Politicians in the UK, and maybe elsewhere, like to hold up the USA as a role model for local universities in how to deal with business. Gordon Brown even went so far as to throw millions at MIT and Cambridge University to lure them into a shot-gun marriage.
An article in The NewYork Times suggests that university-industry relationships aren't always that great. The piece quotes Stuart Feldman, vice president for computer science at IBM’s research laboratories, as saying “Universities have made life increasingly difficult to do research with them because of all the contractual issues around intellectual property. We would like the universities to open up again.”
The article is about an announcement of a set of new software research projects with seven universities in the USA. IBM's press release says that:
"Under IBM's new Open Collaborative Research program, results developed between IBM Research and top university faculty and their students for specific projects will be made available as open source software code and all additional intellectual property developed based on those results will be openly published or made available royalty-free."
This gets around the problem of patents, which seems to be the issue that upsets companies. As the New York Times explained it, the Bayh-Dole Act of 1980 meant that universities could hold and license out patents on federally funded research. "Since then," the article continues, "universities have often viewed themselves as idea factories and, like many corporations, have sought to cash in on their intellectual property."
There are lessons here for universities everywhere. It is very easy to frighten off people who might otherwise want to support your researchers. And if IBM sees problems, what hopes are there for smaller businesses?
12/18/2006
A Continuing Education Course For Physicians Who Cross Sexual Boundaries
A CONTINUING EDUCATION COURSE FOR PHYSICIANS WHO CROSS SEXUAL BOUNDARIES
Anderson Spickard, Jr., M.D., William H. Swiggart, M.S., Ginger Manley, M.S.N., R.N., C.N.S., David Dodd, M.D.The Center for Professional HealthVanderbilt University School of Medicine
Professional sexual boundary violations are the subject of major interest in professional and lay literature, calling attention to the special hazard of sexual relationships between persons in positions of authority over others. (Guthiel, 1993; Irons and Schneider, 1994; Overlock, 1996; Rutter, 1998, 1999; Morris, 1999). These publications emphasize the special risks to physicians who cross sexual boundaries with patients and staff and cause serious risk management issues for themselves and their practice. Long before the current publicity about this subject the problem of physicians violating professional boundaries was addressed in the report of the Council on Ethical and Judicial Affairs of the American Medical Association in 1991(AMA 1991). These ethical standards state that: 1) sexual contact or a romantic relationship concurrent with the physician-patient relationship is unethical, 2) sexual contact or a romantic relationship with a former patient may be unethical under certain circumstances, 3) education on the ethical issues involved in sexual misconduct should be included throughout all levels of medical training and 4) in the case of sexual misconduct, reporting of offending colleagues is especially important. Winn has described the increase in incidence of problems of boundary violations as seen by the state medical boards. (Winn, 1993)
Gabbard and Nadelson in a special communication in the JAMA summarized the professional boundaries in the physician-patient relationship. (Gabbard, 1995) Dual relationships, gifts and services, time and duration of appointments, language, self-disclosure, the physical examination, physical contact and prevention of boundary violations were noted.
Schneider and Irons define the various categories of sexual boundary violations in their textbook for clinicians and counselors who specialize in evaluation of physicians with suspected sexual addiction. (Irons, Schneider, 1999) In addition, Irons has reviewed the recognition and management of the seductive patient, encountered frequently by all physicians. (Irons, 1994)
The Report on Sexual Boundary Issues by the Ad Hoc Committee on Physician Impairment of the Federation of State Medical Boards of the US, Inc. (FSMB) outlines the current concepts regarding physician impairment in sexual boundary issues and recommends guidelines for state medical boards that are investigating sexual misconduct in physicians. (Ad Hoc Committee, 1994). The FSMB recommends that state medical boards provide both interventions for physicians who cross sexual boundaries with patients or staff in their practice. Interventions include continuing education, in-depth assessment for sexual addiction, and careful monitoring of the physician's behavior to prevent recurrence of these boundary violations.
Physician education is the cornerstone of prevention of sexual boundary violations by physicians. The Federation report emphasizes that physician sexual misconduct has not been adequately addressed during medical school or residency training and that medical boards should take a proactive stance to educate their licensees about sexual misconduct. Because of this lack of education/awareness, physicians encounter situations in which they have unknowingly violated the medical practice act through boundary violations. The Committee urges improvement in education of physicians about acceptable and unacceptable behavior in regard to sexual boundary issues, with emphasis on the serious emotional harm patients can experience when sexual boundary violations occur. They challenged medical boards to publish information in newsletters and contact media to inform the public.
In response to these observations and recommendations, a continuing medical education course entitled 'Maintaining Proper Boundaries- A CME Course for Physicians' has been conducted at Vanderbilt Medical Center for the past two years. The initial courses were supported by a grant from the American Foundation for Addiction Research (AFAR), a foundation devoted to education and research on sexual abuse and addiction. This report describes the experiences with training thirty physicians who have been mandated from their state medical board, physician health program or are self referred.
COURSE DESCRIPTION
This three-day course was begun in July 1999 in the Center for Professional Health at Vanderbilt University Medical Center in Nashville, Tennessee. Three recovering physicians who had already been involved in the Tennessee Physicians Health Program because of their sexual boundary issues reviewed the proposed program.
The faculty is composed of two physicians, a nurse specialist and an addiction counselor. All are trained in addiction and are acquainted with the particular defenses of minimizing, rationalizing, and denying in addicts of all kinds. The course faculty members had experience in teaching physicians referred by state medical boards or physician health programs, having conducted a previous course for physicians who misprescribed controlled substances, principally Schedule II narcotics. (Spickard, 1998, 1999; Swiggart, 1998) Over 300 physicians have attended this course in the 15 years of existence. A few of these physicians had become involved in sexual boundary violations associated with the prescribing of narcotics to their lovers, but sexual boundary violations were not being addressed in any depth in those courses.
The earlier experience had shown that in a three-day format which combined didactic material with guided introspection, a majority of those physicians were able to not only be honest about their prescribing boundary issues, but they also could begin to access deeply held emotions which had previously not been accessible. In the safe setting of other colleagues and with an empathetic faculty, the attendees took ownership of their own failings and were able to receive guidance in reorganizing their professional and personal lives. Using that experience, and with the consultation of well-known experts in physician sexual boundary concerns, a new three-day course format, based on the earlier prescribing course, was developed.
The course is limited to 10 participants in each offering. Physicians who complete the course receive 21 CME credits and a certificate of attendance. All of the discussions occur under a code of strict confidence. Medical boards receive letters indicating only that the physician had completed the course. Letters to lawyers and others if required have been sent only with the physician's written permission.
The course content contains sections on:
* Psychology of the physician;
* General and sexually specific boundary definitions;
* Power imbalances in practice;
* Progression of behaviors model including use-misuse-compulsion-addiction continuum;
* Shame/guilt development and styles of coping;
* Family of origin genograms, with special emphasis on the 'grooming' and socialization of the physician-to-be in his/her family of origin;
* Collateral addictions and recovery programs;
* Guidelines for safety in professional practice;
* Victim empathy
* Intent to change statements.
Each participant receives a course syllabus upon registration, and the course content is preprinted in the syllabus so that they can absorb the material without the need to take extensive notes. In addition numerous reference articles are included in the bibliography to supplement the course materials.
Didactic presentations are offered in a classroom setting. The participants are given approximately two hours of homework each night of the course, during which time they complete their personal genogram and complete a battery of self-report questionnaires. Group processing takes place when the participants are divided in to two small groups facilitated by two faculty members in each group. The participants discuss their genograms and questionnaires on the second and third days in these groups.
In another session the wife of a recovering sexually addicted physician, not in the course, provides a moving story of her experiences of coping with the addictive behavior of her husband. The physicians attending the course listen to her experience and interact with her during a period afterwards, facilitating the personalization of her experience for the attendees.
SCREENING INSTRUMENTS
There was concern by the course faculty that the CME course would provide just education for sexual boundary offenders who were unrecognized sexual addicts and who actually needed more in depth assessment and treatment. Some of the participants have self-reported themselves to be sexual addicts who had previously attended treatment centers for sexual addiction. Their attendance at the CME course was a condition of the court order or prior to reentry to practice as part of their treatment contract with the treatment center. The faculty was concerned about the possibility that the course per se might not be sufficient to rule out more serious problems, having observed in the previous misprescribing course the frequency of dysfunctional family of origin issues and the occurrences of other addictions in the family histories.
Two self-report instruments, the SAST (Carnes, 1989) and the FACES II (Olson, 1993) were used. The SAST [sexual addiction-screening test) differentiates sexual addicts from non-addicts based on a cutoff score of 13 positive answers out of 25 possibilities. Results of the SAST given to the physicians in the courses show that the majority of physicians (23 or 77%) scored under the cutoff score of 13 while 7 (23%) were above the cutoff indicating that most of the physicians attending the course are not addicted. The seven who were screened as possibility having sexual addiction were counseled to seek additional in-depth assessment for possible sexual addiction.
The FACES II, developed by Olson and colleagues (Olson, 1993), is a measure of family function on two dimensions, flexibility and cohesion. The physician participants are asked to answer the questions about their family of origin. The results place the family in one of three categories, 'balanced' (healthy), 'midrange' (between healthy and extreme) and 'extreme' (unhealthy). (Table 1) The majority of scores indicated that the families of these physicians were in the 'midrange' category as defined by this test. Four of the seven with high SAST scores were also in the extreme range.
PARTICIPANTS
Thirty-eight physicians attended the CME course during 1999-2000 for which we have information. Eight physicians refused to have their information included in the data set. The summary of the demographics for the group of 30 who consented to be included is in Table 2. The specialties represented by these physicians are listed in Table 3.
Case Study
The following case study describes a typical physician's history and is a combination of several physician stories to obscure identification. Dr. Smith is a 42-year-old male internist. He practices in an office with three other physicians in a small town in the mid-west. He has been divorced for six years and has no children. He works long hours to forget the loneliness and his feelings about the divorce. Many of the single women available in his community for him to date were also his patients, so his choices for a companion were limited. He became attracted to a female technician who worked in the hospital to which he admitted patients and their relationship turned into a sexual involvement.
During the course of their relationship his companion mentioned a need for pain relief for chronic back pain unresponsive to the usual non-narcotic treatments for pain. She was dissatisfied with her own doctor's care and believed he was under-treating her pain. Dr. S was reluctant to prescribe for her, but he finally relented and began giving her regular prescriptions for Tylenol/hydrocodone.
One year later Dr. Smith decided to end both the sexual relationship and his treatment of his companion's pain. She was not only disappointed that the sexual relationship was over but was angry that he would not prescribe for her pain. She reported Dr. Smith to the state board of medical examiners. The board concluded that Dr. Smith had crossed two boundaries. His personal relationship with a hospital employee was inappropriate because he had supervisory responsibilities in the department where his lover worked, and he had prescribed controlled substances for her pain without a medical record.
Dr. S. was mandated to attend the course on sexual boundary violations. He arrived with an angry, hostile, and defensive attitude. The first day of the course he began to hear other physicians' experiences, and realized that his troubles were not as serious as some. He realized how his medical training that emphasized his role of controlling situations and ignorance of the overlap with the vulnerability he brought to his medical practice from his own family origins might have conspired to cause problems. He completed the course feeling supported in his attempt to be a better physician, and with clear plan to avoid similar problems. The BME in his state concluded he had engaged in sexual impropriety but was not addicted or predatory and allowed him to return to practice without further sanctions.
Discussion
All physicians initially have a high level of anxiety and anger at the beginning of the course. Many physicians do not know the details of the violations for which they have been reported. If there is no lawyer representing them, the specifics of the complaints can be very unclear. Some physicians have been told to go to a CME course on sexual boundary violations and all will be forgotten. We have been impressed with the different approaches state boards have on this issue, some being very strict and punitive and others emphasizing more of a rehabilitative approach.
This CME course is substantially different from the typical CME courses familiar to most of the attendees where didactic presentations of the course material are the usual method of teaching. The format used in the Vanderbilt course of sharing of personal stories in a confidential setting with faculty who do a limited amount of their own self-disclosure quickly breaks down barriers. Some participants are fairly far along in their own recovery when they attend the course, while others have only a vague notion of the scope of their problems. Regardless of the status of their own self-identification, the group members become cohesive and supportive of each other. They confront one another when appropriate, and they encourage and give support to their peers when indicated. By the end of the course, almost all participants have stated that they believe that the course has been very important to their well being personally and professionally.
There are inherent limitations to this educational intervention. Primarily this format does not provide an in-depth assessment of each physician to determine his or her level of sexual behavior, i.e. to separate the abuser from the addict. The faculty cannot be certain about the level of sexual impropriety or violation as defined by the FSMB reports (Ad Hoc Committee on Physician Impairment, 1994). With the informal group process, the use of the SAST, FACES and genogram review, the faculty members do, however, have a good sense of who is addicted and needs more in-depth assessment and treatment.
There is no doubt the group process used in this course for physicians is very important as a therapeutic intervention. Though initially angry and frustrated about being sent to the course, with time and sharing their stories, the participants relax, tell stories, laugh at themselves and each other and become bonded as a group in a short time. Their stories bear out the fact that physicians are starved for relationships with peers. We have been impressed with the openness and honesty in this group of physicians. The commitment of confidentiality by all participants and the faculty is a factor in promoting honesty. Since the CME course is only an educational program, none of the material on any physician is discoverable. This contributes to the honesty we have experienced in working with these individuals.
All the physicians in this course were uninformed and poorly trained in medical school or residency about sexual boundary issues. They were unaware of guidelines and policies of state and national groups about these matters. They did not have policies in their practice to recognize non-sexual and sexual boundaries. Sexual harassment policies are unknown to them even though such policies are federal laws. Neither newsletters from their liability insurance carriers nor or correspondence by their state medical board have informed any of the participants. As a group they report being astounded when angry patients file complaints.
Physicians usually do not realize that the role of the state medical board is to protect the public as their primary mission. In most cases the physician health program in their state is available to advocate for their interests and testify before the board in their behalf when appropriate. However, sexual boundary violation issues are only recently in the spotlight of medical board deliberations and leaders of physician health programs and board members may be untrained and uninformed about the issues.
Physicians report having had some training in recognition of and treatment of the seductive patient, but the issues of transference and counter transference in the patient encounter seem to be remote principles mentioned only in a psychiatry course in medical school. The physicians we see have no idea how these principles apply to them or the physician/patient encounter. The emotionally vulnerable patient as a prelude to a sexual affair with their patient has never been mentioned to them as a red flag in practice. Physicians have not been taught about their own emotional vulnerability to sexual encounters with patients or staff when they are tired or have family difficulties.
Most physicians are competent in cognitive medical principles, but have difficulty expressing emotion or displaying feelings appropriately. Often physicians do not realize that their failure to deal with feelings will make them vulnerable to an emotionally needy patient or staff member. In these relationships the power differential of the physician/patient relationship in not realized by the physician and the physician proceeds with a conquest unaware that he is liable in this affair and that the female patient or staff member is probably not going to be held culpable. Some physicians have tried to cover this situation with agreements with the patient or staff member before the sexual encounter takes place. In each case this has backfired upon him. One physician said after having an affair with a patient, 'She agreed to one $40 one night stand in the motel and my practice and family is ruined.'
We have also been impressed with the lack of understanding about non- sexual boundaries that are crossed in many physician practices. Some practices in small hospitals and even specialty units in large hospitals are operating more like TV style MASH units than like professional practices. The informality of dress, language, personal interactions between the sexes create and atmosphere in which sexual boundary violations are likely to occur. Professional distance and doctor/nurse roles are blurred in an atmosphere where dress codes are not enforced and everyone is called by their first name. Physicians see patients outside office hours and without a chart, prescribe for staff in the hallway, accept large gifts from patients, engage in business deals with patients and form dual relationships that easily escalate into sexual boundary affairs.
Office procedures without proper chaperones are a common problem. Some physicians use family members as chaperones (especially in pediatric cases), fail to drape patients properly and treat the female patient in an unprofessional manner (commenting on her pretty underwear, anatomy, etc.) Constant flirting is a common reason physicians are referred to the course. Telling off color jokes and/or having inappropriate pinups on the office desks are common complaints by employees.
We have been impressed by the physician's inability to say 'no' to patients and staff members even if one's license to practice can be jeopardized. Prescribing narcotics to a sexual partner who is a patient or staff member is not uncommon. In one year of the misprescribing course, nine of forty physicians were involved in this dual boundary violation.
During the course we have been impressed by the physicians' responses to the victim empathy lecture and the story of a wife of a serious sexual addict who had been in treatment for his addiction. Many of our physicians experienced fractured relationships with their wives and hearing a story from an emotionally devastated wife was a powerful message.
Our experiences with some physicians from other cultures who are practicing in various specialties in the U.S. demonstrate a significant lack of understanding about American social and sexual mores. Physicians from India, South America and the Middle East have made many mistakes of language, touching, etc. that are uncomfortable to the American female and lead to reports of sexual boundary violations. Education of international physicians about these issues is a high priority.
SUMMARY AND RECOMMENDATIONS
* All medical schools, residency training programs, state medical boards and other physician education training groups should provide training for physicians in prevention of sexual boundary misconduct.
* Medical school curricula should provide training in feelings for physicians to assist them an understanding of their own feelings and those of their patients.
* There should be organized support groups for physicians to assist them in processing feelings about difficult patients, family crises, practice crises, etc. The effectiveness of support groups for residents and practicing physicians has been documented.
* Programs assessing physicians cited for sexual boundary violations should consider genograms, SAST and the FACES screening tests to uncover unsuspected sexual addiction and serious family of origin issues affecting the physician's behavior.
* All physicians' offices should display the AMA code of ethics or the appropriate specialty's ethical policies guiding the physician's behavior and that of the office staff. Patients will be reassured if there is visible evidence that the physician leader of the practice and the staff commit to ethical behavior and high standards of patient care.
REFERENCES
Ad Hoc Committee on Physician Impairment (1994). Report of the federation's ad hoc committee on physician impairment. Federal Bulletin: 81, 229-242.
American Medical Association - Council on Ethical and Judicial Affairs (1991). Sexual misconduct in the practice of medicine. Journal of the American Medical Association. 266, 2741-2745.
Bloom, J.D., Nadelson, C.C. & Notman, T.N. (Eds.) (1999) Physician sexual misconduct. American Psychiatric Press, Washington, D.C.
Carnes, P. (1989) Contrary to love. Hazelden, Center City, MN.
Gabbard, G., & Nadelson, C. (1995). Professional boundaries in the physician-patient relationship. Journal of the American Medical Association. 273 (18). 1445-1449.
Gutheil, T.G., & Gabbard, G.O. (1993). The concept of boundaries in clinical practice: theoretical and risk-management dimensions. American Journal of Psychiatry. 150. (2). 188-196.
Irons, R. (1994). On seduction and exploitation: a medical model approach. Rhode Island Medicine. (77). 354-356.
Irons, R.R., & Schneider, J.P. (1994). Sexual addictions: significant factor in sexual exploitation by health care professionals. Sexual Addiction and Compulsivity. 1. (3), 198-214.
Irons, R.R., & Schneider, J.P. (1999). The wounded healer: addiction-sensitive approach to the sexually exploitative professional. Northvale, NJ: Jason Aronson Publishers.
Morris, B. (1999, May 10). Corporate America's dirty secret: addicted to sex. Fortune. 69-80.
Olson, D.H. (1993). Circumplex model of marital systems: assessing family functions. Normal Family Processes. Welsh, F. (ed). Chapter 3, 104-137.
Overlock, M., & Gonzales, R. (November 1996). Crossing a patient's sexual boundaries. Tennessee Medicine, 403-404.
Rutter, P. (1991). Sex in the forbidden zone. Toronto, Canada: Ballentine Books.
Spickard, A., Dodd, D., Dixon, G., Pichert, J., & Swiggart, W. (1999). Prescribing controlled substances in Tennessee: progress, not perfection. Southern Medical Journal. 92. (1). 51-54.
Spickard, A., Dodd, D., Swiggart, W., Dixon, G., & Pichert, J. (1998). Physicians who misprescribe controlled substances: a CME alternative to sanctions. Federation Bulletin. 85. (1). 8-19.
Swiggart, W., Pichert, J., Elasy, T., Dixon, G., & Spickard, A. (1999). Continuing medical education courses on proper prescribing of controlled substances in the United States. Federation Bulletin. 86. (1). 20-27.
Winn, J.R. (Summer 1993). Medical boards and sexual misconduct: an overview of federation data. Federation Bulletin. 90-97.
Physicians and Sexual Boundary Violations
Anderson Spickard, Jr., M.D., William H. Swiggart, M.S., Ginger Manley, M.S.N., R.N., C.N.S., David Dodd, M.D.The Center for Professional HealthVanderbilt University School of Medicine
Professional sexual boundary violations are the subject of major interest in professional and lay literature, calling attention to the special hazard of sexual relationships between persons in positions of authority over others. (Guthiel, 1993; Irons and Schneider, 1994; Overlock, 1996; Rutter, 1998, 1999; Morris, 1999). These publications emphasize the special risks to physicians who cross sexual boundaries with patients and staff and cause serious risk management issues for themselves and their practice. Long before the current publicity about this subject the problem of physicians violating professional boundaries was addressed in the report of the Council on Ethical and Judicial Affairs of the American Medical Association in 1991(AMA 1991). These ethical standards state that: 1) sexual contact or a romantic relationship concurrent with the physician-patient relationship is unethical, 2) sexual contact or a romantic relationship with a former patient may be unethical under certain circumstances, 3) education on the ethical issues involved in sexual misconduct should be included throughout all levels of medical training and 4) in the case of sexual misconduct, reporting of offending colleagues is especially important. Winn has described the increase in incidence of problems of boundary violations as seen by the state medical boards. (Winn, 1993)
Gabbard and Nadelson in a special communication in the JAMA summarized the professional boundaries in the physician-patient relationship. (Gabbard, 1995) Dual relationships, gifts and services, time and duration of appointments, language, self-disclosure, the physical examination, physical contact and prevention of boundary violations were noted.
Schneider and Irons define the various categories of sexual boundary violations in their textbook for clinicians and counselors who specialize in evaluation of physicians with suspected sexual addiction. (Irons, Schneider, 1999) In addition, Irons has reviewed the recognition and management of the seductive patient, encountered frequently by all physicians. (Irons, 1994)
The Report on Sexual Boundary Issues by the Ad Hoc Committee on Physician Impairment of the Federation of State Medical Boards of the US, Inc. (FSMB) outlines the current concepts regarding physician impairment in sexual boundary issues and recommends guidelines for state medical boards that are investigating sexual misconduct in physicians. (Ad Hoc Committee, 1994). The FSMB recommends that state medical boards provide both interventions for physicians who cross sexual boundaries with patients or staff in their practice. Interventions include continuing education, in-depth assessment for sexual addiction, and careful monitoring of the physician's behavior to prevent recurrence of these boundary violations.
Physician education is the cornerstone of prevention of sexual boundary violations by physicians. The Federation report emphasizes that physician sexual misconduct has not been adequately addressed during medical school or residency training and that medical boards should take a proactive stance to educate their licensees about sexual misconduct. Because of this lack of education/awareness, physicians encounter situations in which they have unknowingly violated the medical practice act through boundary violations. The Committee urges improvement in education of physicians about acceptable and unacceptable behavior in regard to sexual boundary issues, with emphasis on the serious emotional harm patients can experience when sexual boundary violations occur. They challenged medical boards to publish information in newsletters and contact media to inform the public.
In response to these observations and recommendations, a continuing medical education course entitled 'Maintaining Proper Boundaries- A CME Course for Physicians' has been conducted at Vanderbilt Medical Center for the past two years. The initial courses were supported by a grant from the American Foundation for Addiction Research (AFAR), a foundation devoted to education and research on sexual abuse and addiction. This report describes the experiences with training thirty physicians who have been mandated from their state medical board, physician health program or are self referred.
COURSE DESCRIPTION
This three-day course was begun in July 1999 in the Center for Professional Health at Vanderbilt University Medical Center in Nashville, Tennessee. Three recovering physicians who had already been involved in the Tennessee Physicians Health Program because of their sexual boundary issues reviewed the proposed program.
The faculty is composed of two physicians, a nurse specialist and an addiction counselor. All are trained in addiction and are acquainted with the particular defenses of minimizing, rationalizing, and denying in addicts of all kinds. The course faculty members had experience in teaching physicians referred by state medical boards or physician health programs, having conducted a previous course for physicians who misprescribed controlled substances, principally Schedule II narcotics. (Spickard, 1998, 1999; Swiggart, 1998) Over 300 physicians have attended this course in the 15 years of existence. A few of these physicians had become involved in sexual boundary violations associated with the prescribing of narcotics to their lovers, but sexual boundary violations were not being addressed in any depth in those courses.
The earlier experience had shown that in a three-day format which combined didactic material with guided introspection, a majority of those physicians were able to not only be honest about their prescribing boundary issues, but they also could begin to access deeply held emotions which had previously not been accessible. In the safe setting of other colleagues and with an empathetic faculty, the attendees took ownership of their own failings and were able to receive guidance in reorganizing their professional and personal lives. Using that experience, and with the consultation of well-known experts in physician sexual boundary concerns, a new three-day course format, based on the earlier prescribing course, was developed.
The course is limited to 10 participants in each offering. Physicians who complete the course receive 21 CME credits and a certificate of attendance. All of the discussions occur under a code of strict confidence. Medical boards receive letters indicating only that the physician had completed the course. Letters to lawyers and others if required have been sent only with the physician's written permission.
The course content contains sections on:
* Psychology of the physician;
* General and sexually specific boundary definitions;
* Power imbalances in practice;
* Progression of behaviors model including use-misuse-compulsion-addiction continuum;
* Shame/guilt development and styles of coping;
* Family of origin genograms, with special emphasis on the 'grooming' and socialization of the physician-to-be in his/her family of origin;
* Collateral addictions and recovery programs;
* Guidelines for safety in professional practice;
* Victim empathy
* Intent to change statements.
Each participant receives a course syllabus upon registration, and the course content is preprinted in the syllabus so that they can absorb the material without the need to take extensive notes. In addition numerous reference articles are included in the bibliography to supplement the course materials.
Didactic presentations are offered in a classroom setting. The participants are given approximately two hours of homework each night of the course, during which time they complete their personal genogram and complete a battery of self-report questionnaires. Group processing takes place when the participants are divided in to two small groups facilitated by two faculty members in each group. The participants discuss their genograms and questionnaires on the second and third days in these groups.
In another session the wife of a recovering sexually addicted physician, not in the course, provides a moving story of her experiences of coping with the addictive behavior of her husband. The physicians attending the course listen to her experience and interact with her during a period afterwards, facilitating the personalization of her experience for the attendees.
SCREENING INSTRUMENTS
There was concern by the course faculty that the CME course would provide just education for sexual boundary offenders who were unrecognized sexual addicts and who actually needed more in depth assessment and treatment. Some of the participants have self-reported themselves to be sexual addicts who had previously attended treatment centers for sexual addiction. Their attendance at the CME course was a condition of the court order or prior to reentry to practice as part of their treatment contract with the treatment center. The faculty was concerned about the possibility that the course per se might not be sufficient to rule out more serious problems, having observed in the previous misprescribing course the frequency of dysfunctional family of origin issues and the occurrences of other addictions in the family histories.
Two self-report instruments, the SAST (Carnes, 1989) and the FACES II (Olson, 1993) were used. The SAST [sexual addiction-screening test) differentiates sexual addicts from non-addicts based on a cutoff score of 13 positive answers out of 25 possibilities. Results of the SAST given to the physicians in the courses show that the majority of physicians (23 or 77%) scored under the cutoff score of 13 while 7 (23%) were above the cutoff indicating that most of the physicians attending the course are not addicted. The seven who were screened as possibility having sexual addiction were counseled to seek additional in-depth assessment for possible sexual addiction.
The FACES II, developed by Olson and colleagues (Olson, 1993), is a measure of family function on two dimensions, flexibility and cohesion. The physician participants are asked to answer the questions about their family of origin. The results place the family in one of three categories, 'balanced' (healthy), 'midrange' (between healthy and extreme) and 'extreme' (unhealthy). (Table 1) The majority of scores indicated that the families of these physicians were in the 'midrange' category as defined by this test. Four of the seven with high SAST scores were also in the extreme range.
PARTICIPANTS
Thirty-eight physicians attended the CME course during 1999-2000 for which we have information. Eight physicians refused to have their information included in the data set. The summary of the demographics for the group of 30 who consented to be included is in Table 2. The specialties represented by these physicians are listed in Table 3.
Case Study
The following case study describes a typical physician's history and is a combination of several physician stories to obscure identification. Dr. Smith is a 42-year-old male internist. He practices in an office with three other physicians in a small town in the mid-west. He has been divorced for six years and has no children. He works long hours to forget the loneliness and his feelings about the divorce. Many of the single women available in his community for him to date were also his patients, so his choices for a companion were limited. He became attracted to a female technician who worked in the hospital to which he admitted patients and their relationship turned into a sexual involvement.
During the course of their relationship his companion mentioned a need for pain relief for chronic back pain unresponsive to the usual non-narcotic treatments for pain. She was dissatisfied with her own doctor's care and believed he was under-treating her pain. Dr. S was reluctant to prescribe for her, but he finally relented and began giving her regular prescriptions for Tylenol/hydrocodone.
One year later Dr. Smith decided to end both the sexual relationship and his treatment of his companion's pain. She was not only disappointed that the sexual relationship was over but was angry that he would not prescribe for her pain. She reported Dr. Smith to the state board of medical examiners. The board concluded that Dr. Smith had crossed two boundaries. His personal relationship with a hospital employee was inappropriate because he had supervisory responsibilities in the department where his lover worked, and he had prescribed controlled substances for her pain without a medical record.
Dr. S. was mandated to attend the course on sexual boundary violations. He arrived with an angry, hostile, and defensive attitude. The first day of the course he began to hear other physicians' experiences, and realized that his troubles were not as serious as some. He realized how his medical training that emphasized his role of controlling situations and ignorance of the overlap with the vulnerability he brought to his medical practice from his own family origins might have conspired to cause problems. He completed the course feeling supported in his attempt to be a better physician, and with clear plan to avoid similar problems. The BME in his state concluded he had engaged in sexual impropriety but was not addicted or predatory and allowed him to return to practice without further sanctions.
Discussion
All physicians initially have a high level of anxiety and anger at the beginning of the course. Many physicians do not know the details of the violations for which they have been reported. If there is no lawyer representing them, the specifics of the complaints can be very unclear. Some physicians have been told to go to a CME course on sexual boundary violations and all will be forgotten. We have been impressed with the different approaches state boards have on this issue, some being very strict and punitive and others emphasizing more of a rehabilitative approach.
This CME course is substantially different from the typical CME courses familiar to most of the attendees where didactic presentations of the course material are the usual method of teaching. The format used in the Vanderbilt course of sharing of personal stories in a confidential setting with faculty who do a limited amount of their own self-disclosure quickly breaks down barriers. Some participants are fairly far along in their own recovery when they attend the course, while others have only a vague notion of the scope of their problems. Regardless of the status of their own self-identification, the group members become cohesive and supportive of each other. They confront one another when appropriate, and they encourage and give support to their peers when indicated. By the end of the course, almost all participants have stated that they believe that the course has been very important to their well being personally and professionally.
There are inherent limitations to this educational intervention. Primarily this format does not provide an in-depth assessment of each physician to determine his or her level of sexual behavior, i.e. to separate the abuser from the addict. The faculty cannot be certain about the level of sexual impropriety or violation as defined by the FSMB reports (Ad Hoc Committee on Physician Impairment, 1994). With the informal group process, the use of the SAST, FACES and genogram review, the faculty members do, however, have a good sense of who is addicted and needs more in-depth assessment and treatment.
There is no doubt the group process used in this course for physicians is very important as a therapeutic intervention. Though initially angry and frustrated about being sent to the course, with time and sharing their stories, the participants relax, tell stories, laugh at themselves and each other and become bonded as a group in a short time. Their stories bear out the fact that physicians are starved for relationships with peers. We have been impressed with the openness and honesty in this group of physicians. The commitment of confidentiality by all participants and the faculty is a factor in promoting honesty. Since the CME course is only an educational program, none of the material on any physician is discoverable. This contributes to the honesty we have experienced in working with these individuals.
All the physicians in this course were uninformed and poorly trained in medical school or residency about sexual boundary issues. They were unaware of guidelines and policies of state and national groups about these matters. They did not have policies in their practice to recognize non-sexual and sexual boundaries. Sexual harassment policies are unknown to them even though such policies are federal laws. Neither newsletters from their liability insurance carriers nor or correspondence by their state medical board have informed any of the participants. As a group they report being astounded when angry patients file complaints.
Physicians usually do not realize that the role of the state medical board is to protect the public as their primary mission. In most cases the physician health program in their state is available to advocate for their interests and testify before the board in their behalf when appropriate. However, sexual boundary violation issues are only recently in the spotlight of medical board deliberations and leaders of physician health programs and board members may be untrained and uninformed about the issues.
Physicians report having had some training in recognition of and treatment of the seductive patient, but the issues of transference and counter transference in the patient encounter seem to be remote principles mentioned only in a psychiatry course in medical school. The physicians we see have no idea how these principles apply to them or the physician/patient encounter. The emotionally vulnerable patient as a prelude to a sexual affair with their patient has never been mentioned to them as a red flag in practice. Physicians have not been taught about their own emotional vulnerability to sexual encounters with patients or staff when they are tired or have family difficulties.
Most physicians are competent in cognitive medical principles, but have difficulty expressing emotion or displaying feelings appropriately. Often physicians do not realize that their failure to deal with feelings will make them vulnerable to an emotionally needy patient or staff member. In these relationships the power differential of the physician/patient relationship in not realized by the physician and the physician proceeds with a conquest unaware that he is liable in this affair and that the female patient or staff member is probably not going to be held culpable. Some physicians have tried to cover this situation with agreements with the patient or staff member before the sexual encounter takes place. In each case this has backfired upon him. One physician said after having an affair with a patient, 'She agreed to one $40 one night stand in the motel and my practice and family is ruined.'
We have also been impressed with the lack of understanding about non- sexual boundaries that are crossed in many physician practices. Some practices in small hospitals and even specialty units in large hospitals are operating more like TV style MASH units than like professional practices. The informality of dress, language, personal interactions between the sexes create and atmosphere in which sexual boundary violations are likely to occur. Professional distance and doctor/nurse roles are blurred in an atmosphere where dress codes are not enforced and everyone is called by their first name. Physicians see patients outside office hours and without a chart, prescribe for staff in the hallway, accept large gifts from patients, engage in business deals with patients and form dual relationships that easily escalate into sexual boundary affairs.
Office procedures without proper chaperones are a common problem. Some physicians use family members as chaperones (especially in pediatric cases), fail to drape patients properly and treat the female patient in an unprofessional manner (commenting on her pretty underwear, anatomy, etc.) Constant flirting is a common reason physicians are referred to the course. Telling off color jokes and/or having inappropriate pinups on the office desks are common complaints by employees.
We have been impressed by the physician's inability to say 'no' to patients and staff members even if one's license to practice can be jeopardized. Prescribing narcotics to a sexual partner who is a patient or staff member is not uncommon. In one year of the misprescribing course, nine of forty physicians were involved in this dual boundary violation.
During the course we have been impressed by the physicians' responses to the victim empathy lecture and the story of a wife of a serious sexual addict who had been in treatment for his addiction. Many of our physicians experienced fractured relationships with their wives and hearing a story from an emotionally devastated wife was a powerful message.
Our experiences with some physicians from other cultures who are practicing in various specialties in the U.S. demonstrate a significant lack of understanding about American social and sexual mores. Physicians from India, South America and the Middle East have made many mistakes of language, touching, etc. that are uncomfortable to the American female and lead to reports of sexual boundary violations. Education of international physicians about these issues is a high priority.
SUMMARY AND RECOMMENDATIONS
* All medical schools, residency training programs, state medical boards and other physician education training groups should provide training for physicians in prevention of sexual boundary misconduct.
* Medical school curricula should provide training in feelings for physicians to assist them an understanding of their own feelings and those of their patients.
* There should be organized support groups for physicians to assist them in processing feelings about difficult patients, family crises, practice crises, etc. The effectiveness of support groups for residents and practicing physicians has been documented.
* Programs assessing physicians cited for sexual boundary violations should consider genograms, SAST and the FACES screening tests to uncover unsuspected sexual addiction and serious family of origin issues affecting the physician's behavior.
* All physicians' offices should display the AMA code of ethics or the appropriate specialty's ethical policies guiding the physician's behavior and that of the office staff. Patients will be reassured if there is visible evidence that the physician leader of the practice and the staff commit to ethical behavior and high standards of patient care.
REFERENCES
Ad Hoc Committee on Physician Impairment (1994). Report of the federation's ad hoc committee on physician impairment. Federal Bulletin: 81, 229-242.
American Medical Association - Council on Ethical and Judicial Affairs (1991). Sexual misconduct in the practice of medicine. Journal of the American Medical Association. 266, 2741-2745.
Bloom, J.D., Nadelson, C.C. & Notman, T.N. (Eds.) (1999) Physician sexual misconduct. American Psychiatric Press, Washington, D.C.
Carnes, P. (1989) Contrary to love. Hazelden, Center City, MN.
Gabbard, G., & Nadelson, C. (1995). Professional boundaries in the physician-patient relationship. Journal of the American Medical Association. 273 (18). 1445-1449.
Gutheil, T.G., & Gabbard, G.O. (1993). The concept of boundaries in clinical practice: theoretical and risk-management dimensions. American Journal of Psychiatry. 150. (2). 188-196.
Irons, R. (1994). On seduction and exploitation: a medical model approach. Rhode Island Medicine. (77). 354-356.
Irons, R.R., & Schneider, J.P. (1994). Sexual addictions: significant factor in sexual exploitation by health care professionals. Sexual Addiction and Compulsivity. 1. (3), 198-214.
Irons, R.R., & Schneider, J.P. (1999). The wounded healer: addiction-sensitive approach to the sexually exploitative professional. Northvale, NJ: Jason Aronson Publishers.
Morris, B. (1999, May 10). Corporate America's dirty secret: addicted to sex. Fortune. 69-80.
Olson, D.H. (1993). Circumplex model of marital systems: assessing family functions. Normal Family Processes. Welsh, F. (ed). Chapter 3, 104-137.
Overlock, M., & Gonzales, R. (November 1996). Crossing a patient's sexual boundaries. Tennessee Medicine, 403-404.
Rutter, P. (1991). Sex in the forbidden zone. Toronto, Canada: Ballentine Books.
Spickard, A., Dodd, D., Dixon, G., Pichert, J., & Swiggart, W. (1999). Prescribing controlled substances in Tennessee: progress, not perfection. Southern Medical Journal. 92. (1). 51-54.
Spickard, A., Dodd, D., Swiggart, W., Dixon, G., & Pichert, J. (1998). Physicians who misprescribe controlled substances: a CME alternative to sanctions. Federation Bulletin. 85. (1). 8-19.
Swiggart, W., Pichert, J., Elasy, T., Dixon, G., & Spickard, A. (1999). Continuing medical education courses on proper prescribing of controlled substances in the United States. Federation Bulletin. 86. (1). 20-27.
Winn, J.R. (Summer 1993). Medical boards and sexual misconduct: an overview of federation data. Federation Bulletin. 90-97.
Physicians and Sexual Boundary Violations
12/11/2006
Raids alter campus party scene
By Michael GrassDaily Staff Reporter
In a second weekend of campus party raids, Ann Arbor Police Department officers delivered 58 minor in possession of alcohol citations Friday at a Phi Kappa Psi fraternity party and two house parties.
As part of an undercover operation, AAPD officers handed out nine citations at the Phi Kappa Psi party, six of which were MIP citations, AAPD Sgt. Myron Blackwell said. They delivered seven citations at a house party at 1120 Oakland St. and 48 MIP citations at a house party at 426 Hill St. Citations were given for false identification, supplying alcohol to minors and hosting the party, Blackwell said. AAPD did not conduct undercover operations on Saturday night.
Phi Kappa Psi is the fourth fraternity targeted by AAPD officials in the past two weeks. In a similar operation, AAPD raided parties at Sigma Nu, Beta Theta Pi, Theta Chi and a house party on Nov. 6, issuing 75 citations.
These recent busts have forced fraternities to more strictly enforce the Greek system's rules about serving alcohol and monitoring entrances at parties.
"We could see from observation the fraternities caught on quickly," Blackwell said.
Interfraternity Council President Bradley Holcman, a Kinesieology senior, said the raids have sparked reform in the Greek community.
"People are changing, but unfortunately this group did not change," Holcman said of Phi Kappa Psi.
Holcman said four parties were registered with IFC on Friday and nine Saturday. Fraternities enforced strict admission policies, including guest lists and checking students' identification.
"They were checking IDs and taking enforcement actions," Blackwell said.
Holcman said most of the fraternities and sororities realize they have to follow IFC's party guidelines. IFC prohibits hard liquor, glass containers and common sources of alcohol. Registered parties must post taxi information and monitor entrance and exit points.
"By showing that we can do things right, we are being more responsible," Holcman said. "Internally, things are changing."
Many students attribute changes in the campus party scene directly to recent raids on fraternities and campus house parties.
LSA senior Brian Kowaleskey, a member of Sigma Phi fraternity, said his house canceled an open party Friday night after discussing the implications with members of another fraternity.
"We were planning to have an open party, but another frat said please don't have anything because it might affect how the University views us," Kowalesky said.
Blackwell said he noticed an overall decrease in the number of parties on campus this weekend.
"A lot of younger students are afraid of being caught by the police, so they're drinking less," said Aime Yang, an LSA sophomore. "People are being a little more secretive."
"People are definitely more aware of the situation," LSA sophomore Gina LeClaire said. "With all the busting going around, there's less drinking at parties."
Art first-year student Dave Peabody said he planned to attend a party with friends Saturday night, but didn't want to drink there.
But other students said the threat of citations won't curb campus partying.
"I don't think it will affect anything; it's not solving the problem at the core," said Amy Booher, an LSA sophomore. "People will start drinking at other places where stings don't come."
"Friends tell me they're going to drink one way or the other," LSA junior James Christie said. "It's a part of college life."
Some fraternities said the AAPD raids haven't changed the way they host parties.
"We haven't done much of anything because we feel that we are a responsible house on campus," said Delta Kappa Epsilon President Justin McCabe, an Engineering senior.
For the past two weekends, AAPD used underage volunteers to patrol fraternity and house parties. The volunteers, first used in the Nov. 6 raids, were served alcohol. Undercover officers who witnessed this then delivered the citations and shut down the parties.
Individuals given MIP citations, a misdemeanor charge, have to appear in court and could receive up to 90 days in jail and a $500 fine.
But Holcman said the numbers of registered parties are normal for this time of year.
"The way to get through these raids is not to have parties, but to be smarter about them," Holcman said.
Fraternities tend to host more parties during home football games, Holcman said. Although next week's Michigan-Ohio State game is away in Columbus, he expects fraternities will host more parties to celebrate the rivalry.
SUBHEAD: Drinking at bars
Although The Brown Jug employees expected fewer minors would attempt to drink at the establishment this weekend, they caught a record number of people with fake IDs on Friday.
"On Friday we caught 11 fake IDs. It was mainly Wisconsin people trying to get away with a Michigan ID," said Abid Khan, manager at The Brown Jug.
Employees caught two people using fake identification at The Brown Jug on Saturday.
Brock Sprowl, assistant manager at Good Time Charley's on South University Avenue, said the AAPD crackdown on underage drinking is an important step in making students aware of alcohol consumption.
"If nobody is going to be there monitoring, I'm glad that cops are busting them," Sprowl said. "I hope it makes people realize that they have to become more responsible."
Sprowl compared the accountability of a bar manager to that of fraternities.
"We allow people in here to drink and we assume all of that responsibility, so why shouldn't they?" Sprowl asked.
SUBHEAD: Some liquor stores see increases in sales
Some party store employees attributed low sales this weekend to the recent raids.
"There's been barely any kegs sold this weekend," said In & Out employee Lindsay Tyler, an Art sophomore. "Compared to other weekends, there's been almost none."
Tyler found this behavior abnormal because this weekend marked the end of midterms for many students.
"The amount of drinking goes way down when people have tests," Tyler said. "The weekend after it usually goes up as stress relief, but this weekend, it's down."
Chuck Haas, owner of Maize and Brew, said big police busts rarely change sales.
"My liquor sales are what they have always been," Haas said.
Engineering junior Cory Vander Jagt, an employee at Village Corner, said he also did not notice a significant change in sales.
"It's about the same as last week," Vander Jagt said.
But Village Corner employee Gina Chopp, an LSA sophomore, said she saw an increase.
"Tonight's been really busy, more than last week," Chopp said.
SUBHEAD STYLE: Motivation for raids
AAPD officers say they've always conducted weekend party patrols. But the recent visits to fraternity parties have taken some students by surprise, causing them to question the justification for the recent raids.
"It's really unnecessary for police to start doing this," LSA first-year student Elise Zipkin said. "College is college."
"Police officers overstep their boundaries and infringe on students' rights at their pleasure," LSA junior Todd Johnson said. "They go places where they shouldn't be."
Some students said they feel officers are giving out more MIP citations because of the recent deaths of a Michigan State University student and LSA first-year student Courtney Cantor, who died Oct. 16 after falling from her sixth-floor Mary Markley Residence Hall window.
Cantor, who drank at a Phi Delta Theta fraternity party, had a blood alcohol level of 0.059, Washtenaw County Chief Medical Examiner Bader Cassin said. Cantor's blood alcohol level was below 0.08, which is considered impaired under Michigan driving standards.
Cantor's death is still under investigation by the Department of Public Safety and the role of alcohol in her death has not yet been concluded.
In his weekly column published in The Detroit News on Oct. 25, Courtney's father George Cantor said he did not want his daughter to be turned into the "poster child for underage drinking."
LSA sophomore Amy Anderson agreed Courtney Cantor's death has sparked a crackdown on alcohol.
"Because of what happened to Courtney Cantor, the police don't know what to do," Anderson said. "So they're giving out MIPs to people. But this hasn't affected drinking before."
- Daily Staff Reporters Nikita Easley, Nick Falzone, Jewel Gopwani, Asma Rafeeq and Jaimie Winkler contributed to this report
In a second weekend of campus party raids, Ann Arbor Police Department officers delivered 58 minor in possession of alcohol citations Friday at a Phi Kappa Psi fraternity party and two house parties.
As part of an undercover operation, AAPD officers handed out nine citations at the Phi Kappa Psi party, six of which were MIP citations, AAPD Sgt. Myron Blackwell said. They delivered seven citations at a house party at 1120 Oakland St. and 48 MIP citations at a house party at 426 Hill St. Citations were given for false identification, supplying alcohol to minors and hosting the party, Blackwell said. AAPD did not conduct undercover operations on Saturday night.
Phi Kappa Psi is the fourth fraternity targeted by AAPD officials in the past two weeks. In a similar operation, AAPD raided parties at Sigma Nu, Beta Theta Pi, Theta Chi and a house party on Nov. 6, issuing 75 citations.
These recent busts have forced fraternities to more strictly enforce the Greek system's rules about serving alcohol and monitoring entrances at parties.
"We could see from observation the fraternities caught on quickly," Blackwell said.
Interfraternity Council President Bradley Holcman, a Kinesieology senior, said the raids have sparked reform in the Greek community.
"People are changing, but unfortunately this group did not change," Holcman said of Phi Kappa Psi.
Holcman said four parties were registered with IFC on Friday and nine Saturday. Fraternities enforced strict admission policies, including guest lists and checking students' identification.
"They were checking IDs and taking enforcement actions," Blackwell said.
Holcman said most of the fraternities and sororities realize they have to follow IFC's party guidelines. IFC prohibits hard liquor, glass containers and common sources of alcohol. Registered parties must post taxi information and monitor entrance and exit points.
"By showing that we can do things right, we are being more responsible," Holcman said. "Internally, things are changing."
Many students attribute changes in the campus party scene directly to recent raids on fraternities and campus house parties.
LSA senior Brian Kowaleskey, a member of Sigma Phi fraternity, said his house canceled an open party Friday night after discussing the implications with members of another fraternity.
"We were planning to have an open party, but another frat said please don't have anything because it might affect how the University views us," Kowalesky said.
Blackwell said he noticed an overall decrease in the number of parties on campus this weekend.
"A lot of younger students are afraid of being caught by the police, so they're drinking less," said Aime Yang, an LSA sophomore. "People are being a little more secretive."
"People are definitely more aware of the situation," LSA sophomore Gina LeClaire said. "With all the busting going around, there's less drinking at parties."
Art first-year student Dave Peabody said he planned to attend a party with friends Saturday night, but didn't want to drink there.
But other students said the threat of citations won't curb campus partying.
"I don't think it will affect anything; it's not solving the problem at the core," said Amy Booher, an LSA sophomore. "People will start drinking at other places where stings don't come."
"Friends tell me they're going to drink one way or the other," LSA junior James Christie said. "It's a part of college life."
Some fraternities said the AAPD raids haven't changed the way they host parties.
"We haven't done much of anything because we feel that we are a responsible house on campus," said Delta Kappa Epsilon President Justin McCabe, an Engineering senior.
For the past two weekends, AAPD used underage volunteers to patrol fraternity and house parties. The volunteers, first used in the Nov. 6 raids, were served alcohol. Undercover officers who witnessed this then delivered the citations and shut down the parties.
Individuals given MIP citations, a misdemeanor charge, have to appear in court and could receive up to 90 days in jail and a $500 fine.
But Holcman said the numbers of registered parties are normal for this time of year.
"The way to get through these raids is not to have parties, but to be smarter about them," Holcman said.
Fraternities tend to host more parties during home football games, Holcman said. Although next week's Michigan-Ohio State game is away in Columbus, he expects fraternities will host more parties to celebrate the rivalry.
SUBHEAD: Drinking at bars
Although The Brown Jug employees expected fewer minors would attempt to drink at the establishment this weekend, they caught a record number of people with fake IDs on Friday.
"On Friday we caught 11 fake IDs. It was mainly Wisconsin people trying to get away with a Michigan ID," said Abid Khan, manager at The Brown Jug.
Employees caught two people using fake identification at The Brown Jug on Saturday.
Brock Sprowl, assistant manager at Good Time Charley's on South University Avenue, said the AAPD crackdown on underage drinking is an important step in making students aware of alcohol consumption.
"If nobody is going to be there monitoring, I'm glad that cops are busting them," Sprowl said. "I hope it makes people realize that they have to become more responsible."
Sprowl compared the accountability of a bar manager to that of fraternities.
"We allow people in here to drink and we assume all of that responsibility, so why shouldn't they?" Sprowl asked.
SUBHEAD: Some liquor stores see increases in sales
Some party store employees attributed low sales this weekend to the recent raids.
"There's been barely any kegs sold this weekend," said In & Out employee Lindsay Tyler, an Art sophomore. "Compared to other weekends, there's been almost none."
Tyler found this behavior abnormal because this weekend marked the end of midterms for many students.
"The amount of drinking goes way down when people have tests," Tyler said. "The weekend after it usually goes up as stress relief, but this weekend, it's down."
Chuck Haas, owner of Maize and Brew, said big police busts rarely change sales.
"My liquor sales are what they have always been," Haas said.
Engineering junior Cory Vander Jagt, an employee at Village Corner, said he also did not notice a significant change in sales.
"It's about the same as last week," Vander Jagt said.
But Village Corner employee Gina Chopp, an LSA sophomore, said she saw an increase.
"Tonight's been really busy, more than last week," Chopp said.
SUBHEAD STYLE: Motivation for raids
AAPD officers say they've always conducted weekend party patrols. But the recent visits to fraternity parties have taken some students by surprise, causing them to question the justification for the recent raids.
"It's really unnecessary for police to start doing this," LSA first-year student Elise Zipkin said. "College is college."
"Police officers overstep their boundaries and infringe on students' rights at their pleasure," LSA junior Todd Johnson said. "They go places where they shouldn't be."
Some students said they feel officers are giving out more MIP citations because of the recent deaths of a Michigan State University student and LSA first-year student Courtney Cantor, who died Oct. 16 after falling from her sixth-floor Mary Markley Residence Hall window.
Cantor, who drank at a Phi Delta Theta fraternity party, had a blood alcohol level of 0.059, Washtenaw County Chief Medical Examiner Bader Cassin said. Cantor's blood alcohol level was below 0.08, which is considered impaired under Michigan driving standards.
Cantor's death is still under investigation by the Department of Public Safety and the role of alcohol in her death has not yet been concluded.
In his weekly column published in The Detroit News on Oct. 25, Courtney's father George Cantor said he did not want his daughter to be turned into the "poster child for underage drinking."
LSA sophomore Amy Anderson agreed Courtney Cantor's death has sparked a crackdown on alcohol.
"Because of what happened to Courtney Cantor, the police don't know what to do," Anderson said. "So they're giving out MIPs to people. But this hasn't affected drinking before."
- Daily Staff Reporters Nikita Easley, Nick Falzone, Jewel Gopwani, Asma Rafeeq and Jaimie Winkler contributed to this report
UVa gets a "D" in access to minorities, poor
The Education Trust came out with this report Monday on how well flagship universities serve poor and minority students.
The results show that universities throughout the country are doing a poor job of enrolling and educating these students, according to the nonprofit group and advocate for disadvantaged students.
The lack of access to higher education for the poor and minorities isn't exactly news. Perhaps more surprising were numbers from the study that show universities are doing a worse job of serving these groups than they were a decade ago.
The numbers that jumped out at me: Financial aid from universities jumped 406 percent for students from families making six figures or higher from 1995 to 2003. The percent increase for families making $20,000 to $39,000 went up just 54 percent while families making less than $20,000 actually received less aid from universities.
Inside Higher Ed sums up the findings in a story today.
The results show that universities throughout the country are doing a poor job of enrolling and educating these students, according to the nonprofit group and advocate for disadvantaged students.
The lack of access to higher education for the poor and minorities isn't exactly news. Perhaps more surprising were numbers from the study that show universities are doing a worse job of serving these groups than they were a decade ago.
The numbers that jumped out at me: Financial aid from universities jumped 406 percent for students from families making six figures or higher from 1995 to 2003. The percent increase for families making $20,000 to $39,000 went up just 54 percent while families making less than $20,000 actually received less aid from universities.
Inside Higher Ed sums up the findings in a story today.
Financial aid bits and pieces
I met today with Barry Simmons, director of scholarhips and financial aid at Virginia Tech.
Simmons is also vice president of a new state association to promote access to higher education. The Commonwealth College Access Network was established in July and will soon change its name to the Virginia College Access Network.
The group will be holding a conference in the Omni Richmond Hotel Dec. 4-6. It's open to the public and covers topics such as the application process, earning college credit in high school, the admissions process, Latinos in higher education and grant applications.
Virginia Tech football makes the grade -- again
For the second year in a row, the Virginia Tech football team met new standards for graduation rates set by the NCAA.
The Chronicle of Higher Education reports today that more than a third of bowl-bound football teams failed to meet the criteria.
That's better than last year, when 40 percent of teams failed to meet the graduation criteria. Check out the list of bowl schools and how they fared and read the report for more details.
Only four schools were actually punished by the NCAA for falling short of the required "academic progress rates" but as more data is collected, more schools will be at risk for losing scholarships.
The Chronicle of Higher Education reports today that more than a third of bowl-bound football teams failed to meet the criteria.
That's better than last year, when 40 percent of teams failed to meet the graduation criteria. Check out the list of bowl schools and how they fared and read the report for more details.
Only four schools were actually punished by the NCAA for falling short of the required "academic progress rates" but as more data is collected, more schools will be at risk for losing scholarships.
Tabs on NU events, lifestyle
For some University of Nebraskan-Lincoln students, the Daily Nebraskan is often taken for granted. The student newspaper is always nearby, always free and always an easy target. But what many UNL students don't realize is that the Daily Nebraskan is one of students' few outlets to ask their questions or express their comments and concerns.The Daily Nebraskan, or "the DN" as it is often referred as, is a student-run newspaper that publishes five days a week throughout the fall and spring semesters. The Daily Nebraskan is not only the only daily college paper in the state, but is also the fifth largest paper (by circulation) in the state.Jenna Johnson, editor-in-chief of the Daily Nebraskan for the 2006-07 school year said that while many Nebraska papers try to cover university issues, the Daily Nebraskan is the only paper that covers the university on a daily basis."It's pretty much your daily textbook to the university," she said.Johnson went on to say that reading the Daily Nebraskan is the best way to be informed about what's going on, so that one can actually be a part of the university.She also said that in order for the Daily Nebraskan to be the best paper that it can be, it needs the help of the student body."Let us know what you're upset about or if you have any ideas or complaints," Johnson said.Located in the basement on the south side of the Nebraska Union, the doors to the Daily Nebraskan are always open and anyone is welcome to come in and pitch story ideas.Dan Shattil, general manager of the Daily Nebraskan said the paper has evolved along with the student body and the journalism world.Shattil said that we are comparable to any college paper with the same enrollment and that the Daily Nebraskan has an award winning staff. Last year, the Daily Nebraskan won a Pacemaker Award, for being one of the top college newspapers in the country, as well as several individual awards. The paper also won two awards from the Nebraskan Press Association.But a student reading the paper is one of the best awards we can get, he said. Along with reading the paper, he said getting feedback from the students is very important, as well as students giving the paper story ideas.Johnson said students are lucky to have a paper the size of the Daily Nebraskan at their disposal."It's something campus needs to take advantage of more," she said.
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