Riding Crops And Psychiatric Treatment

The Tennessee Court of Appeals affirmed sanctions imposed on a psychiatrist

As set out in the notice, the specific allegations against Dr. Augustus were that she: (1) “struck [a patient, P.T.,] on the buttocks with a riding crop” during a patient’s session in July 2015; (2) “has struck other mental health patients with a riding crop;” and (3) “has had both a riding crop and a whip displayed in her office.”

Response

In her response to the Notice of Charges, Dr. Augustus did not deny the use of a riding crop in her practice but averred that she “did not strike the patient with the intent to cause harm or pain.” Rather, Dr. Augustus explained that the “riding crop was used in a humorous exchange intended to foster the physician/patient relationship.”

Testimony at the  contested hearing before the Board of Medical Examiners

Patient, P.T., whose complaint that Dr. Augustus struck her with a riding crop during her July 2015 visit gave rise to the investigation, testified that she had been Dr. Augustus’ patient for five months. Although P.T. acknowledge that she had noticed the riding crop and whip in Dr. Augustus’ office, she explained that it “never dawned on [her] that . . . it would be used [to strike patients].” P.T. further testified that during the July 2015 visit, she was very depressed, “very withdrawn,” and that “[e]very time [she] spoke, it was through tears; that she was feeling very vulnerable and had no purpose for living.” During the therapy session, P.T. informed Dr. Augustus that she had not followed Dr. Augustus’ previous instruction to journal. P.T. testified that because she failed to follow Dr. Augustus’ instruction, Dr. Augustus struck her on the buttocks with the riding crop as she was exiting the office. P.T. stated that, “I wouldn’t say that it was dramatic force, but it was enough force that I kn[e]w she hit me and that it stung, and it left a bruise.”

Response

During her testimony, Dr. Augustus admitted that she used the riding crop to “tap” and “make contact with [P.T.’s] buttocks.” She testified that she had also used the crop  on other patients as part of a humorous exchange when those patients failed to follow her recommendations and instructions…

However, Dr. Augustus denied using enough force with the crop to hurt the patient and further opined that none of her patients thought her use of the crop was anything other than humorous.

Expert testimony

Dr. Augustus called William C. Wolters, J.D., M.D., as her expert in psychiatry. Dr. Wolters opined that Dr. Augustus’ use of the riding crop may have crossed a boundary, but it was not a deviation from the standard of care. He opined that, “Humor is important, and I think, I can understand you don’t want someone to leave on kind of a down note. You want to kind of put things in perspective and bring some humor in and some . . . encouragement.”

The board found violations

The Board suspended Dr. Augustus’ medical license for at least 60 days and ordered her to submit to an assessment of her ability to safely practice psychiatry and to attend a two-day course in medical ethics, boundaries, and professionalism. The Board also placed Dr. Augustus on probation and imposed a penalty of $10,000 plus the costs of the administrative proceedings, up to maximum of $50,000.

Her request for reconsideration was denied. The appeal followed.

Despite Dr. Augustus’ decision to defend her actions by arguing that her intent was never to hurt or injure her patients, the gravamen of the Notice of Charges is not whether Dr. Augustus inflicted (or intended to inflict) physical harm or pain on her patients, nor are the charges based on the amount of force Dr. Augustus used in wielding the riding crop. Rather, the gravamen of the charges is Dr. Augustus’ use of a riding crop in any manner during the patients’ therapy sessions.

The court concluded that notice was adequate and substantial evidence supported the findings

Here, the facts and the legal conclusion drawn by the Board are supported by material evidence in the record; as such, the sanctions imposed on Dr. Augustus are not without justification in fact, nor unwarranted in law.

The trial courts order is affirmed, and the case is remanded for such further proceedings as may be necessary and are consistent with this opinion.

The Tennessean reported on the allegations. (Mike Frisch)