Report card: How Tennessee protects patients from sexually abusive doctors

Transparency: 62
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?: 18 of 20
  
  A critical 2015 state audit found it may take years for the board to act, and patients don't know of complaints while the investigation ensues. However, all orders since 1999 are posted.
- Do orders or other information online detail violations that led to sanctions?: 16 of 20
  
  Orders often detail allegations, but some cite only the type of misconduct and the legal basis for action.
- Does doctor profile information include hospital sanctions, criminal charges and orders from other states?: 12 of 20
  
  Information is limited to the most recent 10 years.
- Is it easy to find all doctor information on the website?: 12 of 20
  
  There is a confusing Practitioner Profile link, which is for physicians. Adverse actions and physician profiles are on separate pages.
- Can boards issue private orders or letters?: 4 of 20
  
  Both boards issue private letters of concern and warning

Duty-to-report laws: 58
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?: 20 of 20
  
  The chief administrative official of every hospital or other health care facility must report disciplinary action against any physician related to professional ethics, moral turpitude, medical incompetence or alcohol or drug abuse.
- Does the law set a deadline for them to notify regulators?: 12 of 20
  
  Within 60 days after taking disciplinary action
- Does the law establish penalties for failure to comply?: 4 of 20
  
  None specified
- Are physicians required to report peers?: 4 of 20
  
  State law does not require physicians to report possible violations by fellow doctors.
- Are courts or prosecutors required to notify regulators of physicians’ criminal convictions?: 18 of 20
  
  Clerks of court must report within 30 days felony convictions of physicians. However, a 2015 state comptroller's audit found that the board wasn't collecting the court information.

Board composition: 73
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?: 35 of 50
  
  The medical board had three public members and nine physicians. The osteopathic board has one public member and five physicians.
- Are public members independent and do they represent consumers?: 15 of 25
  
  For the medical board, state law says the three public members can neither own nor have any financial or other interest in any health care facility, business or school of medicine. For the osteopathic board, one public member cannot be engaged in any profession, business or activity regulated by the board. State law calls for the governor to strive to ensure that at least one board member is a racial minority and one is at least age 60 or older.
- Are women well represented on the board?: 23 of 25
  
  Five women served on the 12-member medical board in September. Two women served on the six-member osteopathic board.

Criminal acts: 52
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
  
  State law requires reporting
- Has the state criminalized sexual misconduct involving doctors and patients?: 8 of 40
  
  The state has no criminal laws specific to physicians.

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?: 20 of 25
  
  The board can permanently revoke a license. It must revoke the license of doctors convicted of violent sexual offenses.
- Do medical regulators have the legal right to hospital peer review records and proceedings?: 5 of 25
  
  State law says that such documents are confidential and cannot be used in any proceeding.
- Does state law mandate that regulators deny licenses to physician applicants who have committed certain violations?: 5 of 25
  
  The board has discretion.
- 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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