George Tyndall, MD. A Revisitionist Perspective. Chapter 3. Physician Misconduct.

An important preface to this blog is that in my opinion rape involving the penis of the perp entering a woman's vagina should have no statute of limitations, and rapes that had been covered-up in the past by universities should be re-opened, especially if the victim was by some measure further traumatized by the conduct of the university to undermine her. The administrators who were part of the cover-up should face consequences including being sued and prison-time.

Rape involving penis in vagina (PIV) is really far different and far worse than all other forms of sexual molestation. In addition to the possibility of contracting an infection, which can be fatal (eg HIV AIDS), pregnancy itself can be a very dangerous prospect, with maternal mortality by no means being rare, and in the USA having a much higher incidence than in many other developed nations. Then there are all the permanent changes to body morphology in pregnancy that a woman has to endure, also the potential dangerous complications of delivery. If a woman is very young, pregnancy and having a child changes entirely the trajectory of her life. All of this would take a chapter or more to describe.

Major issues with how justice is served, is that it is generally random, rarely blind, and in the current age, based primarily with how popular the account is to the viewing audience of the media describing the events, and how responsive the community involved is to the particular media. A striking example of this, a senator from one political party was forced to resign because he may have clutched the clothed gluteal region of some women with whom he was photographed in public with. Another politician running for senate from the opposing party it was fine that he allegedly PIV raped a few young women in his car by a dumpster behind a restaurant. Justice really is a Bingo system based popularity contest. This does have to change. Justice should be rational, have consistent penalties, and be consistent for all individuals who experienced a certain form of molestation.

PIV is an entirely separate category on its own of sexual molestation- the penalties for the perpetrators, and the administrators covering it up should be exceedingly harsh to demonstrate that society takes a stern and consistent stand against this.

George Tyndall, MD claimed he was not guilty of misconduct. I am not familiar with the details of his case. But may be he is right?

There are a few factors one has to consider in this matter:

1. many physicians are paternalistic. Training and medical practice in the 1950s through 1990s accepted as standard, that physicians were authoritarian and paternalistic in their approach to patients. Patients were on a lower level and the physician on a dais of authority.

2. heterosexual men like looking at images of naked young women. Estimates of how much pornographic material is on the internet of the total amount of information, suggest that In the 1990s pornography represented 30% of the total content of the internet. Current estimates range from 4 - 20%. 87% of the viewing audience is male, 13 % female. Heterosexual males approximately 90% of the male population. The bottom line being there are a lot of heterosexual men who like to look at images of naked women. Perhaps 95% of the heterosexual male population between the ages of 15- 20 (probably much broader an age group) would consider a job where you look at and touch the private parts of 20-30 year old females and making a lot of money, the best job possible.

3. Speaking as a heterosexual male physician, my opinion is that the general opinion of 3rd and 4th year male medical students (for me that was in 1983) is that male students who went into Gynecology had a greater than the normal high interest of heterosexual males in looking at naked women.

4. There is no formal training in bedside manner in medical school. I think this is still true. Doctors generally are socially awkward, because they have been book worms and nerds growing up. Others are just pompous and self-entitled. So bed side manner for doctors in general is not good, then compound it with how does one have an appropriate bed side manner as a 50 or older male in examining the vaginas of 20-30 year old women. It is an awkward situation, and one can imagine that even reasonable men may say off- color or embarrassing remarks, in their attempt to calm the experience. These may be innocent in nature, although it is not uncommon for older men who are physicians to try to show their humor through odd sexual innuendos. I have seen this commonly in physicians who are now in their 70s and 80s, this was a general norm of conduct during their practicing years. Dr Tyndall was 72 when facing these charges. Part of their poor bed side manner may also be to be too rough in moving female patients, which the doctors perhaps also used to signify that they were not showing sexual interest towards them.

5. The estimates are that atleast 25%, and perhaps up to 50% of women have been raped or in some fashion sexually molested. This is not to excuse inappropriate behavior of male doctors, but the tragic reality is many women have to deal with this, and to learn to carry on a normal life have to sublimate that experience. So a pervy experience with a male Gynecologist is unfortunately part of the experience of mistreatment that perhaps 50% of females have had to deal with independent of the doctor. So the trauma is not terrifyingly unique nor with permanent physical debility. Perhaps 50 years ago 75% of females had experienced sexual molestation, and for the million years prior to that of human development probably 90% +. This is not intended to say that pervy male Gynecologists are ok, but rather that this is by no means a uniquely damaging experience that women are likely not to be able to recover from.

Historically I have always thought and said if asked, if I were a woman I would not see a male gynecologist, because they likely have too great a personal interest in female genitals, More recently, being brought to reflect on this subject, by the Tyndall case, and other such as James Heaps MD, that perhaps male doctors who are more keen to look at vaginas may actually be better Gynecologists than if they were indifferent or find them repugnant? Maybe men who like, really like, looking at vaginas may actually be better Gynecological doctors. I reflected on my days as a medical student on pediatric Emergency Room rotation. There was a female gynecologist who ran the adolescent gynecology program. The university hospital was a downtown hospital that served the indigent population. Many of the adolescent girls who came in were what we called at the time prostitutes, but now I realize primarily sex slaves. The gynecologist taught us that when we remove the speculum from the vagina we had to sniff the speculum, in order to detective infections like gonorrhea. There was no way I was going to intently sniff the speculum, and if I had to perform this procedure in front of the gynecologist I would make a passing en passant sniff of the speculum. But I suspect that male medical students who really enjoyed vaginas may have experienced delight in doing this.

My point is this, I am now of the opinion that male doctors who I had previously thought were probably perverts and to be avoided, may actually be even better doctors at doing what they are doing: examining vaginas, because they really liked to do it.

So, the reality is, a male doctor with awkward and maybe atrocious bed side manner and showing too much time and too much interest in looking at vaginas, may actually be very good and perhaps even better than other doctors at doing their job.

Being a little pervy is not the same as being an incompetent or dangerous physician - perhaps even at times may be the opposite.

The most important aspect of being a doctor is to be competent in managing the health of the patient. I do not think this is how George Tyndall was being judged. Poor doctors are doctors engaged in damaging misconduct and are those that are either incompetent or are impaired by alcohol or drugs.

I fear that these enormous settlements against Tyndall and Heaps open the flood gates to go after other male Gynecologists whose major misdeed is that they have poor bed side manner. We already see this with other cases in southern California and elsewhere.

This is the problem with having the media and lawyers as the watch dogs of medical conduct.

Over 1.1 billion dollars was paid out to victims of pervy behavior of a doctor at USC. One of the major problem with this, is where does the 1.1 billion dollars come from? It does not magically appear. It probably has the effect of decreasing programs at the university, decreasing new equipment for various programs, lowering salaries of faculty ,and raising tuition for students. If the accusations against Tyndall involved PIV then my stance would be dramatically different. Otherwise it seems he was just a pervy old man, but possibly a very good doctor.

It really should be physicians such as myself, with a strong peer-reviewed background in patient safety that are the arbiters of physician conduct and misconduct. Otherwise I could envisage many male Gynecologists labelled as miscreants with huge settlements against their institutions, probably psychiatrists as well. They are males and probably have an excessive interest in female genitals, but that does not make them bad doctors, that maybe just makes them heterosexual men.

USC President Carol Folt said : "I am deeply sorry for the pain experienced by these valued members of the USC community. We appreciate the courage of all who came forward and hope this much needed resolution provides some relief to the women abused by George Tyndall."

It is worthwhile to mention this statement from Folt, because I will get to, in a future blog, how her conduct was dramatically different in a much worse medical misconduct case at the university she left in some shroud of controversy, where she was the Chancellor. I wonder what the settlement was for the 5 female students who spoke up about molestation they experienced at UNC when she was Chancellor there? I doubt it was settlements in the range of 100s of thousands or millions, as occurred at USC a few years later. The extent of molestation should be equally compensated at a university if it occurred by another student or by faculty - it is the injury sustained which is the critical element. If they experienced PIV rape by another student, that is much worse than too lengthy and awkward a pelvic exam by a doctor, if he is doing the exam for an appropriate reason. The former likely traumatizes a woman for life, the latter a weird experience by a strange doctor.

An interesting aspect of the legal settlements is that the lawyers who represented USC offered a flat settlement to all patients in a 3 tier class action settlement, where any patient of his could receive $2,000 and the amount received advances to $250,000. Taking part in the process one had to agree not to file an individual case. I wonder what women who experienced PIV rape at other institutions think about these young women receiving $250,000 because a pervy, but possibly very competent, male Gynecologist showed too much pleasure in doing medical pelvic exams.

Regarding Folt and her using the expression 'valued members in the USC community' for the victims- she took a dramatically different position when confronted with a report of numerous young female doctors being coerced at UNC. Apparently because they did not speak up, they were not valued. Also blanket legal settlements for all individuals who were seen by a doctor, who was involved in misconduct, was also not considered at UNC. This approach seems like an excellent approach for individuals who were victims of true misconduct but did not realize they were. I will write much more pointed blogs on this in the near future.

Further fallout includes, a female who had experienced PIV assault at that or another university over the last decade and had been humiliated by university administration while the perp somehow was rewarded, would view these settlements as reflecting the arbitrary and gross miscarriage of justice. They actually should be allowed to have their cases re-opened. Those victims should receive settlements in the 100s of thousands to million dollar figures. A quick review on the internet can readily reveal institutions that have been involved in this horrific miscarriage of justice, so I do not need to describe this particular rogue's gallery of misconduct.

So, pervy doctors are not necessarily bad doctors, and may actually be very good at what they are supposed to do: care for the health of the patient. These kind of legal settlements at USC and UCLA should be reserved for circumstances where physicians are actually incompetent or impaired and have caused injury or death to patients, and where senior administration has covered it up at the time, and also at later dates. As it stands right now, if I was a hard working and competent male Gynecologist I would be worried that a collection of women may now report me that I had done somehow something too sexually forward on them. At the same time, if I was incompetent or impaired, so far everything would be fine and I could just carry on doing what I am doing, especially safe if somehow I had some dirt over senior administrators or was a pal of theirs.

I would like to change this dangerous paradigm in health care. Educated experienced physicians with a solid background in patient safety should make these determinations, not lawyers, administrators or the media.

Richard Semelka, MD