2LEARNING OBJECTIVESTo recognize and define professional sexual misconductTo distinguish between sexual violation and sexual improprietyTo recognize “red flag” situations to heighten awarenessTo become familiar with the laws and rules governing the physician/patient relationship
3ONLY THE PROFESSIONAL HAS A PROFESSIONAL CODE TO VIOLATE ONLY THE PROFESSIONAL HAS A PROFESSIONAL CODE TO VIOLATE. THE PATIENT HAS NO SUCH CODE.
4PROFESSIONAL SEXUAL MISCONDUCT GENERAL DEFINITION:THE OVERT OR COVERT EXPRESSION OF EROTIC OR ROMANTIC THOUGHTS, FEELINGS, OR GESTURES BY A PROFESSIONAL TOWARD A PATIENT, CLIENT, TRAINEE, SUPERVISEE OR STAFF THAT ARE SEXUAL OR MAY BE REASONABLY CONSTRUED AS SEXUALLY DEMEANING OR DEMONSTRATES A LACK OF RESPECT FOR THE PERSON’S PRIVACY.
52 PRIMARY LEVELS OF SEXUAL MISCONDUCT SEXUAL VIOLATIONSEXUAL IMPROPRIETY
6SEXUAL VIOLATIONMAY INCLUDE PHYSICIAN-PATIENT SEX, WHETHER OR NOT INITIATED BY THE PATIENT, AND ENGAGING IN ANY CONTACT WITH A PATIENT THAT IS SEXUAL OR MAY BE REASONABLY INTERPRETED AS SEXUAL, INCLUDING BUT NOT LIMITED TO:
7SEXUAL VIOLATION - CONTINUED SEXUAL INTERCOURSEORAL TO GENITAL CONTACTORAL TO ANAL CONTACT, GENITAL TO ANAL CONTACTKISSING IN A ROMANITIC OR SEXUAL MANNERTOUCHING BREASTS, GENITALS, OR ANY SEXUALIZED BODY PART FOR ANY PURPOSE OTHER THAN APPROPRIATE EXAMINATION OR TREATMENT
8SEXUAL VIOLATION - CONTINUED TOUCHING THE BREASTS, GENITALS, OR ANY SEXUALIZED BODY PART WHEN THE PATIENT HAS REFUSED OR WITHDRAWN CONSENTENCOURAGING THE PATIENT TO MASTURBATE IN THE PRESENCE OF THE PHYSICIAN OR MASTURBATION BY THE PHYSICIAN WHILE THE PATIENT IS PRESENTOFFERING TO PROVIDE PRACTICE RELATED SERVICES, SUCH AS DRUGS, IN EXCHANGE FOR SEXUAL FAVORS
9SEXUAL IMPROPRIETYMAY COMPRISE BEHAVIOR, GESTURES, OR EXPRESSIONS THAT ARE SEDUCTIVE, SEXUALLY SUGGESTIVE, OR SEXUALLY DEMEANING TO A PATIENT, INCLUDING BUT NOT LIMITED TO:
10SEXUAL IMPROPRIETY - CONTINUED DISROBING OR DRAPING PRACTICES THAT REFLECT A LACK OF RESPECT FOR THE PATIENT’S PRIVACY, DELIBERATELY WATCHING A PATIENT DISROBE, ETC.SUBJECTING A PATIENT TO AN INTIMATE EXAMINATION IN THE PRESENCE OF MEDICAL STUDENTS OR OTHER PARTIES WITHOUT THE CONSENT OF THE PATIENT OR WHEN CONSENT HAS BEEN WITHDRAWN.
11SEXUAL IMPROPRIETY – CONTINUED EXAMINATION OR TOUCHING OF THE GENITALS WITHOUT THE USE OF GLOVESUSING THE PHYSICIAN/PATIENT RELATIONSHIP TO SOLICIT A DATEINITIATION BY THE PHYSICIAN OF CONVERSATION REGARDING SEXUAL PROBLEMS, PREFERENCES OR FANTASIES OF THE PHYSICIANEXAMINING THE PATIENT INTIMATELY WITHOUT CONSENT
12SEXUAL IMPROPRIETY - CONTINUED INAPPROPRIATE COMMENTS ABOUT OR TO THE PATIENT, INCLUDING MAKING SEXUAL COMMENTS ABOUT A PATIENT’S BODY OR UNDERCLOTHING, MAKING SEXUALIZED OR SEXUALLY DEMEANING COMMENTS TO A PATIENT, CRITICIZING THE PATIENT’S SEXUAL ORIENTATION, POTENTIAL SEXUAL PERFORMANCE, SEXUAL LIKES/DISLIKES WHEN NOT CLINICALLY INDICATED
13GENERAL TRUTHSNo matter how difficult or boundary testing the patient may be, IT IS ALWAYS the professional’s responsibility to maintain appropriate boundaries or if unable to do so – refer the patient for competent help or counsel.Crossing boundaries by a professional is ALMOST ALWAYS a power differential.
14GENERAL TRUTHS - CONTINUED Sexual misconduct usually begins with relatively minor boundary violations to include place/space, money, gifts/services, clothing and language.The professional must refrain from obtaining personal gratification at the expense of the patient.No level of training confers immunity from sexual misconduct by a professional.
15ISSUES TO CONSIDERUnderstand there are boundaries which prevent against dual relationshipsImproper prescribing to friendsDoctor/patient confidentiality requirementsCreating a professional atmosphere in the office – which extends to staffRespect of a patient
16ISSUES TO CONSIDER - CONTINUED Ambiguity in the doctor/patient relationship (Ex. hugging, etc.)Unethical requests by patient (Ex. falsification of documents, etc.)Creating an atmosphere of trust so the medical care and healing can occur.The power always rests with the doctor and the patient is vulnerable, even if the patient initiates the unethical act.
17“RED FLAG” SITUATIONSDoctor starts talking to patient about their personal lifeDoctor checks their personal appearance before a particular patient arrivesPatient is scheduled at end of the day to “allow for more time”Doctor allows staff to leave early while he/she interact with a particular patient
18“RED FLAG” SITUATIONS - CONTINUED Doctor offers patient food or drinkDoctor exchanges gifts or hugs with a patientDoctor offers free care to a particular patientDoctor calls patient at home when the condition does not warrant itDoctor meets the patient outside the office
19MEDICAL BOARD AUTHORITY TITLE 43 OF THE OFFICIAL CODE OF GEORGIA ESTABLISHES THE BOARD TO REGULATE THE PRACTICE OF MEDICINETHE BOARD HAS A STATUTORY MANDATE TO PROTECT THE PUBLIC.
20OCGA TITLE 43TITLE 43 OF THE GEORGIA CODE PROVIDES AUTHORITY TO THE BOARD TO REVOKE, RESTRICT, OR OTHERWISE DISCIPLINE A PHYSICIAN’S LICENSE BASED ON UNPROFESSIONAL CONDUCT BY THE LICENSEE.
21UNPROFESSIONAL CONDUCT WITHIN THE RULES AND REGULATIONS OF THE BOARD, UNPROFESSIONAL CONDUCT IS DEFINED.RULE (8) DEFINES SEXUAL MISCONDUCT
22RULE (8)Committing any act of sexual intimacy, abuse, misconduct, or exploitation of any individual related to the physician’s practice of medicine regardless of consent. This rule shall apply to former patients where the licensee did not terminate in writing the physician/patient relationship before engaging in a romantic or sexual relationship with the patient and/or….
23RULE (8) CONTINUED….where the licensee used or exploited the trust, knowledge, emotions or influence derived from the prior professional relationship. The Board will consider the physician/patient relationship terminated if the physician has not evaluated or treated the patient for a period of at least two (2) years.
24RULE (12)This rule concerns the examination of a patient’s genitalia. It states:Unprofessional conduct is further defined as conducting a physical examination of the breast and/or genitalia of a patient of the opposite sex without a chaperone present.
25POTENTIAL OUTCOMESUPON A FINDING THAT A PHYSICIAN HAS ENGAGED IN UNPROFESSIONAL CONDUCT, TO INCLUDE SEXUAL MISCONDUCT, THE BOARD IS EMPOWERD TO TAKE A VARIETY OF ACTIONS AGAINST THE LICENSEE.
26POTENTIAL OUTCOMES - CONTINUED ORDER THE PHYSICIAN TO UNDERGO A COMPREHENSIVE MENTAL/PHYSICAL EVALUATIONEMERGENCY/SUMMARY SUSPENSION OF LICENSEREVOCATIONPROBATION/MONITORING
27ISSUES TO CONSIDER BY THE BOARD WHEN DECIDING APPROPRIATE ACTION PATIENT HARMSEVERITY OF IMPROPRIETYCULPABILITY OF LICENSEEPSYCHOTHERAPEUTIC RELATIONSHIPAGE OF PATIENT (MINOR, ETC.)NUMBER OF TIMES BEHAVIOR OCCURREDPERIOD OF TIME RELATIONSHIP EXISTED
28ISSUES TO CONSIDER BY BOARD - CONTINUED INAPPROPRIATE TERMINATION OF PHYSICIAN/PATIENT RELATIONSHIPRESULTS OF MENTAL/PHYSICAL EVALUATION