April 12, 2021 -- Stephen Snyder-Hill has waited more than a quarter-century to be heard. In 1995, as a 25-year-old student at Ohio State University, he says he was inappropriately examined and touched by Richard Strauss, MD, a former university team and  health center doctor, but his complaints were brushed aside. When he demanded a meeting, he got one. He was told he was ''confused and mistaken."

For years, Snyder-Hill, an outspoken advocate of LGBTQ rights, an author, retired Army major, and dietitian in Columbus, OH, says he dealt as well as he could with the trauma, the deceit, and feelings of betrayal.

The scenario has now changed, and Snyder-Hill, seen above with his husband, Joshua, will be heard. In mid-March, a working group charged with reviewing the state medical board's handling of the investigation involving Strauss issued its final report. As a result, the board reopened 91 cases involving sexual wrongdoing that had been closed and recommended another 42 cases be reopened for failure to report, including an investigation against Ted Grace, MD, who was then the director of student health services and Strauss's superior. Grace, who was in the long-ago meeting with Snyder-Hill, did not return requests for comment.

Now, Snyder-Hill has been called by the state of Ohio to be a witness against Grace, who is now the director of student health services at Southern Illinois University, at a hearing April 20-23. The state wants Grace to permanently surrender his medical license. "I absolutely look forward to being a witness," Snyder-Hill says. "The Ohio State University robbed my chance at closure with Strauss [who died by suicide in 2005], but I will not let them do that again with Grace. He and I will face each other once again, and it will not be pretty."

OSU's scandal involving Strauss has been discussed for years. But it erupted in 2018 after complaints from former students, including former wrestler Mike DiSabato, were covered in the media. The Straus debacle is not the only high-profile recent case of sexual abuse on campus by figures of authority. The University of Southern California recently settled sexual abuse cases against former university gynecologist George Tyndall, MD, paying out $1.1 billion, believed to be the largest sexual abuse payout in higher education history. Tyndall worked for decades at the campus student health center, and the settlements include thousands of women.

In 2018, Michigan State University paid out $500 million to more than 300 young women, mostly gymnasts, who said they were abused by Larry Nassar, MD, under the guise of medical treatment. In 2013, the 26 survivors of abuse by Penn State University assistant football coach Jerry Sandusky were awarded about $60 million.

As more survivors of campus sexual abuse by doctors and coaches speak out, and universities are forced to address the issue, advocates of safer campuses hope the environment will change. But Snyder-Hill, other survivors, and mental health experts say there is a long way to go. Meanwhile, the abuse often results in serious mental health problems, including posttraumatic stress disorder (PTSD) and depression.

Not all of the trauma happened that day in 1995, Snyder-Hill says, explaining that ''half of the trauma all this time later is finding out what transpired, how bad it was, finding out the university covered it all up, and finding out the medical board let the case go into a black hole. That is all new trauma."

Relationships Based on Unequal Power

Both the coach-student athlete relationship and the doctor-student patient relationship are unique, says Ryan Christopher Mast, DO, an assistant professor of psychiatry at Wright State University's Boonshoft School of Medicine.

The coach and the doctor have the power. "When there is a power differential, there is a danger there," Mast says. "Anywhere there is a power differential, special attention must be paid to protect the person who is lower in that hierarchy."

Even through college students are typically over 18 years old, and considered adults, "Many young adults are unaware of what is considered 'normal' versus 'abnormal,'" Mast says. Trust is a key issue, and athletes especially often are told to trust their coaches, team doctors, and other doctors. That gives them a lot of power, he says. "Athletes also hear, 'If you can't follow my rules, then you can leave,' so some athletes will stay, even though they feel uncomfortable."

And, he says, it's not unusual for a college student abused by a doctor or coach to say they thought the interaction was normal but realize later it was not.

Young adults who have had trauma in the form of sexual abuse can report poor sleep, nightmares, social isolation, and distrust, among other issues, Mast says. "Locking away" the memories does not help, but addressing them in therapy can, he says. While approaches vary, for many, a technique known as trauma-focused cognitive behavioral therapy helps, Mast says. It involves having the patient discuss the trauma, then learn to manage their difficult emotions about the experience in healthier ways. Group therapy might also help, he says, as could medication for depression or anxiety, combined with therapy.

Protecting Students and Student-Athletes

Several protections and resources are already in place to help protect students seen by campus doctors, treated by team doctors, and guided by coaches:

  • Title IX of the Higher Education Act protects students against discrimination based on sex and regards sexual harassment as sex discrimination. It also protects a student's right to report or not to report. But updated regulations that took effect in 2020 have triggered debate. "Under the new regulations, there are more procedural protections for those accused," says W. Scott Lewis, JD, co-founder and board member of the Association of Title IX Administrators (ATIXA).
  • The American College Health Association (ACHA) represents college health and wellness centers and the providers that staff them, but membership is open to any faculty and staff, including athletic department personnel, says Rachel Mack, a spokesperson. It has a best practices guideline for sensitive exams. It suggests a chaperone be present and recommends appropriate responses to unprofessional behavior.
  • The National Collegiate Athletic Association (NCAA), with more than 1,000 colleges as members, adopted a policy in 2017 requiring coaches, college athletes, and athletics administrators to complete education annually in sexual violence prevention. In a 2014 report, the NCAA said members must know and follow campus protocols for reporting sexual violence and report suspected violence to appropriate offices for investigation.
  • The Association of Title IX Administrators, which has more than 5,000 members, offers webinars and other resources about best practices and policies.

Universities’ Responses and Actions

In 2018, Ohio State University launched an independent investigation into the allegations of sexual misconduct. In May 2019, a report found that Strauss abused at least 177 former students during his years of employment from 1978 to 1998. It found other university personnel had knowledge of the complaints as early as 1979 but failed to investigate or ''act meaningfully."

The university says it has hired new staff and put in place new policies, programs, and tools. It will cover the cost of counseling for those affected by Strauss and will reimburse those who have already gotten counseling.

In the Southern Cal-Tyndall settlement, the university agreed to several new procedures and oversight, such as hiring additional doctors so female students may choose to see a female doctor. It also provides students with a notice about how to recognize and report sexual harassment.

Reasons for Hope

Will the OSU and Southern Cal cases make a difference? "I think money talks, and I don't see how it couldn't," says Nancy Hogshead-Makar, a 1984 Olympic gold medalist swimmer and now CEO of Champion Women, which advocates for girls and women in sports. "I think more so than sending an individual to prison that large money verdicts send a message to organizations that they cannot minimize the impact of sexual abuse and assault happening with their students."

While statistics about sexual abuse on campuses are difficult to come by, Lewis of ATIXA says he does think the situation is improving. "Twenty-five years ago, if you were a young woman [athlete] at a university or college and sexually assaulted, you either toughed it out, transferred, or dropped out." These days, abuse is reported more, he says. "You get more women in positions of power, and they are less likely to put up with it.'' There is less tolerance and more enforcement of policies, he says.

He recalls being an expert witness for a case in which a female medical student, abused by her superior, at first didn't want to report him, thinking it would run her career. She changed her mind -- and won the case. "That mindset shift, [due to] the ‘Me, Too’, the ‘Time's Up’ movement, is powerful."

Much more is needed, says Hogshead-Makar, who has spoken publicly about being raped while jogging on the Duke University campus while a student there. The NCAA policy, she says, has ''no teeth," no consequences.

According to Stacey Osburn, a spokesperson for NCAA, ''schools remain responsible for personnel background checks for those engaging with student-athletes. Further, schools continue to have responsibility to set standards for appropriate conduct with students, investigation of alleged inappropriate conduct, and resulting discipline to those engaging with student-athletes."

Stopping coach-athlete abuse, Hogshead-Makar says, depends on education. It's important to help athletes understand appropriate boundaries that adults must keep with students. She tells athletes that "a good coach will not text you individually, but include parents and teammates, for instance. A good coach will not try to be alone with you."

Snyder-Hill agrees more is needed to stem the abuse. He suggests that a student who files an abuse complaint needs to know if others have also filed. That gives them the validation they need, that they are not ''confused and mistaken."

Snyder-Hill does give credit to the Medical Board of Ohio for finally shining a light on the abuse. "While the medical board had missteps back in the 1990s, they have realized the severity and importance of sexual abuse cases and have made a huge effort to correct this, and to look at other cases that were closed and shouldn't have been," he says. "I applaud that. The medical board took the high road."

He does not say the same about the university.

Correction: An earlier version of this story incorrectly identified Stephen Snyder-Hill as a former wrestler at Ohio State University. He was not on the wrestling team. 

WebMD Health News

Sources

Stephen Snyder-Hill, author, activist, retired Army major, dietitian, Columbus, OH.

Ohio Department of Public Safety: "Closing Report, Governor's Working Group on Reviewing of the Medical Board's Handling of the Investigation Involving Richard Strauss," "Working Group on Reviewing of the Medical Board's Handling of the Investigation Involving Richard Strauss Delivers Closing Report."

Ryan Christopher Mast, DO, assistant professor of psychiatry and child & adolescent fellowship training director, Boonshoft School of Medicine, Wright State University, Dayton, OH.

Rachel Mack, spokesperson, American College Health Association, Silver Spring, MD.

W. Scott Lewis, JD, co-founder and board member, Association of Title IX Administrators (ATIXA), King of Prussia, PA.

Nancy Hogshead-Makar, Olympic gold medalist, attorney, and CEO of ChampionWomen.org, Jacksonville, FL.

Stacey Osburn, spokesperson, National Collegiate Athletic Association.

The New York Times: "Michigan State's $500 million for Nassar Victims Dwarfs Other Settlements," "Penn State to Pay Nearly $60 Million to 26 Sexual Abuse Victims."

USC Student Health Center Litigation Settlement.

The Ohio State University Office of University Compliance and Integrity: "Report of the Independent Investigation: Sexual Abuse Committed by Dr. Richard Strauss." 

Los Angeles Times: "USC to pay $1.1 billion to settle decades of sex abuse claims against gynecologist."

Innovations in Clinical Neuroscience: "Psychotherapy with Survivors of Sexual Abuse and Assault."

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