Woman claims improper contact during treatment
Fairfax County (VA) Circuit Court
A 23-year-old woman who received treatment from a psychiatrist for approximately 2½ years claimed that he sexually abused her during that time. She alleged that the inappropriate sexual relationship included holding, hugging, kissing, fondling, and watching pornography. The patient claimed that the relationship led to emotional distress and caused her to attempt suicide.
The psychiatrist admitted that a sexual relationship occurred but contended that the patient suffered no harm.
A $400,000 verdict was returned
Did inappropriate contact cause agoraphobia, anorexia?
Suffolk County (MA) Superior Court
A patient in her 20s had a history of emotional problems and sexual assaults against her. A psychiatrist treated her for obsessive-compulsive disorder for 4 years. He acknowledged giving the patient stuffed animals, cards, and letters and visiting her home several times when she was unable to go to his office. During sessions he touched her hand for comfort and hugged her. The patient claimed they had regular sexual contact.
The patient alleged that the psychiatrist was negligent for engaging in inappropriate sexual conduct, which she claims caused ongoing emotional distress. She claimed she was unable to work and suffered from agoraphobia, intimate relationships difficulties, and anorexia as a result of his actions. The psychiatrist denied any inappropriate sexual conduct.
The psychiatrist’s license was suspended indefinitely, but the suspension was stayed under an agreement that he attend medical education courses.
A $750,000 settlement was reached
Dr. Grant’s observations
Although most physicians would agree that sexual relations with a patient are inappropriate,1 the fact that cases continue to occur suggests a need to emphasize treatment boundaries. Establishing clear boundaries in the doctor-patient relationship creates an atmosphere of safety and predictability that allows treatment to thrive.2
Boundary problems are one of the most frequent reasons for malpractice actions against mental health providers.3 Although much of the literature discusses boundary violations during psychotherapy, issues may arise in all treatment settings, including psychopharmacologic management.
One-half of all psychiatrists will treat at least 1 victim of physician sexual misconduct during their careers.4 One study5 examining sex-related offenses committed by U.S. physicians in all specialties found:
- The number of physicians disciplined for sex-related offenses increased each year from 1989 to 1996.
- 22% of disciplined physicians had sexual intercourse with patients, 15% had sexual contact or touching, 37% committed other sexual abuse that did not fit in either of these 2 categories, and 25% involved nonpatients.
- 28% of disciplined physicians were psychiatrists, the most represented specialty in the study.
Boundary violations: Code of ethics guide conduct
The American Medical Association’s Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry states: A psychiatrist shall not gratify his or her own needs by exploiting the patient. The psychiatrist shall be ever vigilant about the impact that his or her conduct has upon the boundaries of the doctor-patient relationship, and thus upon the well-being of the patient. These requirements become particularly important because of the essentially private, highly personal, and sometimes intensely emotional nature of the relationship established with the psychiatrist.
“Further, the necessary intensity of the treatment relationship may tend to activate sexual and other needs and fantasies on the part of both patient and psychiatrist, while weakening the objectivity necessary for control. Additionally the inherent inequality in the doctor-patient relationship may lead to exploitation of the patient. Sexual activity with a current or former patient is unethical.”
Source: Reference 9
In a 1986 survey of psychiatrists, 7% of male and 3% of female clinicians reported having sexual contact with their patients.6 A 1988 survey of fourth-year psychiatry residents found that 1% of respondents acknowledged having sexual relations with a patient.7 In a 1992 study, 9% of physicians across specialties reported engaging in sexual contact with 1 or more current or former patients.8 In that study, 19% of female physicians and 40% of male physicians reported that they did not think physician-patient sexual misconduct was always harmful to patients.8 These views and behaviors are in violation of medical codes of ethics (Box).9
How misconduct harms patients
Trust is essential to establishing a secure therapeutic relationship. Boundary violations may result in missed diagnoses, inappropriate treatment, and/or worsened psychiatric symptoms. Patients might develop complex posttraumatic stress disorder, depression, anxiety, dissociation, sexual dysfunction, somatoform disorders, eating disorders, sleep disorders, or substance use disorders.4 They could lose faith in their treatment providers, have difficulties expressing anger, feel guilty, develop poor self-concept, experience a loss of confidence, and develop problems establishing trusting relationships.4 For these reasons, clinicians can be sued for negligent treatment and sexual misconduct.10