Report card: How Florida protects patients from sexually abusive doctors

Transparency: 58
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?: 12 of 20
  
  Only final orders, not earlier disciplinary orders, are online. No orders may be posted if a doctor is no longer licensed in Florida.
- Do orders or other information online detail violations that led to sanctions?: 16 of 20
  
  License surrenders may not include details on the allegations.
- Does doctor profile information include hospital sanctions, criminal charges and orders from other states?: 14 of 20
  
  The most recent 10 years of hospital sanctions and other states' disciplinary actions are posted. Crimes are not limited to 10 years.
- Is it easy to find all doctor information on the website?: 12 of 20
  
  When looking for discipline, you'd have to know "proceedings and actions" is the path to take from the profile.
- Can boards issue private orders or letters?: 4 of 20
  
  The probable cause panel can issue a letter of guidance in lieu of finding probable cause. Such letters are confidential.

Duty-to-report laws: 74
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
  
  Any disciplinary actions taken by a licensed facility, such as hospitals, clinics and nursing homes, must be reported in writing to the Division of Health Quality Assurance.
- Does the law set a deadline for them to notify regulators?: 12 of 20
  
  Within 30 days after disciplinary action
- Does the law establish penalties for failure to comply?: 20 of 20
  
  $5,000-$25,000
- Are physicians required to report peers?: 18 of 20
  
  Every licensed health care practitioner must report any allegation of sexual misconduct to the Department of Health, regardless of the practice setting in which the misconduct occurred. Physicians can be sanctioned for failing to report violations by other doctors who work with them in the same licensed facility.
- Are courts or prosecutors required to notify regulators of physicians’ criminal convictions?: 4 of 20
  
  State law does not require courts to report criminal convictions to the Department of Health.

Board composition: 65
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 has 12 physicians and three public members. The osteopathic board has five physicians and two public members.
- Are public members independent and do they represent consumers?: 13 of 25
  
  One public member of the medical board must be a licensed health care risk manager; on the osteopathic board, the public members cannot be active or retired health care practitioners
- Are women well represented on the board?: 18 of 25
  
  Three women served on the 15-member medical board; six women serve on the seven-member osteopathic board.

Criminal acts: 76
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?: 32 of 40
  
  Required at initial application and renewal, 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?: 24 of 40
  
  State law says psychotherapists shall not engage in or request sexual contact until 2 years after termination of psychotherapy, but the two-year limit is not the sole determination of a criminal offense. Consent is not a factor. Violations are third-degree felonies (punishable by up to 5 years in prison), but on second offense are second-degree felonies (punishment up to 15 years).

Discipline laws: 45
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. In cases where a doctor surrenders his or her license in lieu of investigation, the relinquishment order may state that the doctor agrees to never reapply. There are no mandatory revocations for any type of sexual misconduct or convictions, but suspension is mandatory for those convicted of certain felonies and some misdemeanors.
- Do medical regulators have the legal right to hospital peer review records and proceedings?: 20 of 25
  
  The Department of Health has legal authority to obtain this information with a subpoena.
- Does state law mandate that regulators deny licenses to physician applicants who have committed certain violations?: 5 of 25
  
  State law doesn't require that licenses be denied to those whose licenses were revoked or surrendered for sexual misconduct anywhere else.
- What is the standard of proof for regulators to impose disciplinary sanctions?: 5 of 25
  
  The state requires clear and convincing evidence to prove a disciplinary case against a doctor. That may make it hard to prove a sexual misconduct case when it may be a patient's word against a doctor's. Most states require a preponderance of evidence to impose discipline.

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