Question: Just how is it that despite numerous ethical complaints from patients, physicians keep working?
In recent years this topic continues to be a problem, from abuse of Olympic athletes to major HIPAA violations and inappropriate behaviors. To be honest, I could post about this sort of abuse every week and not run out of material. I could write a book of such cases – and have more than enough to discuss. So, why does this keep occurring?
Dr. Ricardo Cruciani
In a recent Yahoo.com article by Roni Caryn Rabin (October 11, 2021), we are introduced to Ricardo Cruciani, M.D., who worked out of a prestigious New York City hospital. Cruciani’s specialty was pain management. As it is unfolding, he relieved physical pain, and in return, he delivered a double-dose of psychological pain. He was able to do this by prescribing powerful drugs and create a kind of domination/dependency cycle.
Cruciani was said to be brilliant but he was a predator.
He hooked those having intractable pain on opioids, but allegedly, with certain women, as he increased dosages and varied medications until they became dependent on him, he became sexually aggressive.
One patient who came forward, said “he became more aggressive, groping her and masturbating in front of her, she said. Then he forced her to perform oral sex. When she resisted, he withheld refills of her prescriptions.”
I have written about opioid addictions in the past. The drugs are responsible for tens of thousands of deaths, hundreds of thousands of dependencies and are major contributors to the nationwide homelessness problem. For the addiction, created in part by the cavalier attitude of “Big Pharma,” and physicians such as Cruciani.
Cruciani knew how much certain patients needed to relieve their pain. Perhaps, in his mind, he rationalized it as a quid pro quo, i.e., “I will help you, if you do something for me.”
Moving Target
For several years, Cruciani would follow a similar pattern. He would move to a city, become a sexual predator, get numerous complaints, and move on to another city. According to the article:
“He was finally charged with sexual assault in Pennsylvania, registering as a sex offender and surrendering his medical license in a plea agreement in 2017. He still faces criminal charges in New York and New Jersey.”
The question lingers as to how physicians, despite complaints from institutions and from states to states, are free to practice and abuse again.
James DuBois, a bioethicist at Washington University in St. Louis said: “Physicians manage to continue practicing. Sometimes they move states to keep their license. Sometimes they just move institutions.”
The core problem, according to DuBois are peers who fail to speak up. Allegedly, some patients, hooked on massive doses of narcotics prescribed by Cruciani, became so addicted that other physicians refused to treat them. In fact, abused patients followed Cruciani to a new practice because they couldn’t find any other physicians who would agree to maintaining the high regimens of painkillers.
In lawsuits filed by patients, not only is Cruciani named, but also nurses, hospital administrators and staff members. They were all aware, they never warned other institutions or even state medical authorities. They all protected him.
Cruciani was able to practice “pain management” for 35 years. According to the article:
“Cruciani did not have a chaperone in the room when he saw female patients, and he resisted their entreaties to have a nurse or companion present. At times, he would take the patient into the room with him and lock the door, former patients claim.”
Ironically, none of the hospitals were aware of any problems. The pattern of complaints went back to at least 2005. He would increase his sexual advances along with increases in medications.
Oversite? Where?
No one, apparently, is ethical enough to say, “I knew there were problems and I elected to do nothing.” This “doctor” hooked women on opioids, sexually abused them and then when things got too hot or potentially litigious, he moved away. Healthcare professionals, am I getting that right?
Every time this type of scandal occurs, some “fool medical ethicist” (forgive my anger) will call for greater oversite and a higher degree of ethical behavior. It is lip service of a profession covering for itself.
Do I have a solution? Yes, I do, and it starts with my core philosophy that every choice must have a consequence. There are scant consequences. It must start with ethical training and it must be rigorous – and it must be renewable. State medical authorities, as well as medical schools, must mandate independent ethical instruction.
When ethical violations are reported, they must first be met with ethical counseling and the second offense must result in a suspension of license. I don’t care how “brilliant” a physician is portrayed to either peers or by virtue of meaningless online reviews. If there has been a confirmed ethical violation, it must be noted.
We are in a time of social change and I am tired of those arbiters who comment on what is and is not “ethical.” It is past time we elevated our standards from what is legally acceptable, to what is right. If a former football head coach can (and should) be pilloried for racist and sexually abusive comments he made 10 years before in emails, then sure as hell a physician who hooks women on painkillers and then sexually abuses them, must be out of the medical profession. It is time ethics returns to healthcare.
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