Report card: How Missouri protects patients from sexually abusive doctors

Transparency: 56
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?: 20 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?: 8 of 20
  
  "Licensee search" is the wrong link. Instead, the link is licensee search active or non active. If consumers use the "Profession Name" field they will get a drop-down list with various kinds of osteopaths and allopaths to choose from.
- Can boards issue private orders or letters?: 4 of 20
  
  The board is authorized to administer a private reprimand. It does send private letters of concern to licensees.

Duty-to-report laws: 56
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 CEO or other official of hospitals and other health care facilities is required to report any final action to reprimand, discipline or restrict in response to activities that are also grounds for disciplinary actions.
- Does the law set a deadline for them to notify regulators?: 16 of 20
  
  Within 15 days of final action
- Does the law establish penalties for failure to comply?: 12 of 20
  
  The law states that it is an infraction for a health care facility to fail to comply. That offense carries a fine up to $400.
- 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?: 4 of 20
  
  State law does not require courts to report physicians' criminal convictions to the board.

Board composition: 60
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?: 30 of 50
  
  The nine-member board has one public member and eight physicians.
- Are public members independent and do they represent consumers?: 20 of 25
  
  The public member cannot be or ever have been a member of any profession licensed or regulated by the board or the spouse of such person, nor have or ever have had a material, financial interest in either the providing of professional services regulated by the board or in an activity or organization directly related to any profession licensed or regulated by it.
- Are women well represented on the board?: 10 of 25
  
  Two women served on the nine-member board as of September.

Criminal acts: 20
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?: 8 of 40
  
  Criminal background checks are not required
- Is board required by law to notify law enforcement?: 4 of 20
  
  No legal requirement
- Has the state criminalized sexual misconduct involving doctors and patients?: 8 of 40
  
  The state has no criminal laws specific to physicians.

Discipline laws: 85
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?: 25 of 25
  
  Automatic revocation is mandated for conviction of felony-level crimes of moral turpitude; for offense reasonably related to profession; and for any act of violence. The board cannot stay the revocation. However, for any order or revocation, the board may set a period of from 2 to 7 years when a doctor may not reapply. If it doesn't specify a period, the doctor must wait at least one year.
- Do medical regulators have the legal right to hospital peer review records and proceedings?: 20 of 25
  
  The board can subpoena for peer review information.
- Does state law mandate that regulators deny licenses to physician applicants who have committed certain violations?: 15 of 25
  
  Anyone revoked in another state is automatically denied a license in Missouri. In addition, anyone denied a license in another state is automatically denied a license in Missouri, but the board may set up qualifications to allow them to be licensed.
- 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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