The problem is deep and wide, and there’s been no progress,” said Choo, an associate professor of emergency medicine at the Oregon Health and Science University School of Medicine, in Portland.

Like the other 69 medical boards in the United States, the California board does not publicly release data regarding the types of infractions that result in disciplinary actions against physicians.

So, the Los Angeles Times requested data from the California board and determined that the number of sexual misconduct complaints had jumped 62% since the fall of 2017. In a recent story, the newspaper suggested that the increase had been fanned by the #MeToo movement.

According to the Los Angeles Times, during the fiscal year (FY) that ended June 30, the board received 11,406 complaints — a record. In FY 2017, there were 279 complaints of sexual misconduct, and in FY 2018, there were 280, compared to 173 in FY 2016.

“Uptick in Complaints”

It’s not clear whether California is an anomaly. The Federation of State Medical Boards (FSMB) has “heard from a number of our member boards that they are seeing an uptick in sexual misconduct complaints,” said FSMB spokesman Joe Knickrehm. In a 2018 annual survey, “sexual harassment and physician boundary violations was one of the top five most important topics to state medical boards,” Knickrehm told Medscape Medical News.

The FSMB, however, does not track specific kinds of complaints. In 2017, 4081 physicians — of 970,090 licensed doctors — were disciplined by the 70 FSMB member boards, according to the organization’s 2018 annual report. Medical boards suspended the license of 656 doctors and put 711 on probation. They revoked the license of 248 physicians.

In a 2016 Pulitzer Prize–winning series, the Atlanta Journal-Constitution reported, after reviewing public records from medical boards, that more than 3100 doctors had been accused of sexual misconduct from 1999 to 2015. The newspaper revisited public records in 2017, and in an addendum published on the series’ home page, reported that “more than 450 doctors had been brought before medical boards or courts in 2016 and 2017 for cases involving sexual misconduct.”

FSMB Panel to Issue Recommendations

The FSMB is taking the issue seriously, said Knickrehm. He noted that it has convened a Workgroup on Physician Sexual Misconduct, which will issue draft guidelines and recommendations to all state boards and “relevant stakeholders” for comment later in 2019.

The work group is charged with the following:

  • Collecting and reviewing available disciplinary data, including incidence and spectrum of severity of behavior and sanction, related to sexual boundary violations;

  • Identifying and evaluating barriers to reporting sexual boundary violations to state boards, including, but not limited to, the impact of state confidentiality laws, state administrative codes and procedures, investigative procedures, and cooperation with law enforcement on the reporting and prosecution/adjudication of sexual boundary violations;

  • Evaluating the impact of state board public outreach on reporting;

  • Reviewing the FSMB 2006 policy, Addressing Sexual Boundaries: Guidelines for State Medical Boards, and revising, amending, or replacing it, as appropriate; and

  • Assessing the prevalence of sexual boundary/harassment training in medical and graduate medical education and developing recommendations and/or resources to address gaps.

A final draft will be presented to the FSMB House of Delegates at its 2020 annual meeting. If the new policy is approved, it will be “widely shared with the public,” said Knickrehm.

“It’s wonderful they are taking an interest,” said Choo regarding the FSMB’s work group. She believes state boards should be committed to investigating sexual misconduct cases and disciplining physicians when appropriate.

Choo also applauds the idea of “making a very clear and broad definition” of what constitutes misconduct. “You want a really clear statement about what constitutes harassment and what actions will be taken,” she said.

She’d also like to see more communication between boards, especially how “the occurrence of sexual harassment can be more transparent, so we don’t make patients and other healthcare workers vulnerable from people who can just hop from state to state,” she said.

Boards should also provide clear explanations of how processes lead from an allegation to a determination of harassment to specific types of disciplinary action, Choo said. Due process is also crucial. There should be “an individualized approach to each case that allows fair reviews,” she said.

She’d also like to see more data sharing — at a minimum, an aggregate number of how many physicians are determined to have committed sexual misconduct, and what actions were taken.

“Transparency will make everybody feel better,” Choo said.

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