A group representing Maine physicians is cautioning its members about sexual misconduct involving patients in light of recent complaints to a state licensing board.
The Maine Medical Association reminded physicians of the definitions and ethical rules around “boundary violations,” including sexual harassment or sexual improprieties involving patients or their immediate family members, in its regular update to members this week.
At least two complaints alleging sexual misconduct were filed the past month with the Maine Board of Licensure in Medicine, which regulates medical doctors and physician assistants in the state, according to Andrew MacLean, deputy vice president of the MMA.
He was unwilling to discuss details of the complaints.
“We put it out there as a risk-management effort to remind physicians to be cautious in this area,” MacLean said. “Every day, there’s some new news story about this topic.”
Official complaints of physician sexual misconduct are uncommon in Maine, but the current swirl of allegations nationwide against celebrities, politicians and other high-profile professionals should put everyone on notice, MacLean said.
“We thought it best to remind physicians what the guidance is,” MacLean said.
Dennis Smith, executive director of the licensing board, said he could not discuss the number or status of complaints filed with the agency and would not confirm any recent complaints of physician sexual misconduct.
Overtly sexual behaviors such as intercourse, masturbation and “french kissing” involving a doctor and a patient constitute sexual violation, even if it’s consensual, according to a 20-year-old rule written jointly by the Board of Licensure in Medicine and the Board of Osteopathic Licensure, which oversees Maine’s doctors of osteopathic medicine.
More subtle behaviors, including watching a patient disrobe without providing privacy, touching the genital area without wearing gloves or making non-clinical comments about a patient’s body, clothing or sexuality constitute sexual impropriety. Exploiting the physician-patient relationship to solicit a date or initiate a romantic encounter also is unacceptable.
In addition, according a policy developed by the American Medical Association, physicians are explicitly cautioned against developing romantic or sexual relationships with “key third parties” involved in a patient’s care, including family members, close friends or advocates.
“Sexual or romantic interactions between physicians and third parties … may detract from the goals of the patient-physician relationship, exploit the vulnerability of the third party, compromise the physician’s ability to make objective judgments about the patient’s health care, and ultimately be detrimental to the patient’s well-being,” the section reads, in part.
All of these behaviors are reportable to licensing boards and may be punished by suspension or permanent loss of a medical license. More egregious cases, such as those involving a minor or a patient with mental disabilities or when a physician shows a regular pattern of transgressive behaviors also may be prosecuted as legal infractions.
Few would dispute that the power in the physician-patient relationship generally skews in favor of the physician. But Dr. Charles Pattavina, president of the Maine Medical Association and an emergency room doctor in Bangor, said physicians also can be the target of unwanted advances from patients. Because they are often alone with patients, he said, they are particularly vulnerable to being charged with unfounded allegations of misconduct.
“It will occasionally make me very nervous to be alone in a room with a patient,” he said.
Pattavina advises doctors to pay attention to their instincts and take steps to protect themselves, such as leaving the exam room door open, asking a nurse or other staff to “chaperone” during an exam or just be extra mindful of how they interact with their patients.
At Eastern Maine Medical Center in Bangor, which employs about 350 physicians, Interim Senior Vice President and Chief Medical Officer James Jarvis said the national surge in reports of sexual harassment and misconduct has everyone on alert.
“People will be much more cognizant of [the issue] now,” he said.
Jarvis said doctors employed by the hospital go through the same training on patients’ rights and sexual harassment as every other employee, both at the start of their employment and annually thereafter. Other doctors who are not employed but have practice privileges attend an abbreviated version of the training. The goal is to protect patients and employees, he said.
In addition, all EMMC patients are provided with a document outlining their rights and responsibilities, according to Victoria Merry, director of patient experience.
“We give them a brochure that explains who they can alert [if they have questions or concerns about the care they receive],” she said. Options include contacting the licensing arm of the Maine Department of Health and Human Services; reporting to the Joint Commission, an independent organization that certifies hospitals nationwide; or telling any hospital staff member.
Staff are required to report patient concerns to their supervisors and the incident will be investigated. After “due diligence,” Jarvis said, physician misconduct of any type will be reported to the Maine Board of Licensure in Medicine for further investigation.
Pattavina said doctors must always take the high road, even when approached by an attractive patient. Unless the patient-physician relationship is permanently terminated, he said, there is no ethical argument for allowing a personal relationship to develop.
“It doesn’t matter if the patient initiates it,” he said. “The doctor knows it’s wrong.”
Whether sexual misconduct involves a teacher, a clergy member, a powerful employer or a doctor, Pattavina said, “it’s all the same thing. The person has placed their trust in a professional. And the basis for professionalism [in medicine] is that we always do what we do for the good of the patient. The good of the patient should always come first.”
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