December 1, 2011 — Child psychiatrist Charles Henry Fischer, MD, was fired November 14 from the Austin State Hospital in Texas for suspected sexual abuse of his patients.

Subsequently, on November 22, a disciplinary panel of the Texas Medical Board temporarily suspended his medical license after determining that Dr. Fischer "has demonstrated a pattern of sexually abusing teenage boys in his care for inpatient psychiatric treatment over a period of nearly 20 years."

Dr. Fisher, 59, has not been charged with a crime, but the Travis County (Austin) district attorney's office has confirmed it is preparing a grand jury indictment.

According to the medical board's order, Dr. Fischer allegedly abused 7 boys, who ranged in age from 13 to 17 years, during individual "counseling" sessions in his office.

It is also alleged in the order that an eighth patient was sexually abused by Dr. Fischer at another facility in 1992, and that he additionally acknowledged to investigators that "there was another allegation involving a ninth patient" during his psychiatric residency in San Antonio in the 1980s.

Texas Medical Board spokeswoman Leigh Hopper told Medscape Medical News that a disciplinary panel of the state medical board convened for a temporary suspension hearing without notices to Dr. Fischer and used evidence from the state Department of Family Protective Services investigators and other evidence to make its finding that Dr. Fischer poses a "continuing threat to the public."

Dr. Fischer has the opportunity to rebut the board's findings at a subsequent hearing at his request. However, if he is arrested, a second license hearing would not be held because, according to Ms. Hopper, a new law in Texas gives the board authority to conduct an administrative trial to permanently revoke his license, "not just if he is convicted, but if he is simply arrested for child sexual assault, abuse, or indecency."

Allegations Denied

Contacted at his Austin home by the Austin American-Statesman newspaper, which first broke the story, Dr. Fischer's only comment reportedly was: "You'll have to ask the hospital about that."

However, Dr. Fischer's attorney, Antonio Cobos, subsequently issued a statement "categorically and vehemently denying any allegations of misconduct."

The Department of Family Protective Services alerted the Austin State Hospital that it had "confirmed" 2 cases of sexual abuse. The agency uses the term "confirmed" if its investigation shows, through a preponderance of the evidence, that the allegation is supported.

In its suspension of Dr. Fischer's medical license, the Texas Medical Board determined that Dr. Fischer's "continuation in the practice of medicine constitutes a continuing threat to the public welfare."

"Unfounded" Allegations Confirmed

Dr. Fischer reportedly earned $185,000 a year from the state. An Austin American-Statesman newspaper article quotes Carrie Williams, a spokesperson for the Department of State Health Services, which oversees state hospitals, as saying Dr. Fischer was accused of sexually abusing patients in the past.

"There were previous allegations against Dr. Fischer over the years. Each was reported and investigated outside the agency, but the allegations were never confirmed," she said.

According to records at the Travis County district clerk's office, in 2002 a grand jury heard charges of child sexual assault against Dr. Fischer but did not indict him.

However, after this latest allegation, Dr. Fischer had restrictions imposed on his conduct. He was not allowed to touch any patient or provide counseling behind closed doors, and could not conduct counseling sessions beyond 5 pm.

A typical abuse investigation by the Department of Family Protective Services is completed within 12 days, according to the agency's annual data book, yet the investigation into Dr. Fischer's alleged behavior took far longer than most.

"This investigation took a lot longer than average because it's very complicated, with old allegations going back many years," department spokesperson Patrick Crimmins told Medscape Medical News. "It was much more complex and time-consuming than typical."

Crimmins added that he could not release information about the earlier cases that were previously determined by his agency to be "unfounded," but are currently listed in the medical board's suspension order as "confirmed."

New Rules

Dr. Fischer's case has resulted in the issuance of more than half a dozen new rules outlined in a memo issued last week by Mike Maples, assistant commissioner for mental health and substance abuse services in Texas. The memo was sent to the superintendents of all 10 state hospitals.

Among these rules is one stating that staffers accused of sexual abuse at the state's psychiatric hospitals must now be transferred or put on emergency leave while under investigation.

"We have a responsibility and duty to ensure a safe treatment environment for patients and staff," Mr. Maples wrote in his memo. "Recent events have identified opportunities to provide additional protection for both patients and staff."

Other new requirements in the memo include:

Staffers may not provide unplanned individual therapy outside usual times unless 2 staff members are in the immediate vicinity.

Therapy or treatment room doors may not be locked during sessions.

Staff may only provide individual treatment services in rooms with windows or other locations where they can be directly observed by other employees. If windows are not available in therapy rooms, staffers must leave the door open or take patients to other public locations, such as a picnic table or park bench.

All class I abuse allegations, which include sexual abuse or very serious physical abuse, must be reported to Mr. Maples' office immediately.

Another Investigation

A nonprofit organization officially designated by the federal government to protect the rights of the state's disabled, called Disability Rights Texas, reports it has also launched an immediate inquiry into cases involving Dr. Fischer's 8 alleged victims.

Last year, Texas state investigators confirmed 39 cases of sexual abuse in facilities that are either state-run or contracted by the state. Yet investigators "confirming" an allegation of abuse are rare: Less than 2% of more than 2100 abuse allegations made in state psychiatric hospitals in 2010 were confirmed by the state.

One of the boys was allegedly abused at the Waco Center for Youth, where Dr. Fischer worked as a contractor, and another allegation came from a patient he saw under a treatment services contract at the Southwest Neuropsychiatric Institute in San Antonio.

Dr. Fischer received his medical license in 1978 from the University of Texas Health Science Center in San Antonio. State records indicate Dr. Fischer completed his general residency and was licensed as a psychiatrist in 1984. He received further training in child psychiatry and also served on a committee that developed state guidelines for prescribing psychotropic medication to foster children, according to those records.

In addition to the Austin State Hospital and the Waco Center for Youth, state records indicate that during his career Dr. Fischer has been employed as a psychiatrist at the Southwest Neuropsychiatric Institute in San Antonio, the Lutheran Social Services Residential Treatment Center for Girls, and the Central Counties Center for Mental Health and Mental Retardation.