Sugarman v. Board of Registration in Medicine

• Citation: 422 Mass. 338,662 N.E.2d 1020
• Parties: Muriel SUGARMAN v. BOARD OF REGISTRATION IN MEDICINE.
• Decision Date: 28 March 1996
• Court: United States State Supreme Judicial Court of Massachusetts Supreme Court

Page 1020

662 N.E.2d 1020

422 Mass. 338

Muriel SUGARMAN v. BOARD OF REGISTRATION IN MEDICINE.

Supreme Judicial Court of Massachusetts,

Suffolk.

Argued Jan. 11, 1996.

Decided March 28, 1996.

CIVIL ACTION commenced in the Supreme Judicial Court for the county of Suffolk on October 31, 1994.

The case was reported by Nolan, Judge.

Charles P. Reidy, Boston (Mary T. Gibbons, with him), for plaintiff.

Karen J. Laufer, Assistant Attorney General, for defendant.

ABRAMS, Justice.

A single justice of this court reserved and reported the issues raised by the appeal of the plaintiff, Dr. Muriel Sugarman, from a decision of the Board of Registration in Medicine (board). The board determined that Sugarman's conduct in releasing confidential information to the press undermined public confidence in the integrity of the medical profession and therefore Sugarman was subject to professional discipline. The board imposed sanctions. See infra at 1026. Sugarman appealed. We affirm the decision of the board.

Sugarman is a psychiatrist specializing in adult and child psychiatry but is not board certified in either specialty. She was retained as an expert witness in a highly publicized and acrimonious custody dispute in the Essex Probate and Family Court involving allegations of sexual abuse of a minor child by her father. The child's mother strongly opposed any unsupervised visitation between the child and the father, while the father denied all allegations of sexual abuse. ¹ Both a guardian ad litem and an attorney were appointed to represent the child's interests.

With the consent of the guardian ad litem, unsupervised visitation between the child and her father was ordered on June 26, 1986, to commence on June 27, 1986. Rather than allow this visitation, the mother fled the Commonwealth with the child. Temporary custody was awarded to the father. The mother returned in March, 1987, without the child, and was jailed for contempt of court. She remained jailed until the child was located in October, 1987, and returned to Massachusetts. The child then was admitted to Cambridge Hospital for a court-ordered evaluation by the hospital's psychiatry, psychology, and pediatrics departments (Family Crisis or FACT team), which was to issue a report to the court (Cambridge report). During the period of the mother's incarceration and the child's evaluation at Cambridge Hospital, the allegations of sexual abuse were highly publicized in the news media. The Probate Court judge, on September 18, 1987, issued a protective order requiring that the parties, attorneys, Dr. Dennis Harrison, ² and "all other known and potential expert witnesses ... cease forthwith from making public extrajudicial oral or written statements or both concerning this case or releasing (tapes) material including but not limited to [the child's] medical history and records, [and] psychiatric and psychological history or treatment." ³ In October, 1987, a more specific order prohibiting disclosure of the contents of the Cambridge report was entered (the gag order). It required the mother's attorney, as a condition of receiving a copy of the report, to sign a statement which provided that she "accept[ed] a copy of the Report with a clear understanding that [she would] discuss the contents with [her] client only and such expert medical personnel as [she] may engage and counsel, the parties and such expert medical personnel are not to discuss nor disclose the contents of the Report with anyone else." The Cambridge report, received by the parties in December, 1987, contained psychiatric evaluations of the father, the mother, and the child, psychological reports on the parents, physical findings from the child's pelvic examination and the child's treatment records. The authors of the Cambridge report specifically concluded that further media publicity was not in the child's best interest.

In December, 1987, the attorney for the mother forwarded a copy of the Cambridge report to Sugarman, who had been retained by that attorney to act as an expert witness and consultant. The attorney informed Sugarman of the court's gag order and that the attorney would be subject to a charge of contempt of court if Sugarman discussed or disclosed the contents of the report with anyone.

Sugarman believed that the child was at an unreasonable risk of harm if the court allowed unsupervised visitation between the child and the father and that she had a moral duty to protect the child from the risk of further abuse by her father. ⁴ Therefore, despite the judge's prohibition, Sugarman showed selected portions of the Cambridge report to Steve Curwood, a reporter for the Boston Globe newspaper, allowed him to take notes, and gave him permission to publish selected information contained in the report. ⁵ Neither the child, her parents nor the attorney authorized Sugarman to disclose the information in the Cambridge report or to speak with Curwood. ⁶ Curwood's article was published in the Boston Globe on December 30, 1987, and included detailed quotes from the Cambridge report. On that same date, Sugarman held a press conference in which she identified herself as an "advocate" and a "child psychiatric expert consultant on the issue of sexual abuse" and in which she asserted that the "evaluation report from the sexual abuse team at The Cambridge Hospital, which I have studied in depth, contains ample psychological and physical evidence to indicate that [the child] was sexually abused by her father ... on at least three, but possibly more, occasions." ⁷ Sugarman went on to describe several other statements made in the report or by members of the evaluation team and then to criticize the report and state her belief that the treatment decisions being made for the child placed her at grave risk for further serious psychological damage and repeated sexual abuse. ⁸ Sugarman acknowledged that she called the press conference at "some personal and professional risk."

As a result of Sugarman's actions, a contempt hearing was conducted in the Essex Probate and Family Court to determine whether the mother's attorney could be held in contempt for violation of the gag order. On February 24, 1993, the board issued a statement of allegations alleging that Sugarman had engaged in conduct which undermined public confidence in the integrity of the medical profession by knowingly disregarding the express warning of the FACT team that publicity would be detrimental to the child, by deliberately defying the gag order intended to prevent disclosure of the Cambridge report by the parties and their experts, and by undermining the fair and orderly administration of justice. ⁹

A hearing was held before an administrative magistrate of the Division of Administrative Law Appeals who, in her proposed findings of fact and conclusions of law, recommended that Sugarman be disciplined for engaging in conduct which undermined public confidence in the integrity of the medical profession on two separate occasions (the leak to Curwood and the press conference). On September 28, 1994, the board issued its final decision and order in which it determined that Sugarman did indeed engage in conduct which undermined public confidence in the integrity of the medical profession. The board ordered indefinite suspension of Sugarman's license, which suspension would be permanently stayed on payment of a $10,000 fine and approval of Sugarman's plan to perform one hundred hours of community service.

1. The board's authority. Sugarman asserts that the board lacks authority to discipline her because she did not engage in any wrongdoing. Therefore, Sugarman asserts that the board cannot discipline her for her actions. We do not agree. The board has broad authority to regulate the conduct of the medical profession, see Kvitka v. Board of Registration in Medicine, 407 Mass. 140, 551 N.E.2d 915, cert. denied, 498 U.S. 823, 111 S.Ct. 74, 112 L.Ed.2d 47 (1990), which authority includes its ability to sanction physicians for conduct which undermines public confidence in the integrity of the medical profession. Raymond v. Board of Registration in Medicine, 387 Mass. 708, 713, 443 N.E.2d 391 (1982) (board has authority to discipline physicians for conduct that undermines public confidence in the integrity of the profession; reasonably related to promotion of the public health, welfare, and safety).

Conduct which undermines public confidence in the integrity of the medical profession is an independently sufficient ground for the board to sanction a physician. Such conduct is not limited to that outlined in G.L. c. 112, § 5 (1994 ed.). The board has broad authority to "protect the image of the medical profession" and is not limited to disciplining conduct involving direct patient care, criminal activity, or deceit. Id.

Sugarman's actions violated the family's privacy interests, her ethical obligations as a forensic psychiatrist, ¹⁰ and her duties to the Probate Court, the attorney who hired her, and the family. Sugarman was on notice that the evaluation was confidential. Prior to the press conference, the mother's attorney specifically forbade Sugarman from proceeding and warned her that, as the attorney who gave the report to Sugarman, the attorney would be at risk of contempt if Sugarman so proceeded. Sugarman also was aware of the FACT team's conclusion that additional publicity was not in the child's best interests.

Sugarman was, or should have been, aware of the Ethical Guidelines for the Practice of Forensic Psychiatry (AAPL Guidelines) promulgated by the American Academy of Psychiatry and the Law (AAPL) in May, 1987, ¹¹ and the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry (1986) promulgated by the American Psychiatric Association (Principles of Medical Ethics). As she was engaged in the practice of forensic psychiatry in this case, Sugarman's lack of membership in the AAPL is immaterial. The guidelines...