‘Breach of trust’: landmark study delves into sexual misconduct complaints made against Australia’s health professions

Led by Assoc Prof Marie Bismark, a doctor and lawyer with the University of Melbourne, the study is the first to look at official complaints of sexual misconduct across all health professions, including medical practitioners, nurses and midwives, allied health professionals, pharmacists, dentists, chiropractors, osteopaths, physiotherapists and psychologists. Medical practitioners included general practitioners and specialist doctors such as surgeons, psychiatrists, gynaecologists and paediatricians.

The researchers analysed all sexual misconduct allegations made to the Australian Health Practitioner Regulation Agency (Ahpra) and the New South Wales Health Professional Councils Authority between 2011 and 2016. Regulators received 1,507 sexual misconduct reports during that period, including 208 practitioners who were the subjects of more than one complaint. Alleged sexual relationships were the subject of 381 (25%) of the reports, while 1,126 (75%) of the reports related to sexual harassment or assault.

Reports regarding sexual relationships were more frequent for psychiatrists, psychologists and general practitioners. The rate was higher for regional and rural than metropolitan practitioners. Notifications of sexual harassment or assault more frequently named male than female practitioners, with 88% of complaints about men, the study, to be published in the Medical Journal of Australia, found.

Bismark said breaching sexual boundaries was “one of the most profound ways” in which trust could be broken. “I’ve been researching patient safety for a long time, and what we can learn from patient voices and complaints to improve health care,” she said. “Sexual misconduct is one of the most serious ways in which health practitioners can harm their patients. This is highly sensitive data and through a research partnership with Ahpra our research group was able to get this de-identified data.”

Although nurses and midwives comprised 59.2% of health practitioners, they made up 19.2% of sexual misconduct complaints.

“There were very few reports of sexual misconduct by nurses who are a huge group of practitioners doing very personal and intimate care,” Bismark said. “I found that very interesting and they’re obviously doing something right in their professional training and in the way they communicate with patients and respect boundaries.”

When it came to medical practitioners, rates of notifications alleging sexual harassment were higher for obstetricians and gynaecologists, psychiatrists, and psychologists than for internal medicine physicians. Rates of notifications alleging sexual assault were higher for chiropractors and osteopaths, psychiatrists, and general practitioners than for internal medicine physicians. Rural and regional practitioners were more likely to enter into sexual relationships with their patients.

“When you think about these professionals a common feature among the practitioners most likely to have a notification against them such as psychiatrists and general practitioners as they are more likely to have ongoing, one-to-one relationships with patients behind closed doors,” Bismark said. “It’s really rare for sexual misconduct to happen in a team-based setting, and physiotherapists and nurses usually work in a team environment.”

Bismark said it was important to note that her study only captured those who made complaints to the regulators. Her previous research has found that elderly women, those from low socioeconomic backgrounds, Indigenous women or those from cultural and linguistic minority groups are the least likely to make a formal complaint.

“Many, many women who have an uncomfortable experience with a doctor don’t make a report to Ahpra,” she said. “One of my concerns is when people do complain is how long it can take for these allegations to be resolved. We found a complaint about sexual misconduct would take longer on average than a clinical complaint to reach an outcome which is both stressful for the complainant and the practitioner.”

In 2017 Ahpra and the Medical Board committed to wide-ranging reforms to the management of sexual misconduct cases, as recommended by the independent reviewer Prof Ron Paterson in the chaperone review report. As a result of that report, health professionals being investigated for sexual misconduct are no longer allowed to continue working accompanied by a chaperone, after the review found the measure was outdated, paternalistic and did not improve public safety.

Paterson found many examples of practitioners breaching chaperone conditions. “Predatory practitioners who have come to view patients as sexual objects may not be deterred by a safety mechanism that still leaves the practitioner in control,” he found. “The mandated chaperone system keeps patients in the dark. They do not know why a chaperone is required. This is the most significant flaw in the current system.”

On 31 July Ahpra published a review of how many of the recommendations made in Paterson’s report had been implemented.

“Much has been achieved over the past three years,” the review found. “Nearly all 28 recommendations of the chaperone review report have been fully implemented, resulting in significant changes in regulatory practice. Nonetheless, in some cases, tribunals continue to countenance use of a chaperone condition as an immediate action, seeing it as an effective risk mitigation strategy to minimise the risk of harm to patients.”

The review also found there had been a “surge” in sexual misconduct allegations made to Ahpra. The #MeToo movement and greater societal awareness of sexual abuse had likely contributed to this, the review found. But there continued to be delays in the investigation of complaints.

“There is no quick fix to the problem of investigation delays,” the review found. “Ahpra faces an ongoing challenge of how best to prioritise investigation resources, given the competing demands for timely action on other conduct investigations, such as into performance concerns. However, the delays in concluding investigation of sexual boundary notifications need to be reduced, in the interest of public protection and public confidence.”

By Melissa Davey
Published in The Guardian
3 August 2020