When Marianne DiTrani described months of alleged sexual abuse at the hands of her physician, in a lawsuit and at a press briefing this week, her accusations may have sounded painfully familiar.
The names come quickly to mind: Dr. Larry Nassar, charged with sexually assaulting 265 young women and girls he was supposed to care for as team doctor for the US women’s gymnastics team. The late Dr. George Tyndall, a former University of Southern California gynecologist, accused of sexually abusing hundreds of patients over many years. Dr. Robert Hadden, the former Columbia University gynecologist, also accused of sexually assaulting numerous patients over 25 years and sentenced this past summer.
Nassar and Hadden are in federal prison; Tyndall was awaiting trial at the time of his death last week.
These cases raise the question: Why is physician sexual abuse so prevalent and often so long-lasting?
DiTriani’s doctor, rheumatologist Derrick Todd, has not been charged and denies wrongdoing. But he is under investigation by the Suffolk County district attorney and Boston police, agreed to stop practicing medicine, and faces multiple lawsuits, including a class action filed Wednesday that had more than 91 plaintiffs as of Thursday evening.
When a doctor sexually abuses a patient, the behavior is regarded as the ultimate violation of the trust essential to the patient-physician relationship. But it’s that very trust that often allows the abuse to continue.
“The public comes to the physician with a high degree of trust and not everybody questions the behavior in the first instance,” said Dr. Chinmoy Gulrajani, associate professor of psychiatry at the University of Minnesota, who recently wrote an article calling on physicians to report sexual misconduct by other physicians.
Azza AbuDagga, health services researcher at Public Citizen, noted: “There is also the knowledge gap – patients do not know when certain intimate tests are medically necessary.”
In her lawsuit, DiTriani describes questioning the need for breast and gynecological exams. She alleges that Todd, who worked at Brigham and Women’s Hospital, called her to insist they were in fact a necessary part of her care.
At the press briefing, she remarked: “You know — it’s a doctor. He always had an answer. He’s very charming, very personable.”
In addition to not being sure whether they were abused, patients may also suffer from shame, or fear that they won’t be believed. There is also a “power differential between the physician and the patient that they’re treating,” Gulrajani said. “Patients are scared that nobody is going to believe them, and how can I go up against a powerful doctor?”
Patients who are concerned about their care may not know where to turn; the average person is not familiar with physician disciplinary procedures.
Some may fear that other doctors will refuse to treat them if they learn of the complaint. Some may realize how hard it will be to even find another doctor.
As a result, it’s estimated that only 10 percent of patients sexually abused by physicians report the abuse (compared with about 36 percent who report rapes).
The systems surrounding patients also work against detecting and quickly stopping abuse, advocates say.
“These things continue to happen because the medical community continues to tolerate this problem, unlike other professions,” AbuDagga said.
“Physicians regulate themselves. Most medical boards are composed of physicians. Committees that investigate physicians are primarily made up of physicians. . . . Physicians are willing to give their colleagues . . . a second chance.” (Five of the seven members of the Board of Registration in Medicine in Massachusetts are physicians. Rhode Island’s board is unique in that only half its members are doctors.)
Still, Brigham officials reported to the Department of Public Health that the Todd case came to light after two anonymous tipsters who identified themselves as physicians contacted the hospital.
A 2019 study of 101 cases of sexual violations in medicine found that 87 percent of perpetrators lost or surrendered their medical licenses, but it was often temporary or restricted to one state, and only 74 percent discontinued practicing medicine.
Public Citizen’s review of disciplinary actions against physicians from 2003 to 2017 found that 1,354 physicians had been disciplined for sexual misconduct, about two-tenths of 1 percent of the physician population. But in an anonymous survey in 1998, about 3.4 percent admitted they’d had sexual contact with one or more patients, AbuDagga said, suggesting the physicians who are disciplined are just “the tip of the iceberg.”
“Had every physician who’d been involved in a single act been stopped at the first instance . . . we wouldn’t have a series of victims,” AbuDagga said. “The gold standard should be zero tolerance of sexual abuse by health care practitioners, especially physicians.”
The solution, advocates and experts say, is more transparency and more reporting — by both patients and physicians.
“Part of the reason it keeps happening is that there’s not a lot of transparency in the process,” said Stefan Turkheimer, vice president of public policy at the RAINN (Rape, Abuse & Incest National Network). “The only time you ever hear about it is when there are so many cases that it forces it out in the open.”
In Massachusetts, the state Board of Registration in Medicine posts its final actions online, but the documents tend to contain scant information, and those who want to learn more have to file a formal public records request.
Lisa Robin, chief advocacy officer for the Federation of State Medical Boards, said that failure to report incidents — by both patients and physicians — was a key problem. “We saw that in these really egregious cases, the medical board was the last to know,” she said. The federation represents the boards in each state that regulate physicians.
Most states have a requirement that doctors report to the board when they know of another physician’s misconduct, but they vary in how much teeth they have, Robin said.
In Massachusetts, state law requires doctors to report to the board when “there is a reasonable basis to believe” that someone has violated the board’s regulations, including misconduct. “Failure to report could result in a complaint against the physician who failed to report, and if found in violation after an evidentiary hearing, could face discipline,” said a statement from the board.
A few years ago, the federation formed a work group to address physician sexual misconduct, which produced a series of nonbinding recommendations in 2020. They include providing clear guidance for patients on how to file a complaint, moving quickly to address complaints of sexual misconduct, requiring hospitals to report sexual misconduct to licensing boards, and sanctioning physicians who fail to report known instances of sexual misconduct.
The federation did not have information on how many state boards have adopted the recommendations. But Dr. Patricia A. King, the Vermont internist who led the group, said she believes boards are taking the matter seriously and pointed to tougher regulations in several states. “It’s starting to make a difference, in duty to report, in public awareness. It takes all of medicine to make a change,” she said.
Equally as important, though, is educating patients about what is necessary and appropriate care and also about how to file a complaint, King and others said.
AbuDagga, of Public Citizen, urges patients to trust their gut and think twice before agreeing to undergo an intimate exam that seems unnecessary. Trained practice monitors should attend sensitive exams, she said.
In Massachusetts, patients can file complaints through the Board of Registration in Medicine’s online complaint system at https://www.mass.gov/submit-a-complaint.