The role of a medical professional requires the assumption of many responsibilities, among them, the duty to report. The duty to report is a licensee’s individual obligation to report violations of law, rule, and code of ethics standards to a state medical board. Although many boards have duty-to-report regulations, licensees often struggle in grasping their full responsibility.

Any profession, and any institution, has an instinctive reflex to circle the wagons, engage in secrecy, and protect its reputation by turning a blind eye to misbehavior within its ranks. The irony is that this reflex damages the profession or institution all the more by allowing bad physicians to continue practicing.

It also hurts the profession in a way that is profound and significant: A failure to report a colleague’s misconduct betrays the mission of the health care professions, which is to serve and heal the public.

The public rightfully becomes jaded about the medical profession as a result, and this leads to hesitance on the part of the public to seek needed care. Those who fail to report the misconduct of a colleague are complicit.

A very recent situation in Ohio highlights the importance of the duty to report. Richard Strauss, MD, who died by suicide in 2005, was found to have sexually assaulted at least 177 male students while working as a physician in a university’s athletic department and/or student health center from the late 1970s to mid-1990s. In response to the uncovered information, the governor of Ohio assembled a working group to investigate the SMBO’s practices, protocol for sexual abuse allegations, current rules and the details of the Strauss case. The SMBO was then tasked by the governor to update its internal processes and review the past 25 years of sexual misconduct cases.

Ohio has both laws and rules that require medical professionals to report certain behavior to the board. In the Strauss situation, adherence to these regulations may have helped to avoid decades of egregious abuse by a licensed physician. In the aftermath of this tragedy, the SMBO was able to use the recommendations offered by the governor’s working group to improve its handling of sexual misconduct complaints and strengthen Ohio’s duty-to-report regulations, protecting the public from dangerous providers.

The duty to report is not a new requirement in Ohio. Before these changes were implemented, Ohio’s regulations defined provider responsibilities and the possible consequences of violation — including disciplinary action by the SMBO and fines up to $20,000. Despite these existing requirements, in 2016, the SMBO was presented with a case in which a physician, Robert Geiger, MD, failed to heed the importance of the law.

Dr. Schottenstein recalls the experience from his perspective as an SMBO board member:

The case of Dr. Robert Geiger was a watershed moment for our board, and for medical boards around the country. Historically, it is very rare when a physician loses his or her license for keeping quiet about health care professionals who engage in misconduct. There has historically been a code of silence in the culture of health care professionals. There is a certain natural discomfort at the thought of reporting a colleague to a medical board. There is a desire to not get involved in an uncomfortable situation, and to not make waves. And there may be concern about retaliation for speaking up, either professionally or personally.

And regrettably, medical boards have historically not stepped up to educate their licensees about the importance of the duty to report misconduct. Medical boards are more substantially concerned about those licensees who engage in violations, rather than the licensees who knew about the violations but kept silent.

That all changed for the SMBO when a decision was made to investigate the allegation that Dr. Robert Geiger was aware that another physician in his practice was engaging in the sexual abuse of patients. Rather than report this to the board, Dr. Geiger chose to keep silent. During the hearing, it became clear that Dr. Geiger had been made aware of the other physician’s behavior but turned a blind eye because of concerns about the reputation of the practice. Dr. Geiger defended his behavior by pointing to Ohio law, which requires a doctor to report a colleague if there is a belief that the colleague engaged in offensive behavior. Dr. Geiger denied that he had formed that requisite belief.

The SMBO was skeptical of his denial, based on staff witnesses to the behavior, and Dr. Geiger’s own communications about it. There was a sense that the physician rationalized his failure to report to the board and the board ultimately voted to permanently revoke his license.

This response portrays the gravity of the licensee’s individual responsibility. The duty to report must be inculcated as one enters medical school. And it needs to be conveyed from the leadership of health care institutions and medical schools. CME dedicated to this topic should be required. It is the right thing for the public, and for the profession.

Although there is often fear or ambivalence about reporting a fellow practitioner, medical professionals may be some of the most uniquely positioned individuals to identify and report misconduct; and duty to report extends beyond sexual misconduct to impairment, standard-of-care and prescribing issues and other violations that put Ohioans at risk. Regardless of individual perception, there is a cost with failing to report. Not only is the well-being of patients threatened, but the damage done to the profession can never be undone.

Preserving the importance of the duty to report has required an evaluation and update of existing board processes. In most cases, the first interaction medical professionals have with a medical board is when they are completing an application. The SMBO voted to add a new, mandatory section to its application process to ensure those applying for and renewing licenses are aware of the duty to report. This language not only acts as an alert to new applicants but also serves as a reminder to existing professionals of their licensure responsibilities.

The new language states:

Do you acknowledge your personal duty to report to the State Medical Board of Ohio when you believe that any individual licensed by the Board has violated the Board’s laws or rules?

Violations include, but are not limited to, sexual misconduct, impairment, practice below the minimal standards of care, and improper prescribing of controlled substances.

Reports of misconduct to supervisors, law enforcement or health care system management do NOT fulfill your duty to report to the State Medical Board of Ohio; failure to report could result in formal disciplinary action.

Yes □ No □

The SMBO also approved and adopted a requirement for continuing education about a physician’s duty to report misconduct. Effective May 31, 2021, licensees are required to take a dedicated one-hour course to renew their license every two years. To fulfill the requirement, the board has created an interactive, educational video, which is available at med.ohio.gov. The video not only explains the duty to report but also clarifies the complaint and investigations process, shares resources and provides instructions for reporting.

The SMBO has also discussed potential legislative amendments to fortify the duty-to-report framework. These amendments could expand the definition of sexual battery to include sexual contact and sexual conduct in the Ohio Revised Code and to define “medical treatment” to provide more clarity around the situations in which providers can be held responsible for their actions. Similarly, the SMBO is seeking to amend several statutes that would require the prosecutor or court to notify it of a licensee’s offenses.

Patient care and safety — as well as the livelihood of licensed providers — are impacted by decisions of the SMBO as it acts in its capacity as a regulatory agency. This is why education is an important precursor to enforcement of Board regulations. The SMBO has recently increased its outreach and education efforts, accessible online resources and frequency of communication with the licensees it serves. To disseminate this important information, the SMBO has begun employing a variety of tactics:

  • Presentations: As part of outreach efforts, SMBO staff will deliver tailored presentations to practitioners across the state, making sure they know their responsibility and the support system the board has in place. Duty-to-report slides will also be incorporated into any presentation delivered by board staff, regardless of the topic. This has already taken place with medical school presentations.

  • Posters: Visual reminders are powerful tools to reinforce important messaging. The board will create and share posters with the imperative to report violations of the Medical Practice Act and the needed resources to contact the appropriate parties.

  • Video: The board has combined narrated content and interviews into a polished, educational video for licensees. The video covers the topics of duty-to-report regulation, the complaints/investigations process, sexual boundary education, disciplinary actions, available SMBO resources and how to report to the board. The final video has been shared with licensees and includes interactive quiz questions based on the presented content.

  • Education and Outreach: The board is often asked to staff a display table at medical conferences. These interactions, even virtually, provide another avenue to share information about the duty to report and to answer licensee questions.

  • Website and Digital Communications: The board uses multiple online platforms to share information with its licensees, including targeted emails and website articles.

  • Sexual Boundaries Videos: The board has created a patient- and licensee-facing video to provide education around sexual boundaries in a provider-patient relationship. Viewers are also instructed how to report misconduct.

Another outcome of the work accomplished in response to the working group’s recommendations is the SMBO’s sexual-misconduct transparency dashboard. Transparency is often a sought-after goal and important for public trust, but it also has defined limitations in a public agency’s administrative processes. The transparency dashboard highlights efforts to increase accountability and integrity among Ohio physicians and practitioners. On it, the SMBO displays its progress in implementing changes, the historic sexual misconduct case review, a “heat map” of reported sexual misconduct complaints in Ohio and the number of complaints opened and closed on a monthly basis. The dashboard is hosted on the board’s website at med.ohio.gov.

As important as it is to identify the need for duty-to-report regulations, it is of equal importance to establish a mechanism for reporting and a method of communicating the information with the intended audience.

In Ohio, one can file a complaint against an SMBO licensee by going directly to the state’s licensing website or by navigating through the board’s website. A “File a Complaint” button has been placed on the board’s homepage for easy accessibility. Once opened, the page provides information about filing a complaint and the types of violations under board jurisdiction.

Individuals may also call the SMBO to file a complaint. At the end of 2019, the board created a confidential hotline as an alternative method to file a complaint, available to both licensees and the public. The board announced this information on its website and in its monthly electronic newsletter, emphasizing the confidentiality of all complaints received.

Pervasive change in reporting culture will require intentional preparation and execution. The SMBO is committed to regularly communicating the duty to report, replicating successful strategies and seeking to strengthen its existing regulations.

The inconsistency of licensees reporting violations committed by fellow licensees will not change overnight, but the board believes that — with continuity and the collaboration of regulators, health systems and individual providers — the duty to report can become a widely accepted and valued aspect of practicing medicine.

About the Authors

Jerica Stewart is Communications Officer at the State Medical Board of Ohio.

Michael Schottenstein, MD, is a psychiatrist and physician board member of the State Medical Board of Ohio.