Report card: How Montana protects patients from sexually abusive doctors

Transparency: 52
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?: 16 of 20
  
  While orders often detail allegations, some provide scant information.
- 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
  
  There are blind alleys when searching for information. Also, for weeks this summer no information was available because of a system upgrade, and the public was advised to email for disciplinary orders.
- Can boards issue private orders or letters?: 4 of 20
  
  The board issues private censures and reprimands.

Duty-to-report laws: 76
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
  
  Hospitals and health care facilities are required to report actions that prohibit or limit the privileges of a physician to practice medicine.
- Does the law set a deadline for them to notify regulators?: 12 of 20
  
  Within 30 days of actions affecting privileges
- Does the law establish penalties for failure to comply?: 20 of 20
  
  Up to one month license suspension
- Are physicians required to report peers?: 20 of 20
  
  Every licensed Montana physician is required to report information that appears to show another doctor is medically incompetent, mentally or physically unable to engage in the practice of medicine or is guilty of unprofessional 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: 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?: 30 of 50
  
  The 13-member board includes two public members, six physicians, one acupuncturist, one podiatrist, one nutritionist, one physician assistant and one volunteer EMT.
- Are public members independent and do they represent consumers?: 10 of 25
  
  Public members cannot be medical practitioners.
- Are women well represented on the board?: 25 of 25
  
  Eight women served on the 13-member board in September.

Criminal acts: 24
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?: 12 of 40
  
  Criminal background checks are not required. The state says that once the Interstate Medical Licensure Compact is implemented, it will perform criminal background checks of license applicants. That may be sometime in 2017.
- 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. But it notes that patients in mental health or residential facilities are deemed incapable of consenting to sexual contact with a person having supervisory authority over them or with an employee of the facility.

Discipline laws: 50
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 require revocation for any type of sexual misconduct or convictions.
- Do medical regulators have the legal right to hospital peer review records and proceedings?: 5 of 25
  
  The board does not have the right to proceedings and records from hospital peer review panels. State law says these are not subject to discovery or introduction into evidence 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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