A Manhattan doctor was arrested this month for sexually abusing patients in multiple states over a 15-year period. Former pain management doctor, Ricardo Cruciani, abused numerous female patients at renowned medical institutions in the states of New York, Pennsylvania, and New Jersey, reports the United States Department of Justice. As espoused by U.S. Attorney Damian Williams, “Doctors like the defendant take an oath to do no harm. It is difficult to imagine conduct more anathema to that oath than exploiting patients’ vulnerability in order to sexually abuse them.”
Opioids as Bait
The U.S. Department of Justice alleges that the doctor would develop a personal relationship with his victims to create a false sense of trust. Since the doctor had the ability to prescribe or withhold pain medications, his patients (who were in extreme pain) were in a vulnerable position in which they became increasingly independent and the doctor increasingly abusive. The doctor has been charged with five counts of enticing and inducing patients to travel to other states so he could abuse them. Each of these counts carries a sentence of 20 years in prison. The Dr. attended to his patients in his medical offices and other locations for in-person appointments in order for them to obtain their prescription pain medication refills.
Taking Advantage of Vulnerability
It is easy to see why patients were in such a vulnerable position. Most were battling severe, chronic pain and Dr. Cruciani became a figure of power that could bestow or withdraw the only treatments that could quell their pain. The process of abusing victims involves various stages—including developing a personal relationship with them so that they trust their abuser. In the lawsuit, the victims claimed that there were various sexual acts committed, ranging from forced kissing to touching of intimate body parts, vaginal sexual intercourse, and attempted anal sexual intercourse. Of course, the Department of Justice stresses that the charges contained in the Indictment are accusations and that the defendant is to be presumed innocent unless and until he is proven guilty.
The Link between the Opioid Crisis and Sexual Abuse
There is a strong link between the opioid crisis and sexual abuse. As pills are more freely prescribed to patients who do not necessarily need them, the floodgates are opened to various types of abuse—including sexual and financial abuse. As reported by the BBC, currently some of the U.S.’s biggest pharmacy chains are currently on trial, the accusation being that they are fuelling the nation’s devastating opioid epidemic. Over the past few decades, millions of Americans have developed an addiction to these drugs via the over-prescription and abuse of legal opiate-based pain medication like OxyContin. This has overburdened the public health and police system and endangered the health and wellbeing of people of all ages. In the current trial, specific counties allege that the defendant pharmaceutical giants did not train their pharmacists well enough so they could put a stop to the improper sale of opiates. It is also alleged that the companies did not pay attention to employee complaints about inadequate safety precautions. As a result, millions of prescription drugs make their way to the black market.
How Often does Medical Abuse of This Type Occur?
A report on sexual violence of patients by physicians (DuBois et al, 2017) showed that it was not possible to give an accurate estimation of the frequency of sexual violations in the health field because most patients do not report the actions of an inappropriate doctor who has sexually violated them. One study estimated that less than one in 10 victims file a report. Factors such as poor mental health, power disparities, and emotional vulnerabilities can exist between physician and patient can exist. When sexual misconduct takes place, patients can have various long-term consequences, which include depression, PTSD, anger, trust issues, and more.
Signs Health Professionals May be Taking Advantage
It is vital for patients to be aware of signs that their medical professional may not be behaving appropriately. These include an insistence to see the patient alone, being left without clothing for no reason, or comments and looks that make one feel uncomfortable. Sometimes, the way a doctor touches a patient seems intended to produce sexual arousal; at other times, the doctor may recommend a follow-up appointment without an apparent reason. Initiating social relationships with patients is also considered a red flag.
Patients’ Rights Should be Respected
When you see a medical professional for an exam, treatment, or procedure, you should know and your rights so you can protect and/or enforce them if necessary. Basic rights include ending the appointment any time you feel uncomfortable, asking to have a chaperone in the room, privacy, undressing only the parts of your body the doctor needs to examine, having your questions answered, and having your pain and discomfort taken seriously. If, owing to religious reasons, you need to continue to wear certain jewelry or garments, this should also be permitted whenever it does not interfere with an examination. For instance, when having a CT scan, you will need to remove metal objects such as eyeglasses, jewelry, and dentures. Find out as much information as you can prior to the treatment or procedure so you can leave these items at home if you wish.
The DuBois report recommended various changes to reduce the risk of this type of abuse. They include teaching health professionals to respond to and report observed unprofessional behavior, demanding that medical boards take the responsibility for reporting sexual abuse to the police or prosecutors when the victim is an adult, providing formal training to chaperones so they can provide appropriate oversight, and empowering patients through education on the importance of reporting and the appropriate channels to approach. They should be taught not to accept inappropriate comments, since in 94% of sodomy cases and 88% of rape cases, abuse begins with this type of comment or with touching of the victim or other patients.
The recent arrest of a prominent pain medicine specialist is a reminder of the problem of predatory behavior from medical professionals. Most cases of abuse go unnoticed, yet they can leave long-term scars on victims’ mental health and wellbeing. It is important to make various changes, including better education of health professionals and the fostering of a greater awareness of how to stop incipient abuse (and be vigilant for signs of inappropriate behavior) when one is a patient.