Not a single state met the highest bar in every category the newspaper examined, although Delaware came the closest. Meanwhile, in 49 states and the District of Columbia, multiple gaps in laws can leave patients vulnerable to abusive physicians, according to the newspaper.
Trailing the nation, with scores below 50 out of 100 points in the AJC's study, are Arkansas, Hawaii, Idaho, Louisiana, Mississippi, Oklahoma, South Dakota, Utah and Wyoming. Study results can be found at http://doctors.ajc.com/states/.
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Among the AJC’s findings:
- In Minnesota, state law affords zero tolerance for doctors who are convicted of felony sex offenses: They are banned from practicing medicine. In 36 other states, no such ban exists.
- In Iowa, state law says women get half the seats on the board that licenses and disciplines physicians. But in most states, men control medical boards, and only half the states give consumers a strong voice in deciding whether doctors who have hurt patients should be allowed to stay in practice.
- In Texas, state law demands that doctors undergo rigorous criminal background checks before they're licensed and while they're practicing too. But 14 states still do not require criminal checks before giving a license to someone who can prescribe powerful drugs and ask patients to strip down and submit to being touched, the newspaper found.
The newspaper’s findings explain how it’s possible for a doctor who has served time on felony charges, molested patients or demanded sex in exchange for prescription drugs to continue seeing patients: In most states, there’s no law against it.
In July, the AJC reported that physician sexual misconduct is more common than previously acknowledged and that doctors who violate patients are often allowed to stay in practice. The national investigation identified more than 2,400 doctors disciplined for sexual misconduct involving patients since 1999. Half were still licensed.
Visit doctors.ajc.com to read the entire series, including cases from every state, tips for staying safe and further explanation of the problem.
Doctors dominate most medical licensing boards and have the authority to decide who is fit to practice medicine and who isn't. Most states do not restrict a board's authority by mandating certain punishments for some types of violations. Many licensing boards say that's how it should be.
>>Read more of The Atlanta Journal-Constitution's investigation
“Having a bold, bright line saying a felony equals this or that is not good policy,” said Bob Jeffery, executive director of the Georgia Composite Medical Board.
Minnesota is among the few states that took some of those decisions out of regulators’ hands. There, physicians who are convicted of felony sexual offenses are automatically and permanently revoked.
California requires that doctors who become felony-level registered sex offenders lose their license.
The law grew out of the experiences Rudy Bermudez had while he was a member of California’s medical board.
A former parole officer who had supervised sex offenders, Bermudez said he disagreed repeatedly with physicians on the board who re-licensed doctors who had molested patients.
When Bermudez was later elected to the legislature, he sponsored and won passage of his bill to ban sex offender doctors from practice.
“I wasn’t going to have it anymore,” Bermudez said. “I was tired of watching these cases go through.”
The Federation of State Medical Boards, which represents regulators in every state, recommends that at least one-fourth of board seats go to consumers.
Mark Bowden, executive director of the Iowa Board of Medicine, said it's the consumer members who keep the focus on the patients and public accountability. "They're the ones who raise their hands and say 'That's just not right.' "
But the newspaper found that only about half the boards across the nation have the kind of consumer representation the federation recommends.
The AJC also found that about half the states have laws that criminalize sexual contact between therapists and patients. That wave of laws passed after studies showed that psychiatrists and other therapists were sexually exploiting vulnerable patients. In those situations, the laws say, patients cannot give meaningful consent to sex.
But just a handful of states criminalize sex between all doctors and patients — something that is clearly forbidden by medical ethics, the newspaper found.
Delaware has some of the nation's strongest patient-protection laws, including the one that covers therapists. Representative Williams pushed last year to take criminalization to that next step when she introduced a bill to make doctor-patient sexual contact a felony. A veto by Gov. Jack Markell killed the bill.
Too often, Williams said, bad doctors are given a pass. Now, instead of waiting for 50 states to enact laws to protect patients, Williams thinks the federal government should step in.
“As a society, we don’t take sexual misconduct, sexual assault and sexual abuse seriously enough,” Williams said. “These are bad, bad crimes they are committing on people and we do not treat them that way.”