One of the most vexing aspects of the case against Dr. Roger Ian Hardy, the former medical director of the Fertility Centers of New England who recently gave up his medical license following allegations of the sexual molestations of female patients dating back to the 1990s, is why nurses in his practice apparently failed to report him. An investigation by the state Board of Registration in Medicine revealed that the nurses in the practice either failed to report what they had witnessed or were ignored when they brought their concerns to supervisors. The organizational culture of the clinic, according to one psychologist involved in the investigation, encouraged a “code of silence.”
Codes of silence within professions, such as the police, are often rooted in shared beliefs that outsiders could never understand the pressures and moral ambiguities of difficult jobs. But in medical settings, the code appears based more on intimidation, fear of reprisal, and inflexible hierarchies.
The code of ethics as promulgated by the American Nurses Association makes it clear that a nurse’s primary commitment is to the patient. The nursing practice, according to the code, must be “grounded in the moral principles of fidelity and respect for the dignity, worth, and self-determination of patients.’’ But the code also includes this real-world warning: Any decision by a nurse to report a case of impaired practice “may present substantial risk to the nurse.’’
Summoning the moral courage to blow the whistle on an immoral or impaired doctor could be the hardest thing required of a nurse. State health officials provide what protection they can by mandating that doctors, nurses, aides, and others working in medical settings report any incidents of patient abuse directly to the state Department of Public Health. But state officials aren’t available to intervene in the middle of a night shift.
Futher investigation by state health officials must focus on Hardy’s alleged actions and the possibility of more victims. But it won’t be complete unless it also delves into just how long these alleged abuses were taking place, and under whose nose.