Dayton Children’s Hospital has revamped its policies — including a new requirement that a staff chaperone be made available during all sensitive procedures — in the wake of allegations a doctor there improperly touched the breasts of two teen-age patients during exams.
The doctor, Dr. Arun Aggarwal, was stripped of his Ohio medical license Wednesday by the State Medical Board of Ohio.
Hospital CEO Deb Feldman, in an exclusive interview with the Dayton Daily News, said the hospital has taken steps that “we think will prevent even the opportunity for a child to either be unsafe or feel unsafe.”
“Frankly, our process failed us,” Feldman said.
The policy changes Feldman laid out include requiring increased chaperoning of physicians, notifying law enforcement of all complaints and new training for staff on communicating with patients.
Medical board members Wednesday were sharply critical of the hospital’s response to the complaints by Aggarwal’s patients.
“The medical staff seemed to drag their feet in my opinion. They did not investigate this very heavily,” board member Dr. Richard Edgin said. “I don’t think they really were appropriate in disciplining this doctor.”
A Dayton Daily News investigation used internal documents from the hospital to illustrate an internal dispute over how to handle the allegations against Aggarwal, a pediatric gastroenterologist practicing at the hospital through a contract with the Wright State University Boonshoft School of Medicine.
Aggarwal was hired in 2013. Within months, the first allegation surfaced that he touched a 15-year-old patient’s breast after asking her mother to leave the room. Some hospital staff pushed to tell authorities, but Aggarwal said it was a misunderstanding and hospital administrators told him to start using chaperones.
When a second complaint from another patient came in months later, hospital and WSU administrators issued a written warning and ordered him to use chaperones, but did not inform law enforcement of the allegation.
A Dayton police investigation was launched after a hospital worker reported it on her own. Aggarwal was not charged criminally, but the police probe led to the action by the medical board to permanently revoke his Ohio medical license.
Aggarwal’s attorney, James Fleisher, said he will appeal the decision by the medical board.
“We respectively disagree with the decision of the board and intend to pursue the matter as permitted in the courts,” he said after the hearing.
Aggarwal has argued that he pressed on the first patient’s sternum because she was complaining of chest pain, and inspected a surgical scar on the second patient’s breast out of concern for infection.
Wright State officials have declined comment, citing a lawsuit Aggarwal filed against the school alleging wrongful termination.
‘The situation was ambiguous’
Feldman said hospital attorneys advised that they weren’t legally required to report the incident to law enforcement because, “They believed we had insufficient information to make that conclusion.
“The situation was ambiguous, and we really were trying to determine if the concerns that were being expressed by the families were a reflection of potential inappropriate behavior or if they were misunderstandings,” she said.
This became clearer as the Dayton police investigation went on, Feldman said.
“As the police were able to move through their investigation and gather more detailed information themselves, we began to understand more fully what had occurred,” she said. “And as we did that we realized our own process had not uncovered certainly enough information.”
The new reporting policy marks a significant change in how Children’s officials will now handle complaints.
“We will consult directly (with the hospital’s social work division) and then immediately consult with the police,” Feldman said. “We will no longer do an internal investigation here at Dayton Children’s prior to that.”
‘Our policy now is much tighter’
Medical board member Dr. Michael Schottenstein said the allegations against Aggarwal should not have been handled in-house.
“Common sense, as well as duty under the law, dictate this doctor need(ed) to be reported to the medical board, and to the appropriate legal authorities,” he said.
But the board stopped short of advocating taking any action against the hospital.
State law requires health care professionals to contact law enforcement or child welfare agencies if they have “reasonable cause to suspect based on facts that would cause a reasonable person in a similar position to suspect” that a child under 18 years of age has suffered or faces the threat of suffering abuse.
The Montgomery County Prosecutor’s Office said that after the Dayton police investigation, “There was insufficient evidence against any one individual to support a charge of failing to report a reasonable suspicion of child abuse.”
Feldman said the hospital followed its previous policy, which included attempting to get more information from the families, which she said was unsuccessful.
“I think we followed our policy in general, but our policy was not as specific as it needed to be to really ensure that certain steps were always taken,” she said. “Our policy now is much tighter, much more prescriptive, and does not leave any question.”
Chaperones required on all sensitive exams
The biggest change, said Feldman, was a new medical chaperoning policy that was drafted during the police investigation and implemented last year.
Per the four-page policy, provided by hospital officials: “Dayton Children’s providers will offer a medical chaperone to patients and/or their family member for any or all portions of a physical examination that involves a focused, sensitive exam of a sensitive body region (breast, genital, urinary, buttocks, anal or rectal exam).”
Previously, Feldman said, the hospital followed the recommendations of the American Academy of Pediatrics, which considered a parent an appropriate chaperone. She said having a separate medical professional in the room protects both the patient and the physician.
“We believe with that change, a situation like this can never happen again,” she said.
This policy is also part of a new curriculum for physicians that is focused on helping staff communicate to patients why they are doing certain sensitive procedures.
‘We could have done better’
Feldman said no hospital officials were disciplined over the handling of the incident, which she oversaw as hospital CEO.
Neither of the former employees who most vocally pushed for Aggarwal to be reported still work there, including former department clinic manager Angela Cox, who told the medical board that both employees felt retaliated against by the hospital.
“There was not retaliation,” Feldman said. “That really saddens me because we really work hard here at Dayton Children’s to instill a culture of safety. We don’t want this situation in any way to inhibit any employee at Dayton Children’s to come forward if they have a concern.”
“We could have done better, and our process did not work as we hoped it would and we have done everything we can to tighten up and address where the process failed,” Feldman said.
“We absolutely are deeply committed to the children of this community. That’s why we exist. We exist to care for these children.”
STORIES FROM OUR YEAR-LONG SERIES:
LICENSE REVOKED:Doctor’s license revoked after accusations of improper touching
HUBER HEIGHTS:Doctor accused of sexual advances toward 13 patients
PRACTICING AGAIN:Dayton doctor suspended for two years allowed to practice again