Medical School, #MeToo, and Toxic Men Keeping Jobs

written by Valerie Morales

Before the culture was reshaped and reorganized, women were silent. It didn’t matter who they were, how much salary they earned, or how much responsibility was on their agenda. Their workplace trauma was absorbed into the day to day. Forced to heed to the whims of abusive men and pretend A was not B, and B was not C, and that men were not spewing garbage at them, or worse, touching them without consent, women walked the fragile line of a subordinate.

But Meenah Zareh didn’t heed to the old way of doing things. A medical fellow at the University of Southern California (USC), she filed a complaint of sexual assault against USC and L.A. County USC Medical Center. According to the complaint, Dr. Guillermo A. Cortes backed Dr. Zareh into an empty call room, shut the door, and molested her by reaching under her scrubs. Once the accusation became public, two other women came forward and accused the physician of similar sexual assault allegations.

Dr. Zareh waited three months to report the allegations because she was frightened of retaliation. The physician she accused had a half-brother who was a USC faculty member and a director of another cardiovascular fellowship program. When she finally told administrators, it was as imagined, and, the end was the beginning. She was gratuitously retaliated against. One of her mentors said, “you knew what you were doing.” Another suggested she take a leave of absence. Or, that she change fellowship programs.

Dr. Zareh filed a lawsuit and shortly thereafter the Accreditation Council of Graduate Medical Education (ACGME) began a review of the cardiovascular fellowship program at USC. Late last week, USC’s cardiovascular fellowship program had its accreditation revoked. The fellowship will be on probation until 2020, giving all students a chance to finish their fellowship. And then the cardiovascular fellowship will be disbanded. There is no appeal.

There has been a lot of applause for the decision- despite its catastrophic consequences. Complicity however is transactional. It creates unintended consequences for the unseen and naive. L.A. County-USC hospital now has the burden of loss for its indigent vulnerable. The fellowship’s end will impact the number of trained physicians working with cardio patients. As a medical unit, L.A. County-USC hospital is weaker today than they were yesterday.

Dr. Zareh’s lawyer, Leslie Levy, was quick to point out that the lawsuit wasn’t what caused ACGME to look into USC. Another survivor was the impetus. Nevertheless, what happened to Dr. Zareh (and other victims of Dr. Cortes) was evidence of how USC looks away when victims of sexual assault demand fairness and justice. “There is no one to blame but the people in power who had the ability to correct the iniquities and failed to do so” Leslie Levy said.

USC has over 1,000 residents training in a variety of medical fellowships. The accreditation revocation has struck a nerve and there is tension. Perhaps other fellowships are in danger. Sexual assault isn’t a stigma at USC. It is a thing.

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Two years before Dr. Zareh’s lawsuit, the dean of USC’s Keck School of Medicine, Carmen Puliafito, regularly hosted drug parties and entertained escorts and prostitutes. There were warnings that the Harvard Medical School grad had a decadent past that went unchecked. He had been previously investigated for sexual assault when he was employed by the University of Miami. But Dr. Puliafito’s fundraising- over a billion dollars in donations to USC- immunized him from scrutiny.

But when a 21 year old companion of Dr. Puliafito’s overdosed in his Pasadena hotel room, the absurdity of his behavior and the privilege of his position at USC dovetailed. He was symbolic of the consequences when oversight and accountability are lacking and when privilege is unchecked over time. The outrage was intractable and swift.

Puliafito was accused of abusing meth and ecstasy and other narcotics. He resigned as dean but USC never filed a complaint with the California Medical Board. The Los Angeles Times uncovered he was still practicing medicine. The state then stripped him of his medical license. They found he was smoking meth right before seeing patients and that he willingly passed out drugs to criminals. His replacement at USC was Rohit Varma.

Dr. Varma wasn’t saintly either. In 2003, he tried to coerce a student he was supervising into sharing his hotel room at a conference by blaming it on the grant’s fine print. Dr. Varma then threatened to have the international student’s visa revoked. The student then sued him and USC settled but Dr. Varma was able to keep his professorship if he went to counseling. His background was uncovered after he became dean of the medical school. Then he resigned.

In February, USC paid more than $200 million dollars in damages to the sexual abuse victims of Dr. George Tyndall, the university gynecologist accused of molesting patients for over 25 years. USC only acted when a nurse called the rape center on campus. The complaints from over 100 women were never reported to the California Medical Board. USC doubled-down on their enabling a predator behavior, saying they did not have a legal obligation to report Dr. Tyndall, as if they are not required to uphold a standard of morality, decency and safety.

More sex assault charges were forthcoming when Dennis Kelly, the former sexual health physician, was sued earlier this year by gay and bisexual students for sexual battery, sexual harrassment and gender violence. Dr. Kelly was a 20 year USC employee; he resigned last August.

It’s all so sinister and depraved. But the definition of culture is the shared attitudes, values, goal and practices that characterizes an institution or organization. USC has demonstrated through their enabling of sexual predators that their culture is one in which men have the privilege to create sexual trauma uninterrupted and without punishment. Victims aren’t believed until an objective third party does a review.

Despite the history of enabling abusers, it would be foolish to gaze at USC through a venal prism, as if they are somehow a strange outlier in sea of moral equity, that they are that reprehensible school that just can’t stop hiring sexual predators, that they renew and reinvigorate the powerful. Undervaluing sexual abuse and its victims is the hagiographic record of graduate education. It is persistent, like a super virus, and it is everywhere. Look at Yale.

Michael Simons, a Yale School of Medicine professor, received an elite honor in 2018: the endowed Waldemar von Zedtwitz chair. This came after a university committee found he had sexually harassed a postdoctoral researcher in 2013. His punishment for sexual harassment? He was barred from leadership for five years. But because men have to save other men and at an accelerated rate, Yale’s provost, Ben Polak, reduced the punishment to 18 months. Last fall, over 1,000 signed a later to Yale’s president, Peter Salovey, expressing their disgust about the honor given Simons. Simons was then stripped of his leadership position as endowed chair. He sued Yale, saying in part, he was already punished for the sexual harassment and paid his penalty. He blamed #MeToo for the “disproportionate response.”

“Doctors in training work in high-stress, life or death situations, often late into the evening when hallways are empty. It’s a perfect storm for aggressive sexual behavior and harassment” noted Dr. Timothy Johnson, ObGyn and Women’s Studies, University of Michigan.

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To peel sexual assault like an onion, layer by layer, leads us to a familiar and uncomfortable place, a shadowy world of microaggressions, insults, objectifications, exclusions, as well as sexual advances and assault.

The 2017 Medical School Graduation Questionnaire of the Association of American Medical Colleges (AAMC) found that only 21% of students who experienced some level of harassment reported the behavior. 37% said they didn’t report because they didn’t think anything would be done. 57% said they didn’t think it was important. Fear of retaliation was given by 28% of the respondents in the AAMC survey. Only 9% said they didn’t know what to do.

If #MeToo is victorious as a culture shift it is because women are aware of their options. A new hashtag #MeTooMedicine has pulled the soiled bandage off the wound and women in medicine are telling haunting and painful tales of being groped, singled out for their breast size, forced into kisses. One resident in Florida was called a “slutty whore.” Because women are consistently being told not to rock the boat and not to call attention to themselves and to suffer through it, the path of least resistance is to ignore it. But what if you cannot?

“As physicians climb up the ladder, the rules change. You have a faculty member who is very valuable to the institution, or a director who brings in revenue from grants, or a principal investigator who holds Nobel prize. They seem untouchable. But we know that we can and must change that perception” said Dr. David Acosta, AAMC chief diversion and inclusion officer.

Last year, Dr. Carly Goldstein sued the University of Maryland, Baltimore for sexual harassment. Vascular surgeon and professor, Dr. Robert Crawford is responsible for her trauma, according to her legal filing. The harassment was during the years of 2014–2017. Dr. Goldstein would seek a signature for Dr. Crawford on necessary documents. He would only agree if she accompanied him to a bar. At one of the bar outings “he touched her legs and thigh and commenced kissing her against her will” according to the lawsuit. The bartender noticed and came over to ask if she needed help. She took the opportunity to grab her purse and run.

After her rejection of him, Dr. Crawford tried to have Dr.Goldstein fired. An ally of hers, a male vascular surgeon intervened on her behalf but said she should be prepared for these kinds of things because she is a “pretty” girl.

While the university agreed Dr. Crawford made advances, they could not determine if the advances were unwelcome. They did rule that his judgement was not in accordance with his leadership role and his contract was not renewed. Dr. Crawford was also accused by other women of sexual harassment. Two surgeons left the vascular department because of Dr. Crawford’s harassment. He is now employed at Emory.

If it seems similar to the Catholic Diocese where abusive priests are moved around and around, then it is intentional. The privilege men have is their power is divine. Because they are getting away with sexual harassment and sexual assault crimes, their entitlement supplants the human capacity to express empathy. It is creating a backlash vacuum where social movements like #MeToo and #MeTooMedicine demand equity. And accountability. Discrediting survivors is no longer a defense to remain employed. The comfort of men is suddenly a non-sequitur.

After Dr. Varma resigned as the USC dean, Laura Mosqueda was named the new dean, as a way to stabilize the rocky boat. It’s an encouraging trend, women in leadership positions. The number of women at the Mayo Clinic has doubled since 2010. Yale hired a women to chair the Department of Surgery, a position held by men all over the country. Focus on Health and Leadership for Women has a budget unparalleled for Women In Medicine and the University of Pennsylvania is responsible. Women in positions of power and influence will not erase sexual harassment, dirty jokes, inappropriate behavior and touching, but their visibility and power sets a tone as women lead male dominated departments absent the authoritarian rigidity of their male counterparts. Their presence encourages victims to not disappear into their trauma but to speak loudly and clearly. Equity is no longer owned by men and rented by women.

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“The greatest predictor of sexual harassment is perceived organizational tolerance” Dr. Timothy Johnson, University of Michigan.

At USC, behavior was ignored and abusers accumulated social capital. But the days have disappeared when men could harm women by their insinuations, jokes or assaults and women just buried it into the dirt and excused the ones who were harming them, as if it was nothing more than a perfect storm that would soon fade away. Appeasing the abuser seems absurd in these torturous times.

A decade ago, Dr. Zareh may not have come forward. The culture insisted upon silence in order to maintain the fallacy of male decency. Many victims were trapped. They had worked hard for their fellowship program and simply refused to let it be derailed by a toxic man bullying them with non-consensual sexual behavior or insults. A generation ago, speaking up would have harmed Dr. Zareh’s chances of completing her fellowship and her career would have been tainted. She would have been labeled a trouble maker, difficult, and bitter.

On January 7th, a group of surgeons that included medical residents and faculty wrote a letter to University of Maryland, Baltimore (UMB) President Jay A. Perman, and School of Medicine Dean E. Albert Reece about inappropriate sexual relationships that were responsible for a “hostile work environment” in the medical school and hospital. The letter pointed to a surgeon who was having sexual relations with more than one subordinate. They also spoke of another surgeon who made “racial slurs and sexual commentary.” Being a female surgeon is now hazardous and risky and violent. But being a female surgeon is not a position of silence and submission.

“We don’t understand why you continue to promote men who abuse their power, fuel a culture of inequality and further extend a work environment of hostility.”

The physicians and faculty ended the letter appropriately. They signed it #MeToo.