Sexual Misconduct by Health Care Professionals Research Paper

Introduction

Sexual misconduct is referred to as an act of engaging in any conduct with a patient that is perceived to be sexual, which may be either physical contact or verbal (National Council of States Boards of Nursing 11). Studies conducted reveal that cases of sexual misconduct by health professionals are rising significantly in many countries. Generally, patients can level lawsuits for damages based on of the following allegations: that, either the physician convinced the patient that engaging in sex was part of the medical treatment, or that physicians failed to exercise self-restraint and thus breached his fiduciary duty to the patient. Sexual misconduct entrails all sexual contacts between health practitioners and patients during doctor-patients relationship (Smith & Australian Institute of Criminology 118).

The prevalence rate of sexual misconduct in physicians is estimated at 6-10 percent, but this phenomenon is likely under-reported in physician surveys and by patients. Generally, health care providers alleged of sexual misconduct are predominately male whose average age is 53 years; possess a history of personal life crises and they are in private practice. Further, the problem of sexual misconduct affects all medical disciplines and patients involved. However, most complaints of sexual misconducts are launched against practitioners, psychiatrists and gynecologists. Nevertheless, the case of consent does not apply between health professionals and their patients, mainly because of imbalance of power between the two parties (Smith & Australian Institute of Criminology, p.118).

Internal investigating and self-regulation by health professional bodies have proved to be ineffective. Moreover, most medical boards lack independence and impartiality whenever handling cases of sexual misconduct from their members. This is worsened by the fact that medical boards assume that past offenders can be rehabilitated, hence they offer short license revocation periods or allow offenders to practice under supervision.

This research study investigates the case of sexual misconduct among health care professionals and the corresponding effects to healthcare administrators and their insurance policies.

Reporting of sexual misconduct

Reporting of sexual misconduct by health professionals has significantly increased. According to Smith and Australian Institute of Criminology (1998), increased reporting of sexual abuse is attributed to increased awareness in the community. Additionally, some policies compel health practitioners to report any sexual misconduct from their colleague (Breen et al., p.162). However, ‘lesser’ sexual offenses are more tolerated by patients and go unreported. According to Smith & Australian Institute of Criminology (119), “there are five categories of sexual misconduct complaints that are reported namely; sexual assault, inappropriate sexual relationship, inappropriate treatment/examination, coercion, and sexual harassment.”

Reporting of sexual misconduct is mostly done by affected victims or their families; approximately 52 percent of sexual misconducts complaints are made by patients or their families. Generally, most victims of sexual harassment are female patients of variant ages. Anonymous reporting is encouraged in States where there is reluctance of reporting sexual misconduct. However, some areas do not encourage this form of reporting due to victimization of health care practitioners and the difficulty of investigation and prosecution. Consequently, reported cases of sexual misconduct should be taken seriously since false accusations by patients against physicians are not common (Breen et al., p.164).

Cases of sexual misconduct are reported to either police, employers or practitioners’ registration and licensing board. However, victims of sexual abuse in health care facilities are reluctant to report due to some stigma associated with the abuse.

Case of sexual misconduct

The NSW medical tribunal recently prosecuted Dr. Gordon Howe, a plastic surgeon for a series of sexual misconduct. The surgeon was accused of engaging in unethical relationship with a female patient. The tribunal found the doctor guilty of third degree criminal sexual conduct, and in this case, the tribunal reprimanded and imposed conditions on Dr. Howe practice. These conditions include “attending to counseling, undertaking a neuropsychometric assessment, must have a chaperone present when examining or treating female patients and provide monthly reports to the Medical Council” (HealthCare Complaints Commission, Para.2).

Effects sexual misconduct by health care professionals

Healthcare professionals accused of sexual misconduct are liable to civil law suits, license revocation, suspensions and restriction, family consequences and criminal charges. Generally, civil suits cost physicians approximately $50,000 in fines among other conditions. Further, the reputation of a hospital or individual practitioners is at risks, if the cases of sexual misconducts are highly publicized, making the hospitals and accused physicians unable to find clients in their practice. This has resulted to closure of private clinics operated or owned by physicians accused of sexual misconduct. Moreover, revocation of licenses of health practitioners is leading to shortage of healthcare staff in hospitals, which has led to a decline in the quality of healthcare services.

The hospital administrators are also concerned by additional costs that arise from prevention or handling cases of sexual assaults committed by their employees. Primarily, hospitals administrators incur additional costs of paying chaperons to prevent complaints of sexual assaults in their institutions. Further, hospitals have to contend with increased costs of insurance due to high risks of legal suits. Moreover, hospitals have to fund multi-disciplinary assessment of its staff constantly, hence raising the cost of operation.

Additionally, healthcare administrators have been forced to facilitate more supervision of its staff actions to promote the wellbeing of their patients. Besides, the administrators have to educate their employees on the boundaries of patient-physician relationship and consequences of breaching the code of ethics. Further, the hospital administrators are obliged by law to report any cases of sexual misconduct by their employees to the relevant authorities namely, regulating and licensing boards or police. Indeed, cover up of any case by the hospital administrators can lead to legal actions.

On the other hand, cases of sexual misconduct are deterring health practitioners from examining patients properly due to fear of complaints from patients. This can lead to wrong diagnosis which can result to fatal consequences.

Sexual misconduct and hospital insurance

Liability of any sexual misconduct falls on the independent practitioners, or the hospital or both. Hospitals can be liable for sexual assault if the hospital failed to provide supervision and security to a patient. In some civil litigation, victims sue both the physicians and the hospital for damages caused. Thus, some insurance companies are not liable to indemnify physicians who have committed sexual misconducts in their medical practice.

Generally, malpractice insurance taken up by healthcare practitioners does not cover liabilities incurred due to sexual misconduct lawsuits (Smith 101). Nevertheless, hospitals can generally be held liable if a physician engages in sexual misconduct while working there, even if he is not considered an employee of the hospital. Thus, hospitals are incurring huge costs due to civil suits caused by sexual misconducts from their employees.

Additionally, hospital insurance, which offers limited coverage for sexual misconduct, has raised the costs of premium due to high risks of civil suits against hospitals and their staff.

Prevention of sexual misconduct

Education

Generally, prevention of sexual misconduct should be approached primarily through educating healthcare professionals and the public. Medical schools should review their teaching curriculums to include comprehensive teaching on medical ethics. In addition, healthcare professionals should be trained on boundaries, as well as how to manage sexual emotions, of doctor-patients relationship (Breen et al., p.164).

Some health professional bodies provide rehabilitation programs for errant professionals who wish to review their conduct. Subsequently, patients need empowerment and education so that they can identify boundary violation and the procedures for reporting sexual mEducation about sexual misconduct would also inform physicians and medical students about ethical implications of physician-patient sexual contact, as well as the potential harm to patient well-being.

According to Breen et al. (2010), constant education of the public on sexual misconduct has led to acceptability and recognition of the effects of the problem.

Detection and reporting of sexual misconduct in health care facilities

In Australia, the Australia Medical Association has introduced mandatory reporting of sexual misconduct; and failure to report may be considered professional misconduct and subject to disciplinary action. Although anonymous reporting is not encouraged in most cases; anonymous reports have been used to investigate suspects since these offenders tend to perpetrate the offence repeatedly. Healthcare administrators have also endorsed zero tolerance to sexual misconduct and require all their staff to report any suspected cases. Consequently, by using multi-assessment, administrators can identify practitioners who are vulnerable to committing vices in the practice.

Multi-disciplinary assessment

A new approach of preventing sexual misconduct has been introduced in most healthcare facilities. Healthcare professionals are subjected to a short residential where the professionals are assessed of any mental illness or professional impairment. According to Myers and Gabbard (43), “the primary role of the multi-disciplinary assessment is to establish if there is professional impairment, recommend a course of action, and assess feasibility of rehabilitation.”

Usually, this assessment is conducted independently and objectively to attain maximum benefits. The assessment can diagnose and recommend treatment for professionals who exhibit conditions that can drive the health practitioners to commit sexual offences. Moreover, this model of assessment is used in collaboration with anonymous reporting system where suspected offenders are examined for possible offences. Notably, the multidisciplinary assessment is not meant to replace any legal proceeding; rather, it is a supplementary inquiry. In cases where the assessing team observes concrete evidence of sexual misconduct, the team is obliged to report the cases to the supervisory committees or the police.

However, multi-disciplinary assessment has some limitation in that, the process is expensive. Similarly, the assessment is conducted by a team, which comprises of practitioners from varying fields who do not have uniformity in definition of key terms (Myers & Gabbard 43).

Policies

Legislative bodies have enacted zero tolerance policies towards sexual abuse of patients. The policies recommended five years mandatory revocation of licenses; also all health professionals are obliged to report any abuse being perpetrated by their fellow workmates. Consequently, States have passed laws that define disciplinary actions to be taken against health care practitioners who break their ethics. However, in some jurisdictions, there are no specific laws that can be used to prosecute sexual offences committed by healthcare practitioners. Moreover, medical boards were compelled to review policies regarding investigating and hearing of sexual misconduct complaints.

New strategies have been employed which include reduction of the number of pre-hearing interviews, employing qualified staff to investigate complaints, and using victims’ impact statements in determining penalties imposed to the offenders (Breen et al. 162).

Additionally, suspects of sexual misconduct are accorded fairness and justice during prosecution and investigation. Previously, Medical boards’ disciplinary actions tended to be infrequent, ineffective, and substantially weighted in favor of the accused (Smith 101). Nevertheless, the investigating and prosecuting boards have become more vigilant in disciplining sexual offenses from their members.

Further, the use of chaperons in intimate examination and testing has become frequent to reduce cases of sexual misconduct complaints. However, this strategy has its limitations in its practicality, privacy of patients and associated costs. Moreover, there are concerns that medical practitioners are not adequately protected by law in their duty and are subject to malicious accusation from their patients.

Conclusion

Sexual misconduct by health practitioners is unethical and a breach of the fiduciary codes. The effects of sexual misconduct to patients include post traumatic stress, high dependency, stress and suicidal tendencies. Some of these effects of sexual misconduct are very severe and irreversible.

Although majority of high profile cases of sexual misconduct cases are committed by male practitioners, female practitioners do also commit such acts. However, the issue of consent does not apply since doctor-patient relationship is not balanced; physicians have more power than their patients do. Most medical bodies were self-regulating; however, due to frequent cases of sexual misconduct governments have limited the self-regulating capacity.

Reporting of physician sexual misconduct has significantly increased, but it is clear that a lot of cases go unreported. Anonymous reporting is not effective since it is difficult to investigate and prosecute such cases. Notably, many cases of sexual assaults are perpetrated to women of various ages. Additionally, victims and family and friends of victims are the groups that report cases of abuse. However, medical boards have several disciplinary measures that they use to discipline errant members including revocation of licenses, restriction of practice, and suspension. Moreover, sexual misconducts have led to expensive civil law suits and criminal suits from victims.

Hospital administrators have to contend with increased cost of operation since they have to supervise their staff more closely to avoid occurrence of sexual assaults. Indeed practitioners may need chaperons whenever conducting some kind of examination. Additionally, the hospital administrators have concern on the lack of adequate staff to meet of the needs of their hospitals due to revocation of licenses, and suspension due to sexual misconduct. In deed, decline in staff numbers is affecting delivery of high quality health care to patients.

To prevent cases of physician sexual misconduct, educating health practitioners on the boundary of doctor-patient relationship is very essential. Importantly, healthcare providers need to be trained on how to manage sexual emotions felt. Further, the public also needs to have a clear understanding of boundaries and the process of reporting assault. Insurance companies are not required to indemnify physician found liable in sexual misconduct. However, there is insurance that covers the cost of defense of law suits. In this case, the cost of insurance premiums is very costly for practitioners and hospital administration.

Works Cited

Breen, Kerry et al. Good medical Practice: Professionalism, Ethics, and Law. NY: Cambridge University Press, 2010.

Healthcare Complaints Commission. “Dr Gordon Howe – reprimanded and conditions imposed on practice by Medical Tribunal.” Healthcare Complaints Commission. 2010. Web.

Myers, Michael & Gabbard, Glen. The physician as Patient: A Clinical Handbook for Mental Health Professionals. NY: American Psychiatric Pub, 2008.

National Council of States Boards of Nursing. Practical Guidelines for Boards of Nursing on Sexual Misconduct Cases. 2009. Web.

Smith, Russell & Australian Institute of Criminology. Health Care, Crime and Regulatory Control. Sydney: Hawkins Press, 1998.

Smith, Merrill. Encyclopedia of Rape. Westport: Greenwood Publishing Group, 2004.