Risk factors for recurrence:
(1) history of sexual misconduct in the past (best predictor)
(2) history of other abusive behaviors (substance abuse, violence, etc.) in the past
(3) motivational factors in personality
(4) ego factors affecting inhibitory failure
(5) superego factors affecting inhibitory failure
(6) frequency of boundary violations
(7) extent of isolation in practice
Motivational factors: entitled and predatory factors tend to be resistant to change
(1) masochistic, with desire for punishment
(2) needy, such as under stress or with poor coping mechanisms
(3) entitled (grandiose, excessive self-confidence)
(4) predatory (dehumanizes and manipulates, lying common, ruthless towards accepting goals)
Ego factors:
(1) impulsiveness
(2) impaired judgment from substance abuse or mental illness
(3) failure to anticipate consequences of actions
Superego factors:
(1) lack of empathy, with failure to admit that the previous victims have been harmed
(2) failure to accept responsibility
Points for the Board of Directors to identify:
(1) The physician does not want contact.
(2) The level to which the physician accepts responsibility for actions (denies vs admits charges vs has gained insight into behavior).
(3) The extent to which the physician has been truthful about events, without lies or discrepancies.
(4) The physician shows evidence that he or she has made changes in behavior and appear better able to control self.
(5) The physician has taken steps to reduce risk, such as switching to a more public practice setting.
(6) They feel comfortable about the physician, enough to send a family member for care to the physician.
Options for the Hospital Board if the physician is already on the Medical Staff:
(1) full reinstatement
(2) reinstate with stipulations
(3) probationary, which may only delay the decision
(4) revoke privileges, with option to reapply after certain criteria met
Options for the Hospital Board if the physician is a new applicant to the Medical Staff:
(1) normal privileges
(2) privileges with stipulations
(3) probationary, which may only delay the decision
(4) deny privileges, with option to reapply after certain criteria met
