1. BOUNDARY ISSUES AND PHYSICIAN SEXUAL MISCONDUCT

2. LEARNING OBJECTIVES
To recognize and define professional sexual misconduct
To distinguish between sexual violation and sexual impropriety
To recognize “red flag” situations to heighten awareness
To become familiar with the laws and rules governing the physician/patient relationship

3. ONLY THE PROFESSIONAL HAS A PROFESSIONAL CODE TO VIOLATE
ONLY THE PROFESSIONAL HAS A PROFESSIONAL CODE TO VIOLATE. THE PATIENT HAS NO SUCH CODE.

4. PROFESSIONAL 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.

5. 2 PRIMARY LEVELS OF SEXUAL MISCONDUCT
SEXUAL VIOLATION
SEXUAL IMPROPRIETY

6. SEXUAL VIOLATION
MAY 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:

7. SEXUAL VIOLATION - CONTINUED
SEXUAL INTERCOURSE
ORAL TO GENITAL CONTACT
ORAL TO ANAL CONTACT, GENITAL TO ANAL CONTACT
KISSING IN A ROMANITIC OR SEXUAL MANNER
TOUCHING BREASTS, GENITALS, OR ANY SEXUALIZED BODY PART FOR ANY PURPOSE OTHER THAN APPROPRIATE EXAMINATION OR TREATMENT

8. SEXUAL VIOLATION - CONTINUED
TOUCHING THE BREASTS, GENITALS, OR ANY SEXUALIZED BODY PART WHEN THE PATIENT HAS REFUSED OR WITHDRAWN CONSENT
ENCOURAGING THE PATIENT TO MASTURBATE IN THE PRESENCE OF THE PHYSICIAN OR MASTURBATION BY THE PHYSICIAN WHILE THE PATIENT IS PRESENT
OFFERING TO PROVIDE PRACTICE RELATED SERVICES, SUCH AS DRUGS, IN EXCHANGE FOR SEXUAL FAVORS

9. SEXUAL IMPROPRIETY
MAY COMPRISE BEHAVIOR, GESTURES, OR EXPRESSIONS THAT ARE SEDUCTIVE, SEXUALLY SUGGESTIVE, OR SEXUALLY DEMEANING TO A PATIENT, INCLUDING BUT NOT LIMITED TO:

10. SEXUAL 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IN THE PRESENCE OF MEDICAL STUDENTS OR OTHER PARTIES WITHOUT THE CONSENT OF THE PATIENT OR WHEN CONSENT HAS BEEN WITHDRAWN.

11. SEXUAL IMPROPRIETY – CONTINUED
EXAMINATION OR TOUCHING OF THE GENITALS WITHOUT THE USE OF GLOVES
USING THE PHYSICIAN/PATIENT RELATIONSHIP TO SOLICIT A DATE
INITIATION BY THE PHYSICIAN OF CONVERSATION REGARDING SEXUAL PROBLEMS, PREFERENCES OR FANTASIES OF THE PHYSICIAN
EXAMINING THE PATIENT INTIMATELY WITHOUT CONSENT

12. SEXUAL 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

13. GENERAL TRUTHS
No 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.

14. GENERAL 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.

15. ISSUES TO CONSIDER
Understand there are boundaries which prevent against dual relationships
Improper prescribing to friends
Doctor/patient confidentiality requirements
Creating a professional atmosphere in the office – which extends to staff
Respect of a patient

16. ISSUES 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” SITUATIONS
Doctor starts talking to patient about their personal life
Doctor checks their personal appearance before a particular patient arrives
Patient 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 drink
Doctor exchanges gifts or hugs with a patient
Doctor offers free care to a particular patient
Doctor calls patient at home when the condition does not warrant it
Doctor meets the patient outside the office

19. MEDICAL BOARD AUTHORITY
TITLE 43 OF THE OFFICIAL CODE OF GEORGIA ESTABLISHES THE BOARD TO REGULATE THE PRACTICE OF MEDICINE
THE BOARD HAS A STATUTORY MANDATE TO PROTECT THE PUBLIC.

20. OCGA TITLE 43
TITLE 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.

21. UNPROFESSIONAL CONDUCT
WITHIN THE RULES AND REGULATIONS OF THE BOARD, UNPROFESSIONAL CONDUCT IS DEFINED.
RULE (8) DEFINES SEXUAL MISCONDUCT

22. RULE (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….

23. RULE (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.

24. RULE (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.

25. POTENTIAL OUTCOMES
UPON 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.

26. POTENTIAL OUTCOMES - CONTINUED
ORDER THE PHYSICIAN TO UNDERGO A COMPREHENSIVE MENTAL/PHYSICAL EVALUATION
EMERGENCY/SUMMARY SUSPENSION OF LICENSE
REVOCATION
PROBATION/MONITORING

27. ISSUES TO CONSIDER BY THE BOARD WHEN DECIDING APPROPRIATE ACTION
PATIENT HARM
SEVERITY OF IMPROPRIETY
CULPABILITY OF LICENSEE
PSYCHOTHERAPEUTIC RELATIONSHIP
AGE OF PATIENT (MINOR, ETC.)
NUMBER OF TIMES BEHAVIOR OCCURRED
PERIOD OF TIME RELATIONSHIP EXISTED

28. ISSUES TO CONSIDER BY BOARD - CONTINUED
INAPPROPRIATE TERMINATION OF PHYSICIAN/PATIENT RELATIONSHIP
RESULTS OF MENTAL/PHYSICAL EVALUATION