After Years of Sexual Abuse Allegations, How Did This Doctor Keep Working?

All Tanisha Johnson wanted was for the pain to go away.

Doctors had offered little hope for her intractable migraines. But at Beth Israel Medical Center in New York, Ricardo Cruciani, who had a reputation as a brilliant pain physician, was warm and charming and prescribed powerful opioids, Ms. Johnson recalled in an interview.

When he put his arm around her, she thought, “Finally, a doctor who cares.”

Over the next few months, the doctor increased the doses and added medications. As Ms. Johnson became dependent on the drugs, he became more aggressive, groping her and masturbating in front of her, she said. Then he forced her to perform oral sex.

When she resisted, he withheld refills of her prescriptions. “The first week of opioid withdrawal feels like death,” Ms. Johnson said.

She was not Mr. Cruciani’s only victim. But even as complaints from patients mounted, the doctor was able to move from job to job, securing positions at hospitals in three states over the course of a decade. He was finally charged with sexual assault in Pennsylvania, registering as a sex offender and surrendering his medical license in a plea agreement in 2017.

He still faces criminal charges in New York and New Jersey. At the moment, Mr. Cruciani is free on $1 million bail.

His case illustrates failures that permeate oversight of the medical profession, in which physicians wield enormous power within hospitals, misconduct is underreported and often glossed over, and institutional employers are seldom held to account.

At least 150 young women have said they were abused over the course of nearly two decades by Lawrence Nassar, the doctor for the U.S. women’s gymnastics team. Gynecologists like Robert Hadden, the former Columbia University physician, and George Tyndall of the University of Southern California are accused of abusing women under the guise of physical exams.

Dr. Robert Anderson, a physician at the University of Michigan for almost four decades, sexually assaulted numerous patients and frequently conducted unnecessary rectal, breast and pelvic exams, according to a report in May — 13 years after Dr. Anderson’s death.

“One of the biggest scandals is just how often a person who offends, offends repeatedly,” said James DuBois, a bioethicist at Washington University in St. Louis who helped develop recommendations for improving physician training and oversight.

In many cases, “physicians manage to continue practicing,” Dr. DuBois said. “Sometimes they move states to keep their license. Sometimes they just move institutions.”

“Some of the problems, in my opinion, are peers who have suspicions but don’t speak up,” he added.

Mr. Cruciani’s former patients say he used his prescription pad to manipulate women in pain, pave the way to addiction and exploit their dependency for sex.

Some of his patients took such high doses of narcotics that other pain doctors refused to see them. At one point, Ms. Johnson said, she was prescribed a concoction of more than 1,300 pain pills a month.

Now a lawsuit filed in New Jersey on behalf of Ms. Johnson and six other former patients, along with civil suits in New York and Pennsylvania, seeks to hold liable both the former physician and the hospitals that employed him.

The suits claim that hospital administrators and staff members ignored reports that Mr. Cruciani was sexually assaulting patients until they could no longer look the other way. They allowed him to quietly change jobs — never warning other hospitals, state authorities or the police about the allegations — and enabled him to continue his predatory behavior, the plaintiffs claim.

“There is a web of protections in place within the profession and within the law so that this type of behavior can be detected and acted upon, and we allege that they have failed in every regard,” said Jeffrey Fritz, a lawyer who represents dozens of former patients who are suing Mr. Cruciani.

Mr. Cruciani’s lawyer, Robert E. Lytle, declined to comment. A spokeswoman for Mount Sinai Health System, which includes Beth Israel, said the hospital does not comment on pending litigation.

A statement issued by Drexel University said that Mr. Cruciani was terminated in March 2017, after complaints from patients prompted an internal investigation that substantiated their claims. The university notified licensing authorities in Pennsylvania, New Jersey and New York, and cooperated with police investigations, the statement said.

But Drexel officials pointed the finger at other hospitals for failing to take action or to warn them. “Drexel hired Cruciani after conducting a thorough background check, as is done with all potential employees, that did not reveal any improper or illegal conduct,” the statement said.

Mr. Cruciani had practiced medicine for more than 35 years at several other hospitals, the statement continued. “None of these hospitals ever notified Drexel about Cruciani’s conduct.”

Sexual contact between a physician and a patient is expressly prohibited by the American Medical Association. Its code of ethics requires all licensed medical professionals and nurses, as well as physicians, to report unethical behavior.

Throughout Mr. Cruciani’s tenures at Beth Israel, Capital Health System in New Jersey and Drexel University in Pennsylvania, there were red flags, according to several civil lawsuits and interviews with six former patients who are suing him.

Mr. Cruciani did not have a chaperone in the room when he saw female patients, and he resisted their entreaties to have a nurse or companion present. At times, he would take the patient into the room with him and lock the door, former patients claim.

The one-on-one visits could stretch for an hour or more. Patients said their appointments were often scheduled at the end of the day, when there were few other people in the office.

Several patients said they repeatedly asked nurses or other staff members to stay in the room with them during consultations, but the requests were usually turned down.

“If a nurse knocked on the door, he’d open the door and peek around it,” one former patient said in an interview. “I felt like they had to know.”

A number of patients informed other staff members at hospitals where Mr. Cruciani worked about his sexual assaults, according to the lawsuits. Several patients said they dropped complaint letters in hospital comments boxes in an effort to alert the administrators.

The husband of one patient, identified as Jane Doe 8 in lawsuits, said in an interview that he called the patient advocate’s office at Capital Health and described the assaults, but he never got a response.

Representatives of Capital Health denied that numerous members of its staff were alerted to the abuse, and said that the hospital received no complaints from patients about Mr. Cruciani while he worked there.

“We were shocked and saddened when these allegations came to light,” a statement issued by Capital Health’s press office said.

One of the earliest reports was made in 2005 by a longtime patient, Hillary Tullin, who had been treated by Mr. Cruciani for three years at that time.

Like many of the women treated by Mr. Cruciani at Beth Israel Medical Center (now Mount Sinai Beth Israel), Ms. Tullin experienced severe, chronic pain, and her condition baffled other doctors.

“I had been to 15 or 18 different doctors who had no idea what was wrong with me and dismissed me as crazy,” Ms. Tullin said in an interview. Mr. Cruciani diagnosed her with full-body complex regional pain syndrome, which is poorly understood.

The doctor prescribed opioids, but Ms. Tullin did not respond to them, and he tried other treatments.

He also started calling her at home on nearly a daily basis, telling her about his personal and family life, that she was beautiful and that he was thinking of her. Brief embraces during office visits turned into extended hugs and eventually into assaults, she said.

Ms. Tullin told a Beth Israel psychologist that Mr. Cruciani had forcibly kissed her, according to the latest lawsuit. The psychologist asked Ms. Tullin if she had wanted the doctor to kiss her and then asked what she wanted her to do about it.

“I told her, ‘I want you to report it,’” Ms. Tullin recalled. The psychologist did not.

“It was a culture of silence,” Ms. Tullin said. “I never spoke about it again.”

Like Mr. Cruciani’s other patients, Ms. Tullin was unable to find another physician who would treat her, and she continued seeing Mr. Cruciani for medical care. Though she tried to stop the assaults, they intensified.

On Jan. 8, 2013, a patient named Nella Vince told New York City police officers that Mr. Cruciani had sexually assaulted her several times over the years, and offered evidence: a shirt with his semen on it.

The police report, which has been reviewed by The New York Times, said that Ms. Vince was taking multiple medications, including methadone, and that she had discussed with police officers the possibility of her wearing a wire to her next doctor’s appointment.

What happened after that is unclear. The police report said Ms. Vince stopped responding to their calls, and officers closed the case in June, saying that the “complainant was uncooperative.”

Ms. Vince said in an interview that the police did not take her seriously because, they said, the doctor had no criminal record.

Later in 2013, Mr. Cruciani abruptly resigned from the hospital and went to work at Capital Institute for Neurosciences in Hopewell Township, N.J. Unable to find other physicians to take over their care, many of Mr. Cruciani’s patients followed him to Capital, where, they said, he became even more aggressive.

Several patients said they told nurses at Capital about the abuse. On at least one occasion, Ms. Johnson said she begged a nurse to stay in the room with her, but the nurse refused.

In November 2015, Mr. Cruciani announced he was resigning to take a position in Philadelphia at Drexel University, as chair of the neurology department.

Mr. Cruciani began working at Drexel in February 2016, where plaintiffs in one civil suit claim he continued to prescribe large doses of narcotics and to sexually assault patients.

Little action was taken after the first complaints were made in August 2016. But by Feb. 1, 2017, at least five patients and at least three staff members had come forward, and Drexel initiated an investigation into the doctor’s behavior, according to the lawsuits filed in Philadelphia.

A month later, Mr. Cruciani left Drexel. Additional former patients, alerted to the investigation, reported his assaults to the police in Pennsylvania.

In September 2017, Mr. Cruciani was arrested on charges of multiple counts of indecent assault and a single count of indecent exposure. But he reached a plea agreement that allowed him to serve no jail time as long as he gave up his medical license and registered as a low-level sex offender.

The coronavirus pandemic has delayed the other criminal and civil cases. A trial on charges including predatory sexual assault had been scheduled for next month in Manhattan, but it has been postponed because of the pandemic.

Consumer advocates say that Mr. Cruciani’s ability to continue seeing patients despite a long trail of misconduct and complaints is not unusual.

“We’ve been calling for zero tolerance for sexual abuse by health care providers against patients,” said Azza AbuDagga, a researcher with Public Citizen’s Health Research Group. “If that standard isn’t adopted, we’re not going to be anywhere close to solving the problem.”