Portrait of Doctor as a Woman-Hater Emerges : Inquiry: Tustin gynecologist seemed to enjoy inflicting pain, ex-employee says. Patients tell grisly tales.

As investigators confront California’s biggest-ever sexual misconduct case against a doctor, new details are emerging that indicate that their target--Tustin gynecologist Ivan C. Namihas--might harbor a hatred of women.

Interviews and court documents indicate that Namihas impregnated at least two of his patients, and that he told one of those women, whom he attended for more than 10 years, that he became a gynecologist so he could vent his anger toward women by cutting them.

Questions of deliberate cruelty arise, too, from the sworn statements of women in the court record. A former employee says Namihas “seemed to get some perverse pleasure” from inflicting pain on patients, and several women tell grisly tales of enduring excruciating procedures without anesthesia.

The California Medical Board initiated proceedings in December to revoke Namihas’ license for alleged unprofessional conduct and gross negligence in the treatment of five female patients between 1967 and 1988. Since then, more than 160 women have come forward to accuse the Brazilian-born doctor of kissing, fondling, masturbating or otherwise sexually assaulting them during pelvic examinations, or subjecting them to unnecessary surgery or incompetent medical treatment over a 30-year period.

Reeling from the unexpected onslaught of complaints, the board rushed into Orange County Superior Court March 13 and won an order shutting down Namihas’ practice temporarily while they press their case to strip him of his medical license permanently.

At the court hearing, Namihas’ lawyers contended that the state lacked enough evidence to justify halting his practice. And as the days pass, they have remained silent, refusing to respond publicly to the many accusations against him.

But more and more women are coming forward to tell their stories. Since most consider themselves victims of sexual abuse, The Times has withheld their names unless they consented to be named or publicly identified themselves by filing a lawsuit.

The Namihas case, while disturbing, reflects a problem that is not uncommon.

Kenneth Wagstaff, executive director of the California Medical Board, says sexual misconduct accounts for 20% of the discipline it imposes on doctors.

Dr. James Winn, head of the Federation of State Medical Boards in Fort Worth, said no nationwide statistics have been compiled, but said he doubts many other states have as large a proportion of sex-misconduct cases as California does.

But the case also points out how little definitive research has been done on the subject. There are no nationwide statistics that illustrate how often patients report sexual abuse by doctors, and likewise, little to substantiate whether such occurrences are becoming more frequent.

Both Wagstaff and Winn said sexual abuse by doctors is reported more than it used to be, but theorized that it is because women are increasingly willing to come forward, as law enforcement officials say they have become in reporting claims of rape. The California Medical Board says it has seen a modest increase lately in calls from women asking exactly what constitutes sexual misconduct by doctors.

One of those who came forward against Namihas was his former office manager, also a patient, who said that she and many of Namihas’ other patients had been sexually molested by him. In a sworn statement, she said that one evening, when he was in a “confessive” mood, he told her that his mother “had sexually molested him.”

Another woman, a patient and temporary employee, said in an affidavit that she “felt he had problems with women in general because he talked about how much he hated his mother and bad relationships he’d had with girlfriends and his wives.”

Jeanette Jacobs, a former patient and girlfriend of Namihas, contends that after she became pregnant by him, he performed an abortion on her in his office after hours. And The Times has learned that another patient, Sue Bowers, became pregnant and delivered twin girls in 1982, later suing Namihas for child support.

Bowers refused to discuss the lawsuit, citing a confidentiality agreement attached to its settlement. But her friend and longtime baby-sitter, Bernadette Wells, said that Bowers told her before the suit was filed that Namihas had fathered the babies in his office.

Wells said that at her urging, Bowers sued Namihas for child support when the twins were toddlers, and that the money resulting from a settlement was placed in a fund for the girls, now 10 years old.

Bowers, for her part, said she became Namihas’ patient when she was 18. She became pregnant by him at age 29. She said he once told her of his feelings toward women.

“He told me the reason he became a gynecologist was because he hated women and he could use a knife to cut them,” Bowers said.

In the court record, women tell of enduring laser surgery without anesthesia. One patient, the office manager said in her affidavit, was “in tears and hanging onto the table edges,” crying out in pain. Another underwent a dilation and curettage, in which the lining of the uterus is scraped, without anesthesia.

A medical expert who reviewed complaints against Namihas for the board said in his written report that it appears Namihas falsely informed patients they had cancer so he could perform “unnecessary and expensive” laser surgery on them.

Stacy Crumpler, a 19-year-old who recently sued Namihas for assault and battery and negligence, contends that she saw the doctor last month for a vaginal rash, and he “started screaming and yelling” that she had AIDS and syphilis.

He later told her tests for those two diseases had come back negative, but that she had cervical cancer and needed immediate laser surgery. An examination by another doctor showed no evidence of cancer, the lawsuit said.

Namihas’ office manager also raised questions about his laser surgeries. She said that when she did the insurance billing, she sometimes noticed Namihas reported wrongly that some patients had abnormal Pap smear results indicating precancerous conditions that justified surgery. In at least three instances, she said, she specifically remembered those patients having normal Pap smear results.

“I now wonder if he was substituting abnormal Pap smear results for normal ones so he could make money doing laser surgeries,” the woman said.

Over and over, women who submitted sworn statements describe a man who was verbally abusive, who boasted of his sexual prowess and asked them unwelcome questions about their sex lives and sexual satisfaction. The most frequent complaint is that he attempted to masturbate them.

Namihas’ conduct with women also became an issue in his divorce from his first wife, Shirley. In a document signed in August, 1987, she asked that her husband be ordered out of their Villa Park home.

“In the past he has threatened me on several occasions and I believe that my mental and physical health demand that he be excluded from our family residence,” she said. “He has also become involved with our housekeeper, which provides an additional reason (for him) to vacate the residence for my emotional well-being.”

The emotional makeup of a doctor who sexually abuses his patients has received little academic study and, until recently, those examining the problem focused mostly on psychiatrists and psychotherapists.

One of the few experts in the field, Irwin Dreiblatt of Seattle, has worked to rehabilitate health care providers who engage in sexual misconduct with patients, and summarized some of his observations in a recent article for the monthly bulletin of the Federation of State Medical Boards.

Sexual misconduct with a patient usually is part of a pattern of behavior that tends to escalate over time, Dreiblatt said. Since the causes of such conduct are complex, Dreiblatt suggested thinking of it as “a behavioral, addictive-like disorder. . . . The individual often becomes hooked on illicit sexuality, power, narcissism.”

Perpetrators do not share a common psychological profile, ranging instead from the “relatively healthy” to “compulsive sex offenders,” Dreiblatt said.

Such doctors choose “vulnerable and impaired” patients to get involved with, so their victims “often appear to have little credibility,” Dreiblatt said. A “cure” for these doctors is unlikely, Dreiblatt said, only the possibility of managing their behavior.

Dreiblatt’s article, and a similar speech he made before the national convention of the Federation of State Medical Boards last year, indicates the rising awareness of the problem of sexual misconduct, both by the public at large and within the medical community, Winn said.

It is demonstrated by the actions of state medical boards across the country, Winn said. Of all the doctors who stray, he said, those who get the harshest penalties are those who engage in sexual misconduct with patients. Most lose their licenses, he added.

This heightened awareness of the problem of sexual misconduct can also be seen in more and more medical schools, as course work includes discussion of medical ethics and conduct.

As part of just such a required course at UC Davis, fourth-year medical students listen to an investigator from the Medical Board detail the definition and consequences of sexual misconduct, said Dr. Robert C. Davidson, who teaches the class.

And increasingly, Davidson said, medical students are being encouraged to break the code of silence that has so often discouraged doctors from reporting their colleagues for abusing patients sexually, emotionally, or medically.

Davidson said he is hopeful that in the future, sexual misconduct will be less of a problem because the public and the medical community will grow increasingly intolerant of it. He also noted that between 40% and 50% of medical students nationwide are women, a factor he believes will reduce the incidence of sexual misconduct.

Staff writer Mark I. Pinsky contributed to this report.