Mark Weber, a Health and Human Services Department spokesman, declined to say whether Dr. Tilus’s punishment had been in retaliation for sending the e-mail.

The agency refused to make Dr. Tilus available for an interview.

But in the reprimand letter, which was obtained by The Times, Dr. Candelaria Martin, the department’s clinical director of medical staff at Spirit Lake, said Dr. Tilus’s dissemination of the e-mail to health and law enforcement officers outside his chain of command constituted “engaging in action and behavior of a dishonorable nature.”

Dr. Martin wrote that Dr. Tilus had brought discredit to the federal government’s public health services and had damaged relationships with the tribe, the Indian Health Services and the Bureau of Indian Affairs.

The tribe did not return a call seeking comment.

The reprimand bars Dr. Tilus, who has been in the Public Health Service for 10 years, from promotion for two years and could put his professional license in jeopardy. The letter is dated June 25, but Dr. Tilus wrote in a response to the department that he received it on July 13, six days after The Times article was published, and the same day both he and Dr. Martin signed the letter in acknowledgment of receipt.

Dr. Tilus also wrote in his response that he had consulted his direct supervisors about abuse on Spirit Lake over the course of several years but that his efforts had failed to curtail it, which he said led him to fear that some young victims would commit suicide.

“After significant thought and with great concern for the protection of my patients, I acted as a whistle-blower and made a lawful disclosure by raising my concerns about the health and safety of these abused children to more than just my direct supervisors, but to multiple appropriate agencies who could be intimately involved in resolving this public health crisis,” Dr. Tilus wrote. “This was more than just doing my job. Doing my job for five years had resulted in no agency action.”

Mr. Weber, the Health and Human Services spokesman, said: “The foremost concern of the department is the health and safety of the children of the Spirit Lake Tribe. We will work closely with tribal leaders, the Bureau of Indian Affairs and state officials to address abuse and neglect in the community. The department respects the need to protect individuals who speak out about issues regarding public health and safety, and will afford all applicable legal protections to those who do. We are reviewing all of the facts related to this matter.”