Part IV
Chapter 21
 Eight boys from white, stable, upper middle-
class families were among the most
delinquent – “Saints”
 Parents and community unaware that the
“saints” were constantly occupied with
truancy, drinking, wild driving, petty theft,
vandalism
 None were arrested during two years of
observation
 Six lower-class white boys, same high school
but different gang – “Roughnecks”
 These boys constantly in trouble with police
and community even though rate of
delinquency about the same as Saints
Part 4: Ch. 21
Part 4: Ch. 21
 Getting out of school as early as possible
 They did so with minimum danger of
detection through elaborate procedure for
obtaining “legitimate” release from class
 For example, one boy would ask to use
bathroom but instead get another boy out of
another class by saying he was needed for a
drama rehearsal, the boy released would do
same for another, etc.
Part 4: Ch. 21
 The boys would then go to car and leave
school for a day of fun
 On average about five boys would get away
and this pattern was repeated often
 Once leaving school, they would go to pool
hall at lower-class side of town or to a café in
the suburbs where they were unlikely to
meet people they knew
Part 4: Ch. 21
Part 4: Ch. 21
 They traveled to Big Town - 25 miles from
their town most Fridays & Saturdays
 Activities included drinking heavily in bars,
drunk driving, committing acts of vandalism
& other pranks
 In spite of their activities, the boys managed
to avoid being stopped by police most of the
time
 Their activities were surely delinquent but
they did not see it that way: they were
merely having a little fun
Part 4: Ch. 21
Part 4: Ch. 21
 Highly successful in school, the Saints had
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“B” averages with two getting straight “As”
Boys were popular and many held offices
and played sports
Teachers and school officials saw them as
role-models who would “make something of
themselves”
Cheating on exams was rampant but
teachers usually gave them benefit of doubt
Local police saw boys positively, as among
leaders of youth in community
If on rare occasion a boy was stopped by
police for speeding, they would be polite,
contrite and plead for mercy: none ever
received a ticket
Part 4: Ch. 21
Part 4: Ch. 21
The Roughnecks
 Roughnecks were somewhat “opposite” of
Saints
 Although boys engaged in equal amounts of
wild-oat sowing, the not-so-well-dressed, notso-well-mannered, not-so-rich boys were seen
negatively as heading for trouble
 The Roughnecks were constantly in trouble
with the police which reinforced
community’s view of them
Part 4: Ch. 21
The Roughnecks
 Town’s view of gang delinquency was
distorted: both groups more or less
delinquent than community realized
 Fighting activities were readily and
accurately perceived by everyone
 Engaged in drinking alcohol which town was
aware of
 More serious was theft which community did
not realize was as extensive as it was for the
Roughnecks
Part 4: Ch. 21
The Roughnecks
 High level of mutual distrust and dislike
between Roughnecks and police:
 Boys felt strongly that police were unfair and
corrupt which may have been true
 Main source of boys dislike of police came
from fact that police would periodically
harass them
 Police viewed them as engaged in criminal
activities and saw their job as keeping tabs on
them and preventing their crimes
Part 4: Ch. 21
Part 4: Ch. 21
 Boys behavior in school not especially
disruptive - while they would like to have
avoided it & were unsuccessful, they
attended regularly
 Some were seen as incapable of meeting
academic standards
 Teachers, like the community, saw boys
negatively, as heading for trouble,
uninterested in making something of
themselves
 The boys had a “C” averages
 Two of them were good football players
Part 4: Ch. 21
 Why did the community, the school and the
police react to the Saints as though they
were good, upstanding, non-delinquent
youth with bright futures but to the
Roughnecks as though they were young
criminals headed for trouble?
 Why did the Roughnecks and the Saints have
quite different careers after high school,
careers that for the most part lived up to
community’s expectations?
Part 4: Ch. 21
 In sheer number of illegal acts, Saints were
more delinquent and in terms of
“seriousness” – not much difference :
 The cost of Roughnecks’ stolen property may
have been slightly higher than the Saints
 Roughnecks more prone to physical violence
& sought opportunities to fight (sometimes
each other) whereas Saints never fought
 Yet Saints frequently endangered their own
and others’ lives in their drunk-driving & in
some of their pranks – removing traffic or
construction signs on roadways
Part 4: Ch. 21
 Visibility: differential treatment of groups
possibly due to fact that one gang was more
visible than other
 This was a direct function of the economic
standing of the families
 Saints had cars & could remove themselves
from community’s view whereas Roughnecks
didn’t own cars & so could not leave
community
 As a result, Roughnecks hung around
downtown & were highly visible
 Saints, on the other hand, could hide their
time-wasting from community
Part 4: Ch. 21
 Demeanor: another reason for differential
treatment of two groups
 Different responses of group members to
outside intervention
 Saints when confronted by police would be
apologetic and penitent
 The Roughnecks would show hostility and
disdain
Part 4: Ch. 21
 Bias: Roughnecks were simply seen as
committed to deviance as a way of life while
Saints were seen as basically good kids
 What all of this comes down to is class
structure which favors middle and upperclass youth over their lower-class
counterparts
Part 4: Ch. 21
Part 4: Ch. 21
 Most Saints went to college right after high
school; 5 graduated in 4 years & two finished
college a little later after stints in armed
forces
 Three went to graduate education: law,
medicine, and a Ph.D.
Part 4: Ch. 21
 Two Roughnecks who played football
received scholarships to college, both
graduated and became high school
teachers/coaches
 Two other Roughnecks didn’t graduate high
school & both eventually went to prison for
murder
 Another Roughneck became (illegal)
bookmaker for gambling
Part 4: Ch. 21
Part 4: Ch. 21
 The community responded to Roughnecks as
boys in trouble and the boys embraced this
view
 Their pattern of delinquency was reinforced &
departure from it became unlikely
 As the boys acquired self-image as deviants,
they sought new friends who affirmed that
identity
 As that self-conception became more
entrenched, they became more willing to try
new & more extreme deviance
Part 4: Ch. 21
 Their alienation resulted in more expression
of disrespect & hostility toward teachers,
police and others; in turn this increased
community’s negativism, perpetuating entire
process
 College scholarships for two Roughnecks
helped to break this cycle by providing new
basis for self-identity & interactions with
others
 Likewise, Saints were viewed as good kids
who would make something of themselves
which happened for the most of them
Part 4: Ch. 21
 What was cause and result of this disparity
between the Saints and the Roughnecks?
 Could the explanation for the different
reactions to these two gangs be simply that
one group of boys was more delinquent than
the other?
Part 4: Ch. 21
Part IV
Chapter 22
Part 4: Ch. 22
 Recognized as a privileged caste able to heal
the sick, a privilege won through difficult
years of education & exhaustive training
 This honored rank, however, creates
opportunities for doctors to commit crimes
within profession
 Attributes connected with medical practice:
 high status, trustworthiness & professional
autonomy, provide doctors with “protective
cloak” that shields them from scrutiny
Part 4: Ch. 22
 Doctors’ high status derives from high
salaries & occupational prestige, enabling
them to retain elite social positions
 Affords doctors protection necessary to
commit crime: historically there has been
reluctance to use criminal law against high
status offenders
Part 4: Ch. 22
 Altruistic image projected by doctors rooted in
code of ethics which defines doctors as selfless
professionals who perform invaluable service
without regard for personal gain
 Creates assumption of good will that makes it
hard to prove charge of intentional wrongdoing
on part of doctor
 Physicians altruistic image engenders trust from
patients who can become easy targets of fraud or
to overlook negligent medical care
 This reflects a “pattern of deference” to doctors
Part 4: Ch. 22
 Doctors have been relatively immune to legal
scrutiny because of medical professions’
preference for self-regulation
 State medical review boards (typically
composed of other physicians) are first &
often only review of doctors’ conduct
 They can discipline & suspend or revoke
medical licenses
 This may facilitate criminal opportunities by
shielding its members from more effective or
harsher punishments
Part 4: Ch. 22
Part 4: Ch. 22
 Kickbacks involve payments from one party
to another in exchange for referred business
or other income-producing deals
 Their acceptance by doctors is unethical and
illegal because of conflict of interest between
doctors’ commitment to quality patient care
and their own financial interest
Part 4: Ch. 22
 Fee splitting occurs when one physician (often
a general practitioner) receives payment from
a surgeon or other specialist in exchange for
patient referrals - may result in higher patient
costs since they have to be shared
 Referral may be based on the largest fee to the
referring doctor rather than the quality of the
doctor’s work to whom one is referred
Part 4: Ch. 22
 Self-referrals involve sending patients to
specialized medical facilities in which the
physician has a financial interest
Part 4: Ch. 22
 Prescription violations - a few doctors
overprescribe or mis-prescribe drugs to
patients which may cause serious illness or
death
Part 4: Ch. 22
 Unnecessary treatments or surgery may be
recommended to patients because of the fees the
doctor will earn and not the well-being of the
patient
 This can be a very difficult matter to determine
and opens the door to abuse
Part 4: Ch. 22
 Sexual misconduct - sex may be exchanged
for professional services
 Doctor’s trust and authority may be used to
exploit relationship with patient
 Doctors may sexually assault patients when
under anesthesia
Part 4: Ch. 22
Part 4: Ch. 22
 Medical profession opposed original
Medicaid legislation in 1960s as a threat to
their autonomy because program set price of
medical services
 AMA lobbied against provisions to sanction
doctors for violating the rules
 As a result doctors billed for duplicate
services or items not performed
 Many doctors adopted defiant attitude
toward Medicaid because viewed it as
illegitimate intrusion on their autonomy
even though intent was to provide health
benefits to the poor
Part 4: Ch. 22
 What kinds of retaliatory avenues exist for
patients who are mistreated or abused by
physicians?
 How are “deviant” doctors able to avert the
label and what consequences are faced by
most?
Part 4: Ch. 22