How Medical Centers Fail To Police Sexual Predators
Second of a three-part series on physicians who abuse patients and the institutions that enable them
by Elizabeth Hlavinka, Staff Writer, MedPage Today
In the first part of this series, we examined some of the patterns and characteristics of doctors that sexually violated patients, many of whom were repeat offenders and stayed under the radar for years.
In several recent high-profile cases involving university-affiliated physicians, complaints first surfaced decades ago, but years passed before the the physicians — and their employers — were finally held to account. Here we look at how these institutions responded or failed to respond to early complaints of abuse, and the extent to which they may have enabled this behavior and contributed to a culture of silence.
In 2016, former New York-Presbyterian ob/gyn Robert Hadden, MD, surrendered his license after pleading guilty to felony and misdemeanor sex crimes. But according to a recent lawsuit, the first complaint against Hadden came to light in the early 1990s, when a nurse walked into an exam room at a Columbia University clinic to find him “sexually abusing” a patient.
The nurse reported the incident to her supervisor but was told to keep quiet, stay with her doctor, and not “let him get himself in trouble.” The December 2018 lawsuit, which initially included 17 women but has since grown, alleges that Columbia University and its affiliated hospitals knew of and “actively concealed” Hadden’s actions.
“When an institution’s response is to just ‘keep quiet,’ or simply remove a professor from student contact — as Columbia has done — it creates this kind of toxic culture where sexual predators exist and thrive,” said Anthony DiPietro, who represents the plaintiffs in the Hadden case. “This is what enabling looks like — knowing that inappropriate behaviors are taking place, while failing to take any real action to stop it.”
In a statement, Columbia University said that Hadden has not practiced medicine there since 2012, and that the behavior described in the allegations leading to the 2016 case and the recent complaint are “abhorrent.” New York-Presbyterian declined to comment for this story.
A Blind Eye
In the now infamous case of U.S.A. Gymnastics team doctor Larry Nassar, DO, of Michigan State University (MSU), there were eight instancesstarting in the 1990s where his misconduct was reported to someone in leadership who then failed to escalate the complaints. In 1999, for example, an MSU track runner reported to members of the athletic staff that Nassar penetrated her vagina when she went to see him for an injured hamstring — the student was told that Nassar was an Olympic doctor who knew what he was doing.
“Leaders need to be particularly sensitive to their role in enforcing policies and supporting interventions to end serious wrongdoing by physicians,” wrote James DuBois, PhD, ScD, of Washington University, and colleagues, in recently published recommendations on preventing misconduct in medicine. “Far too often, cases of egregious ethical violations are ignored, covered up, or even enabled by leaders.”
Five MSU officials (including the former president) were charged with various counts in relation to the Nassar case — lying to investigators, tampering with evidence, and acting as a party to his assaults. MSU denied any attempt to cover up the abuse.
The Nassar case mirrors other cases of egregious ethical violations, DuBois’ group found — oversight was “lax or absent,” and individuals who were aware of the action failed to report or discipline the physician at fault.
At the University of Southern California (USC), administrators denied they knew about sexually inappropriate behavior of longtime campus gynecologist George Tyndall, MD, until 2017, but colleagues say they reported his “creepy” habit of inappropriately touching during pelvic exams and excessively photographing patients genitals back in the 1990s. At least three patients submitted letters reporting inappropriate touching and remarks from Tyndall in the early 2000s.
In 2013, chaperones reported their concerns over Tyndall’s behavior to their supervisor, but an investigation found that no school policy violation had occurred and the only apparent repercussion was that he was barred from locking his office door when seeing patients.
“The protection offered to the public by administrative review and action may fall short of that provided by criminal prosecution,” DuBois and colleagues noted.
According to Anthony DiPietro, who represented plaintiffs on the Columbia and USC cases, the similarities between the allegations are “unmistakable.” He said those who commit these acts are often relying on administrations to provide them with victims, and that when administrators “turn their backs, cover their ears, and fail to deal with acts of misconduct, a completely different and dangerous culture is created.”
After the allegations came to light, USC President C. L. Max Nikias, published an apologyand the administration made efforts to improve reporting on campus and provide additional educational materials on sexual violence to students. But when Tyndall was terminated, the university failed to report him to the medical board, only doing so when he sought reinstatement there. Nikias eventually stepped down following numerous complaints on how the situation was handled.
In other cases, however, administrative bodies remained largely silent.
Where to Turn in Cases of Abuse?
Sexual assaults can be reported directly to state medical boards, which are obligated to investigate the case.
They can also be reported directly to law enforcement. DuBois noted that although this is the only way a criminal action would be taken against a physician for misconduct, some patients may not be aware that this is an option.
Still, he said some may feel more comfortable reporting an assault within the medical community, because the cases will typically be dealt with more swiftly and confidentially.
“We know institutions often want to keep these things very quiet and handle them internally,” DuBois told MedPage Today.
Some, however, may not know who to report an assault to.
Marissa Hoechstetter, the only named plaintiff in the Columbia case, was initially encouraged to report her experience after Bill Cosby was charged in 2015 in his sexual assault case. She was convinced to come forward when she heard the more than 150 women testifying during Nassar’s sentencing, where he was given up to 175 years in prison.
According to the complaint, Hoechstetter was “exploited and abused” by Hadden, who was “enabled” by the lack of action on behalf of the institution. She, along with 16 other “Jane Does,” claim Hadden engaged in deviant sexual acts, often while they were pregnant, including “surreptitiously licking” and digitally penetrating their vaginas for no medical purpose. They allege that the university knew about but failed to stop the misconduct.
When Hoechstetter came forth with allegations against Hadden in 2015, she said she was told her accusation was outside the criminal statute of limitations and did not participate in the initial criminal case against him.
“It was a contrary experience to what we talk about in the public now of believing and supporting survivors,” Hoechstetter told MedPage Today. “As a person who had something like that happen to me, and I go forward and it doesn’t matter is really troubling and disappointing.”
“We need to figure out how our legal system can support and respond to people who come forward, especially when it relates to serial crimes,” she said.
In 2016, Hadden ultimately entered a guilty plea for charges of criminal sex acts and forcibly touching patients, surrendered his medical license, agreed not to seek registration in other jurisdictions, and was registered as a Level 1 sex offender (the lowest tier) in the state of New York.
Hoechstetter later learned that oral sexual contact can be prosecuted within 5 years in New York, and since the incident had occurred in 2012 during a post-op visit it would have fallen within the criminal statute of limitations.
After her experience, Hoechstetter tried to find some information about Hadden online. But in New York, when a physician has his or her license revoked, only the final action is made public. Today, information on the Professional Misconduct and Physician Disciplinewebsite states that Hadden surrendered his license and was convicted of a criminal sex act and forcible touching, but when Hoechstetter initially reported her experience before the 2016 case, the public information available about Hadden was limited.
“I know now I could have reported it to the medical board and the hospital and the police, but at the time, as a patient, as a new mother, you don’t know what to do and it’s not obvious,” Hoechstetter said. “I don’t know if at the time I even thought about the fact there was a state medical board.”
She and some of the plaintiffs are also seeking to have Hadden’s name removed from their children’s birth certificates.
An investigation from the Atlanta Journal-Constitution uncovered 2,400 cases since 1999 where physicians were publicly disciplined for sexual infractions involving patients, but the number is likely far higher as most of these cases stay hidden.
In reality, there are not current, clear data on the prevalence of sexual assaults committed by physicians, said Catherine Caldicott, MD, of PBI Education in Jacksonville, Florida, an organization that provides preventive and remedial courses on topics such as professional boundaries and ethics. This is in part because patients may be hesitant to report, but also because a facility might avoid doing so.
When the case is handled internally within the hospital or institution, it may be influenced by economic considerations, she said.
“They have guidelines and policies and committees in place for handling complaints for any employee or member of their staff, but some institutions appear to be very forgiving of bad behavior on the part of people who might otherwise be very valuable members of the faculty,” Caldicott told MedPage Today.
“Even if an individual does the right thing, sometimes the institution doesn’t do the right thing,” she said.
A tentative $215 million settlement was reached at USC with roughly 500 current and former students over Tyndall’s misconduct. And MSU reached a $500 million settlement with the 332 claimants in the Nassar case, with some of the money set aside for future complaints.
At the latter, financial penalties were not the only pain inflicted. Many university employees in the supervisory chain above Nassar quit or were fired. That went all the way to the top: Longtime MSU president Lou Anna Kimsey Simon resigned a year ago and was later charged with lying to police about her knowledge of the Nassar affair. And her replacement, former Michigan Gov. John Engler, resigned on Jan. 16 of this year after it became known that he had tried to impugn some of Nassar’s accusers and cancelled a $10-million “healing fund” the university had set up for victims.
In the recommendations from DuBois’ group, they suggested that a broad culture of professional integrity in medicine needs to be instilled early on and across the board in order to combat inaction.
“Medical students, residents, nurses and others who are often in the best position to observe and report wrongdoing must be empowered to do so,” they wrote, adding that these individuals must be protected as they may be vulnerable to retaliation. “A culture of professional integrity can protect patients and whistleblowers more than current laws.”
The third and final part of this series will examine the role of national associations and state medical boards.