Sexual misconduct: numbers may be higher than notifications

A LANDMARK study of sexual misconduct notifications to health regulators against Australian health professionals may underestimate the level of sexual misconduct being committed, say the authors.

The study, published by the MJA, found that reports of sexual misconduct were rare overall, with regulators receiving 1507 sexual misconduct notifications for 1167 of 724 649 registered health practitioners (0.2%) during 2011–2016. Of these, 208 practitioners (18%) were the subjects of more than one report; 381 notifications (25%) alleged sexual relationships while 1126 (75%) alleged sexual harassment or assault.

Lead author Associate Professor Marie Bismark, professor of Public Health Law at the Melbourne School of Population and Global Health, told InSight+ that “it’s important to acknowledge that not all of the instances of sexual misconduct in Australia will be represented in this study”.

“[Since the study was published,] I’ve already had multiple women contact me to describe instances of sexual assault that they experienced from a doctor, which they never reported to the Australian Health Practitioner Regulation Agency,” she said.

“Some of these women have carried tremendous guilt that they didn’t make a report at the time, and that perhaps they could have prevented other women from suffering the same experience.”

The multiple complaints against some individual practitioners raise questions around whether attempts at remediation for confirmed perpetrators of sexual misconduct are worthwhile, or whether those practitioners should be removed from the profession.

“We do need to assess which interventions are effective, which group of practitioners can be remediated, and which groups of practitioners are likely to continue engaging in this conduct,” Associate Professor Bismark said.

“That’s an incredibly important question.

“You sometimes hear about regulators imposing conditions like requiring a practitioner to attend an ethics course. I’m not sure of any good evidence that forcing somebody to attend an ethics course against their will has ever really changed their practice.”

Bismark and colleagues analysed data from the Australian Health Practitioner Regulation Agency and NSW Health Professional Councils Authority on notifications of sexual misconduct during 2011–2016.

They also found that:

• notifications regarding sexual relationships were more frequent for psychiatrists (15.2 notifications per 10 000 practitioner-years), psychologists (5.0 per 10 000 practitioner-years), and GPs (6.4 per 10 000 practitioner-years) compared with other practitioner groups;
• the rate was higher for regional/rural than metropolitan practitioners;
• notifications of sexual harassment or assault more frequently named male than female practitioners, with 0.6% of male practitioners and 0.03% of female practitioners being the subject of a report – male practitioners were 37 times more likely to sexually harass or sexually assault a patient than a female colleague;
• a larger proportion of notifications of sexual misconduct than of other forms of misconduct led to regulatory sanctions (242 of 709 closed cases [34%] v 5727 of 23 855 [24%]).

Bismark and colleagues highlighted three areas that need further investigation.

“First, we need strategies for reducing barriers to notifying regulators of sexual misconduct,” they wrote. “The Medical Board of Australia has recently established a national committee for responding to sexual misconduct notifications and has trained investigators with specialist expertise.

“Second, the connection between sexual misconduct and sexual harassment of colleagues should be investigated, with the twin goals of training practitioners to practise ethically and professionally and providing trustworthy processes for reporting and investigating unacceptable behaviour in the health professions.

“Finally, we need robust information about the effectiveness of regulatory interventions for preventing recurrent sexual misconduct.

“Patients, health care practitioners, and the public deserve focused efforts to prevent sexual misconduct in health care, fair and thorough investigation of allegations of sexual misconduct, and prompt and consistent action by regulators when misconduct is confirmed.”

Even though the number of notifications for sexual misconduct represent 0.2% of the total number of health practitioners registered in Australia, study co-authors Dr Katinka Morton and Professor Ron Paterson agreed there was no acceptable level.

“One thing that’s been striking is that actually there’s a very high level of acceptance within certainly the medical profession, and I think all the health professions, that this is a no-go zone,” said Professor Paterson, Professor of Law at the University of Auckland, and Distinguished Visiting Fellow at the University of Melbourne.

“So, while people are quite properly concerned that the process is fair and is not unduly protracted, they also have a very clear view that the workplace is not the place for sexual harassment, a sexual relationship or a sexual assault.”

Dr Morton, a consultant child and adolescent psychiatrist at Perth Children’s Hospital said, apart from the obvious harm to the patient, it was important to acknowledge that sexual misconduct was also harmful to the medical profession.

“It confers a very problematic challenge for the medical profession, in that these [cases] are obviously potentially very extensively publicised,” Dr Morton said.

“For the medical practitioner providing care to a patient to be assuring the patient of their trustworthiness and for the community as a whole to be expecting trustworthiness, it’s a complex challenge.”

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