Report card: How Iowa protects patients from sexually abusive doctors

Transparency: 71
Is complete and accurate information on physician discipline provided to help patients protect themselves? More...
The best states make it easy for the public to find comprehensive information on physicians, including whether they have been disciplined for sexual abuse or other violations. To assess transparency, the AJC used five measures. Top grades went to states where medical regulators posted disciplinary orders on websites going back at least 15 years; fully detailed the acts that led to sanctions; avoided private orders, reprimands or letters; provided easy web access to clearly labeled doctor information including disciplinary documents; and listed any hospital sanctions, criminal convictions and out-of-state disciplinary actions for each physician.
- Are all orders posted?: 20 of 20
  
  Yes
- Do orders or other information online detail violations that led to sanctions?: 23 of 20
  
  Yes
- Does doctor profile information include hospital sanctions, criminal charges and orders from other states?: 4 of 20
  
  The information is not listed.
- Is it easy to find all doctor information on the website?: 20 of 20
  
  The home page link is clearly labeled under the prominent consumers tab. Three clicks to a doctor's profile, which includes hyperlinks to disciplinary documents.
- Can boards issue private orders or letters?: 4 of 20
  
  Confidential letters of warning are issued when action does not involve serious patient harm, criminal conduct or a threat to public safety

Duty-to-report laws: 48
Are colleagues and institutions that are aware of potential physician misconduct required to notify regulators? More...
To break the code of silence that can shield abusive doctors, the best states have laws requiring all physicians and health care institutions to notify regulators of potential violations. To assess these laws, the AJC used five measures. Top grades went to states where a broad range of health care facilities, not only hospitals, are required to notify regulators of alleged physician misconduct; where there is a deadline of no more than 30 days for making those reports; where penalties for failing to report are clear and significant; where doctors are required to report fellow practitioners; and where courts or law enforcement agencies must notify regulators when a doctor is criminally convicted.
- Which health care facilities must report doctors to medical regulators?: 12 of 20
  
  Any final hospital disciplinary action approved by a hospital board of trustees that limits, suspends or revokes a doctor's privileges relating to professional competence or concerning any voluntary surrender or limit of privileges must be reported. The law does not specify clinics or nursing homes must report actions they may take against physicians.
- Does the law set a deadline for them to notify regulators?: 16 of 20
  
  Within 10 days after final disciplinary action
- Does the law establish penalties for failure to comply?: 4 of 20
  
  None specified
- Are physicians required to report peers?: 12 of 20
  
  Physicians must notify the board within 30 days of knowledge that another doctor may have committed reportable conduct.
- Are courts or prosecutors required to notify regulators of physicians’ criminal convictions?: 4 of 20
  
  State law does not require courts to report physicians' criminal convictions to the board.

Board composition: 83
Are consumer members included to balance physicians’ tendency to identify with their colleagues? More...
A blueprint developed by The Federation of State Medical Boards recognized the importance of having independent public members on physician-dominated medical regulatory agencies. To assess the composition of disciplinary agencies, the AJC used three measures, with the most weight given to consumer representation. Top grades went to states where public members make up at least 40 percent of the board; where those members represent consumers and where neither they nor their family members have professional or financial ties to health care; and where women hold at least 40 percent of the board seats.
- Is the public well represented?: 40 of 50
  
  Seven physicians and three public members serve on the board.
- Are public members independent and do they represent consumers?: 15 of 25
  
  State law stipulates that no more than five members can be associated with the same political party.
- Are women well represented on the board?: 28 of 25
  
  Iowa is the only state where law requires gender equity on the board.

Criminal acts: 68
Are medical regulators and law enforcement made aware of doctors’ criminal conduct? More...
The medical profession has long recognized the power imbalance between doctors and patients. But only in recent years have states enacted three key laws to try to protect vulnerable patients from dangerous doctors. The AJC considered two of these laws the most important. Top grades went to states where physicians must undergo criminal background checks, with fingerprints, at initial license application and periodically; and where doctor-patient sexual contact has been made a criminal offense in recognition that patients cannot give meaningful consent. In addition, the AJC also rated states on whether medical boards that learn of allegations of criminal conduct must alert law enforcement.
- Are physicians required to undergo criminal background checks?: 24 of 40
  
  Required at initial application, with fingerprints
- Is board required by law to notify law enforcement?: 20 of 20
  
  Yes. State law requires the board or its employees or agents to notify law enforcement of any investigative information indicating a crime has been committed.
- Has the state criminalized sexual misconduct involving doctors and patients?: 24 of 40
  
  The state's sexual exploitation law includes acts by a therapist with a client or former client for up to one year who is emotionally dependent, meaning that the client is significantly impaired in the ability to withhold consent. Any physician who provides or purports to provide mental health services is covered by the law. If the sexual conduct is found to be a pattern or practice or scheme of conduct, it is a felony offense.

Discipline laws: 55
Do state laws strengthen oversight and discipline of problem physicians? More...
Abusive physicians can be protected by laws that limit regulators’ ability to investigate cases and don’t require permanent revocation of doctor licenses for egregious offenses. To assess the legal environment for doctor discipline, the AJC examined four key laws. Top grades went to states that require permanent revocation of doctor licenses for some violations; where physicians who have been convicted of felonies or who have lost their licenses in other states cannot be licensed; where medical regulators are entitled to records and other proceedings of hospital peer review committees that examine doctor misconduct; and where there is a reasonable standard of proof required for disciplinary action against physicians, especially in sexual misconduct cases where there may be no independent witnesses.
- Does state law require revocation for some violations? Can revocation be permanent?: 15 of 25
  
  Revocation can be permanent. State law doesn't mandate revocation for any type of sexual misconduct or convictions.
- Do medical regulators have the legal right to hospital peer review records and proceedings?: 10 of 25
  
  Access is very limited. The board must subpoena and can't receive certain material
- Does state law mandate that regulators deny licenses to physician applicants who have committed certain violations?: 5 of 25
  
  While there is no legal prohibition on licensing those suspended or revoked elsewhere, the board said it routinely denies licenses in such cases.
- What is the standard of proof for regulators to impose disciplinary sanctions?: 25 of 25
  
  The standard of proof required to discipline a doctor is preponderance of evidence. It basically means "more likely than not." That's also the typical standard for most lawsuits.

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