December 2017

Ethics Corner

B. Stephens Richards, MD
Ethics & Professionalism Committee Member

What obligations does a spinal surgeon have regarding sexual misconduct in the physician-patient relationship?

There has been recent widespread notoriety regarding sexual misconduct involving the entertainment industry, and beyond. Because of the current heightened awareness of this issue, we ask the question “What is a spinal surgeon’s responsibility when an episode of sexual misconduct occurs involving a colleague?”

An adult female patient presents for the first time to Dr. Jones with a symptomatic spinal disorder. During the course of his interview with this patient, he discovers that during a previous evaluation by another spine surgeon, the patient described what she considered very inappropriate sexually-oriented remarks as well as being inappropriately touched during the physical examination. She never returned to that physician and has never reported this to authorities because of her feelings of shame, humiliation, and her concern of self-blame.

Later the same day, Dr. Jones recalls having previously overheard concerning comments about the same surgeon, but had excused it as having misunderstood the conversation.

Does Dr. Jones have a responsibility to report this issue to authorities?

Sexual misconduct exploits the physician-patient relationship. It is harmful to the patient and detrimental to providing care. Nearly all violators are male and most victims are female. The burden of recognizing and avoiding this exploitation rests with the physician.

State medical licensure and disciplinary boards are charged with protecting public welfare, and this includes strict intolerance to physician sexual misconduct. These boards may take prompt and decisive action.

We will consider several of the SRS and AAOS Standards of Professionalism which can be directly applicable to this issue.

SOP Providing Musculoskeletal Services to Patients

Standard 1. A spinal surgeon shall, while caring for and treating a patient, regard his or her responsibility to the patient as paramount.

Standard 7. A spinal surgeon shall maintain appropriate relations with patients.

If evidence is found of physician sexual misconduct with patients, the SRS Board of Directors may discipline (reprimand, censure, suspend) the individual, or expel the individual from fellowship, upon recommendations from the Ethics Committee for any unethical conduct.

Physicians found guilty of sexual misconduct may also face a variety of professional liability claims and possibly criminal charges, depending on the circumstances.

AAOS Code of Medical Ethics – Personal Conduct

II.C. If an orthopaedic surgeon has a reasonable basis for believing that a physician or other health care provider has been involved in any unethical or illegal activity, he/she should attempt to prevent the continuation of this activity by communicating with that person and/or identifying that person to a duly-constituted peer review authority or the appropriate regulatory agency.

Anyone may report instances of suspected physician sexual misconduct to the state licensure or disciplinary boards. These boards are obligated to investigate such complaints. Spinal surgeons have an ethical and, in most jurisdictions, a legal obligation to report physician sexual misconduct whether it involves an adult (as in this scenario) or involves a pediatric patient. Reporting this is a required ethical standard by the AAOS and state boards. Failure to report may be considered professional misconduct and could be subject to disciplinary action as well.

The SRS Standards of Professionalism can be found on the SRS website in the “Members Only Area” under the “Membership” section. It was adapted for the use of SRS, from AAOS.


Chair: Kamal N. Ibrahim Committee: Timothy S. Oswald; Ioannis Avramis (C); Eric J. Belin (C); Abdul M. Mohd Hussein (C); James M. Eule; Timothy A. Garvey; H. Robert Tuten; B, Stephens Richards III, Chair Elect; Jochen P. Son-Hing; Jacob M. Buchowski; David A. Hanscom