With closing arguments this afternoon, the verdict on Annette Bosworth’s perjury on her 2014 Senate nominating petitions is nigh. A felony conviction for violating her circulator’s oath could put her medical license in jeopardy again. But whatever verdict our peers render, the defense team itself has presented evidence of Dr. Bosworth’s disrespect for her medical oath and her patients’ privacy that should put her medical credentials in question.
South Dakota has adopted the American Medical Association’s Code of Ethics to govern physicians’ actions South Dakota Administrative Rule 20:47:08:01 copies the AMA’s Principles of Medical Ethics verbatim; SDAR 20:47:08:03 directs the state medical board to refer to refer to the AMA’s opinions and annotations for further guidance on applying the Code of Ethics to judge unacceptable conduct among physicians.
Principle #8 of the AMA Code of Ethics says, “A physician shall, while caring for a patient, regard responsibility to the patient as paramount.”
In testimony Friday, Dr. Bosworth’s receptionist, Melissa O’Connell Galer testified that when Dr. Bosworth was walking patients out of her exam room to the door, the doctor would ask her patients to sign her nominating petition.
The AMA’s online opinions elaborating on the Code of Ethics do not directly address doctors’ soliciting petition signatures from patients. Opinion 10.018 does address doctors’ soliciting “contributions” from patients:
Donations play an important role in supporting and improving a community’s health care. Physicians are encouraged to participate in fundraising and other solicitation activities while protecting the integrity of the patient-physician relationship, including patient privacy and confidentiality, and ensuring that all donations are fully voluntary. In particular:
(1) Appropriate means of soliciting contributions include making information available in a reception area and speaking at fundraising events. Physicians should avoid directly soliciting their own patients, especially at the time of a clinical encounter. They should reinforce the trust that is the foundation of the patient-physician relationship by being clear that patients’ welfare is the primary priority and that patients need not contribute in order to continue receiving the same quality of care.
(2) The greater the separation between the request and the clinical encounter, the more acceptable the solicitation is likely to be.
(3) When physicians participate in solicitation efforts as members of the general community, they should seek to minimize perceptions of overlap with their professional roles… [“Opinion 10.018: Physician Participation in Soliciting Contributions from Patients,” American Medical Association, downloaded 2015.05.27].
Opinion 10.018 cautions doctors not to abuse their power in the doctor-patient relationship even when soliciting donations intended to promote community health. We may reasonably assume that the AMA would urge even greater caution in soliciting patients for assistance in a political project that is much further removed from the doctor’s responsibility to care for the patient and promote community health. Yet Bosworth’s employee testified that Bosworth directly solicited patients for political help in her office, at the time of clinical encounters, with no effort to minimize the overlap between her political role and her professional role.
The South Dakota Board of Medical and Osteopathic Examiners could look at this testimony, easily conclude that Dr. Bosworth behaved unprofessionally by exploiting the doctor-patient relationship in her office for her own political gain, and revoke her medical license.
Dr. Bosworth’s own lawyer drew Bosworth into another violation of her professional responsibilities. The attorney (and I apologize for not keeping track of whether it was Robert Van Norman or Dana Hanna) displayed one of the contested petition sheets, one on which she hadn’t actually witnessed all signatures, and asked Bosworth if she had signed it as circulator. Bosworth said yes. The attorney asked if she thought it was o.k. to sign that sheet because she knew the signers. Bosworth said yes. The attorney then asked if she knew them because they were her patients. Bosworth said yes.
Ever hear of HIPAA, the Health Insurance Portability and Accountability Act? HIPAA says that a doctor cannot release a patient’s medical information without the patient’s prior written consent, even in a court of law when a lawyer asks the doctor a question. If I were a patient of Dr. Bosworth (pause for alternate-universe fear and trembling), I would consider the mere fact that I was her patient one of the most basic private pieces of medical information. Bosworth stated on the stand Friday that she focuses on treating addicts; naming me as a Bosworth patient could hurt my reputation by raising suspicion that I suffer from an addiction.
Unless Bosworth has a stack of written authorizations from her patients, she violated HIPAA on the stand Friday. The South Dakota Board of Medical and Osteopathic Examiners could look at that testimony, easily determine that Bosworth willfully betrayed a professional confidence, and revoke her medical license.
None of these points are material to the guilty verdict jurors should render this week for Annette Bosworth’s perjury on her nominating petitions. But her ongoing exploitation of her patients and disrespect for their privacy should form the foundation of the state medical board’s next disciplinary action with Bosworth.