The system for ferreting out questionable doctors seems more hit and miss than you might suppose. DOPL scans the Utah Controlled Substance Database, which primarily identifies people who are doctor shopping for drugs, where it might discover a doctor writing too many prescriptions. Regulators also use it to look into cases where the police, FBI or state fraud units are involved.

That's how Dr. Alexander Theodore came to DOPL's attention earlier this year. The state Insurance Department is investigating the doctor for allegedly operating an OxyContin drug ring in Salt Lake County.

But DOPL relies chiefly on complaints, mostly from patients or their families, occasionally from hospitals, colleagues and insurance companies. If there are no complaints filed, DOPL may not have that doctor on its radar.

Doctors who don't practice at hospitals are among the hardest to keep tabs on because there's no one responsible for monitoring or reporting them, says Dr. Marc Babitz, a member of the state Physician's Licensing Board, which acts as an advisory body to DOPL on discipline matters regarding physicians. And most "doctoring" isn't done in hospitals but in doctors' offices. The American Society of Anesthesiologists estimates that 10 million surgeries nationwide now take place in doctors' offices and free-standing clinics.

Hospitals must tell DOPL and the federal practitioners database when they take away or restrict a doctor's privileges for more than 30 days. But sometimes a hospital will place restrictions on a doctor for 29 days to avoid reporting, according to several sources.

"It is rare, almost nonexistent, that action taken by a hospital short of revoking his privileges or suspending his staff membership is brought to the attention of the division," says former DOPL director David Robinson. "You may have a physician who is displaying practice patterns that don't meet professional standards, and patients have no way of knowing about it."

"When hospitals try to discipline a doctor, there is a 95 percent chance they will be sued" by the doctor, says a midlevel health-care administrator, voicing a sentiment the Deseret Morning News heard repeatedly. So hospitals sometimes shy away from taking away a doctor's privileges to practice there On the other hand, says Salt Lake attorney James McConkie, "a good doctor can get crosswise with a hospital and get drummed out."

If a doctor does lose his privileges to practice at a hospital, patients won't be able to find out why — unless he sues the hospital. That's how details about Utah County doctor James A. Brinton surfaced in the early 1990s.