In a building that once housed a taxi service, Dr. Armando Sanchez plies his trade.
“Abierto Los 7 Dias” — open seven days — reads the sign out front at the Sanchez Medical Clinic, wedged among the auto insurance agents and pawn brokers on Windy Hill Road in Smyrna.
Sanchez, 59, has been practicing there since earlier this year.
The question for some is, should he be practicing medicine at all?
Twelve years ago, Sanchez pleaded no contest to solicitation of capital murder after he was accused of trying to hire a hit man to kill a disgruntled patient in Houston.
The medical board in his home state of Texas took away his license and refused to reconsider. The board in California, where he also held a license, did the same.
But in Georgia, the disgraced doctor found a board willing to give him a second chance.
In agreeing to license Sanchez, the Georgia Composite Medical Board was going down a familiar road.
For decades, physicians whose misconduct caused other states to reject them have been given the green light to practice in Georgia, typically through decisions made largely behind closed doors, an Atlanta Journal-Constitution investigation found.
The AJC examined more than 500 licensing and disciplinary decisions involving Georgia physicians. On nearly two dozen occasions, the newspaper found, the board allowed physicians cited for criminal offenses or other types of improper behavior to practice in Georgia when boards in other states, reviewing the same matters, told them no.
Some committed financial crimes or similar transgressions that likely wouldn’t directly affect patients. But others had inappropriate sexual relations with patients or engaged in other types of misconduct that would leave physical or emotional scars.
It’s not uncommon for state medical boards to disagree on how certain types of misconduct should be punished, according to people who closely monitor board actions nationally. On occasion, one state will allow a physician to practice when another will not, they said.
But, they said, some of the cases examined by the AJC leave Georgia’s board open to criticism.
“When the people in state X are protected from this guy and those in state Z are not, it seems a little strange to me,” said Ruth Horowitz, a New York University sociology professor who wrote a book on physician licensing.
When the former chairman of the Texas Medical Board was told that Sanchez had been licensed in Georgia, his first response was, “Wow.”
The murder-for-hire plot “just smacked of somebody you wouldn’t want to be your doctor,” said Dr. Lee Anderson, a Fort Worth ophthalmologist.
Prosecutors in Houston, with evidence that included secretly-recorded conversations, charged Sanchez with arranging to pay a police officer $20,000 to kill a patient with whom he had a disagreement over a workers’ compensation claim.
The plea agreement allowed Sanchez to receive 10 years’ deferred adjudication, meaning his case would be dismissed by completing the terms of probation, and it did not require that he surrender his medical license.
Nonetheless, the Texas board revoked his license, ruling that he had “committed unprofessional and dishonorable conduct that was likely to injure the public.”
`We just see things differently’
The AJC also found that the Georgia board has given its OK to at least five physicians whose sexual misconduct or serious drug and alcohol problems caused other states to deny them licenses.
In one of those cases, Georgia agreed to reinstate a physician dismissed from the Air Force for having sex with two female patients, one of whom was a teenager. Ohio would not.
Both states revoked the physician’s license after his court martial, but the Ohio ruling was permanent. The Ohio board based its decision on a hearing examiner’s report that said the physician had not accepted responsibility for his actions.
“The board takes any kind of inappropriate relationship (with a patient) so seriously that it often permanently revokes (a license),” said Aaron Haslem, the former executive director of the Ohio board.
In another case, a physician who was sentenced to prison for exchanging prescription drugs for sex more than 100 times had his license reinstated in Georgia but not in Virginia.
A spokeswoman for the Virginia Board of Medicine declined to comment beyond the board’s order denying the physician’s reinstatement, which simply recounted the elements of the crime.
“In seeking reinstatement, it is the petitioner’s burden to prove he is safe and competent to return to practice,” Diane Powers, director of communications for the Virginia Department of Health professions, wrote in an email.
And, in yet another case, an emergency room physician who missed a shift after he was found unresponsive in a hotel room has regained the ability to practice in Georgia but not in Alabama.
The physician, who later admitted to drinking alcohol and taking Ambien to assist in his work, can't practice in Alabama until he submits a detailed practice plan, a requirement that wasn't imposed in Georgia.
“We just see things differently,” said Larry Dixon, executive director of the Alabama Medical Board. “When you find an ER physician unresponsive because of alcohol or drugs, you’re very careful with letting them back in.”
Public Citizen, the nonprofit consumer advocacy organization, has for years ranked state medical boards by calculating the number of serious disciplinary actions per 1,000 doctors. In the group’s most recent analysis, published in 2012, Georgia ranked in the bottom fourth.
But no one has evaluated how states view the same forms of misconduct, an area that, according to the director of Public Citizen’s health research group, would have major importance to consumers.
“That lack of consistency is certainly cause for concern, particularly when you’re talking about significant issues like hiring a hit man,” the director, Dr. Michael Carome, said. “I mean, that’s just extraordinary. Why would anyone think that person should be a licensed physician anywhere?”
Board: We’re careful
No one affiliated with the Georgia board queried for this story would comment on specific cases, citing state law that makes investigations and licensing applications confidential.
However, in a series of interviews, board members and other officials stressed that the board is careful to ensure that the physicians it licenses pose no danger to the public. They further noted that physicians whose pasts include serious misconduct are only licensed with conditions that, at least in the short term, require that their practices be monitored.
“I can’t go case by case, but I can give you a scenario,” said Dr. David Retterbush, the Valdosta surgeon who currently serves as the board’s chairman. “An individual will go to treatment, have advocates who say, `This person is rehabilitated. He can practice if he does this, does that.’
“If we have any doubt, we’ll get more information from the treating professional or have that person come in (for questioning). If we don’t think they’re safe to practice, we won’t grant a license.”
Scott Waguespack, a physician who has been practicing in Georgia after losing his license in South Carolina, said he appreciates the Georgia board for recognizing his efforts to overcome substance abuse. But he also pointed out that the board has placed him under heavy scrutiny.
Waguespack, a family practitioner in Hazelhurst, surrendered his license in South Carolina in 2004 rather than take a board-ordered blood test. He later asked to be reinstated, but the board refused.
Since being issued a license by the Georgia board in 2009, Waguespack has practiced under requirements that include random drug and alcohol screens and participation in outpatient therapy and support groups.
“I’m grateful that, after all the mistakes I’ve made, I’m still allowed to practice,” he said. “But there has been a heavy toll. … I’m not free and clear.”
The medical board consists of 15 members, all of whom are appointed by the governor. Thirteen are physicians and two are “consumer” members from the public.
It votes in open session, but much of the work in evaluating whether physicians are worthy of being licensed is conducted in executive session or in committee meetings that are closed to the public.
Licensing decisions involving physicians with disciplinary issues are recorded in public board orders. Orders issued since 2001 are generally available on the board’s web site.
However, most of the orders are basically bare bones accounts, typically including only a brief statement of the physician’s misconduct and the conditions under which he or she must operate until there is further board review.
Board members and other personnel acknowledged that much of the material they consider isn’t available to the public, but they said what’s available is still enough for patients to make informed decisions.
“We do tell you, `This guy’s got an order, and it’s on the website for you to make a decision,’ ” said LaSharn Hughes, the board’s executive director. “The law limits how much is out there, but, on the positive side, there is information out there.”
A decision in 2010
Sanchez, who also has used the names Armando Sanchez-Gonzalez and Armando Sanchez G, applied for a Georgia license in October 2009, two months after a judge in Texas discharged him from probation, records show. The license was approved by the board at its November 2010 meeting.
The order spelling out the board’s decision on Sanchez says he pleaded no contest to solicitation of capital murder and that his medical licenses were revoked in Texas, California and Pennsylvania, but it provides no details.
The order also placed Sanchez on probation and set out conditions that included working under a supervising physician for at least two years. According to an order issued by the board in February, those conditions have been met and he's no longer on probation.
When asked recently about the decision to license Sanchez, the chairman of the board at the time said he had no recollection of it.
“To be honest with you, I don’t recall anything about this at all,” said Dr. Alexander Gross, a Cumming dermatologist.
Sanchez declined to be interviewed, asking that a reporter contact an Atlanta attorney, Melvin Goldstein. However, Goldstein said he didn’t represent the physician in his dealings with the Georgia board and couldn’t speak to his past.
Ace Pickens, an Austin attorney who represented Sanchez when the physician’s case was heard by the Texas board, said the murder-for-hire charge was a misunderstanding. He said Sanchez, seeking protection from a patient who threatened his family, made comments to the police officer that sounded ominous but were not meant as an order to have anyone killed.
Given an opportunity for deferred adjudication, Sanchez agreed to plead no contest, the lawyer said.
“When you say what he was accused of, man, your antenna goes way up,” Pickens said. “Solicitation of capital murder — that sounds pretty damn bad. But when you stir it around, you see it really wasn’t all of that.”
The Texas board “loves to consider itself tough” when that may not be justified, he said.
Secret tapes and $100 bills
But court documents and other public records reviewed by the AJC paint a picture of a case built on evidence that included an exchange of cash and seven recorded conversations between Sanchez and the officer.
After being approached by Sanchez, the officer went to his superiors, who set up the secret tapings.
In one of the conversations, the officer told Sanchez, “If you want me to kill him, I’ll kill him,” and asked the physician if he wanted to back out. Sanchez indicated he did not.
Sanchez later provided the officer with $8,000 in $100 bills, which, according to the officer, was an initial payment for the killing.
Although the case never went to trial, the evidence was heard by an administrative law judge in Texas when the state board sought to discipline Sanchez. The judge thought Sanchez was guilty.
“After considering the voice tones and inflections and other aspects of these tape-recorded conversations, the ALJ has no doubt that Dr. Sanchez was soliciting (the officer) to kill (the patient),” the judge wrote, recommending that the physician’s license be revoked.
Two Texas courts later upheld the decision, knocking down Sanchez’s contention that he should retain his license because the criminal proceeding had no bearing on his professional competency.
“Even if not directly related to the practice of medicine, Sanchez’s acts serve to undermine public trust and confidence in the safety of Texas medicine, if not manifesting behaviors that would actually endanger patients,” the Texas Court of Appeals said.
Pressed for details on what Georgia saw in Sanchez that Texas didn’t, Hughes and Retterbush would not go beyond generalities. They reiterated that every case is reviewed carefully, often with information that isn’t available to the public.
“I can assure you we are not an open door,” Retterbush said.