No report, no justice

Her doctor was making her uncomfortable. He wouldn’t explain why she needed a breast exam. He didn’t give her a gown. He just told her to lie back and lift up her blouse.

In minutes, her physician became her abuser. He felt her breasts under her bra repeatedly, making a sound of pleasure and saying they felt “excellent.” When he backed away, she could see a bulge in his pants. “It made me feel so dirty,” the woman recalled later.

Yet nothing in the Maryland medical board’s public records shows it did anything to stop Raafat Y. Girgis when it got the complaint. Nor did the agency inform law enforcement about a possible sexual offense.

Medical regulators say they have an ethical duty, and some have a legal requirement, to alert law enforcement when a doctor may have committed a sex crime against an adult patient.

But The Atlanta Journal-Constitution’s examination of thousands of cases found that regulators failed to consistently live up to that responsibility.

Instead, regulatory agencies, often dominated by physicians, can and do find reasons to avoid notifying police.

The result is that some abusive doctors can continue practicing and harm other patients, and others are allowed to quietly retire, without a full investigation into whether they committed crimes that could mean jail time for those in other walks of life.

“Too often, I think, it’s cronyism,” said Pauline Trumpi, whose book, “Doctors Who Rape: Malpractice and Misogyny,” describes how her psychiatrist drugged and raped her in 1963. “It takes a lot of money and it takes a long time to become a doctor. So they feel empathy for the doctor rather than the victim.”

In case after case, medical panels can decide that a doctor won’t offend again if he gets rehabilitation and refresher courses. That if a victim doesn’t want to talk to police, there’s no point in letting police know what’s been alleged. That there’s nothing in criminal law that covers what the doctor did. That a case can’t be pursued because it’s only a he said/she said.

“The last thing we want to do is unjustly accuse a physician of something,” Wyoming Board of Medicine Executive Director Kevin Bohnenblust said. “We’ll certainly go after them if they screw up, but we don’t want to perpetuate something if it’s really, truly a miscommunication or something like that.”

It’s impossible to know how many crimes by doctors go unreported because many cases are handled privately. But the AJC’s investigation revealed alarming cases in which medical agencies were aware of possible misdemeanor or felony sexual offenses, with trails of victims, yet never passed along the information to law enforcement.

That left accused doctors free to keep their doors open to other patients, such as the ones who kept going to Girgis in Catonsville, Md.

A second patient eventually came forward, alleging that in back-to-back appointments the doctor rubbed his groin against her, kissed her and fondled her breast. “I was kind of numb,” she would testify years later. “It (took) a while to realize what happened.”

The medical board still didn’t act.

Then a third woman reported that during an exam for a skin rash, Girgis fondled her breasts, put his finger inside her without wearing gloves and kissed her on the mouth. The medical board finally revoked his license.

Girgis never faced so much as a police interrogation. He is now retired in Florida. In a brief conversation with the AJC, he said the allegations were false and called the medical board “a bunch of animals.”

Across the country, it is legal for medical panels to act as gatekeepers. Thirty-nine states and the District of Columbia do not have laws requiring medical regulators to notify police or prosecutors about potential criminal acts against adults, the AJC found. Georgia is among them. Nationally, laws requiring reporting of child abuse are nearly universal.

Doctors historically have given each other “an excessive benefit of the doubt,” says John Banja, a medical ethicist at the Center for Ethics at Emory University.

Even in states that require reporting of adult victims, regulators still hold back. Maryland has such a law but didn’t follow it in Girgis’ case, the AJC found.

“It’s deplorable, for heaven’s sake,” said John Banja, a medical ethicist at Emory University’s Center for Ethics. “One of the things that you’re going up against here is the historical, traditional sensibility of doctors to protect one another — to give their peers an excessive benefit of the doubt.”

One jailed, one not reported

When doctors are reported to police, the investigation may differ dramatically.

While it took the Maryland medical board six years to take action against Girgis, it took Louisville, Ky., police just hours to have neurologist Ghias Arar in handcuffs after Tara Batrice reported him.

Kentucky neurologist Ghias M. Arar is serving a three-year prison sentence after a patient reported he sexually violated her.

Batrice, who suffers from a degenerative bone disease, was attacked the first time she saw Arar. First, the doctor moved her walker to another part of the room, stranding her on an exam table. Then, as she tried to fight him off, he ripped off her bra, kissed her breasts, fondled her, masturbated and ejaculated on her.

She left the office terrified, driving aimlessly until she called her parents and pulled into a shopping center. Her stepfather called a rape crisis center, and a victim advocate met her at the hospital. Arar’s DNA was still on her sweatshirt.

Two days later, Batrice told her story to a TV news station and made a plea for any other victims to speak out. Within a week, four other patients told police they were victimized.

Arar is now serving a three-year sentence and will have to register as a sex offender.

“I knew he’d done it before,” Batrice said. “I was willing to do everything I could in my power to make sure this doctor never ever touched another victim, ever.”

Ryon Horne/AJC

Tara Batrice of Louisville, Ky. was sexually abused by neurologist Ghias Arar. Two days later, Batrice told her story to a TV news station and made a plea for any other victims to speak out. Within a week, four other patients told police they were victimized.

While Kentucky prosecutors put Arar in prison, the Kentucky Board of Medical Licensure allowed Mitchell E. Simons to continue as a pain management doctor after allegations he fondled patients.

Records show a patient told the board in 2003 that Simons had her stand with her back toward him, then lifted her bra from behind and rubbed her breasts. He pulled his hips to her, the woman alleged, and asked if she could feel him, saying, “I am aroused by this.”

He also put her hand on his crotch and kissed her, she alleged.

Another patient alleged Simons rubbed her breasts while smiling and asking her about breast implants.

Simons still practices in the Cincinnati area on both sides of the Ohio River. He did not respond to phone messages or certified letters seeking comment.

While he told the Kentucky board he denied the allegations, he agreed to an order requiring him to have a chaperone with female patients and to take a boundaries class. Ohio also required chaperones.

No law enforcement agency or prosecutor’s office with jurisdiction in either state said they’d ever been informed about the accusations, the AJC found. The Kentucky board’s executive director, Michael Rodman, said he could not offer an explanation because the case is so old.

Closing the loophole

Some states have decided reporting shouldn’t be optional.

In Delaware, it took a public outcry. State Rep. Helene Keeley and Sen. Patricia Blevins tried to get a mandatory reporting law passed after being tipped that doctors who committed heinous sex crimes were only being reprimanded. But Keeley said resistance from the Medical Society of Delaware killed the legislation.

That changed after the arrest of pediatrician Earl Bradley, estimated to have assaulted as many as 1,000 young patients in Delaware and Pennsylvania.

Delaware now requires its Board of Medical Licensure and Discipline to report possible crimes “upon receiving a complaint.” Keeley said every state should do the same.

“Because you don’t know whether or not that person is going to end up being an Earl Bradley or not,” Keeley said, “and you’re better off being safe than sorry.”

Not all laws are airtight.

In Maryland, where Girgis practiced, the board is required to report after it determines that information in a record concerns possible criminal activity.

Reporting an unsubstantiated allegation, a spokeswoman said, would be premature. But citing confidentiality, she would not explain why law enforcement agencies said they received no report on Girgis even after the board found he had sexually abused three patients.

Washington state’s Medical Quality Assurance Commission initially didn’t tell law enforcement when John G. Thomas, on advice from his therapist, admitted in 2013 to touching the breasts of more than a dozen anesthetized women.

After inquiries by the AJC, in July the commission finally sent local prosecutors its final order revoking Thomas’ license. The newspaper’s inquiry led to a review of the commission’s notification process, Executive Director Melanie de Leon said in an email. “Since we have typically received information from law enforcement of alleged criminal acts, we needed to revamp our procedures and train the staff how and when to make this notification when we are the first to determine or believe that the practitioner committed a crime,” she wrote.

In a short phone conversation with the AJC, Thomas said details about his violations should not have been made public. Much of the commission order was heavily redacted, but a health department news release said he victimized 15 women over a 12-year period. Thomas declined to discuss the case further and hung up.

While de Leon said she’s not sure why Thomas’ case wasn’t forwarded, she said a prosecutor will probably have a tough time building a case without witnesses. Thomas told the commission the victims were unconscious and he didn’t know their names or when the abuse happened.

Law enforcement authorities should at least have a chance to try, said Boston attorney Stan Spero, president of AdvocateWeb, a nonprofit online resource for sexual abuse victims.

“Historically, doctors and therapists were held in high regard and protected in general,” he said. “And so to start bringing them into the criminal system, there’s a lot of resistance.”

An ethical duty

Board representatives said the most egregious cases do get handled by police because victims or their family members report the crimes.

If police aren’t aware, most medical boards told the AJC that they inform law enforcement, as an ethical duty.

“All boards have an obligation to, whether it’s in statute or not,” said Susan Strout, executive secretary of the Maine Board of Osteopathic Licensure.

But there are exceptions, such as when boards believe the victim doesn’t want police involved. Or they may say it’s the victim’s responsibility to go to police.

“We can’t file a criminal complaint on behalf of a citizen,” said Larry Dixon, executive director of the Alabama medical board. “What if this woman doesn’t want anybody else to know, and we’ve told the local police and all of a sudden a cop comes to see her? She’d be outraged.”

Law enforcement immediately should be notified when medical boards look into complaints that a doctor has sexually violated a patient, says David LaBahn of the Association of Prosecuting Attorneys

David LaBahn of the Association of Prosecuting Attorneys said medical regulators shouldn’t make such delicate decisions. Police and prosecutors often have specially trained counselors who can help victims, increasing the likelihood they will pursue a criminal case.

“We can get them some services,” LaBahn said, “and have a better determination as to whether they’ll cooperate or not cooperate.”

In some cases, victims aren’t even aware they were abused. Complaints to medical boards can come from nurses or other witnesses. No one may alert police, if regulators don’t.

Many medical regulators, including Georgia’s, told the AJC they know which cases to report and not to report because they employ certified peace officers and retired police as investigators. In California, for example, the Department of Consumer Affairs has about 75 law enforcement officers who investigate complaints.

Still, even investigators trained in law enforcement can be more comfortable handling complaints as disciplinary matters, and they can steer cases in that direction, said Doug Grant, who worked for San Jose police for 25 years before going to work for Consumer Affairs.

“If you’re a person who isn’t all that fond of criminal cases, you really don’t have much experience with it, it’s just human tendency to go with an administrative case,” said Grant, who left the agency after two and a half years. “It’s easier.”

Sanctioning without protecting

Some medical regulators say it is punishment enough for a doctor to be put on probation, suspended or lose a license. “The obligation of ours is to get him out of business,” Dixon, of the Alabama board, said.

Agencies may even pull the plug on their investigation if the doctor agrees to step aside.

That means any evidence of violations is hidden from the public. Doctors can return to their communities with their reputations intact. A medical board censure won’t put a doctor on the local sex offender registry.

The Nebraska health department allowed Dr. William K. Stetson to avoid a public hearing by admitting his actions and surrendering his license for two years. Details of the case are thin in public filings, revealing only that he “inappropriately touched the breasts and genital areas of patients during routine examinations for non-gynecological matters” between 2000 and 2008.

There’s no account of how the department found out and no indication of the number of victims, or whether the department tried to find them.

Stetson has not applied for reinstatement. His wife told a reporter he did not wish to talk about the allegations.

The AJC could find no law enforcement agency in the Chadron area that reported receiving the case.

Susan Ugai, who worked as an assistant attorney general at the time, said she doesn’t recall the medical board ever sending a case to law enforcement.

“He definitely could have been charged criminally, but apparently that choice was made not to do that,” she said. “I’ll be honest, in these cases, everybody’s just happy that he’s giving up his license and going away.”

Quiet discipline

Regulators can also discipline a doctor without ever considering whether his violations could be criminal. It is impossible to know if that is what happened in the case of Georgia internist Vincent K. Knight, though it seems likely.

After four patients accused Knight of sexually inappropriate exams, the board required him to undergo therapy and use a chaperone with female patients, among other conditions.

The board’s 2012 order offers scant details.

Knight told the AJC that among his accusers were two patients at a Dacula clinic who said he inappropriately touched their breasts. He said he had no sexual intent. One woman, he said, had asked him to check a lump under her arm and he checked her breasts as well, without a chaperone; the other had agreed to let him see how a plastic surgeon had reconstructed her breasts after cancer.

It never occurred to him, he said, that his actions might have been reported to police.

“If the women had to stand up in court and actually try to prove that I assaulted them, they wouldn’t have been able to prove that,” he said. “It would have been ridiculous.”

Knight said he also got in trouble for, among other violations, having sexual relationships with women he hadn’t formally discharged as patients and making comments to other female patients that they said were inappropriate.

When he spoke to the AJC in June, the Emory-educated doctor was driving a Krispy Kreme truck and working part time for Wal-Mart. His career stalled, he said, after the board put his license on probation.

“I know I had boundary issues,” he said. “Now I understand that there’s this power differential, because I’m a doctor.”

He said he’ll apply to have the license restrictions lifted next year when his probation ends.

Robert Jeffery, executive director of the Georgia board, wouldn’t comment on specific cases, but said in the same interview that when complaints can’t be substantiated, turning them over to police would be illogical.

“Does the board look at everything and say, ‘This might possibly be a crime?’ Probably not,” he said.

LaBahn, with the prosecuting attorneys association, said that kind of scrutiny should be the norm.

“The moment they open that investigation, I see no downside that the criminal investigation ought to open at the same time,” he said. “They’re looking at the licensing aspects. We’re looking into if a crime occurred.”

— AJC investigative intern Jerrel Floyd and staff writers Becca Godwin and Danny Robbins contributed to this article.

Inconsistencies, subtleties in reporting laws among states