From the BBC:
David Britten, 54, a former manager at the Peter Dally Clinic in Pimlico, central London, preyed on patients over a 20-year period.
Claims by patients of sexual misconduct emerged after his dismissal from the clinic in 2002 over unrelated issues.
The NHS launched an inquiry in 2006 into how he escaped detection.[...]
The investigators blamed poor management, missed opportunities and the reluctance of his victims to come forward as the reasons for Mr Britten "grooming vulnerable patients".
The report described Mr Britten as a "manipulative predator who represented a clear danger to women".
Alison McKenna, who led the inquiry, said: "The effect of David Britten's abuse of these vulnerable women cannot be overestimated.
What I find striking is the contradiction between the idea that the effect of this man's abuse cannot be overestimated and how the blame for this man's serial abuses included the reluctance of his patients to come forward.
Britten was an eating disorder specialist and there are no criminal charges pending due to insufficient evidence in this case which involves 23 patients. Some jurisdictions have criminal statutes which specifically address this type of violation by health professionals so that consent cannot be used as a defense, but I don't know if England has any such laws.
Since the first official complaint came after Britten was dismissed for other reasons, it looks like there was a pervasive sense that until that happened these complaints would not have been taken seriously or complaints would put the complainant's health at risk because that health center would likely become hostile territory.
This blaming of victims wrongly makes victims equally responsible for what was done to all subsequent patients. This habit of making victims scapegoats when they don't report immediately helps mask or excuse systemic problems. The most obvious systemic problem is having other employees fail to take note of any behavior which crossed or neared an ethical line. If abused patients had the sense that the clinic accepted Britten's sexualization of them why would they believe that their complaints would be welcome?
These systemic problems unfortunately create a predator-friendly environment where abuse can easily flourish and patients are protected by luck alone.
I can't imagine an inquiry into a serial practitioner of a blatantly unsafe medical practice -- which was done in front of the patients harmed -- which would list those patients failure to report that unsafe practice as one of the factors to blame for the continuation of that unsafe medical practice.
It's definitely worth noting that patients didn't speak up, but that notation shouldn't be under the category of blame.
This silence on the part of patients only shows that patient outreach is important to give patients tools which they can use before, during or after something happened which harmed them. Any outreach program would be putting patients in danger the minute the medical facility started depending on patient reports to keep the staff from committing unsafe medical practices.
Most members of the public would be outraged at the idea that they could be blamed after a family member died because of an intentional lethal drug injection administered in their presence. A nurse who was a master manipulator would work to convince the family member that the lethal action was appropriate. If the medical system didn't recognize the true cause of death that family member might naturally say nothing until they learned that nurse was fired.
We need to see inquiries into sexual misconduct which blame the victims with this same outrage.
A family member's silence is not complicity with the crime and it does not prove that no crime occurred. The same is true of victims of sexual abuse within medical settings.