Home Forums Discussions General Discussion Dilema

Usually I have a pretty good idea how I want to handle problems but yesterday I became stumped. Any thoughts on this non-AC issue would be appreciated. I have a 68 yo lady who switched to me from a local male doctor, she very convincingly elaborated, because "her heart had been broken" by him. Short version, after her husband died he made advances towards her (he is in his late 40s and never married). She told me how they had a "romantic" relationship, how he would come to her house and take pictures of her in her nightgown, blah, blah, blah. I really found this difficult to believe (although her telling of it was very convincing and never varied). Her son confronted him and he blatantly denied it, calling it preposterous!. He "tells the patient he can never see her again, either as a patient or a lover". So, the son and the rest of the family thought she was "crazy" and begged her to see a psychiatrist. The D-I-L brought her to my office on her first visit and pulled me aside telling me how upset they were about her mental state and could I convince her to see a psychiatrist.
I ended up diagnosing an ovarian tumor which she had removed and, after surgery,the patient reports that this doctor comes over to her house to see her, asks to see her scar and, while looking at it, places the patient's hand in his crotch to show her "what effect she has on him".
She tells her family and they finally get her to see a psychiatrist who tells them "she is not the first". This doctor apparently corralled the female psychiatrist in a closet at the hospital 15 years ago and tried to grope her. She has also had other patients report similar encounters with this doctor! So now, the family realizes that their mother is not crazy and that she was telling the truth all the time!! But neither they nor the patient have made any move to report this scumbag! The patient "doesn't want to hurt him"!!
So, I am sitting there yesterday listening to all of this and cannot believe no one has filed complaints. Here is my question...should I, as an advocate for my patient, without her consent or approval, report what I have been told to the Medical Licensing Board? Apparently, the psychiatrist told my patient her story "in confidence. Whew.

Just based on the original story, it is inappropropiate, and the board should know. It sounds as if he is having relations with his patients.

The board should know, but if none of the patients have officially complained, and this one doesn't want to, and the psychiatrist doesn't want to,... well, I don't know if it will in some twisted and unimaginable way end up actually harming YOU. How? I'm not sure I can figure out the twist, but the fact that none of the patients have complained should be taken as a warning.

The patient and or family is free to contact the Board of Medical Examiners. But they won't. What you have is hearsay. The patients family can also contact Adult protective services, but they won't. The female psychiatrist was groped by this guy 15 years ago. Did she report it then? Perhaps this is where the onus lays. The DIL is still able to report this as well. Victims as a rule don't report their assailants. This sounds like a new reality TV show. What a mess.

Wayne, my fears exactly! Tom, I have wondered the same thing, why they have failed to notify anyone. I know as a physician it is my job to listen to patients but, in reality, there are some things, I would rather just not hear!

Leslie,
I would enourage the patient to make a report to the board, but would not do so directly myself (As Wayne said, in some twisted way you could get in trouble for like violating the patients confidentiality, etc.) Good luck.

Believe me, I strongly urged both she and her D-I-L to file a complaint but I do not think they will.

Leslie
I hope you have noted in your chart notes that you have given them the names & addresses of the appropriate authorities where they can file their complaints or grieviances. Atleast in that way you have covered yourself, even it is heresay
Grenville

Leslie,
As if medicine isn?t complicated enough without this type of issue!
Here is my take:
It appears that a physician in your community is serially abusing patients. Not once, not twice, but many times over a period of years. The damage done to your patient is significant and is at least partially known to you, but is likely the tip of the iceberg. It is hard to imagine the extent of damage to all of the victims of this dirt-bag. Yes, you have an obligation to your patient, but I would feel an even greater obligation to the community at large; to others who have been molested (and maybe suffering ongoing abuse now) and to potential future victims whom you can protect by taking some action. If we know about someone like this, I really feel that we have an obligation to take action. Is there a chance it will somehow come back to hurt you? Perhaps. But wouldn?t you think that you can approach this in a way that minimizes that risk, and make it worth taking? Please consider trying the following:
1. Call the state medical board and ask to speak to someone in authority in the legal department. Lay-out the situation for them. Do not at that point divulge the name of your patient, simply tell them the story and ask how they can help you deal with this threat to your community.
2. Speak directly with the psychiatrist. Again, you need not name your patient. (Will this mental health ?professional? know who you are talking about? Perhaps, but you need not name the patient). This doctor apparently not only has personal knowledge of the guy?s malpractice and potentially criminal actions, but she has confirmation from multiple patients! This is someone who is obligated to report the abuse of her patients to the authorities. Try to convince her of this.
3. Even if none of the patients involved are willing to come forward, if you and the psychiatrist both report this doctor to the medical board, at the very least if a patient does come forward in the future (and maybe they already have!), then the level of suspicion and likelihood of action is far higher.
4. Be sure to document what the patient told you. That helps protect you against any potential libel claim by the doctor or denial by the patient that they made the statement.

Leslie, I hope I don?t come across as being sanctimonious or overly insistent, but I really think that it is essential that we try to police our own profession. This is truly a ?bad doctor?, if there ever was one, and you may be able to stop him in his tracks.

These comments are exactly on point. No one in any position of trust is above answering for misdeeds. Case in point, the French diplomat in the NYC rape -- he could have been outed 10 years ago, if anyone had the guts.

In my state, the psychiatrist is actually risking sanctions from the state board for not reporting the sexual assault on her by another licensed physician:Most states have similar rules. Leslie is not obligated to report hearsay. But the psychiatrist is a different story.

The first person I would call would be my malpractice carrier. They are the professionals in regards to the laws in your state. Please do act quickly before other patients are victimized.

Leslie,
Many good comments above. I just can't emphasize enough even if you do the "right" thing you may end up being victimized. American justice isn't about the victims, it's about the attorneys (IMHO). The doctor in question will "get off" (pun intended) if no victim steps forward and gives a statement. You will be left will dozens of hours of uncompensated work and could even face legal action by the perp. Tread very carefully...
I agree with Jon we should police our own profession, but unfortunately the legal protections aren't there to prevent us getting sued for doing the right thing.

All very good posts! Believe me, I have given this a great deal of thought and have considered already everything that has been presented here. I will most likely call the psychiatrist and run it past her. As was mentioned, everything so far is just hearsay. I have not even received a consultation note from the psychiatrist. I really appreciate all the input...it helps to make doing the right thing less painful.

Leslie,
Please let us know the follow-up, if you are able.
One other thought...the way you described the story, I assumed the family was present for the psychiatrist's description of the past events. Is that true? If not, you may have to consider the possibility that the patient fabricated that part of the story, as well.

Jon,

Good point. I honestly don't know if they were or not.

And, Leslie, also bear in mind...

If this is all fabricated, the next target might well be you.

I spoke with the psychiatrist. She did indeed have another patient who had "issues" with this doctor as did she herself. However, that patient was appalled and disgusted whereas, I believe, mine was flattered and receptive. I have decided since my patient does not "want to hurt him" and that their relationship, as disgusting as it was, apparently was consensual, I have no legs to stand on. I have however documented in the chart that I strongly urged the patient to file a complaint and gave her the numbers and addresses of where to do so.