Whatever may have happened between Dr. James L. Heaton and a female patient, the Georgia medical board buried it.
There were allegations that the prominent North Georgia doctor may have traded addictive drugs for sex. The Georgia Composite Medical Board, the state agency responsible for protecting the public from dangerous physicians, apparently looked into Heaton’s conduct, though it never publicly disciplined him.
Yet recently, a federal investigation has accused him of sex with at least four women while he was writing them prescriptions, including one patient who got hooked on Xanax, according to a court document filed in U.S. district court here. Details came to light only because Heaton faces hundreds of criminal charges in a massive opioid prescribing case.
Heaton is among thousands of doctors across the country who have been accused of sexually exploiting their patients, national investigations by The Atlanta Journal-Constitution have found. Because of a system of self-regulation that grants extraordinary deference to physicians, even those found to have repeatedly abused their position of trust are more likely to be sent to therapy than to lose their license. Like roughly half of the doctors the AJC identified, Heaton still has an active license.
Finally, though, signs are emerging that a culture that fosters secrecy and forgives doctors could be shifting. In late April, when medical boards throughout the nation met for an annual conference, their featured session in a prime-time slot on day one was called “Sexual Boundary Violations: What State Medical Boards Need to Know.” Such a public conversation on the issue was unprecedented for the group.
What’s more, the Federation of State Medical Boards is preparing changes to its guidelines on how medical boards should deal with physicians accused of sexual misconduct. While the federation can’t tell state medical boards how to police the profession, boards often incorporate language from its guidelines into their own rules and policies.
If medical boards are feeling more pressure to hold physicians accountable, it’s likely because victims are now coming forward more frequently, and because the news media is continuing to give attention to their cases, the AJC’s ongoing investigation into doctors and sexual abuse has found.
The convention was held during a month that saw new sexual misconduct allegations made public against physicians in at least 18 states.
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“No industry wants to admit that it has a problem,” said Marissa Hoechstetter, who was among 19 women who accused Manhattan gynecologist Robert A. Hadden of groping and sexually assaulting them. In a 2016 plea deal, Hadden gave up his license but won’t appear in the state’s sexual offender registry.
"It takes a certain amount of courage and public shaming, and at some point, there's a critical mass that turns the tide," Hoechstetter said.
While there’s no hard data on how many sexual abuse complaints medical boards receive each month, there’s a general consensus that more women have been reporting, said Dr. Humayun Chaudhry, the federation’s president and CEO.
"Anecdotally, I'm sensing that as well as I travel around the country," Chaudhry said. "Which is why our updating this guidance at this time, I think, is not only timely but it may be critical."
Doctors protecting predators
Seemingly immune to the #MeToo movement, doctors who fondle, harass, molest, rape or plow through boundaries have remained something of a protected class.
Discipline gets meted out by state medical boards whose members are overwhelmingly fellow physicians. Sanctions can come by way of secret or vaguely-written orders, with the language often negotiated by the accused doctors' high-priced attorneys.
Medical regulators were confronted with the impact of board decisions during the federation conference, as Hoechstetter, a bioethics researcher, a medical board attorney and a Canadian regulator described some of the disturbing realities of sexual abuse by doctors.
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The panel described how allowing an offender back into practice with chaperone requirements — as boards frequently do — leaves patients in the dark and at risk because chaperones don't always do their jobs. The researcher explained how the national database for backgrounding doctors can't be relied upon because of severe under-reporting by medical boards, hospitals and others. The lawyer and others spoke of how predator doctors choose victims who are vulnerable and unlikely to be believed, which can make criminally prosecuting them next to impossible.
Hoechstetter said that on her way to the stage, she rode down an elevator with a group of older, white, male doctors who all resembled her abuser, and she had a severe case of nerves.
"I would ask that you think really about who you are serving," she told the audience. "Do you care more about the career of one doctor and working and spending countless hours and resources to put that person back in a position where they have access to the people they've previously assaulted? Or do you care more about the public and putting them unknowingly in situations — even with a chaperone present?"
The discussion at this year’s convention grew out of the federation’s move a year ago to form a 16-member workgroup to study physician sexual misconduct and recommend revisions to guidelines on how boards should deal with such cases, Chaudhry said. The policy hadn’t been updated in 13 years. Georgia medical board member Dr. Alexander Gross is part of the workgroup.
Three years ago, in a groundbreaking national investigation, the AJC reviewed thousands of cases and found a pattern of doctors targeting the voiceless and vulnerable. The newspaper discovered that of the 2,400 doctors publicly disciplined for sexual misconduct against patients from 1999 to 2015, half still had active medical licenses. Two-thirds of doctors disciplined in Georgia for sexual misconduct were still permitted to practice.
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Last year, the newspaper took another look in light of #MeToo and the Larry Nassar scandal involving Michigan State University and USA Gymnastics. Little had changed. Out of 450 additional cases of doctors brought before medical regulators or courts for sexual misconduct or sex crimes in 2016 and 2017, nearly half of the doctors remained licensed, no matter whether the victims were patients or employees, adults or children.
Accusations pile up
News reports this past April detailed some of the latest cases to come to light.
Among them, Indiana's medical board suspended a physician's license over allegations of repeatedly touching and propositioning female patients. After one woman came forward with an accusation, more cases were uncovered, according to the state's Attorney General's Office.
In Minnesota, a 71-year-old doctor was arrested on two criminal sexual conduct charges after a female patient complained to police about inappropriate sexual touching and kissing during medical treatments. She reportedly took video of one incident.
A Kansas psychiatrist agreed to an indefinite license suspension after being accused of having sex with three patients, including one who overdosed on opioid painkillers he prescribed. He remains licensed in Missouri.
In New Mexico, a psychiatrist was arrested and charged with sexually assaulting six female patients. Among the allegations were that he fondled patients in the guise of exams, and that he told patients he would provide painkillers in exchange for sex.
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Heaton says the woman was no longer a patient when their sexual relationship started, and he denies having relationships with three other women, the document notes.
The doctor is among the defendants in a high-profile federal case that also involves the former CEO of Union General Hospital in Blairsville. His defense attorney did not return messages from the AJC. A trial is set for Oct. 8.
The white coat circle
Some cases have triggered huge public outrage. Beyond the Nassar case, those include accusations that a Columbia University physician sexually assaulted dozens of female students, that a University of Southern California gynecologist sexually abused and harassed hundreds, and that a Pennsylvania pediatrician molested generations of children.
But John K. Hall, a medical doctor, attorney and former executive director the Mississippi medical board, said he doubts the federation’s efforts will make much of a difference in how medical boards handle such cases — despite its good intentions in opening a public dialogue.
"State medical boards are largely controlled by state medical associations," Hall said, "and they still suffer from the white coat circle syndrome, where all the doctors circle up to protect other doctors rather than addressing what FSMB would like for them to do – address the need to protect the general public."
Mississippi’s board fired Hall two years ago after he pushed for a crackdown on drug and sex cases. More than guidance for medical boards, states need tough new laws that make sexual abuse easier to prosecute, he said, but such proposals often sink under push back from medical groups.
Hall advocated for a law in Mississippi that would have criminalized sex with a patient and allowed judges to permanently revoke doctors’ licenses, but the bill stalled.
Last year, a proposal faded in the Georgia legislature which would have required health care professionals to report sexual abuse by physicians, and mandated license suspension or revocation for doctors who sexually assault patients.
Other states are still trying to enact reforms. A bill pending in North Carolina would make it a felony for a physician to engage in sexual contact with an incapacitated patient, or to falsely claim that sexual contact is part of legitimate treatment.
Massachusetts has a similar law in the works that would criminalize sexual abuse under the guise of exams. Currently, doctors can't be prosecuted for groping if a patient consents to being touched, which is true for many exams.
James DuBois, director of the Bioethics Research Center at Washington University School of Medicine and one of the panelists at the federation’s convention in Fort Worth, said putting predators out of business may take an act of Congress. He wants to require medical institutions that fire doctors to enter detailed narratives into the National Practitioner Data Bank, which tracks complaints against U.S. doctors. Currently, they can enter ambiguous codes that may have been negotiated in settlement agreements with the doctors, leaving future employers and medical boards in the dark.
“It’s actually extremely difficult to prevent a first-time occurrence,” DuBois told the audience last month. “But where we could do so, so much better is reducing the number of repeat occurrences.”
OUR REPORTING
The AJC’s work is ongoing, with 3,700 names currently in a database of doctors who have faced accusations of sexual misconduct since 1999. Of those accused of abusing patients, about half remain in practice — the result of a broken system that leaves patients at risk.
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