IamA investigative reporter at The Atlanta Journal-Constitution, who exposed how doctors across the country keep their medical licenses even after they're caught sexually abusing patients. AMA!

I was 15 when I was sexually assaulted by the doctor that I had seen since I was 2 years old. I never said anything about it, for a lot of reasons, but mainly because he was the medical professional and I was his young patient, what do I know about what is appropriate in the examination room. Do you think it is even more common than your study finds because of people like me who never told anyone?

yes, definitely! this was one of the findings of our story that many people do not report it because they are confused or do not think anyone will believe them. We also know that many complaints are never really investigated -- so yes, it is way more common than the total number of doctors disciplined whose cases we were able to research.

It is scary how often this stuff happens. I am so thankful for everyone involved in this movement of exposing these people who abuse their power for their own sexual gratification that has been gaining more momentum over the last couple of years. I wish I would have known when I was 15 that I was not alone and I was not weird or out of line by saying something. Thank you for your work and efforts in exposing this to the public.

Thank you so much for sharing this with me. We have been thanked by many other victims of this abuse who truly thought they were alone and had no idea that it happened so often. Do you find it interferes with your doctor/patient relationship today?

Hearing how many others have gone through similar experiences definitely inspired me to open up and share on here. I do feel like it interferes with my relationships with doctors today, but I will go even further and say it has affected the way I view people in general. This person who I knew my entire life and felt like he was a safe person completely took advantage of me and used his position to do so. Just because you think you know someone or you think you can trust someone because they are trusted and liked by others, does not make it true.

yes this is true and is so damaging. Thank you for sharing this with us.

As a father of an 8 year old little girl I thank you for exposing this for me and many others who will now know about this inhuman, disgusting behavior. I had no idea I needed to be careful or make sure she is aware of this possibility. Every day it seems I am told or informed about levels of human indecency I never even knew existed. This makes me really sad for these victims and really angry that people are like this. It's sickening, but now I know so thank you.

Thank you so much! Yes, it made me aware that I will need to inform my own daughter about these things as well! It's not something I would have thought of before working on this series.

Can you give us some examples of this injustice? I was friends with someone raped by a doctor and no one really believed it because.... "hes a doctor he helps people" "he saves lives" bluh bluh.

Is this lack of critical reasoning why they get away with it so often?

the situation your described is very common. we wrote about it in a lot in our series in 2016. all of the stories are available for free on our project website: doctors.ajc.com there was a pediatrician who got away with it for years in Delaware and had hundreds of victims even though he had been reported numerous times. Even when medical licensing boards know that someone has abused patients, they often still allow them to keep practicing after they go to treatment.

Whats this "treatment?" To me that sounds like sending a physical therapist to "treatment" for hitting their patients. It wouldn't happen because its a retarded idea.

There is a whole industry for treating doctors who are in trouble for sexual misconduct. Some of the treatment places also deal with doctors who have substance abuse issues. They make them take polygraphs and assess the danger and go through treatment for their sexual misconduct issues. We did a whole story on this in 2016. Here's a link if you would like to know more. http://doctors.ajc.com/part_2_illness_or_crime/

They make them take polygraphs

Seriously? As in they make them take a polygraph to determine whether or not they are telling the truth?

You'd think that people in the medical field would know that they do not work like that and are extremely susceptible to both inaccurate readings and being tricked.

Honestly, if that's how they're using them, it almost seems like it's intentional. Like they're making it easy for the doctor to pass and get back to practicing.

yes -- i heard you. But it is an important element of the way these therapy programs work. We see it all the time in cases.

Having worked in the medical field since '08 when I was 18, I've learned just how often these situations actually happen. Especially in regards to the special treatment prescribed to the doctors who commit such abuses of power.

Thank you for you and your teams research and reporting on these cases.

Thank you so much!

Wow, 2016, this is the first I've heard of it. Why has there been so little coverage of this? Is it just because it happened during Trump and there's no time for anything else?

Thank you for your efforts, keep up the good work!

Thank you! we just did a follow-up story where we found 450 new cases just in the last two years! We just published that on Sunday to bring more attention to this problem. You can read the story for free at doctors.ajc.com if you would like to know more. Thanks again.

One of the reasons I wanted to speak to the reddit audience today was to tell more people about our work -- this audience has great questions and comments and we really appreciate the interest! We have to use as many platforms as possible to try to share our investigative work. Thank you!

I had a friend have this happen to her. The doctor was caught after he had molested her and other patients over many years. I know he was found guilty but idr how long he was sent to prison for..

I am so sorry to hear this. I would imagine it was a traumatic situation. I think the victims in the Larry Nassar case who were permitted to speak publicly helped everyone understand how damaging this can be. Thank you for sharing this with us.

Did you? I must know very different people.

I would help a stranger that told me this happened and felt like nobody was believing them, nevermind a friend or family member.

I have to believe these doctors look for people with weak support structures to do this to.

We did find in a number of cases that the victims were vulnerable -- some were young, some had addiction issues, others were low-income and didn't have many other options for medical care. In some cases, they had to go to that certain doctor b/c it was a work injury -- things like that enhanced the power imbalance between doctors and patients.

What's your take on the current state of investigative journalism? Is it doing well? Struggling?

At our newspaper in Atlanta, investigative journalism is still doing well but that is because our owners and editors make it a top priority. Our staff, overall, is much smaller than it used to be, so it takes a very bit commitment for us to keep doing this kind of work. Our readers tell us that this is very important to them, so that helps. Other newspapers especially in smaller cities really struggle to find the resources to do this kind of reporting.

Am from Atlanta and grew up reading AJC. Can confirm that the paper is pretty dedicated to investigative journalism and has uncovered some shit in the past (APS cheating scandal was the one that came to mind). Keep up the good work!

Thank you so much!

As a person born and raised in Atlanta, thank you. I appreciate it.

Thank you so much!

Hey, I'm in the UK and have listened to breakdown from season one. It's great quality and does a great job of explaining your justice system and I just wanted to pass on the message to keep up the good work, even if it's only the podcasts that reach us.

Thank you so much! I will let my colleagues know -- the guys who do the podcast are good friends of mine. I enjoy it too.

What should someone do if they have been abused by a doctor? Who can they tell?

They can do to their state medical licensing board and file a complaint, they can file a police report and they can also tell the hospital or health system that employs the doctor.

What if on paper it appears to be just another examination or procedure?

What comes out more often is that something happened that was not recorded in the medical record -- one doctor was touching a lot of sedated patients' genitals before surgeries and she said it was for a legitimate medical purpose but did not put it in records. Also, there may be consent issues. But the issue you raised is part of the problem that comes up -- it can be difficult to prove.

I'm guessing by your response that one report might not do much, but like votes, when the hospital or medical board gets a ton of complaints, yeah they will probably do something.

it's much more likely if there is more than one complaint that something will happen. Often, if a complaint leads to an arrest or a media report of discipline, then other patients will come forward at that time and then the board or hospital is more confident about pursuing the case.

This. As a young teen my endo made it seem like a part of the exam. Even assured the nurse (or usually med student) that it was part of the exam. As an adult I found out it was not part of the exam.

What you are describing is the kind of thing we saw in case frequently. I'm so sorry that happened -- has it made it difficult for you to be comfortable during a medical exam since that took place? We often hear that from people who have experienced this kind of abuse.

It’s okay if you don’t want to, but do you mind sharing what happened? I have endo too and have dozens of people in my vagina a year for it. I’ve also dealt with severe sexual trauma and it’s difficult for me every time. I don’t know if I would know what to look out for.

So. Part of the exam was to check on the size of my clitoris. Which is actually part of the exam, as the endo after he left looked to, the new endo was also female and every very by the book, this is what made me ask about the whole thing a few years ago. I’ve come to find out most of the time it’s just a let’s have a look see. Mind you I was like 12 I think. Maybe a little younger, when this began.

This endo made me strip my pants and underwear. As I remember there was no covering like when you go to the gyno or have a pelvic exam. Just my gown on top. And I’d lie down. My parents were always asked to leave because I was at that “sensitive age” according to the doctor. I think at first they were allowed to stand behind a curtain but pretty quickly they were shown to the waiting room. He’d then take a small ruler sometimes and spend so much time “measuring”, and touching. And tell his “witness” a nurse or med student that this was just part of the exam. It was so uncomfortable. And I could I guess understand if this was like a every year thing or every six months. But it was pretty much every six weeks.

This doctor also told my parents (in front of me) that kids my age lie, so my parents didn’t trust a word out of my mouth for years about anything (mostly that the meds were making me sick - when I couldn’t keep anything down because of them he told them I must have been intentionally throwing up to lose weight - I was underweight if anything and I loved food). He also told me I was going to die before I was 30. And to expect to have miscarriages. All when my parents were asked to leave for “privacy”. He ended up going to a hospital in Missouri or something just before I aged out of pediatrics.

I got a new pedi endo and she never measured. Never made me strip my pants and undies. She just lifted the waist and took a peek. She really only did that part of the exam like twice in the year I saw her. She was the one that realized I was being massively overdosed. Thought the dosage was a typo at first. She always asked me if I wanted my parents there. Even dad was allowed to stay if I wanted him to. Never told me anything without asking if I wanted dad there.

Really there is clinical we need to look at this for reasons. And then there is unnecessary invasive exam. It might not have been so bad if I was older maybe. But I was 12 or there about a when it started.

And honestly? I don’t know if there was malicious intent. He had mentioned a few times about writing a case study on me (told my parents it was okay because he wasn’t publishing my name- I don’t know if you are supposed to give consent for something like that. We never did) so I don’t know if I was just seen as a science experiment?

Thank you for having the courage to share what happened to you and how this doctor treated you at such a young, sensitive age. I'm very sorry this happened to you -- your second doctor seemed to get it right.

They can do to their state medical licensing board...

That typo in the first part of that sentence had me on a real evil revenge fantasy tirade for a split second... and then I read the rest.

sorry! I was typing too quickly there!

As a medical student, the Larry Nassar case has brought me to contemplate how flaws in professional and personal conduct sometimes go unnoticed or unchecked throughout a person's early professional life until their career matures to place them in a position of power where it can be difficult for people to do something about them. A relative of mine told me about a conversation he had with a former classmate of Nassar who said she wasn't at all surprised by what he did, because he demonstrated similar behavior/disrespect towards women while he was in medical school.

I've noticed that many of these people who honestly shouldn't be doctors anyways tend to torpedo their own career early on (eg recently, a student was arrested on arms/drug charges who was also reported by fellow students to have been running a secret neo-nazi blog). However, there are others who demonstrate sufficient charm and social awareness to hide red flags well enough from people who could prevent them from advancing in their career. I have a classmate who has disgusting attitudes towards women and other races, but knows better than to behave in a way that can get him reported. I can see him in Nassar's position a few decades down the road. Usually, their peers are aware of these problems because they interact with these individuals on a regular basis, but professional complaints by colleagues are often ignored and administration is either unaware or uncaring to do something about it until something big happens.

What do you think the role of medical education should be in preventing individuals like Larry Nassar from reaching positions of power? How can doctors better check the behaviors of their peers?

Okay -- wow! You have raised so many important issues here. Some of the biggest experts in this area say that sexual harassment can be a "gateway drug" for doctors who will later go on to sexual assault and molest patients. They say it's very important to take those issues very seriously when they come up, but that too often that does not happen. Peers are often discouraged from reporting and hurting someone's career they worked so hard to achieve. We now know that complaints against Nassar were not taken seriously for a long time. And yes, I believe there should be more emphasis on this in medical education. I recently spoke at Yale at the invitation of medical and nursing students there -- but that is the only time we have been asked to speak to medical students.

sexual harassment can be a "gateway drug" for doctors who will later go on to sexual assault and molest patients

I can believe this. Fortunately, my school has a proactive policy on peer reporting of harassment, and I have seen it work at the level of medical students. However, higher up the career ladder, this protection seems to diminish. There is a surgeon at one of our clinical sites who will allow female med students scrub in on his cases "if they're attractive enough" among other sexist behavior, but he's a big wig at the hospital and it's daunting for students to report someone so much higher on the professional ladder. It seems he has become established enough to feel he can behave this way with impunity.

Sexual harassment and improper professional conduct is taken seriously when we're med students. I wonder why this expectation seems to fall for older doctors?

You raise an important point here. and it's up to the institutions to demonstrate that no matter how powerful someone is, the behavior is not acceptable. We still find that while the #MeToo movement has arrived, it hasn't fully arrived in medicine. That was a big point in our story that published on Sunday. It's available at doctors.ajc.com

Also a medical student. Have similar concerns about 1-2 classmates. There's not much to do about it, seemingly...

In our research we definitely found cases where there were warning signs in medical school that were never acted on and then it just got worse and worse. Those are some pretty sad cases.

What was your biggest fear when your story came out?

When we were working on the story we had so much information we wanted to make sure that we could tell the story in a compelling way. We had read thousands of cases of misconduct and we wanted to make sure that our findings became known across the country and we weren't sure if it would reach a national audience in 2016 when we first exposed this, but we were gratified that it was picked up by many other news outlets too.

What motivated you to do the story? It's quite a specific one. How did your work impact those doctors, victims, doctors board, etc?

We discovered the story when working on another one. My colleague Danny Robbins was researching the history of a prison doctor who had been in trouble in the past and he noticed a lot of cases involving sexual misconduct by doctors. He also noticed most in Georgia were allowed to keep practicing. Our work exposed a problem that had never been studied to the degree that we studied it in all 50 states and it brought this issue to the attention of the medical licensing boards in all 50 states, too.

1. Were you threatened or offered anything to prevent you from releasing your findings?

2. Did you ever doubt yourself during your investigation?

There were doctors who did not want us to report about their cases, but we chose cases that had been dealt with by medical boards and/or courts so we were confident in our work. We had a big team of experienced investigative reporters working on this topic and we knew that it needed to be exposed. It reminded us of the reporting by the Boston Globe which exposed the abusive priests and how they were sent on to other churches and we knew it was important to make this known, too. So we did not doubt ourselves.

What was the biggest change you've seen ever since you published your story?

Medical boards that decide whether a doctors can keep practicing know that we watch these cases. We're still waiting on major changes, but we think there is a lot more awareness of the problem. The Georgia medical board tells us they take these cases more seriously but it's hard to check because they keep most of their cases confidential. Some states have considered legislation to increase punishment when these cases come up, but it's hard to get these laws passed.

Don't these cases also include legal action. I mean these are crimes. Are there no convictions? Can a convicted felon, a sex offender, hold a medical license?

yes, we have many cases where convicted sex offenders and people coming out of prison keep their medical licenses or have them reinstated! Sometimes, in grave cases, they will go to prison for a long time and lose their licenses.

Wow! It would seem to me that an easy correction, and probably a popular one with the public, would be for medical examiner boards to automatically revoke licenses for sex offenders. In fact I wonder how these boards are not subject to lawsuits brought by victims who are abused after the board became aware of the sex offender conviction.

I assume that one responsibility of these licensing boards is to protect the public.

I had someone else suggest holding the boards responsible. In California, if a doctor is a high-level sex offender it's automatic revocation, but that's not true in most states. That law came to be in California after controversial reinstatements of license in sex abuse cases.

If you had the power to prevent this from happening again, what changes would you make in the short term and long term?

As part of our coverage on this topic in 2016, we studied the laws in every state to see which ones did the best at protecting patients. Here is a link to that coverage: http://doctors.ajc.com/part_4_failing_grades/ we found that Delaware had the strongest laws b/c of legislation that was passed after a horrible case involving a pediatrician who abused hundreds of children even though he had been reported. Some changes that help are Duty to Report laws and also the make-up of medical licensing boards -- most are made up primarily of doctors and having more consumer members can make a difference. Also, we hope our work of bringing this to the public's attention will make a difference. Have you ever heard about these kinds of cases in your state?

I don’t think I have heard of any here (think Wizard of Oz), but now I am going to do some research. Thank you for exposing this, a patient should never have to worry about something like this happening to them.

Thank you! Our project page has a page for every state so you might want to check that out.

I’m going to do that now!

Thanks so much for your interest!

What's the worst abuse that you have uncovered?

There are so many cases of different kinds. We saw pediatricians who abused small children -- one in Delaware victimized hundreds before he was finally caught. We have seen psychiatrists who abuse their patients who were victims of sex abuse as children. We have seen many vulnerable patients who become victims and some doctors use the very personal information they know about a patient to make the abuse possible. We see doctors trade drugs for sex. And we have seen a lot of cases like Dr. Larry Nassar (USA Gymnastics) where doctors act like they were doing a legitimate exam and then molest the patient.

Do you fear any repercussions? For example do you think you are on a sort of medical black list? Like you won't be given proper care from doctors in an emergency situation or do you think the moral and honest doctors appreciate you for ridding their profession of these monsters?

I'm pretty open with doctors about the kind of work I do. I think the really good doctors out there are disturbed by a system that does not hold dangerous doctors accountable. Sometimes I get good tips from doctors I know! It's just hard to change some of the institutions. For example, I think most priests were very upset that abusive priests were sent to other parishes. So, yes, I think the honest doctors appreciate us exposing the problems in many cases.

Not sexual, but Christopher Duntsch, neurogsurgeon in Texas. Dude was so incompetent his colleagues thought he was lying about going to med school. Another thought he was intentionally crippling his patients. A bunch of them reported him to the state, but Texas's medical oversight is about what you would expect in a red state (incompetent and terrible).

We have done some reporting and hope to do more on the issue of how doctors who harm patients are handled by medical boards. We've looking closely at sex abuse and improper prescribing but standard of care is another huge issue. I'll look at the Texas case. Thanks!

[deleted]

Exposure is powerful but some states have laws requiring doctors to report other doctors and a few states will go after doctors who fail to report. Also, some people think medical licensing boards should have more consumers members so it's not so much self-regulation. I think the Dr. Larry Nassar case is opening a lot of eyes.

Hello,

Thank you for your time!

Is there a database of collected claims against Drs?

Not a public one. We primarily used public medical board disciplinary orders, which we collected from every state to do our research.

How can people protect themselves against criminals/abusers like this if they are allowed to continue to practice medicine? You mentioned below you use/have non-public databases built around data taken from medical board disciplinary orders. If those are not public, how can patients even know if their doctor was brought before a board, much less if they were given orders to stop abusing or sexually assaulting patients if the boards do not stop these abusers from practicing medicine?

It can be difficult. Each state has a medical licensing board. Some have two -- with osteopaths having a separate board. They all post disciplinary actions on their websites, but you have to know how to search for it and most people would never know about it. But what makes it more complicated is that some boards issues private orders or letters and that is all kept secret. We have written about that in our series.

And the boards do not have to report the alleged assaults to the authorities? Or do the authorities get involved and THEY go to the medical boards?

Crazy stuff. I'll have to take a look at your series. Thanks for doing this AMA!

we did a whole thing about how the police do not hear about these cases from boards -- some states require it but many do not. here is a link. thank you so much! http://doctors.ajc.com/part_2_illness_or_crime/

First of all: Great job!

Did you just stumble across this, or did you go looking for this story and were able to dig up the details?

We kind of stumbled across it when working on another story about a prison doctor who had a bad record. My colleague started reading medical board disciplinary actions and was surprised by how many involved sexual misconduct and that most of the doctors were still allowed to practice in spite of the behavior.

Wow! Thanks for the reply. That is amazing, really. Some top notch journalism there!

Thank you so much!

I live and Atlanta and would just like to hear what you think your best story was. Which one are you most proud of?

Thank you for this question! I am very proud of this doctors series. Today marks my 29th anniversary working as a reporter at AJC so I have done a LOT of stories. This series was a Pulitzer finalist last year, so that was gratifying. I'm done a lot of reporting on criminal justice issues that have led to some reforms. I've written a lot about hospital quality that has pressured local hospitals to do more to protect patients. Each story I do I feel has the potential to make the world a slightly better place -- so I value all the stories we have done especially those that have impact in our community.

Thank you for replying! I love reading AJC articles. Keep it up!

thank you! That is so great to hear!

Thank you for doing this AMA. I have a numbers question, stemming from the opening paragraph in your AJC article.

The AJC found 450 cases involving doctors who were brought before medical regulators or courts for sexual misconduct or sex crimes in 2016 and 2017.

How many of doctors are subject to one of the 450 cases? A single incident can spur a board complaint and a criminal prosecution.

You also report that the doctors in almost half of these 450 cases remain licensed.

How many of these still-licensed doctors were actually found to have committed sexual misconduct or abuse?

Furthermore, how many of those doctors committed their crimes in the course of their medical practice?

I ask these questions, because the thrust of your article is that doctors who are found to have sexually abused their patients are still treating patients.

Your article describes four examples of such doctors among the pool of 450 cases. (Roberts, Burgess, Kapoor and Nassar) How many such doctors were there altogether?

The 450 is the number of doctors -- if someone had a criminal case and a medical board case, we only counted that as one case. Most were found either by medical boards or courts to have committed the act, or there was a medical board consent order that resolved the case and imposed discipline. In some cases, however, there was a formal accusation by a medical board (like an indictment with a lot of details) and the final resolution was still pending. The Kapoor case in our story would fall into that category -- he had been arrested and restricted by the medical board for exposing himself and masturbating during an exam. But the criminal case and board case have not reached a final resolution. Most of the cases were in the course of medical practice, but we did include some where the doctor was convicted on child porn or another sex crime. Does this help?

Do you think medical licenses should be given or monitored at the federal level to avoid state skippers and to have a physician's record follow them sound they try to elope to a different state?

Some people do argue for a federal system, but I'm not sure that would be the answer. The states do try to inform the other states when there is an action -- but sometimes we do see a time lag. I wrote a story earlier this year, though, about a doctor who had complaints in Georgia that were never acted on and then he moved to Wyoming and was criminally charged for actions up there. Here is a link to that story, just FYI -- because it does speak to the issue you are raising. https://www.myajc.com/news/crime--law/did-georgia-easy-dangerous-doctor/5wvFKsRGRQ91lvLe6lEr4H/

In your experience, what do you think is the main reason why doctors are allowed to keep their license? Is it because people on medical boards are actively defending their abusive colleagues? Is it because taking away licenses is difficult and time-consuming? Or is there a fear of being sued by doctors who had their licenses revoked without ironclad evidence of wrongdoing?

Medical boards are primarily made up of doctors and they view themselves as healers who want to help other doctors recover from their problems. Also, many medical boards know that there is a doctor shortage and training doctors is expensive, so they want to keep them in practice when they feel they can do that. Also, medical boards do tell us they have to be very cautious in taking a license and make sure a doctor's due process rights are protected. That can take a long time. Sexual misconduct cases can also be harder to prove.

Have you looked into a similar phenomenon that doctors with drug abuse history will be allowed to maintain their licenses as well?

I have written about opioid prescribing and doctors who overprescribe. We would like to do more reporting on substance abuse by the physician. We know it's similar where they go to treatment programs and can return.

I listen to the AJC Breakdown podcast. Do you see this as a growing medium for local investigative journalism, or more of a side project?

yes, we definitely view it as a growing medium -- Breakdown has been very successful for us. Tons of people across the country listen to it and that allows us to bring investigative stories to a younger audience that might not subscribe to a printed paper like their parents or grandparents do. Do you see it as a good way to hear an investigative report?

Has your organization thought about broaching the unnecessary surgery epidemic topic at all? It's pretty horrific to have a surgeon coerce a patient into unnecessary surgery using the power and information asymmetry of the doctor/patient relationship, but it seems like it's standard practice now since these surgical departments are hospital profit centers and the lack of effective regulation provides little incentive against these abuses.

Important topic to look at unnecessary procedures! Are there specific types of procedures that you believe are the most commonly overdone?

This may be in the article, I apologize if so. I haven’t gotten a chance to read it yet.

What justification do the medical boards give for allowing the doctors to continue practicing? I assume a piece of it is that revoking the right to practice medicine hinders the doctor’s ability to earn a living?

Also, how do medical boards normally handle doctors convicted of crimes in their personal lives? For example, what happens if a doctor gets convicted of domestic abuse?

Thank you!

I'm going to repeat a little of what I said in answering another reader's question. Medical boards are primarily made up of doctors and they view themselves as healers who want to help other doctors recover from their problems. Also, many medical boards know that there is a doctor shortage and training doctors is expensive, so they want to keep them in practice when they feel they can do that. Also, medical boards do tell us they have to be very cautious in taking a license and make sure a doctor's due process rights are protected. Sexual misconduct cases can also be harder to prove. In terms of other crimes, it depends. We do see some doctors who are sex offenders for child porn cases and things like that who are allowed to practice again after prison time, but in other cases boards do not reinstate.

In situations like this how can proof of the crime be obtained? Is it generally only after multiple complaints that something will be done?

I'm asking because, like in a lot of sexual assault cases, there are only two people involved which makes it very hard for the victim to prove what happened and vice versa.

We see a number of ways that investigators proved the cases. Sometimes, after going to police, the victim would call the doctor on a recorded line and the doctor would make statements that proved what happened. In our coverage in this Sunday's newspaper, a patient who had been molested in a previous appointment came back with a video recorder on and captured an act by the doctor. In another case we reported on this Sunday, a male patient turned around to see a doctor who was examining him had exposed himself and masturbated into a napkin -- the patient grabbed the napkin when the doctor left to capture DNA evidence. That was a male on male incident. These cases are in our most recent story at doctors.ajc.com

Thank you for using your set of skills to look out for people!

How can we challenge misinformation that is unwittingly spread by countless news organizations?

Since the Obama administration, the CDC, FDA and DEA unwittingly continues to mislead the public on opioid overdose by placing blame on prescription medication for the opioid epidemic. Prescription medication used to play a major role in opioid overdose deaths but after the government's swift response to the epidemic, by limiting healthcare access to opioids, heroin and fentanyl became the leading cause of opioid overdose.

Not only did heroin and fentanyl overdose increase but chronic pain patients and terminally ill patients lost access to pain medication as well. There is an ongoing humanitarian crisis where patients with debilitating conditions are denied life-changing - sometimes life-saving - medication because the DEA strong-armed doctors and pharmacists with the federal power to unexpectedly seize doctors' and pharmacists' licenses, freeze their assets and shut down their practice.

This injustice has been allowed to continue because the media believes prescription medication is still at fault whereas the data collected by the government says otherwise.

https://www.acsh.org/news/2016/11/03/have-opioid-restrictions-made-things-better-or-worse-10400

it is apparent that overdose deaths from prescription drugs (9%) were dwarfed by those from heroin, fentanyl, or a mixture of both (85%). So, when a headlines says "There were 100 opioid overdose deaths last week," what it really means is that nine deaths were a result of pills, and 85 from heroin/fentanyl.

http://www.bendbulletin.com/localstate/6033839-151/opioid-limits-hit-hospice-cancer-patients

Palliative care patients have complained that some doctors have been more reluctant to prescribe opioid pain medications, even at the end of the life.

Six years ago, Lenny Estrada of Redmond had been undergoing treatment for malignant brain tumors, and despite outliving his initial prognosis, felt his quality of life was lacking. “He was in pain. He was miserable. He didn’t feel like he was living life to the fullest,” said his wife, Angela Estrada.

He went from his primary care doctor to his oncologist to his rheumatologist — eventually to seven different doctors treating him at the time, seeking help. “Everybody was hemming and hawing, not sure what to do,” Angela Estrada said. “Everybody was kind of nervous about giving pain medicine.”

https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935

Pharmacy chains are imposing bureaucratic barriers on filling prescriptions and denying prescription refills. The US Association of Attorney's General is lobbying US Insurance providers to revise their formularies to emphasize non-opioid medications in preference to opioids. The Veterans Administration has been directed by Congress to make the CDC prescription guidelines mandatory rather than voluntary.  Hospitals and pain management practices all across America are discharging patients and forcibly tapering down the dose levels of those they retain.

https://reason.com/blog/2018/03/28/new-medicare-rule-promises-needless-suff

The CDC's controversial but officially optional opioid prescription guidelines, which encourage doctors to be as stingy as possible with pain medication, seem to be getting more mandatory every day. The recommendations, which were published in March 2016, already have been imposed on veterans, incorporated into state laws, and adopted as a guide to proper medical practice by regulators, insurers, and doctors. Now the Trump administration plans to impose them on the 44 million Americans enrolled in Medicare, against the advice of critics who say that move will lead to needless suffering. Those critics include doctors who helped produce the guidelines.

More info:

https://www.statnews.com/2017/02/24/opioids-prescribing-limits-pain-patients/

https://medium.com/@stmartin/neat-plausible-and-generally-wrong-a-response-to-the-cdc-recommendations-for-chronic-opioid-use-5c9d9d319f71#.ci3i05u8k

Thank you for this question! Readers of my work on prescribing and even some friends have talked with me about this issue -- that we may be going back to a time when legitimate pain is being undertreated. I will look into it! Like I said, I've heard this from numerous people, including families of very elderly patients.

As an investigative journalist myself, I've noticed a worrying trend over the last year or so. We do phenomenal stories, exposing high-level fraud and corruption. Yet, contrary to previous years, the officials implicated now merely brush off the exposes. I find the lack of true accountability and a sense of some resolution increasingly more frustrating. While investigative journalism exposes the crimes, there's a sense that little else is done once the story is out there. What could we, as investigative reporters do to fight back against this nonchalant attitude? I just feel readers want some solution following a story, but they're simply not getting it. What are your thoughts?

Great questions. It does sometimes take longer to get results -- this is one of the reasons we revisit our investigations and continue working on them. This is a 50-state issue, so it takes time for change to take place. #MeToo took off because of continuing coverage -- so that I think that is important and also using social media to gain interest in our work. Those are just a few thoughts. What do you think can help?

Is there any common theme across this abuse? Such as a higher incidence of abuse with patients that might be unable to articulate the abuse (youth, elderly, mentally impaired, etc), or patients under anesthesia?

And is there any advice you could recommend to help patients or parents of patients to help prevent this abuse? Thanks!

There are so many cases of different kinds. But vulnerable patients were especially at risk. We saw pediatricians who abused small children -- one in Delaware victimized hundreds before he was finally caught. (He video-taped himself is the only reason they found out how extensive and horrible the abuse was.) We have seen psychiatrists who abuse their patients who were victims of sex abuse as children. We have seen many vulnerable patients who become victims and some doctors use the very personal information they know about a patient to make the abuse possible. We see doctors trade drugs for sex. And we have seen a lot of cases like Dr. Larry Nassar (USA Gymnastics) where doctors act like they were doing a in any intimate exam (genitals/breasts) done by provider of the opposite sex there should be a chaperone in the room. In Georgia it's required, in every state it is considered a best practice and all young women should be told b/c it can be a red flag if no chaperone is present.

Have you or your team ever considered reaching out to victims of Dr. Larry Nassar, to see if they'd be willing to raise awareness of this issue? As victims themselves I would assume some would actively seek change.

Thank you for mentioning this. We just did a story on 450 new case we have uncovered. The victims in the Nassar case, who so bravely spoke out, definitely raised the awareness on this issue in a big way. The judge who let so many of them speak also played an important role. We are so glad their voices were heard. I think we're trying to show in our reporting -- especially our most recent story -- is that this kind of abuse is more common that most people think so we try to find victims outside of the Nassar case to help with that. The Indy Star newspaper really exposed Nassar so hats off to that newspaper's investigation!

First, thank you so much for doing what you do. Second, having to read and investigate these cases day in and day out is so difficult. How do you keep from burning out?

I've been asked about this quite a few times! As investigative reporters, our team is very used to dealing with unpleasant topics. But when we were first reporting on this in 2016, we had to read thousands of cases. The way we got through it all was that several members of our team were spending all day every day reading about disturbing cases -- so we spent a LOT of time sharing what we were reading. It was helpful to just share and say to each other -- wow -- you can't believe this. That helped a lot. We do not get burned out because we are passionate about what we do and we know it can make a difference. We recently uncovered another 450 cases from just the last two years and we had to research all of those too. we just wrote a new story about those cases that ran in Sunday's newspaper.

Do you generally see Institutional protection for many of these doctors that Michigan State University displayed for Larry Nasser?

We did see this when working on our series, where doctors were allowed to leave a hospital or clinic and it was kept quiet. But we will never know how many were kept hush-hush -- we only know about the ones that later result in public discipline.

How are the genders splitted between the abusers?

The responses below are pretty accurate. It's primarily male doctors and female victims. But in our story we just published, there were two cases involving male doctors and male patients. We see a few cases of female doctors but it's honestly pretty rare.

In your investigation what is the ratio of actual sexual abuse cases vs false accusations?

Unfortunately, we do not have the data to answer this. Complaints to medical boards are confidential, so we are not able to determine how many complaints come in related to sexual misconduct. I wish we could get that information and take a look at how often false allegations are made.

First off, you’re an amazing person. Secondly, what’s your favorite color?

thank you! I don't really have a favorite color, but my daughter's favorite color is teal.

How do you suggest someone who thinks they may have been sexually assaulted but unsure if it was part of a legitimate medical procedure, find out whether it was one or the other?

That is a good question. I would go to a doctor in the same specialty and ask that question. So, if it was an ob-gyn I would find another ob-gyn to ask. Is that an option for you? If you have more than one doctor, that's also a good option. Often, we see cases where a patient tells a therapist or a general practitioner what happened and then finds out that something was inappropriate.

So how do they keep their licenses after being caught sexually abusing patients?

The most common way is they are sent to treatment programs -- there are quite a few treatment centers for this across the nation. Many of them involved taking polygraphs and going to a lot of therapy sessions and then often having a requirement to have a chaperone in the room with some patients after being allowed to come back to seeing patients. However, most patients will not know that their doctor has been disciplined unless they know how to look it up and the discipline was public.

In the spirit of an AMA, I must know:

• What's your favorite kind of sandwich?

you are funny. I'd probably say grilled turkey and cheese on rye with tomato. how about you?

My psychiatrist sexually exploited me when I was 21 and in undergrad. He was a campus psychiatrist who then moved me to his private practice off campus. I reported him to the medical board and he voluntarily surrendered his license but got it back a few years later. How can this happen? Why was I not contacted or had no say in this? Is it because he is an MD that he had a much lesser punishment than if he was licensed by a mental health board? For all purposes he was my psychotherapist as he wasn't prescribing me any meds, just talk therapy.

I am so sorry this took place! I'm sure this had a big impact on you given the amount of trust someone places in a therapist. When he surrendered his license, was it noted that he had engaged in misconduct? Or was that kept hush-hush? Some states reveal that reason if someone gives up a license while under investigation, while other states allow it to be kept secret.

Being an investigative reporter is my dream job, taking down and exposing evil or corrupt people must feel absolutely amazing.

Do you have any tips on how I can become one or where I can even get started? How do you even know where to start and what to investigate?

Almost everyone who is an investigative reporter spends many years covering news -- police beat, county commission, city hall, etc. It's important to learn how to cover news and accuracy is so important. Start there, and then look for "watchdog" angles to news coverage to work up to investigative reporting. I've been a reporter for more than three decades and I never tire of the work. It's very rewarding.

What are some of the most common specialties of these cases of sexually abusive doctors? Like gynecology/primary care/surgery?

We often see ob-gyn, psychiatry, primary care. those are probably the most common but to be honest we saw just about everything. In Georgia we had a sex for drugs case involving a medical examiner who would not normally see patients. But he was writing prescriptions in exchange for sex and was recently criminally charged.

What is your favourite Toy Story movie?

the first one

What roll do you play in the investigative journaling process? do you ever have to deal with awkward moments or conflict when speaking with the people involved? How do you (or whoever you're working with) talk to someone about information they might not want to share? Is there an art to it?

When we are working on a story like this, it is very important that we speak to as many people as possible -- especially those who have been disciplined for misconduct. I think the most important thing I try to do is tell the person what I'm working on, what information I have and listen very carefully and patiently to what that person has to say. I try to be as open as possible with the source. I have been doing this for three decades, and I have gotten better over time.

Did you want to get a new doctor after your research?

no -- I have great doctors. They find this stuff outrageous too and have shared information and thoughts with me. Plus, my ob-gyn is a woman.

What are the demographics of these doctors?

it's a diverse group in terms of race. However, one thing we have noticed is there are a lot of cases involving a lot of older doctors -- in their 70s and sometimes in their 80s. I saw that sometimes, too, when looking into cases of overprescribing of opioids.

[deleted]

Thank you for your question -- and it's a hard question to answer. There are a lot of doctors who come to US from other countries and we do not have the data we would need to calculate a rate -- so I can't answer that question. I did have a former medical board member tell me that some medical boards are more likely to discipline a foreign-trained doctor and 'protect' their colleagues who went to the same medical schools they went to.

I am in a journalism class at university, and we just covered the work of reporters at the Boston Globe in uncovering the sexual abuse scandal in the Catholic Church. How do you feel your work compares to the Spotlight team, and what else do you expect to find about this story?

Also, what advice would you give to journalists to do their best work and report fairly and accurately in times of crisis?

Spotlight is a very accurate portrayal of how investigative reporters do their jobs. One significant difference for us was new technology available to us now that helped. For example, we were able to use computers to help us obtain about 100,000 disciplinary records covering all kinds of infractions and computers helped us find the cases that involved sexual misconduct. But a lot of the shoe leather reporting that the Globe used to uncover the clergy story is also the kind of work we did for our series. In terms of fairness, you always want to talk to those who are being accused of something. We did this in our stories and you find out things that are important.

How does the percentage of doctors that are caught sexually abusing patients compare to the percentage of the general public that is convicted as a sex offender? Do the offending doctors tend to practice in certain types of communities, such as low income ones?

Why do some news organizations take social media comments from the public and create a "story" about the comments?

We are not able to calculate that because a lot of cases are kept secret, so we're only seeing a portion of the overall cases. We frequently saw case were patients were vulnerable for one reason or another -- maybe they were low income and had few options in terms of healthcare. Patients who are under anesthesia are also vulnerable. We frequently saw cases with psychiatrist and ob-gyns and doctors who traded prescriptions for sex. Many experts believe it's important to protect patients because a doctor who wants to abuse patients has unusual access to a person who willingness takes off his or her clothes in a private setting and submits to being touched. that is supposed to happen in a medical exam. So a doctor who has an issue has a lot of opportunity.

Is the comma in your title really necessary?

probably not! thank you!

Do have a song you play before you go do stuff, to get ya in the zone?

I primarily listen to a lot of podcasts, and I can't really think of one song I go to.

We've been living in ATL for about a year and a half now, and I just want to say I absolutely love what you do. Keep it up!

I'm a volunteer writer for a somewhat popular news website. Most of my stories are published a week after the actual event happens, can you give me any advice on how to choose stories that aren't time sensitive?

sometimes you can preview an event if you know it's coming up and interview the folks involved -- that way if can run before an event takes place -- that applies to entertainment or even public meetings on local government issues. Thank you for your kind words!

Did you work on the breakdown podcast that covered this subject?

My colleague Johnny Edwards and others from AJC worked on that breakdown podcast that covered the physician sexual misconduct case. Johnny was one of the reporters on our team for the series. Did you listen to the podcast?

What is your opinion on the whole olympic doctor fiasco?

Sorry it got removed before beccause I didnt have a question mark.

In our recent story published on Sunday, we made the point that the Dr. Larry Nassar story (he's the USA gymnastics doctor) horrified the nation, when all the victims were testifying. But Nassar was just one of more than 450 case of doctor sex abuse that we found that took place in the last two years. What happened in Nassar's case -- esp that he got away with it so long and that there had been reports that were brushed off -- is pretty typical. What wasn't typical was that when he was finally prosecuted, he got a very long sentence. Part of our coverage Sunday was showing how light sentences can be for some doctors in these types of cases.

.... Can you help me get a job? Being an up and comet journalist is hard

What helped me when I was just getting into the business was getting internships and then taking a job at a smaller newspaper and writing a lot of stories and covering as much news as possible. I hope that helps!

Hello! Thank you for doing this AMA, it has been very eye-opening. Given that your investigation uncovered abuse in so many states, is there anything that could be done on the federal level for this issue? It sounds like each case has to be handled by the state medical board of wherever it occurred.

Thank you for your question! Unless we went to a federal system of licensing doctors, which seems unlikely anytime soon, it is a 50-state issue. But the Federation of State Medical Boards does have influence and AMA could also take this on to push for changes. In some states, medical societies lobby against laws that would crack down on this.

Can you explain why your newspaper lost the scoop on Atlanta's racial disparity and continued strife to Atlantan magazine? Y'all missed out on an interview with new mayor, for journalism's sake!

Does this issue not affect everyone within the Atlanta metropolitan statistical area?

Thanks for your question. We do not have as many reporters as we used to have when I came to the newspaper 29 years ago -- we wish we still did! But I will say that we have very strong coverage of the mayor's office right now -- especially as it relates to the current investigation. Have you been following that at all? /

'Member the Asian doc who got thrown off the united airlines plane and everybody was upsetti spaghetti? He traded drugs for sex, a lot. Still practiced medicine. However under close supervision and not very often.

There were reports at the time of these allegations, although I didn't investigate this case myself.

Old news. Doctors protect their own and don't discipline themselves well against accusations of all bad behavior. Why pick just sexual abuse vs patients?

We do think our coverage exposes the forgiving nature of medical boards in general, but we do report on other types of inappropriate conduct as well -- that includes overprescribing of opioids which I covered in a series published last year.