There are no words more devastating than, “Our hands are tied” to a survivor reporting abuse and seeking some semblance of accountability from a larger institution. “The institution admitted no fault” is a close second.

Picture this sequence: a trusted physician at a renowned academic medical center sees a patient at a vulnerable stage in her life for a regular appointment. As she is exposed for a standard physical exam, he sexually assaults her.

Devastated, humiliated, she leaves the clinic and calls the police.

The police arrest the physician. He is led away, paraded past appalled faces, his disgrace a highly public display.

Mere days later, he has been released from custody and is permitted to resume his clinical responsibilities by his supervisors, working with the same vulnerable patients, with unfettered access to the same putative victims.

He practices for another 5 weeks. He assaults 8 more patients in that time.

There must be more to it. How could this happen? How indeed. But it did happen.

After years of sexual misconduct, Robert Hadden was sentenced in July 2023 to 20 years in prison on federal charges of sexually assaulting an appalling number of patients during his long career as an OB/GYN at Columbia University Irving Medical Center. And with the long-overdue sentencing comes the overwhelming feeling of relief to the survivors and their families.

But there is a darker part of the narrative. The piece that we were missing in the story I just relayed? Several members of Columbia’s OB leadership were aware of Hadden’s arrest, among several other instances of predatory and sexually assaultive behavior. And yet, they permitted this predator to return to the clinic, where he proceeded to victimize other unwitting patients. Furthermore, the institution failed to take true accountability for its role in perpetrating the abuse.

Hadden and his ilk are undoubtedly predators. But — hear me out — they are not the problem. They are merely symptoms of a more pernicious illness pervading the medical profession.

The institution in question failed Hadden’s patients. Hadden is responsible for assaulting the victims. But Columbia, which had knowledge of the imminent danger he posed to patients, is responsible for allowing him access to vulnerable patients and is equally responsible for egregious harm, in my opinion.

As an alumna of the Mailman School of Public Health at Columbia University, I am deeply troubled. I recall their stated ethos presented while I was a student there: a decided, and indeed noble, focus on social justice, ethics, equity, and protecting vulnerable and marginalized populations. Yet, the institution’s actions in the Hadden case lie decidedly antithetical to these stated values.

I say this not to hurt the institution, but to use it as a case study to highlight a problematic culture that is by no means unique to Columbia. Upon discovery of a predator in a white coat, academic medical centers often close ranks, silencing all talk of misconduct and either passing the trash to another institution or flat-out refusing to act. In this particular case, inaction led to countless victims and irrevocable trauma. This is a matter of public record. Robert Hadden finally faces prison, a small victory for his victims who still suffer the consequences of his innumerable abuses.

But what consequences does Columbia face? And if the culture of silence remains unchanged, what will stop another Hadden from abusing more vulnerable patients?

We have many other examples of institutional complicity with abuse perpetrated by physicians: Christopher Duntsch, Michael Swango, Larry Nassar. In every single case, a larger institution was aware of misconduct, yet permitted these predators access to more victims. Who suffered? Patients who trust our profession with their most sensitive information. And we wonder why the general public is losing trust in the medical community.

While these cases are extreme in nature, the phenomenon of institutional complicity with misconduct in medicine is not as rare as you might hope. These are cases that happen to make the news. The unreported and silenced cases are the ones that concern me.

If the MeToo movement showed us anything, it is that sexual predators exist in virtually every corner of society: from the Catholic Church, to the government, to Hollywood. Certainly, medicine is no exception. No medical institution can prevent the entry of every possible perpetrator. But how a medical institution responds to the presence of a known predator says everything about that institution’s ethics and commitment to patient safety.

I recall a different institution cautioning me after I reported a pattern of abuse and sexual misconduct. The alleged perpetrator moved onto the next level of medical training with zero tangible consequences. I was advised not to appear “angry,” as though my anger were more concerning than the subject allegedly perpetrating on hospital employees and patients. I held my tongue and left, betrayed and dismayed.

Today, I would ask that institution, and others: If abuse in a white coat does not make you angry, then where exactly do you draw the line?

Our profession has an illness: Complicity with misconduct if the perpetrator is one of our own. It is a daily betrayal of our patients’ trust. When we protect an abuser at the expense of patients, we are flagrantly betraying the trust that we should be safeguarding.

I love my profession. Seriously. I love going to work every day. I want better for my patients and I call on my colleagues to do better. We make a commitment to do no harm. Our inaction in the face of misconduct does just the opposite, and our patients deserve better. We owe it to them to hold perpetrators appropriately accountable, to speak out against their abuse, before their destructive actions irrevocably damage innocent lives entrusted to us. If we do not practice our profession’s stated values by offering sincere action in the face of misconduct, we offer our patients nothing more than empty lip service. We must be better than we are at this moment.

Chloe N. L. Lee is a psychiatry resident.