September 25, 2022
(SEATTLE) — Between 1999 and 2015, more than 2,400 doctors faced public accusations of sexual misconduct against patients nationwide, according to an Atlanta-Journal Constitution investigation. Of those 2,400 doctors, half still have active medical licenses today.
The investigation found that one factor contributing to the perpetuation of sexual misconduct by physicians is a lack of support for victims speaking out. In part 1 of their series, “Doctors & Sex Abuse”, AJC stated, “Intimidated, confused or embarrassed, [patients] fear that no one will take their word over a doctor’s.”
This is how Seattle resident Daisy Amo, 71, felt after seeing Harborview Medical Center OB/GYN, Dr. Alson Burke, for a pelvic exam in 2015.
“It never crossed my mind at all that I can’t trust this doctor,” Amo said in a 2018 complaint filed with King County Superior Court, “and I never thought she could do something horrible.”
Having had this same exam performed on her at least five times previously, according to Amo, she was familiar with the basic sensations and steps of the procedure. However, the exam performed by Burke was “quite the opposite,” Amo said in the complaint. After feeling little to no sensation at all for around two minutes, Amo felt what she described as “a considerable pulling out of something from way inside.”
Amo described Burke’s behavior for the duration of the appointment as odd. But, puzzled by the unusual exam that had just taken place, she didn’t say anything. “I didn’t want to say things I wasn’t sure about,” she said in the complaint.
The pathology results from this exam, however, only raised more concern for Amo.
Amongst the clinical speak of abbreviations and codes were words like “unsatisfactory” and “cannot be identified”. One sample was even missing a collection date and time, according to the pathology report, compromising the results. Of the three samples taken, only one produced a reliable result which was reported as negative.
In the visit summary written by Burke, she attributed the negative result to the incorrect test and failed to mention the other unsatisfactory results and unidentifiable sample. According to the complaint, Amo’s primary care physician, Dr. Megan Kiefer, also confirmed the results as normal in Amo’s medical records.
The uncomfortable exam followed by the unsettling results pushed Amo to send Burke a six-page letter via priority mail on January 8, 2016. It began, “This letter is written out of my big concerns for my own health issues…”
Amo detailed her understanding of what happened during the exam, voicing her concern that it wasn’t done properly as evidenced by the inconclusive results. She wrote of her worries that her health had been compromised and ended with a request to Burke. “What I want right now is for you to acknowledge what you’ve done so I can have properly executed tests by another provider.”
An Unfulfilled Request
Amo’s request isn’t uncommon for patients who believe a medical error has occurred. In a 2009 Clinical Orthopedics and Related Research paper titled “Apologies and Medical Error,” author Jennifer Robbennolt stated, “almost all the patients (98%) indicated they desired or expected the physician’s active acknowledgment of an error. This ranged from a simple acknowledgment of the error to various forms of apology.”
Instead of an acknowledgment or explanation from Burke, Amo received a letter on January 22 from the Director of Harborview Patient Relations, Tracy Gooding.
“Your complaint letter was forwarded to Harborview administration and an investigation has been initiated,” the letter read, “We take all patient complaints seriously and thoroughly review them following established procedures.”
The established procedure, according to UW Medicine Media Relations Director Susan Gregg, is the initiation of a grievance committee review and investigation by the appropriate area managers. “The findings of this review are shared with the patient in a letter and may include any actions taken and apology for difficult experience,” Gregg said via email.
As part of this review, Dr. Sara Jackson, medical director of the Adult Medicine Clinic where Burke practices, contacted Amo on January 28 to request they meet in person to discuss her complaint.
Amo responded on February 8 with a four-page letter to Jackson in which she stated that before they meet, it’s very important she first got a response from Burke. “Whatever response it is she would like to make,” Amo said in the letter, “I’d like to hear it.”
After getting no response, Amo then mailed the letter to Jackson on March 14.
On March 25, Amo received a letter from Jackson via email — later referred to as a “resolution letter” by Gooding. In this letter, Jackson acknowledged receiving Amo’s letter containing her request via mail. She then repeated the phrases from Gooding’s letter: “an investigation has been initiated” and “we take all patient complaints seriously and thoroughly review them following established procedures.”
Jackson also wrote that any actions taken as a result of the review were confidential, but if Amo feels her complaint warrants further review she may contact the Department of Health.
“I was very disappointed with how Dr. Jackson responded to my letter,” Amo said in the 2018 complaint, “all that I requested was totally ignored.”
When asked why Amo’s request could not be fulfilled, Jackson did not respond for comment.
According to Gregg, Burke did have the option to respond to Amo separately from patient relations, saying “Individual staff members may respond differently to a letter directed to them.”
When asked why there was no attempt made to communicate with Amo regarding her concerns, Burke did not respond for comment.
On July 11, 2017, Amo mailed an 81-page document containing “backups and exhibits” of her case to Dr. Paul Ramsey, UW Medicine CEO, and Johnese Spisso, the clinical operations officer and VP of medical affairs. Included were all correspondence between her and Burke as well as the test results.
“I wanted answers to all my questions,” Amo said, “I wanted them to stop running around in circles with me.” By laying every piece of evidence before them, Amo hoped this would convince them to fulfill her request for acknowledgment from Burke.
On August 4, Amo received a letter from Gooding that acknowledged receipt of the document and stated, “You did not think we sufficiently responded to this complaint. In order to address these concerns, we reviewed the actions that were taken.”
According to Gooding, four actions were taken to resolve Amo’s complaint: 1) A review of the complaint by Jackson, 2) The complaint was forwarded to Harborview and a review was done, 3) A resolution letter signed by Jackson was sent on March 16 (referencing the unsigned resolution letter Amo received from Jackson via email on March 25), and 4) the grievance committee met and concurred with the resolution on March 24, 2016.
According to Gooding, after receiving the document, the grievance committee met again and found that “the complaint had received an appropriate review in 2016 and the information you provided in July 2017 did not alter the resolution.”
Gooding also wrote that the grievance committee review was the end of the Harborview complaint process and that Amo could contact the DOH or Joint Commission on Accreditation of Healthcare Organizations if she felt her complaint warranted further review.
In a last-ditch effort, Amo mailed a seven-page letter to Paul Hayes, then Harborview’s executive director, and Chief Nursing Officer and Sr. Associate for Patient Care Darcy Jaffe on September 13. With frequent use of bolded, underlined, capitalized, and italicized font, Amo’s frustration and confusion can be felt throughout the letter.
“I may not be satisfied with your findings?” Amo wrote, referencing Gooding’s letter, “How could I be? I wasn’t given a word of what your findings are!”
Amo ended this letter by again requesting a letter of apology from Burke.
The final correspondence from Harborview was a letter from Risk Manager Kristin Raymond on September 19, 2017. “We understand you’re seeking more information about the sexual assault you alleged happened in September of 2015,” Raymond said.
This was the first time that Harborview referred to Amo’s complaint as pertaining to sexual assault.
“Your complaint will be reviewed at the regular meeting of our Grievance Committee on September 28, 2017. We will respond, in writing, with the results of that review.”
“Nothing, not even a word this time,” she said.
A Legal Defeat
According to Robbennolt’s “Apologies and Medical Error,” an acknowledgment of wrongdoing from the physician could prevent the patient’s complaint from escalating to a lawsuit. She wrote, ”patients were less likely to indicate they would seek legal advice when the physician assumed responsibility for the error, apologized, and outlined steps that would be taken to prevent recurrence.”
But, without a concrete resolution or acknowledgment from Burke, Amo was “forced to take legal action,” according to the 2018 complaint. On September 10, 2018, 3 years after the exam in question, Amo filed a personal injury lawsuit against Harborview Medical Center and Burke.
Two months later, defendant attorneys Bruce Megard and Rhianna Fronapfel filed a motion to dismiss Amo’s case.
According to the motion, Amo failed to file a pre-suit tort claim form with the Office of Risk Management prior to filing her lawsuit — a requirement when suing an entity of the state like Harborview. It allows the state time to “investigate, evaluate, and settle claims” before going to court, according to the motion.
In an appellant’s brief filed with the court of appeals in June 2019, Amo wrote that she was “crushed and emotionally wrecked” after reading the motion to dismiss her case.
She claimed she failed to comply simply because she didn’t know. “I couldn’t believe I failed to comply,” Amo said in the brief, “when I knew nothing about it, and never heard about it in my entire life.”
During her correspondence with Harborview officials, Amo was told that if she believed her complaint warranted further review she could contact the Department of Health or the Joint Commission on Accreditation of Healthcare Organizations. “I could not understand why I wasn’t referred to the Office of Risk Management,” she said in the brief.
In an answer to the petition review, Megard counter-claimed that Harborview didn’t refer Amo to the Office of Risk Management because they didn’t know her intentions to sue, saying, “Harborview is not required to intuit an individual’s intent to file a lawsuit against it.”
Megard also claimed that the form was readily available and that it was “Ms. Amo’s obligation, not that of Harborview, to determine the procedural requirements for any legal suit against it and its employee.”
Procedural requirements are something that a legal advisor may have been able to notify Amo of, but she pursued her case without legal counsel. When asked why, Amo declined to comment.
Additionally, Megard claimed the two-year statute of limitations for assault and battery had passed which Daisy thought was intentional on HMC’s part. However, in the original complaint, it cited personal injury, which has a statute of limitations of three years, which Daisy is in compliance with having filed on September 10, 2018, and the assault having taken place on September 15, 2015.
From the beginning, Amo made it clear that all she wanted was an explanation from Burke. But despite making it all the way in front of a judge, an explanation was never provided.
“I continued to come to them hoping they would see me, hear me and finally treat me like a real human being,” Amo said in the 2018 complaint, “but to no avail.”
Fear of legal liability is the most commonly cited barrier to patients getting an apology from a physician, according to Robbennolt.
However, Washington law states that “any statement, affirmation, gesture, or conduct expressing apology, fault, sympathy, commiseration, condolence, compassion, or a general sense of benevolence” is not admissible in court if it’s issued within thirty days of the physician becoming aware of the wrongdoing.
The fear of legal liability may even be distorted. According to Robbennolt, “empirical research has demonstrated both that most injured patients do not file lawsuits and that physicians tend to substantially overestimate the risk of being sued.”
Hospitals are required to report suspected abuse, assault, sexual assault, or other possible crime to local police or the appropriate law enforcement agency within 48 hours, according to Washington DOH Public Information Officer Frank Ameduri. Additionally, he said, “hospitals must file an adverse event report to the DOH if an event is confirmed to have taken place.”
According to the Washington DOH provider credential search, Burke had no actions taken on her license, suggesting that Harborview either confirmed the event did not happen or failed to file an adverse event report.
It’s still unclear as to what specific actions, if any, were taken against Burke. To this day, Amo has received no communication from Burke. She still does not know the details of what happened during her exam.