Abuse Scandals Involving Doctors Have Shaken Several Colleges. Now Others Are Making Changes.

When top officials at North Carolina State University’s student health center huddled this summer to discuss how they respond to patient complaints, headlines from around the nation were at the front of their minds.

Just as one doctor-abuse scandal seemed to leave the national spotlight, another would emerge. Larry Nassar’s abuse of Michigan State University athletes brought both turmoil and turnover to the campus. An investigation by the Los Angeles Times accused George Tyndall, the University of Southern California’s only gynecologist at a student health center, of inappropriate conduct.

And Ohio State University disclosed that more than 100 former students had said they had been sexually abused by Richard Strauss, who worked as a wrestling team doctor and for student health services. Strauss died in 2005.

Julie Casani, who started as director and medical director of North Carolina State’s student-health-services center last year, began asking questions. Are comment cards available for students? Could what happened at those other campuses have happened here? And, crucially: Do we have any open complaints?

“The answer to that was no, which was a great thing to hear,” she said.

North Carolina State isn’t alone in looking inward. Allegations of physician abuse at research universities — and poor oversight that may have exacerbated it — have forced institutions nationwide to reassess their own practices.

Many universities have found reason for at least some change. Campus officials have revised some policies on doctor-patient interactions, trying to take a proactive stance to protect students — and to defend their universities against the legal, reputational, and financial woes that come with large-scale scandal.

When one individual holds too much power within an institution, that can lead to trouble, said Chad Asplund, president of the American Medical Society for Sports Medicine and director of athletic medicine at Georgia Southern University. Institutions that place multiple checks on physicians “are less likely to have a Nassar-like or a Strauss-like occurrence,” he said.

He characterized the recent scandals as outliers in a broad culture of physicians that reveres the “do no harm” creed.

Still, institutions around the country are bulking up their policies with an eye toward patient protection.

In some cases, they are rethinking what happens when patients accompany physicians inside the examination room. In an inquiry that cited many failures of policy and oversight at Michigan State, state lawmakers criticized the university for failing to require a chaperone in the room during all “sensitive examinations or treatments of minors.”

During certain intrusive examinations, the University of Illinois at Urbana-Champaign will start asking all students whether they want a third party in the room. The practice now is to ask only students who are seen by a physician of the opposite sex.

The University of South Carolina will add language to its student-health website, telling patients they have a right to a request a chaperone at any point.

Other institutions are aiming to make it easier for students and other patients to express concerns. Northeastern University expanded the responsibilities of a new patient-advocacy position, created last year. The advocate was initially hired to keep tabs on wait times. After the national scandals, that staff member is now responsible for tracking down answers to questions and taking reports of misconduct.

“What happened at USC has put a highlight on part of the scope of that work — which is to be a true advocate for students and to be a place, and a visible place, where complaints and concerns can be lodged immediately,” said Madeleine Estabrook, Northeastern’s vice president for student affairs.

In some cases, protecting students means explaining what happens when institutions fail.

Gathered this summer in advance of the fall football season, players at Texas Tech University heard a Title IX trainer tick off specific examples of institutional abuse, mentioning Michigan State, Ohio State, USC, and Baylor University, a conference foe whose failings felt close to home, said Judi Henry, the university’s executive senior associate athletics director. In lawsuits, female students have accused Baylor of mishandling their reports of sexual assault.

Athletes learned about consent and about how to report abuse, she said. And the examples, though challenging to absorb, helped them grasp the message.

“It’s real, it’s ongoing,” she said. “And it’s happening — at this place, this place, and this place.”

‘Some Concerns’

One lesson of the scandals: Abuse at a university health center implicates the entire university. Repercussions have extended to all levels.

C.L. Max Nikias and Lou Anna K. Simon, presidents of USC and of Michigan State, pledged to resign after victims came forward. (Nikias resigned on Tuesday; Simon resigned in January.) Hundreds of patients, in lawsuits, have accused USC of failing to protect them from Tyndall, the Los Angeles Times reported. Michigan State will pay $500 million to Nassar’s victims in settlements.

In each case, groups have pointed to poor oversight or policy loopholes that may have allowed the abuse the continue.

With this backdrop, senior campus administrators have started questioning their own campus health-clinic leaders in the wake of the scandals.

Indiana University’s general counsel is examining internal controls to make sure they adequately protect students, a spokesman said. Erin Baldwin, director of Iowa State University’s student health center, said she discussed with senior leadership whether they needed to make any practical changes after the scandals elsewhere.

Reading about the Michigan State case raised “some concerns” for Lowa Mwilambwe, associate vice chancellor for student affairs at the University of Illinois at Urbana-Champaign, whose division includes the university’s McKinley Health Center.

On top of legal, financial, and reputational challenges, he realized, large-scale mistakes could ripple elsewhere, including in enrollment. So Mwilambwe made sure to talk to the health-center director about effective procedures around the nation and how theirs measured up. “I wouldn’t be a good administrator if I didn’t,” he said.

Many administrators who oversee patient care say vetting processes and mechanisms for responding to complaints are already extensive at campus health centers, which are obvious options for students seeking care. Survey data from the American College Health Association from 2010 show that students visit a campus health center about once each year, with greater frequency at rural campuses.

Administrators cite thorough background checks, regular review of student feedback, high accreditation standards, and regular check-in meetings with student-affairs leaders as ways to prevent misconduct and, if necessary, catch and resolve potential problems. More than 80 percent of the institutions that responded to the association’s survey reported providing primary care, urgent care, gynecology, and health-promotion services.

Still, at a recent American Medical Society for Sports Medicine conference for new sports-doctor fellows, Asplund said, officials used an opening address to call attention to doctors’ core responsibilities of integrity and smart decision making.

Since the Nassar case, he said, “we made sure they were emphasized.”

Lindsay Ellis is a staff reporter. Follow her on Twitter @lindsayaellis, or email her at lindsay.ellis@chronicle.com.