To the Editor: The Medical Board of California defines "sexual contact" as "sexual intercourse or touching of an intimate part of a patient for purpose of sexual arousal, gratification, or abuse." However, that is not quite the point, inasmuch as we used the term only in our discussion (and abstract) as shorthand for "sexual relationships or other inappropriate personal contact with patients." These matters are basic biology; nearly all incidents involve body violations that any person on the street, let alone any psychiatrist, would agree are out of bounds.

The process used to determine whether a sexual relationship has occurred is through a thorough investigation that includes interviews with the complainant, the physician, and all other persons who might have relevant information. If validating factual information is lacking, the state psychiatric association is not involved in this process. When an allegation goes to investigation, it is with input from a board-certified psychiatrist who must have recent active practical experience and have no disciplinary actions completed or pending against him or her.

Board officials explain that they do not operate in an environment that is unfavorable to physicians. There is a presumption of innocence until the facts are established to a degree that is "clear and convincing to a reasonable certainty." Certainly, the public records of these investigations leave the reader in no doubt as to the appropriateness of the actions taken. No accusation is taken on faith, and no action is taken on the basis of an uncorroborated complaint. Although the Medical Board of California does not keep such data, its investigators report that spurious accusations against psychiatrists appear to be no more frequent than for other physicians.

We believe that prevention can be achieved through education and reeducation, which requires continuously keeping the problem on the radar screens of all mental health providers. To that end, we thank Dr. Burstein for his comment. In their anxiety to protect the innocent, we hope that mental health professionals will neither blame the victims nor ignore the signs that a clinician has become lost in the dark continent of desire. In either event, we find ourselves camping at the headwaters of denial.