Last month, the Los Angeles Times reported USC allowed its only full-time gynecologist, George Tyndall, to continue practicing despite repeated accusations of sexual misconduct during his nearly three-decade career at the campus health center.
Over 400 of his former patients have now come forward to complain about Tyndall's behavior. They accused him of inappropriate behavior, such as photographing patients' genitals, touching women inappropriately during exams and making sexually suggestive remarks.
For the last two school years, following Tyndall's removal in a secret severance agreement in 2017, only one part-time gynecologist saw patients at Engemann Student Health Center. In the fall, Engemann plans to add two full-time gynecologists. The current and incoming gynecologists, all female, are board-certified in gynecology. Since there has only been one gynecologist for the last two years, the primary care specialists with women's health specialties also see patients for women's health appointments.
Women's health doctors at the Engemann Student Health Center are working to regain the trust of students. Dr. Lindsey Victoria Dunn, assistant professor of clinical family medicine, and Dr. Patty Pinanong, clinical assistant professor of family medicine, want to educate students about what they should expect during their appointments.
"We want to treat women with respect and with dignity and we want her to feel safe and know that she can trust us when she comes in," Dunn said. "One of the most important things when a woman comes in is that she has the opportunity to talk to us first, share her expectations for the consultation, what she's hoping to get out of it and what she thinks she needs."
After allowing patients to express their concerns, Dunn said she will ask more questions to find out what she thinks they need.
"Sometimes we have to ask some fairly personal questions. We want to assess somebody's risk so we will probably want to know how many sexual partners they've had, potentially in the last 12 months, potentially longer because we're thinking about whether we need to test for STDs and what sort of STDs we're testing. We need to know whether your partners are male or female," she continued. "Those are the sorts of things that are important when we're thinking about risk factors for the testing needed."
Pinanong, who has worked at Engemann for a decade, said she first takes care of what a patient wants and then offers counseling.
"If you're not having any symptoms… you may not even really get much of a physical exam," she said. "If you're coming in for a problem, then, of course, we would offer you an exam."
If patients are having symptoms such as unusual discharge, pelvic pain or irregular bleeding, they will get a physical exam, Pinanong said.
"It would entail a visual genital exam. That might entail doing a pelvic exam and a bimanual – that's when fingers are inserted and you check things like the uterus. That might involve using a speculum so we could see the vaginal walls and the cervix," Pinanong said.
Another kind of physical exam is for STD testing.
"That can be done either with a vaginal swab or an urine sample and most of the time we will give the woman the choice of which she prefers. The vaginal swab can be self-taken. So we can close the curtains and she can go the other side and take the swab herself. If she prefers, we can do it for her and we're happy to," Dunn said.
If a patient is over 21 years old and is sexually active, they need a Pap exam every three years to check for cervical cancer, she added. If a Pap is abnormal, it may need to be repeated more often.
"A Pap exam is where we use the speculum and we have a little light that attaches. It goes inside and then we open it very slightly and we can see the cervix. Sometimes it requires a little bit of adjustment because somebody's cervix might not be perfectly central," Dunn said. "Then we take a Pap. It's just like gentle brushing to take any loose cells off the top. Then they go into a little bottle and are sent off-site to test in a lab."
It might feel invasive, she said, and that's why they try to explain it to patients and show them the speculum beforehand.
"Once we're examining, we're not looking at somebody's face, we're focused on the area that we're examining. So I always say just please speak to me and let me know if there's anything uncomfortable and I'll stop right away," Dunn said. "Then we can regroup and see what happens next."
Additionally, the national guidelines recommend that all sexually active women should be tested for chlamydia and gonorrhea once a year unless they're in a long-term monogamous relationship, said Dunn.
USC did not report Tyndall to the Medical Board of California when they first became aware of his behavior. However, both Pinanong and Dunn said doctors at the campus health center are answerable to the Medical Board.
In light of the accusations against Tyndall, the two doctors along with their fellow Engelmann staff, are working to empower and educate women and to rebuild trust. They are creating educational materials for patients to learn about their bodies and about what to expect during exams. They are also reevaluating their policies and trying to create better communication within their own team.
"We've been recently reviewing our protocols, our policies and what is expected because we realized that it was very different within the team. So we want to make it standard. We want women to know when they come… they're going to get the same high standard of care from whoever they come in to see," Dunn said.
The Engemann Student Health Center follows the guidelines set by the American College of Obstetrics and Gynecology as well as the United States Preventive Task Force, Centers of Disease Control, American Academy of Family Practice and American College of Physicians. However, Dunn acknowledges that the care might look slightly different with each practitioner.
"While appointments are fairly standard, there has to be some space for clinical judgment," Dunn said.
Last summer, Keck Medicine assumed administrative oversight of the health center.
"So it means that there is more accountability. There is a big structure for reporting, for safety, for knowing who you can go to," Dunn said.
The process for filing complaints has undergone a massive transition since then, said Steven Schulman, manager of ambulatory quality for Student Health Services, in an email. The health center's partnership with the Keck Office of Integrated Risk Management provides one option for filing complaints — or "event reporting," in Keck lingo.
"This partnership also allows us to have access to an electronic event reporting system that is split up into two applications, a safety event application and a feedback event application," Schulman said. "All events are entered into this system, and each one follows a very specific path. Any student or employee complaint is entered into this system and is reviewed not only by USC Student Health leadership, but also by the staff members in the Office of Integrated Risk Management."
Concerns about care or physician behavior are then referred to external peer review bodies of the USC Care medical group, he added.
"This process allows us to track the status of each event to ensure that each event is investigated by the appropriate means necessary. An event is only closed once an investigation has been completed and a resolution has been determined," he said.
During the last year, the Engelmann staff underwent rigorous training to learn how to report and who reviews the reports. Staff can report through an online portal that gives them the option to report anonymously. The reports are reviewed at the leadership level of the health center, by an executive team at Keck Medicine and by an outside organization through Vanderbilt University.
Students can report through the Engemann website by clicking on Tell Us What You Think or by directly calling Schulman, whose phone number is provided on the page. Schulman goes through the complaints and then reports them to the Quality and Safety Committee at Engelmann.
Pinanong is a member of the committee, which reviews all reports, whether made by internal staff or from students. Then each report goes to the medical director who will meet with the person in question. Then Sarah Van Orman, the associate vice provost, will also review the reports with an executive committee.
Orman reads every complaint about the health center, she said in an interview, but usually the medical directors are the ones who take action regarding common complaints. If the issue reported is severe, she said, it will be turned over to the university for peer review.
Under this new report reviewing system, which started in August 2017, all reports are stored in an electronic system. Previously, with the old reporting system, no database existed for the complaints.
"Over the last year we've gone through a lot of changes, which has made the whole organization much more transparent and also much more accessible," Pinanong said.
"Most importantly, now [complaints] don't just go to some wide open space. There are people looking at it at multiple levels."
She acknowledges that rebuilding trust isn't going to happen overnight.
"It's going to take some time and some healing and that's OK," Pinanong said. "People are going to have concerns and that's fine."