How predators are protected and enabled in medicine
Five women came forward claiming that he sexually assaulted them. It’s the same old story. They had gone to the police. They had gone to the state medical board. They looked everywhere for help, but of course there isn’t even a good phone number for victims to call when the problems occur in medicine.
Seven Years Later
Finally there were so many victims in their community that they bumped into each other socially. Still no one would listen. But when there are five of you with the same complaint and you are now grown ups, you can get a lawyer, something that is managed by only one in some thousands of patients with legitimate grievances (see Studdert).
Having there be five also got the attention of the news. When things end up in the news and appear to be so open and shut that the medical community cannot discredit the victims and dispose of them in the usual ways, agencies finally have to pay attention. The state medical board pretended to do so by doing what it historically always has done in order to appear as though it is doing something. It proposed passing a rule. This time against sex abuse.
The thing that is frivolous
is the way the problems of patients are treated
Of course it already has rules against sex abuse. Sex abuse also is against the law. And the state medical board is composed of people who are intelligent enough to know that sex abuse is wrong without there having to be any rule. But passing yet another rule will take the air out of the discussion about the real problems and protect them from having to do something that actually addresses the problems. The fact that nothing was done when these women asked for help was not because they didn’t have a rule against it. It already was against the rules. That’s not the problem.
The state medical board of Ohio did this same thing years ago when Dr. James Burt ruined the lives of so many women. After news reports finally forced their hand, the state legislature increased funding to the board so that it could double its number of staff attorneys, hire six more investigators and establish a consumer complaint bank. At the time, Lauren Lubow, a board spokesperson said that, “In the past the legislators gave us the (legal) tools. Now they’re going to give us the bodies.” (Dayton Daily News, July 1989) The state board medical board enacted policies and reorganized, yet continued not to find anyone guilty of sex abuse when patients complained. Or of anything else really. And it won’t begin to now as a result of passing this rule because the rule has nothing to do with why boards and agencies like this do not do the job that they persuade themselves and the government and the rest of the population that they will take care of.
A rule that it would be better for them to pass would be one that stops them from continuing to derail the rule of law in medicine, which they do all the time. As they did in this case. But explaining that to them yet again will have no effect. They are providers and so are inclined to protect other providers. There are no injured patients on their board. They are doctors. No matter how many ways you explain to them that they protect criminals in medicine, the most they will do is humor you, and perhaps pass some rule. It’s not something they want to fix. And discussion of the real problems will not be passed on to new boards of directors, as it wasn’t passed on to this board. So we get Richard Whitehouse, director of the Ohio State Medical Board, saying on tape to a news reporter about investigations of crimes in medicine, “Well, I don’t know if we’ve run into that situation where someone has just left it on our doorstep.”
I have talked to so many patients. And I have been such a patient. That happens all the time. This is just another case of people in medicine remaining unaware of the ultimate outcomes for patients, something that is endemic in medicine without anyone in medicine I’ve ever talked to being anything but in denial of that fact.
The police have a policy of not duplicating the investigations of other agencies. They told me that over and over. If that is the case, then every time that the state medical board accepts to investigate a crime, they guarantee that it has been left exclusively at their own doorstep. It never will become subject to a timely police investigation. The criminal never will be interrogated by police who are trained in Reid Interrogation techniques designed to elicit confessions. The criminal never will be taken to court, never indicted, never sentenced, never have to face the law in any way. If the police will not duplicate the investigations of other agencies, then every single time that the medical board accepts to investigate a complaint about a criminal matter, they have ensured that it has been left exclusively at their doorstep. Every single time. And yet the director of that board does not know if they have run into that situation.
It’s no skin off their back
Whether or not it is an official policy of the police, sometimes the police do tell patients to take their complaints to the medical board. When the patients follow that directive, they believe they are doing the right thing by leaving it on the doorstep of the medical board. Either way, it is the same thing. When a state medical board accepts to investigate something like sex abuse, they run into that situation where it has been left at their doorstep and they protect miscreants in medicine by so lowering the stakes, that those inclined to prey on patients have little to inhibit them (as is covered elsewhere on this site). Criminals in medicine most likely will get away with preying on patients forever, but if they get caught, the stakes are relatively low. They won’t be going to jail. The most that will happen is that the medical board will hear a complaint. Medical boards can not put people in jail. They only can suspend or revoke licenses. But even that is extremely rare when the complaint is brought to them by a patient (see OSMB). And even if they do revoke a license, that isn’t necessarily permanent. Medical personnel almost always resume careers again somewhere in medicine.
So the stakes are low partly because of how the state medical board derails the rule of law in medicine. But rather than addressing that issue, and similar issues that are as important in the Kashyap case, they fell back on a ruse. It could not even be called spin. It was a sham. It was a ruse. They passed a rule against sex abuse as though that had anything to do with why the current rules and laws against sex abuse were not enforced when women complained.
One woman, seeking treatment for a broken finger, complained that he touched her inappropriately and forced her to touch his pelvic region then gave her his cell number and asked her to call him.
They need a rule to know that’s wrong?
Passing a rule will give the well-meaning press and well-meaning politicians the idea that something has been done to address the problem without anything having been done. Somehow in medicine these ruses always work. We have so much misplaced faith in medicine to be well-meaning and lucid.
What will happen next to the five women is that they will be silenced. Either they will settle, either pre or post trial, and sign something that requires their silence, or they will lose and have to remain silent in order not to be sued by Kashyap for defamation. Victims of miscreants in medicine always get silenced. So they do not become part of the patient safety conversation. When we don’t hear from them, it sounds as though there must have been a satisfactory resolution. This contributes to making our view of the world of medicine unrealistically rosy. Discussions and initiatives about patient safety don’t have the knowledge of the experiences of those victims to draw on, so the discussion (see Silence versus Safety for one) is out of touch. And nothing improves.
In their suit the five women accused the internist of assault and battery, malpractice, destruction of evidence, intentional infliction of emotional distress and defamation – the normal list of the injustices perpetrated on patients injured in medicine.
The Ohio State Medical Board said it had investigated a complaint filed against him a couple of years earlier but took no disciplinary action. They almost never do take disciplinary action based on the complaints of patients (see osmb). And their records are not public and patients have no advocates to follow up on just what the board does with complaints.
Micheal Lyon, Kashyap’s attorney, said that money was the motivation behind the allegations. He said he reviewed the medical records and found nothing to confirm the allegations. Apparently he thinks that when people commit crimes they write down that they did in records that are available to the people against whom they committed the crimes.
Lyon also said he interviewed the offices staff and found no evidence from them. He also appears not to know that in medicine careers are ended for giving that kind of testimony. He appears also to be unaware of the extent to which people in medicine see the world through self-interested lenses.
The lesson here has to do with doctors policing doctors. And with there being no advocates for patients, only caregivers imagining themselves to be. Passing more rules and hiring more people in an organization that has a conflict of interest with achieving the goal is a fool’s errand. They are the wrong people and it is the wrong organization to advocate for patients.
Dr. Shafik Ahmad
Two things should come from the victimization of these women if we are to learn anything from their experience. One is to use it to shed light on at least one of the reasons why state medical boards do not protect patients. And second would be for the women themselves to learn how to keep from being silenced.
Unfortunately, none of the many sites blossoming to rate physicians could have let them complain about Kashyap, or they would have been sued by him. Isn’t it time to give liability limitations to patients, rather than physicians, so we at least can talk?