Los Angeles - After decades of complaints about a campus gynaecologist, administrators at the University of Southern California hired a team of medical experts to evaluate him.
The experts came back with a disturbing report saying there was evidence Dr George Tyndall was preying on vulnerable Asian students and had signs of "psychopathy."
Still, the university did not fire Tyndall or notify the state medical board.
Instead, lawyers for USC arranged a secret deal with the doctor that allowed him to leave his post with a substantial financial payout and a pristine professional record.
The confidential report was among a cache of internal university records made public Thursday after the Los Angeles Times sought a court order for access to the documents. The records are evidence in a federal class-action suit by former patients against Tyndall and USC and had been filed earlier this year under seal.
US District Court Judge Stephen Wilson granted the newspaper's request, writing in a ruling Tuesday that the public had an interest in "all pertinent information" about Tyndall and the university's response.
"Providing the public with all available nonprivileged information furthers the public narrative about inappropriate sexual behavior and ensures for longer-lasting changes beyond the case at hand," Wilson wrote.
USC has apologized for university employees' handling of Tyndall and the complaints against him, first exposed by the Times last year. The revelations led to the ouster of President CL Max Nikias, one of the largest sex crimes investigations in Los Angeles police history, more than 650 lawsuits alleging sexual misconduct by Tyndall and pledges by USC's board to fix a broken school culture.
Nearly all of the university's top administrators have or will soon depart, and a new president, Carol Folt, takes over July 1.
Tyndall is the subject of a grand jury investigation, but has not been charged with a crime. He and his attorneys have repeatedly denied wrongdoing and said he acted within the standards of gynaecological care.
The materials released Thursday afternoon are not exhaustive of the university's file on Tyndall, and records currently held in the judge's chambers are also slated for release.
The approximately 60 pages of unsealed documents offer a new level of detail to the known accounts of Tyndall's former patients and colleagues. A collection of memos, correspondence and hand-written complaints, the records date back more than 20 years and reveal the specific information administrators possessed about Tyndall and, in many cases, what they did or didn't do with that knowledge.
Among the revelations is that USC was told in 2016 that Tyndall appeared to be targeting international students from Asian countries. Their language skills and lack of familiarity with US gynaecology made them ripe for victimization and unlikely to complain, administrators were told in a report by outside medical experts.
"If the patients were young and Asian, they were more likely to have a pelvic exam completed," the report from Colorado-based consulting firm MDReview found.
The Chinese Consulate in LA expressed "serious concerns" about Tyndall in the wake of the Times initial reports. USC said at the time it had no evidence he was focused on Asian students.
A 1997 student comment card informed clinic personnel that the author would never again visit Tyndall and called him "the worst doctor I have ever seen in my life." The writer claimed to know of 20 others who felt similarly and wrote, "If you don't want a huge future lawsuit on your hands, I highly suggest the termination of this man."
Tyndall's supervisor at the time, Dr Larry Neinstein, confronted the gynaecologist that year about three written complaints. In a letter summarizing the meeting, Tyndall defended his care as personalized and engaging and thanked his boss for "bringing this minor problem of practice style to my attention."
The records show clinic supervisors in the early 2000s regularly fielded complaints from "chaperones" - medical assistants and nurses who were present for gynaecological visits. The staffers told their bosses that Tyndall was blocking their view of pelvic exams by placing a curtain or screen between them and the lower bodies of patients.
One complaint logged in 2003 noted that "once again GT is not allowing Mas [medical assistants] to be behind curtain when chaperoning MD during pelvic exams." The log said he had been warned previously.
In 2009, a student complained that Tyndall had complimented her pubic hair, and the following year, an alumna contacted the clinic and alleged that the gynaecologist had conducted a pelvic exam six years earlier without wearing a glove, the records show.
Neinstein, the clinic's executive director, asked for help in dealing with Tyndall from the university's Office of Equity and Diversity in 2013, according to a summary of the report. He told the office, which handles harassment and discrimination claims, that there were "several difficulties" with Tyndall over the years and that recently staffers and a student had claimed Tyndall made "inappropriate comments or otherwise made them or others feel uncomfortable ... "
Neinstein died in 2016.
The investigator assigned to the case did not interview Tyndall, but questioned seven clinic colleagues and a student. Some staffers said students found the doctor "creepy," and one administrator said a patient recently complained that Tyndall "would not leave her appointment ... and that when she told him she needed to leave for another appointment, he asked her, 'What's more important than your health?'"
Still, the investigator decided not to pursue the matter.
"Interviews with these individuals yielded mixed opinions of Dr Tyndall but none yielded actionable evidence of any policy violations," investigator Karen Nutter wrote in a three-page memo. She wrote that there was "insufficient evidence of any University policy violation to justify continuing an investigation."
Less than three years later, a nursing supervisor frustrated by what she saw as administrators' inaction sought advice from a rape crisis counselor. That led USC in 2016 to hire MDReview, the outside medical consulting firm. The CEO and an expert gynaecologist inspected medical charts, reviewed university files and conducted interviews with clinic staffers, administrators and Tyndall.
In their 17-page report, the experts concluded that Tyndall's pelvic exams were inappropriate and not within medical standards, and he had "unusual and potentially dangerous opinions about breast exams."
They also expressed concern about photographs Tyndall had taken of patients' genitals, noting that he had used a commercial processing lab in upstate New York to develop some images and offered "dubious" explanations for retaining the pictures.
Not only did Tyndall show a preference for Asian students, but he changed his medical practice for patients perceived as less favorable: "non-Asian, obese or older" patients were less likely to receive a pelvic exam, the report states.
The report concluded that many patients were particularly vulnerable because of their age and language skills, and may not recognize harassment or lodge a complaint.
"It would be easy for a health care provider to take advantage of this," the report said.
The firm's report said Tyndall had potential mental health problems, including "underlying psychopathy," and listed possible signs: his hoarding, poor hygiene and his request to personally keep a patient's used intrauterine device. The experts said such issues were outside the scope of the report but "impossible to ignore."
In interviews with the external experts, Tyndall maintained that he practiced "evidence-based medicine" to explain his view that Kegel exercises were related to orgasms. When pressed for the source of this view, "he referred to a Reader's Digest article he read more than 20 years ago."