I read an article in the New York Times this morning about the role of Patrick Fitzgerald as an adviser to Michigan State University (NYT). He was hired by MSU to help them sort out the allegations against Dr. Nassar. It appears that his team did not speak to anyone who placed a complaint but instead focused on senior leadership and other sports medicine doctors.
While there has been lots of coverage in the news about this saga, there has been little written on exactly what Dr. Nassar did which qualified as assault. I believe this is where a problems lies. Physicians are granted some degree of latitude in terms of how we are allowed to interact with others. We are allowed to ask very personal questions. We are allowed to touch others in ways which no one can do, except those who have very intimate relationships. Each specialty may engage is specific activities which are uniquely delicate and sensitive. Specialists dealing with anatomic areas that may be associated with sexual arousal must tread a fine line.
I don't know what Dr. Nassar did but I can speculate that he manipulated parts of female anatomy under the guise of "treatment". For the young girls who were placed in his hands, they likely started with the default state of trust. They had some musculo-skeletal problem that Dr. Nassar was charged with diagnosing and treating in order to enhance their gymnastic performance. When Patrick Fitzgerald did his review, he asked a number of Dr. Nassar's peers questions regarding the appropriateness of interventions done and the information he got back from them was the interventions represented standard of care. Yes, taken outside the context of treatment what he did might appear to be quite inappropriate but his colleagues assured investigators that the actions were "not sexual in nature".
The truth is health care providers can do almost anything plausible to a patient under the guise of diagnosis or treatment. In the absence of the ability to measure clinically meaningful outcomes, it is essentially impossible to tell if a given practice is appropriate or not. For the most part, outrageous behaviors can be identified. A dentist does not to fondle breasts in order to remove wisdom teeth. However, there are domains where context defines apparent necessity. Looking for breast cancer does involve manipulating the breast. This opportunity could be abused by a clinician looking for a titillating experience but it generally provides few opportunities to manipulate the breasts of young girls.
Larry Nassar found himself with the opportunity to manipulate the groins of young girls, all under the guise of treatment of something. The current state of medicine did not readily afford an opportunity to weigh in and say, this is not right. He was afforded the status of an expert and despite the discomfort experienced by literally hundreds of young women, their discomfort could be dismissed by a proclamation that the interventions were "not sexual in nature". From the perspective of one who is part of the "priesthood", this is a claim which is widely accepted. The public does not understand the complexities involved in medicine. We experts know best given our training and experience. Furthermore, we defer to our colleagues in other sub-specialties, in which we are not experts, and the default is to give them the benefit of the doubt.
One of many weaknesses that is evident is that he could get away with what he did for as long as he did because he was not required to show that the interventions he undertook actually accomplished anything. He was not called upon to measure outcomes. He was afforded expert status with no real data demonstrating that he was an expert in anything.
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