The hospital’s response resulted first in a warning to the doctor and then a policy requiring a nurse or other health professional to be in the room whenever he examined a female patient over the age of 10.
“At this time, other than the continued monitoring (which I strongly support), there are no further actions that must be taken by DCH, including any reporting,” Chris Bennington, the hospital’s attorney, wrote in a Jan. 7, 2015, email to Chief Medical Officer Adam Mezoff that is part of the investigative file released to the newspaper.
CONTINUING COVERAGE
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Police didn’t begin investigating until a year after the first complaint and were made aware of the incidents not by the hospital but by Karen Braun, the hospital’s then director of ambulatory services, who reported it on her own. In a memo that is part of the investigative file, Braun wrote that she decided to report Dr. Arun Aggarwal after consulting with her priest.
This newspaper examined thousands of pages of testimony before the State Medical Board of Ohio and police investigative records in an extensive review that reveals new details about how Children's Hospital officials handled the allegations against the doctor. The newspaper's review comes as the medical industry in Ohio and other states has been criticized for too often giving the benefit of the doubt to physicians accused of sexual misconduct involving their patients.
The records reviewed by the newspaper show a raging debate existed among managers at Children’s over how to respond to the allegations against pediatric gastroenterologist Aggarwal. After a second parent complained to the hospital about Aggarwal, Braun filed an anonymous complaint with Montgomery County Children Services, triggering a police investigation.
That investigation led to no charges after one of the alleged victims chose not to cooperate. But the state medical board has taken up the case and is considering a recommendation from its hearing examiner to strip Aggarwal of his license to practice medicine.
In her recommendation to the board, the hearing examiner, Danielle Blue, wrote: “There is no dispute that Dr. Aggarwal abused his position of trust…by engaging in predatory behavior to satisfy some prurient need.”
Aggarwal practiced at Children’s between September 2013 and June 2015 under a contract with the Wright State University Boonshoft School of Medicine. Boonshoft officials were aware of the complaints against Aggarwal and agreed to the approach taken by the hospital, the investigative records show.
The university suspended Aggarwal in the wake of the police investigation and then fired him after he lost his admitting privileges at Children’s. He then filed a lawsuit against the school alleging wrongful termination.
Aggarwal, who is married and has children, told the hearing examiner that if he loses his medical license he may be forced to return to his native India.
Feldman, through the hospital’s communications spokeswoman, declined numerous requests for comment on the Aggarwal case. The hospital also denied the newspaper’s request to speak to other hospital administrators, including Mezoff; James Rick, who was the interim medical director in the gastrointestinal department at the time; and Matt Graybill, the hospital’s vice president for human resources. Bennington was also not made available for comment.
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The hospital did release a statement in response to the newspaper’s questions about the Aggarwal case. “When allegations are made, we investigate them thoroughly and work with law enforcement and state authorities, consistent with Ohio law,” the statement says. “We seek to do so in a confidential manner consistent with the privacy rights of everyone involved until such time as disclosures, if any, are appropriate.”
Wright State declined to comment, citing the lawsuit Aggarwal filed against the university.
“Consistent with its long established practice, the university does not comment on pending litigation,” wrote WSU Boonshoft School of Medicine spokeswoman Emily Stamas.
James Fleisher, an attorney for Aggarwal, said both the police and the hospital investigated thoroughly and concluded the doctor’s actions were not inappropriate.
In a written objection to the hearing examiner’s report, Fleisher said the recommendations are “factually and legally flawed and should be rejected by the board.”
He called into question the credibility of the first alleged victim and suggested she “had either fabricated or seriously exaggerated her report.”
Aggarwal has the option of appealing the medical board’s decision to the court system, Fleisher said.
“It’s not like this was swept under the rug,” Fleisher said. “This was investigated very thoroughly.”
First incident
The first complaint to the hospital stemmed from an incident that occurred in December 2013, just three months after Aggarwal was hired.
The complaint alleged that Aggarwal asked the mother of a 15-year-old girl who he was seeing for Crohn’s disease to leave the room. When she returned, the mother said her daughter — confused and in tears — told her the doctor had touched her breasts. The mother’s account, outlined in the public record, is that she confronted Aggarwal and that he apologized and told her it wouldn’t happen again.
Investigative records reviewed by the newspaper show the conflict within management at Children’s began almost immediately after the hospital was made aware of the allegation.
In January the mother called Children’s and said her daughter wanted to change doctors. The nurse who took the call reported it to her supervisor — Angela Cox, then the department’s clinic manager — who informed Braun and Rick, who was then the interim medical director in the gastrointestinal department. Rick called the family.
“Dr. Rick is very concerned due to the fact that he cannot find any logical explanation as to why (Aggarwal) would have done the exam he is being accused of doing,” Cox wrote in a Jan. 17, 2014, email to Braun. “The mother stated that the patient had a bra on and that his hand slid up underneath the bra. The mother stated that he squeezed both of her nipples.”
In her email, Cox wrote that Aggarwal told her that he had asked the mother to step out of the room so he could ask the teen some sensitive questions, and then couldn’t find her in the hallway when he went to find her. He said he then continued with his examination of the patient, which included pressing on her sternum because she had complained of chest pain.
Rick reported the incident to Mezoff, the hospital’s chief medical officer, according to a memo from Mezoff that is included in the investigative records. Mezoff notified other administrators — including Feldman and Arthur Pickoff, chairman of pediatrics at Wright State’s Boonshoft School — and also talked to Aggarwal directly, according to the memo.
“I spoke with (Aggarwal) for almost two hours after I heard from Dr. Rick, in person,” Mezoff wrote in the memo. “He stated categorically he did not do a breast exam...I counseled (Aggarwal) on 1/18/14 to never again do any kind of examine on a young woman, without a chaperone, as I would suggest to any male MD.”
Aggarwal emailed Cox the next day: “Since this incident was of a serious kind, I would like you not to form a opinion about me based on this (incident),” he wrote. “Obviously you do not know me long enough. I hope you will judge me based on what I am.”
Braun thought the allegation should be investigated further and reported to the hospital’s social work office, per hospital policy. The written narrative Braun provided to police says she told her supervisor, Vice President of Ambulatory Services Ben Goodstein, that she was concerned “nobody talked to this child, nor had we consulted risk management or others.”
“(On Jan. 28) Ben stopped by to tell me that Matt (Graybill) had reviewed with Debbie Feldman and that they are comfortable with Dr. Mezoff’s plan,” Braun wrote. “He asked if I was comfortable with the decision. I indicated I was not but since the decision was made by the CMO, the COO, my boss and CEO reviewed, I felt that there was nothing more I could do at this point.”
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Second incident
Eleven months after the first incident, a second patient made a complaint to the hospital about Aggarwal. Stephanie Lewis, manager of patient relations, summarized the complaint in an email to Aggarwal the next day, saying the patient’s mother complained that on multiple occasions he touched her daughter’s breasts.
The patient was suffering from acid reflux, according to the records. She was 17 when she began seeing Aggarwal in February 2014 and 18 at her third appointment that November. Aggarwal told hospital officials and the medical board that when he saw her in August 2014 he inspected a surgical scar on one breast, concerned it may be infected. In November he had to go under the shirt with a stethoscope to hear her breathing, he told investigators.
In her investigative notes, Dayton Police Det. Elizabeth Alley says the teenager told her that during the August 2014 visit Aggarwal squeezed one of her nipples so hard “green stuff came out.”
Upon learning in November 2014 that another complaint had been made about him, Aggarwal emailed Cox, the head of nursing.
“As the memories of previous (incident) were fading and I was telling myself that time will heal everything, a new thing happened,” he wrote. “I don’t have any excuse for not having nurse in the room. I am ready to face any punishment and only thing I can say is I AM SORRY.”
Again, Dr. Rick called the family, who said the patient no longer wanted to be seen by Aggarwal and didn’t understand why he needed to touch her breast, according to records included in the investigative file. Rick wrote a memo noting that Aggarwal made no mention in the medical records of any breast exam or concerns he had about infection in her breast.
On Nov. 14, 2014, Mezoff and Pickoff met with Aggarwal and provided him with formal warning letters, according to an email from Mezoff that morning to Feldman and Graybill, the vice president in charge of HR.
There is no indication in the records that Aggarwal was barred from seeing other patients, however.
“(Aggarwal) clearly understood my expectations, was ashamed and promised no more misunderstandings,” Mezoff wrote in the email. “I think he is mortified and will check on him later and by next week but we can’t have another incident no matter how unintentional.”
In a signed letter to Aggarwal and copied to Pickoff at Wright State, Mezoff directed the doctor to “immediately cease any examination of the breast in pubescent female patients unless it is absolutely critical to their gastrointestinal evaluation” and to always have a female health care professional as a chaperone when examining pubescent females.
A letter from Pickoff to Aggarwal that same day notes, “This is not the first time such a concern has been expressed by a parent. In response to this latest complaint I am hereby informing you that if a similar complaint surfaces again disciplinary action will be taken.”
Fleisher, noting the teen’s mother was in the room during the exams, said the allegation of inappropriate touching is not credible. He also questioned why the family waited several months after the August visit to report the incident to the hospital.
“It stands to reason that if a physician is performing inappropriate activity in an examination, first, it would be rare that would be done in the presence of the patient’s parent, and second, it’s hard to believe that if it was truly an inappropriate exam, the mother wouldn’t have reported it until months after the fact,” Fleisher said.
The mother told investigators that although she was in the room, she didn’t have a good view of what the doctor was doing.
Timeline of events:
Chaperone policy formalized
The records from the Aggarwal case show that one of the directives from both Wright State and Children’s was that he have a female health care professional as a chaperone when examining young girls.
But in December 2014, Braun raised concerns about whether Aggarwal was following that policy.
In a Dec. 29, 2014, email to Graybill, Braun wrote that she asked Aggarwal if he was using chaperones, as required, observing that he had not noted any in his charts from the previous week. Aggarwal told her he was using them, just not documenting them, she wrote.
Braun then had Cox contact the lead nurse in the department, who alleged that Aggarwal had not been using chaperones, Braun wrote in the email.
“Additionally, (the nurse) expressed concern that Dr. Aggarwal is the only gastroenterologist in the group who routinely does not use chaperones for rectal exams,” she wrote.
A small group of hospital and WSU administrators, including Braun, met on Jan. 6, 2015, to discuss Aggarwal.
“Matt (Graybill) stated at the beginning of the meeting that we weren’t there to look back or question any decisions that had been made but to look forward and do what needs to be done to keep our patients safe,” Braun wrote in her account of the meeting for investigators.
The group agreed to formalize the chaperone policy, having Cox review Aggarwal’s patient chart every morning and assign a nurse to sit in on any visit with a female patient age 10 and older.
But Braun continued to argue that an independent investigation be conducted, according to a memo she wrote that was obtained by the newspaper as part of the police records.
“I told (Graybill) that I’ve worked at DCH for 19 years and had never before elevated a concern to this level. I told him clearly my career was on the line but that I felt strongly that we weren’t doing the right thing by these two girls and potentially other unknown victims,” Braun wrote in the memo.
Records show Mezoff checked with Bennington, the hospital’s attorney, who emailed back that he strongly supported continuing to monitor Aggarwal, but that “there are no further actions that must be taken by DCH, including any reporting.”
Defending Aggarwal
A January 2015 email reveals a concern at least one Children’s administrator had over whether the hospital would subject itself to litigation from Aggarwal.
“This is no doubt a difficult circumstance with difficult, tough decisions to be made,” Mezoff wrote in the Jan. 9, 2015, email to Feldman and Graybill. “First and foremost we must protect our patients and families. But having said that, the most recent episode which is the subject of the current evaluation/investigation, also bears the risk of reacting against the MD inappropriately, which also brings the risk of ruining a life and litigation because of this.”
Mezoff also defended Aggarwal’s actions in a timeline he made for police in the summer of 2015.
“Overall impression was that (Aggarwal) is young, can be quite awkward socially, but was trying to follow accepted medical practice,” he wrote.
On March 12, 2015 — two months after Dayton Police launched its investigation — Aggarwal emailed Mezoff: “I just want to know how long I have to be watched over by a nurse while with a female patient of >10 yr old,” he wrote. “Will there be an end point?”
“Yes there can be. Let me get back to you,” Mezoff wrote in a reply. “I want to review the notes on our discussions.”
Memos show Aggarwal began job-hunting after he couldn’t get a commitment from Mezoff on whether his job was secure.
The hospital received the first search warrants as part of the police investigation in May 2015. By mid-June, Feldman asked for a more stringent chaperoning policy involving Aggarwal, according to a memo from Cox, who says in the memo that Mezoff’s “hope and plan is that (Aggarwal) will find a new job and leave.”
On June 23, 2015, Albert Painter, Associate Dean for Faculty Affairs at Wright State, sent a letter to Aggarwal placing him on administrative leave. That also effectively suspended him from practicing at Children’s because Aggarwal was employed by the university.
The letter from Painter says, “It has come to our attention that you are currently being investigated due to a complaint. These allegations are serious and require immediate attention.”
Under the bylaws of the Boonshoft school, the letter says, administrative leaves are warranted “in situations where the health or safety of an employee or of any person or property entrusted to the employee’s care could be adversely affected.”
During his suspension, Aggarwal was paid $70,000 annually as a Wright State faculty member, but not the $130,000 stipend he received for clinical work at Dayton Children’s.
On Sept. 14, 2015, Painter informed Aggarwal by letter that his employment was being terminated because he no longer had admitting privileges at Dayton Children’s, which was a requirement for his employment.
Aggarwal filed his lawsuit against the university a month later, alleging his due process rights were violated. The civil suit is still pending.
Different perceptions
In his testimony before the medical board, Aggarwal maintained he did nothing inappropriate, saying patients sometimes “perceive things differently than what has happened.”
“I never met with these two families again, though I wanted to and ask them what led you to think that I did these things, but I was not allowed to meet either of these two families,” he testified.
Neither Braun nor Cox would comment for this story. Neither work for Dayton Children’s Hospital anymore but remain in the field.
Cox testified before the medical board in February saying both she and Braun left Dayton Children’s Hospital because they felt retaliated against by the hospital for pushing for the investigation of Aggarwal.
Cox said hospital administrators tried to demote her.
“I made a decision to leave Dayton Children’s because I was struggling to work for the administration of that hospital after these events,” Cox said.
In its statement to this newspaper, Dayton Children’s Hospital officials wrote, “Our first priority and the top value we live by at Dayton Children’s is safety. Before all other considerations, the safety of our children comes first.
“We want to assure parents that we take all complaints very seriously. We do not and will not tolerate any actions that could impact the quality of care the hospital provides or that would undermine the trust placed in us by patients, parents and the community.”
