Boards get tougher on physician sex offenses

Washington state forbids doctors from dating patients, and the Federation of State Medical Boards is revising its policies on sexual boundaries.

By — Posted Dec. 19, 2005

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In Washington, a gynecologist had his license suspended after female patients accused him of sexual assault, including a 21-year-old who said she was raped during an office exam. She claimed that the doctor threatened her if she went to police.

Texas suspended the license of a gastroenterologist who was arrested for sexual assault for groping a woman during a colonoscopy. He later surrendered his license.

A North Carolina family physician denied having sexual relations with a patient, but admitted to it when the medical board confronted him with phone records showing calls to the woman. His license was revoked.

Sexual misconduct has long been a source of complaints and discipline against physicians, state medical board leaders said. But what's new is that more medical boards are aggressively cracking down on sexual wrongdoing in efforts to stop the misbehavior. Some examples:

  • In November, Washington adopted a new sexual misconduct policy that forbids allopathic physicians from dating patients and details what other sexual contact is prohibited.
  • A 2003 Texas law forced the state's medical board to give priority to complaints of sexual misconduct and other serious offenses.
  • In 2003, California passed a law to protect patients from sexual abuse by barring sex offenders from practicing medicine in the state.

Meanwhile, the Federation of State Medical Boards is revising its sexual boundaries policy that boards use for guidance. It plans to vote on the measure at its annual meeting in April 2006. The Texas-based organization in January 2006 will offer medical board officials an online course on sexual boundary violations.

"This is such a hot topic. It's been there all the time. It's just becoming more visible," said Anderson Spickard Jr., MD, medical director of the Center for Professional Health at Vanderbilt University Medical Center in Nashville, Tenn.

Since the center developed a course on sexual boundaries in 1999, boards have sent about 300 doctors to the three-day program. Dr. Spickard said boards are paying more attention to sexual misconduct "because [boards are] getting more complaints."

Boards take action

Because sexual misconduct cases may be grouped with other types of complaints, tracking numbers is difficult. But disciplinary actions taken by medical boards for sexual abuse/misconduct increased slightly from 216 actions in 2000 to 242 actions in 2004, the federation said.

Medical board leaders say numbers are not necessarily the driving force in boards placing greater emphasis on sexual misconduct. Some boards respond after a high-profile case grabs headlines, and the publicity generates more complaints from patients.

"If the public or legislature is demanding increased scrutiny, then of course medical boards are going to respond to it," said North Carolina Medical Board Executive Director David Henderson.

Many medical societies have ethical guidelines on sexual boundaries, and many medical boards now have policies on sexual misconduct.

"[A sexual relationship] is improper. It is unethical. Patients are dependent upon us to maintain their well-being," said Allen J. Bennett, MD, chair of the committee on medical practice ethics for the Medical Society of the State of New York.

American Medical Association policy states that sexual interactions between doctors and patients detract from the goals of the physician-patient relationship, might exploit the vulnerability of the patient and could obscure the doctor's objective judgment.

But even with various guidelines in place, lawmakers and an increasing number of boards believe more needs to be done.

Texas legislators passed a law in 2003 to strengthen the Texas Medical Board. Among the changes: giving priority to complaints involving sexual misconduct, quality of care and impaired-physician issues.

The board since has trained staff and board members on how to handle such cases and defined what constitutes sexual misconduct. Board officials say some physicians have had their licenses restricted and may not treat female patients; one doctor surrendered his license after suspension.

California now requires the Medical Board of California to revoke licenses of physicians who are registered sex offenders. Since the law went into effect Jan. 1, 2004, the board has filed accusations against five physicians. The cases are pending.

Most recently, Washington's Medical Quality Assurance Commission, which disciplines allopathic physicians, adopted new sexual misconduct policy. The commission began drafting the policy six years ago to provide clear guidelines to physicians on unacceptable sexual behavior and to give the board standards upon which to act. Since 1998, the commission has received 160 complaints about inappropriate sexual behavior by physicians and physician assistants.

The new policy, passed Nov. 18, defines sexual misconduct and prohibits such acts as dating a patient, kissing a patient in a romantic manner and failing to give a patient privacy to undress.

"It's helpful for practitioners because they have an idea of, 'OK, these are the kinds of things I need to be aware of and I need to steer clear of,' " said Blake Maresh, commission executive director.

The Washington State Medical Assn. said it is neutral on the rules and that the policy mirrors its principle of medical ethics on the matter. "We all have professional ethical codes, and these are addressed in those ethical codes," said association spokeswoman Jennifer Hanscom.

At the national level, the Federation of State Medical Boards in September drafted a rewrite of its sexual boundaries guidelines, first issued in 1996. If passed, the guidelines would expand the scope of sexual misconduct to include third parties, not just patients, and would be more comprehensive in addressing discipline and physician evaluation, said Lisa Robin, FSMB vice president of leadership and legislative services.

"It makes [the policy] more helpful to boards," she said.

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Setting boundaries

Under a new policy that Washington's Medical Quality Assurance Commission adopted in November, these are among the behaviors considered to be sexual misconduct by a physician with a patient or key third party:

  • Kissing in a romantic or sexual manner
  • Examining or touching of genitals without using gloves
  • Denying a patient privacy to dress or undress
  • Offering to provide practice-related services, such as medications, in exchange for sexual favors
  • Soliciting a date
  • Engaging in conversation regarding the sexual history, preferences or fantasies of the physician

Source: Washington's Medical Quality Assurance Commission

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