Bad practice: What Mississippi doesn’t tell patients about doctors and sexual misconduct

Print Share on LinkedIn More

MEMPHIS — Danielle’s first visit went fine. She’d been referred to a well-respected OB-GYN in northwest Mississippi after a clinic examination determined she had abnormal cervical cells that needed scraping. The doctor’s affable laid-back demeanor put Danielle at ease. 

The second visit raised Danielle’s suspicions. A complication during the first procedure had left her bedridden with pain and caused heavy bleeding. At her next appointment, the doctor asked her to strip naked. Danielle, then 27, was confused why a nurse was not present like previous gynecological exams with other doctors.

“Why would I have to undress from top to bottom and get a breast exam if something was going on down below?” said Danielle (a pseudonym).

“He also just made me feel uncomfortable, and it was kind of a red flag. But I was saying, ‘he’s a gynecologist, he knows this.’ “

Danielle

After being told she would again need surgery for a precancerous cyst growing in one of her ovaries, the doctor said she would need to come in for another examination, a confounding request considering he’d already made his diagnosis.

She made the hour-long drive from Bolivar County to the doctor’s office. He again asked her to remove her clothes. During another full breast and pelvic exam involving what seemed to her inappropriate and unnecessary probing, the doctor asked Danielle for her cellphone so he could take pictures.

“Is he fixing to do some research or something?” she remembers rationalizing at the time. “I’m thinking to myself, ‘He’s the doctor. Maybe he’s going to show me what’s going on or something.'”

The click of a camera phone shutter startled her because she had placed her phone on silent. She realized the doctor was using his own phone. By the end of the exam, she was disoriented, embarrassed and angry.

Never mind about scheduling the surgery, she told Dr. Gregory Norwood before leaving his office for the last time.

“I immediately went and told my mom and found another gynecologist because I knew that wasn’t right,” Danielle said.

Something wasn’t right. Months before that final appointment, a woman had filed a sexual misconduct complaint against Norwood with the Mississippi Board of Medical Licensure, the state agency that regulates doctors and punishes them when they violate state laws.

Board records show she was the first of seven women making similar claims against Norwood between July 2016 and September 2018.

State law lists more than 20 infractions for which doctors might be punished. A separate section for “disabled physicians” covers what the board considers potential cause for “impairment,” which includes mental and physical illness and substance use disorders.

Some of these sub-statutes are specific, such as habitual narcotic use or alcoholism and drug possession or distribution. Most often cited in licensure board rulings are more vague statutes.

For example, 44 percent of licensees with disciplinary records were found “guilty of any dishonorable or unethical conduct likely to deceive, defraud or harm the public” while 31 percent involved a “violation of any provision(s) of the Medical Practice Act or the rules and regulations of the board or of any order, stipulation or agreement with the board.”

Glaringly absent: sexual misconduct.

A Mississippi Today-WLBT examination of physician disciplinary records and interviews with patients and their advocates as well as a former top leader with the licensure board paint a picture of a state agency shrouded in secrecy and slow to put in place policies to protect patients from predatory doctors. 

We compared thousands of federal records dating back to 1990 and state databases dating back a decade to analyze disciplinary actions against practicing doctors as well as doctors whose licenses were suspended, revoked or surrendered.

Mississippi Today and WLBT also found sexual assaults fall under broad categories such as impairments (or disability) or professional misconduct, making it difficult for patients and the public to know if a doctor has been disciplined for sexual misconduct. Doctors also don’t have to disclose to patients if they’ve faced disciplinary actions.

The licensure board does not disclose how it makes disciplinary decisions or how doctors are referred to the Mississippi Physician Health Program, a rehabilitation program for doctors with addiction issues run by the Mississippi State Medical Association, a powerful physician lobbying group. 

Dr. Claude Brunson, the outgoing president of the licensure board, declined an in-person interview request and said he could not discuss specific cases. In an email, he said it’s important for the public to trust the board.

Mississippi State Medical Association

Dr. Claude Brunson, executive director of the Mississippi State Medical Association

“The board takes very seriously our role in protecting the public. We have physicians come before us for violations ranging from failure to complete (continuing medical education courses) to sadly, in some cases, criminal acts. We always put the safety of the public first,” said Brunson, who will soon helm the state medical association.

“We do an emergency suspension in cases where eminent danger exists. Some physicians can safely practice with restrictions placed on their licenses. Some must be referred to the (physician health program) for extensive evaluation. Treatment may be an option. Close supervision occurs for any physician attempting to return to practice.  In some cases, termination of the license is the only appropriate action.”

Reform advocates point to Norwood’s case for the need for more board transparency. They note the board dropped its investigation of Norwood more than one year after the first patient complained “due to the fact the allegation could not be substantiated at the time,” documents show.

Norwood continued practicing medicine with an unrestricted license until more victims came forward. According to board investigators’ reports obtained by Mississippi Today and WLBT, one patient said Norwood put both his hands down her pants. Another said he fondled and placed his fingers inside her vagina. Norwood asked another woman during a pelvic exam whether she thought about men other than her husband. Records show he asked another patient if he could “put his mouth on her nipple,” and yet another if she knew “the depth of her vaginal vault.”

In November, more than two years after the first complaint, the board suspended Norwood’s license indefinitely for “unprofessional conduct,” documents show. In November of this year, he will be eligible to ask the board to reinstate his license.

Although Norwood consented to the board’s outlined allegations and agreement suspending his license, he denies the allegations.

“He has not been charged with any crimes. He certainly denies any wrongdoing, and we believe these people are trying to facilitate civil claims against him and his insurance carrier. That’s the bottom line,” Tony Farese, an attorney for Norwood, told WLBT and Mississippi Today.

A Southaven Police Department investigation is ongoing. Danielle did not file a complaint with the board, but is one of 13 women Memphis-based Wells and Associates is representing in a potential lawsuit.

“I can never see myself going to another male OB-GYN  again. I just can’t. I’ll never have that trust again.”

Dr. John Hall, the licensure board’s former executive director, said he called for stronger patient protections against sexual misconduct and more transparent public information about doctors.

“Patients don’t really have a good way to measure. It’s kinda scary that the best estimate they have of whether or not a doctor’s any good is Yelp,” he said.

By contrast, there is no website for doctors disciplined for sexual assault similar to the state-run sex offender registry. The National Practitioners Data Bank, which the U.S. Department of Health and Human Services operates, collects disciplinary reports from state boards, clinics and hospitals and merges the records with medical insurers’ malpractice payouts. The information is not publicly accessible, but the federal government publishes an annual report of the data bank’s findings.  

In Mississippi, disciplinary actions are public, but finding them on the licensure board’s website can be challenging. From the homepage, it isn’t immediately clear how to find information about doctors. The licensing tab on the navigation bar takes you to general information about how to get licensed; follow the complaint tab, and you’ll find information about how to file a complaint.

To find what you’re looking for, you must use the search bar at the top of the screen and type in a name, or click the “Licensee Search” link in the middle of the home page. That leads to a searchable database of active licensees only — that notably, and unlike other board sites, does not include doctors with current suspensions. You can also search board actions by month going back to 2008. Sometimes, though, information is missing. In our analysis of all the doctors with disciplinary records, one in five show up as “no documents found.”

The medical board’s website can be confusing to navigate, especially when looking for a licensee. Compared to Tennessee’s comparable site, it takes twice as many clicks to get to any reference of sexual misconduct on Mississippi’s site — and through a chain of links and databases.

By some contrast, some states, such as neighboring Tennessee, makes finding disciplinary actions on doctors easy, taking just three clicks. 

In our analysis of all the doctors with disciplinary records, one in five show up as “no documents found.”

In the past few years, the #MeToo movement has shined light on sexual assault and abuse of power. Sexual assault of patients by doctors came into sharp focus after the revelation that Dr. Larry Nassar assaulted hundreds of patients while working as a sports physician at Michigan State University.

In the wake of Nasser’s conviction, the focus shifted to regulations states put in place to protect patients. An April 2016 nationwide investigation by the Atlanta Journal-Constitution found that, despite rising public awareness and pressure, states had largely failed to reform the system that punishes doctors. In the newspaper’s state report cards, Mississippi finished 51st with an overall score of 37 out of 100. Mississippi finished last in every category, including transparency, strength of duty-to-report and discipline laws, whether licensure boards have consumer input, and how well-informed regulators are about criminal acts by doctors.

The story quoted Dr. Vann Craig, the licensure board’s then director, as suggesting sexual misconduct and other inappropriate behavior should be tolerated under certain circumstances.

“Let me say that it takes a lot of money to educate a physician. If they can be safely monitored and rehabilitated, I don’t see why they can’t come back from drugs, alcohol or sexual misconduct,” Craig told the Atlanta Journal Constitution.

Craig resigned a few months after the story published, and Hall was hired. During his year-long tenure, Hall says he made improvements such as eliminating the $25 fee the board charged website users to see doctors’ disciplinary records, a fact the Atlanta Journal-Constitution investigation cited. Hall also pushed unsuccessfully for legislation to make sex between a doctor and patient a felony. He also more than doubled the number of disciplinary actions taken by Craig the previous year.

In May 2017, Hall was fired. Although the board was not obligated to give him a reason, he surmised it was his aggressive approach to rooting out bad doctors.

He told Mississippi Today at the time:

“It’s not OK to have sex with patients. And sometimes discipline is harsh, but it should not be unfair and it should probably not be unexpected. If that makes me a cowboy, then I guess I’m a cowboy.”

Dr. John Hall, former board executive director

Little has changed since the Atlanta Journal-Constitution story. Before his ouster, Hall says he pushed for stronger laws prohibiting all sexual relationships between doctors and their patients and to end a longstanding practice of treating sexual misconduct by doctors the same as substance addiction.  

“The problem with professional sexual misconduct, and what sets it apart from everything else, is that the index occurrence is harm,” he said.

In other words, patients or staff might notice their doctor is drunk or high soon enough to avoid or mitigate any harm. But often there are no warning signs for sexual misconduct, and the harm resulting from an assault is immediate.

“As soon as you cross that line — as soon as Larry Nassar touched that first patient inappropriately — there was harm. So even if Larry Nassar had been rehabilitated, if he relapses, that relapse is going to be harm,” Hall explained.

Some doctors who have been disciplined agree with the need to separate sexual assault from other behavior the board deems inappropriate.

In May 2017, the board suspended the license of ear, nose and throat physician Dr. Larry Stewart of McComb, but immediately stayed that suspension if he entered a recovery program. The board’s report did not mention that Stewart was having sex with a patient, a detail only made clear through the Drug Enforcement Administration report charging him in December 2015 with 27 counts of drug distribution.

A conviction on a single charge prompted the licensure board to suspend his license, but put the punishment on hold if Stewart took ethics courses and participated in the state’s recovery program for life; he would also have to give up drugs and alcohol despite never showing signs of habitual use.

After he admitted in a follow-up to toasting his 25th wedding anniversary with a bottle of champagne, the board banned him from practicing in the state, but didn’t revoke his license. Stewart admits he was wrong to have sex with a patient, but argues the recovery program can set doctors up to fail.

The program is supposed to “keep doctors on the straight and narrow while allowing us to go back to practice,” he said. “My experience of (the program) was not that … it was not about support … it seemed to be ‘How many more wires can we put out before he finally falls?’”

He said it’s confusing to the public when the the board treats all sexual misconduct cases the same, regardless of the seriousness of the claims.

“My case is totally consensual and not predatory. And it’s offensive to me and is wrong for me to be lumped in with people who are sedating and assaulting their patients. That’s absolutely not what happened,” he said.

Among doctors with suspended, revoked or surrendered licenses in the last 10 years with alleged sexual relationships with patients, the records of at least four of them lack any mention of that sexual history or misconduct in official board reports. It’s only apparent after extensively searching legal records and documents from other state boards.

Dr. Scott Hambleton, director of Mississippi Physician Health Program

C.J. LeMaster/WLBT

Dr. Scott Hambleton

Dr. Scott Hambleton, director of the Mississippi Physician Health Program — a private nonprofit arm of the Mississippi State Medical Association that contracts with the licensure board to rehabilitate doctors — says sexaul predation by doctors is rare, but the program recognizes sexual misconduct can take different forms. For example a physician who has a drinking problem has an affair with an office worker, Hambleton says.   

“That’s technically considered sexual misconduct. To lump that into the same category as a psychiatrist having a sexual relationship with a psychotically depressed patient, it’s not even in the same universe,” Hambleton said.

“There are some people who feel like every single one of those cases should be prosecuted as if they are sexual predators. To me, that is neither just nor does it actually promote public safety. It probably has an opposite effect in my opinion. You have to treat the crime, so to speak, appropriately. You can’t give someone who shoplifts a pack of cigarettes a lifetime sentence like you would someone who was involved in a homicide.”

Physician health programs have become increasingly popular among state medical boards in the last few decades, garnering their share of references in #MeToo reporting.

As medical community attitudes on mental health and substance use disorders have shifted from punishment to treatment, state boards have followed suit and started to handle cases among their doctors internally. This includes sexual misconduct, but the majority of the 130 doctors participating in the physician recovery program involve substance use and mental health disorders, Hambleton said.

Should Mississippi consider handling substance use and mental health separately from sexual misconduct cases? Hambleton paused before answering.

“I think there could be an argument made to that point of view. In some states, like Washington, they have an entire division that deals with sex offenders,” he said. “But most smaller states just don’t have the funding to support that kind of thing. In our situation here, we just have a level of expertise that we can lend to the board and help.” Washington state statute also defines and prohibits sexual misconduct. Others neighboring medical boards that handle cases in house like Mississippi explicitly define and condemn sexual misconduct, including Alabama and Tennessee.

Hambleton maintains participating in the recovery program does not mean doctors are immune from discipline or reproach. The program’s counselors use metrics to monitor risky behavior and assess the possibility for relapse to weed out predators unlikely to successfully complete treatment and to focus on those who can recover from sexual misconduct.

Mental health experts agree programs like these are the gold standard for supporting recovery and ensuring patient safety. They tend to work for doctors impaired by substance use or mental health disorders. But, that consensus wanes in cases of sexual misconduct.

For some experts, lumping cases of sexual assault and impropriety into the addiction treatment model is an inappropriate response.

Rory Reid, a research psychologist and assistant professor of psychiatry and biobehavioral sciences at the University of California Los Angeles, makes a distinction.

Virtually no research exists on the effectiveness of treating sexual misconduct as a disorder, Reid says.

“If someone clearly has engaged in sex-offending behavior, sending them to a sex addiction treatment program (is) probably going to be a mismatch,” he said. “If they don’t get the right treatment for the right problem that they’re seeking help for, the question remains: Did they get help? And if they didn’t get the help that they needed, then they could be a continued risk of hurting patients.”

Reformers have had little success in urging the Legislature to strengthen patient protections and increase transparency at the licensure board.

The only reference in state law to prohibiting sexual relationships between health care professionals and patients is in the the section of the Mississippi Medical Act that applies to acupuncturists.

Rep. Jeff Smith, R-Columbus, introduced legislation in 2017 to make doctor-patient sexual relations a felony, regardless of whether the relationship was consensual. That bill died in committee and has not been re-introduced, although similar legislation exists in several states.

Azza AbuDagga, a researcher with the Washington, D.C.,-based consumer advocacy nonprofit Public Citizen, says medical licensure boards have to lead the push for added transparency. What we know about sexual misconduct by doctors is only the tip of the iceberg considering the cloistered nature of the medical profession and the fact these assaults, as with most rapes, usually go unreported.

Her research found that, nationally, state medical boards did not follow suit when clinics or hospitals punished doctors for sexual misconduct.

“Treating (sexual misconduct) as a rehabilitation problem, and not something that should be disciplined, protects physician interests over patients,” she said.

“Unless the medical community steps up, without action, the status quo will continue. And it will disfavor the public, disfavor patients and favor physicians.”

Azza AbuDagga, Public Citizen researcher

Mississippi and Louisiana are the only states whose medical licensure boards do not have consumer members. Legislation introduced to allow more groups to nominate members to Mississippi’s board and create three voting consumer seats died in committee.

Gil Ford Photography

Rep. Sam Mims, R-McComb

Rep. Sam Mims, chairman of the House Public Health and Human Services Committee, said he wants to let the board’s executive director get more acclimated to the role before making any changes to the Medical Practice Act.

Dr. Ken Cleveland was appointed in early February 2018 to replace Hall as the agency’s permanent director. He also declined to talk about specific cases, but said he and the licensure board have a “zero tolerance” position on professional sexual misconduct and takes all sexual misconduct reports seriously.

“That does not necessarily mean to never practice again,” Cleveland said. “In cases of sexual impropriety or boundary violations where no patient harm has occurred this could mean suspension and education on appropriate behavior. On the other end of the spectrum, you have (professional sexual misconduct) of the predatory type. In these cases, patient harm has occurred and is likely to occur again if we do not take immediate and severe action.”

Mims, a Republican from McComb, did not recall the failed 2017 proposal to criminalize doctor-patient sex. He said he would have to study the issue should the bill come back.

“Updates may be needed,” Mims said of state patient protection laws, “but we need to be careful and mindful with changes, and go slow on this.”

In the meantime, patients will have to sound the alarm.

“If something like this has happened to you, even if it’s not a doctor, you need to come forward,” Danielle said. “Don’t wait. It doesn’t matter what nobody is going to think or say about you — just come forward. Let somebody know what happened to you because it could maybe prevent this from happening to somebody else.”