Seven years ago, after a scathing series of stories in The Dallas Morning News, the Texas Medical Board promised to crack down on bad doctors. Patient endangerment would be dealt with severely. And sexual misconduct, one official said, would become "intolerable."
It hasn't turned out that way.
After its last meeting, in late August, the board announced decisions on four sex-related cases. Two involved doctors whom judges had already sentenced for crimes against children. Two involved psychiatrists found to have had affairs with adult patients – potentially sexual assault under Texas law, but they've not been charged.
The child abusers were allowed to go on practicing medicine, though not with kids. The other two are working without restrictions.
It's all part of a broader pattern of tolerance for misconduct, a News analysis shows. Others who kept their licenses after the August meeting include two doctors convicted of lucrative federal crimes that put patients in harm's way; a neurosurgeon who operated on the wrong body part four times; a cardiologist found to have performed dozens of invasive procedures with little or no cause; and at least seven physicians linked to a death.
In all, 131 doctors were disciplined at the meeting. Only two had their licenses revoked, and then only because they quit contesting the cases against them. A handful of others were suspended or surrendered their licenses rather than fight.
The rest carry on with lesser penalties. For the neurosurgeon, it's 10 hours of continuing medical education. For one of the federal convicts, it's 22 hours plus passing a test on legal issues. For an ER doctor who was too drunk to intubate a patient – a patient who then died – it's therapy and urine tests.
State-mandated secrecy makes it impossible to know why the consequences were so limited.
Virtually all complaint and investigation records, unlike police records, are forever confidential. Penalties generally are worked out privately between a small group of board representatives and doctors' attorneys. "Agreed orders" documenting the deals are on the board's Web site but often vague; even dead patients are not named.
And investigators don't contact patients – or their survivors – unless their complaints were what set the case in motion. The daughter of the woman who was treated by the drunken ER doctor, for example, said she learned of the board's action from The News. (It used other government sources to identify the deceased.)
"We weren't aware anything was wrong," Deborah Loveless said.
The whole board rubber-stamps dozens of agreements at a time, and members do not comment on their decisions. But board spokeswoman Jill Wiggins said expediency drives many deals.
Most doctors facing the threat of revocation will contest it, triggering a process that can last years. Many can continue practicing in the meantime.
Even if the board wanted to gamble on more revocation battles, Wiggins said, "we don't have the staff or the resources." Patients are better protected if the doctor is put under some restrictions relatively quickly and publicly identified, she said.
Board president Irvin Zeitler Jr. said he and his colleagues, in addition to balancing patient safety with physicians' due-process rights, must be mindful of "continuing to provide patients access to medical care." The goal "is to protect the public while allowing the physician to keep practicing if possible," Wiggins said.
The language differs little from that cited in The News' series seven years ago, when one of Zeitler's predecessors explained how the board worked.
"We're not really in the business of jerking licenses," said Dr. Lee Anderson, a Fort Worth ophthalmologist. "Our primary purpose in the disciplinary process is remediation."
