Why Medical Boards Excuse Predatory Doctors

The Atlanta Journal-Constitution just published “License to Betray,” an exhaustive investigation into complaints of sexual abuse by doctors. The results of the investigation are appalling:

In a national investigation, The Atlanta Journal-Constitution examined documents that described disturbing acts of physician sexual abuse in every state. Rapes by OB/GYNs, seductions by psychiatrists, fondling by anesthesiologists and ophthalmologists, and molestations by pediatricians and radiologists.
Hospitals and health care organizations brush off accusations or quietly push doctors out, the investigation found, without reporting them to police or licensing agencies. … Physician-dominated medical boards gave offenders second chances. Prosecutors dismissed or reduced charges, so doctors could keep practicing and stay off sex offender registries. Communities rallied around them.

Doctors are always heroes, or so the story goes, and so even the most heinous acts are brushed aside as “mistakes” or “bad judgment.” Just like with the child abuse scandal in the Catholic Church, the culture of heroism, morality, and virtue surrounding medicine is so powerful that people refuse to believe these types of assaults could be real. Even if people take the first step — believing the accusers could be telling the truth — the next step is to assume that this was an isolated incident, that the problem is rare, and that even this particular doctor will never do it again.

There’s an element of sexism at work, too. In one case, seventeen different women came forward with complaints of sexual misconduct against a neurologist. One patient’s case was criminally prosecuted but she lost at trial. In response, the medical board dramatically lowered the punishment, even though it found the victims’ complaints were credible. If seventeen women’s complaints weren’t enough, how many women would be enough? The neurologist is still practicing today with an unrestricted license.

For patient advocates and medical malpractice lawyers, this isn’t surprising. The secrecy of boards of medicine, peer review proceedings, and malpractice settlements allows all kinds of horrors to proliferate in the medical profession, like the surgeon at Baylor who maimed multiple patients. The secrecy of medical boards is a well-known problem, as is the tendency of professions to “close ranks” to protect their own members, even the members that betray the most basic oaths of the profession and who damage it with their actions.

One recurring theme in “License to Betray” deserves its own analysis:

Larry Dixon, the executive director of the Alabama Board of Medical Examiners, has heard the argument that doctors who engage in sexual misconduct should be barred from practice. He doesn’t buy it.
“If you graduate a class of more than 100 people out of the University of Alabama medical school, the resources that have been poured into that education almost demand that you try to salvage that physician — if it’s possible,” said Dixon, who has led the Alabama board for 35 years.
Stop and think, he said, about how badly many communities need their doctors.
“You do not think so? Then leave Atlanta and go down to a little Georgia town and get sick,” Dixon said. “See how far they have to go to find a doctor.”

This sort of bargain is hideous — we have to accept a certain number of pervert doctors just to have adequate medical care? — but Dixon has a point. We don’t have enough doctors. We don’t have enough doctors because we don’t have enough medical school graduates, and even if we had more we wouldn’t have enough residency positions for them.

It’s not like America has too few bright, enterprising young people looking to get into the professional world. We have way, way too many law school graduates, enough that we could easily close half of the law schools and still have more than enough new lawyers.

It’s easy to say that Boards of Medicine should do more to prevent and to punish sexual abuse by doctors (and I say as much without hesitation). But, when we do that, we also need to understand the root causes for why the Boards of Medicine are so hesitant to punish doctors, and to work on those problems as well.