In a lawsuit against Spaulding and the hospital, one patient alleges that his drug use contributed to a botched delivery. Some patients loved him, says former Milford hospital administrator John Gledhill. "He was a great doc." Doctors in places like Milford — not just rural but "frontier," says Gledhill — are overworked and always tired, "on call pretty much 24 hours a day."

After losing his license in Utah, Spaulding moved to New York for a residency program. A check with New York's licensing agency reveals that this month his license was suspended. Spaulding told the Deseret Morning News that he is retiring from medicine for health reasons.

"I think (DOPL) really did treat me fairly. . . . I think they're making a valiant effort to salvage physicians that have difficulty and still protect the public. It's a tough, tough job," he says.

"Drugs and sex." That's how Diana Baker sums up the cases her division is working on most of the time. Baker is chief of the DOPL bureau that oversees physician discipline.

DOPL doesn't keep statistics on such things, but according to the past five years of DOPL's online newsletters, incompetence or negligence accounted for roughly eight of the 100 physicians whose licenses were either revoked, suspended, voluntarily surrendered or were put on probation

That doesn't mean that sloppy doctoring doesn't happen. In fact, most of the complaints made about doctors to DOPL are categorized as incompetence and negligence. But drugs and sex allegations are easier to prove.

Incompetence and negligence are "a very subjective thing," says DOPL director Craig Jackson. Medicine isn't like car repair, where the car runs or it doesn't. Even with very good care, complications occur, people die, and a bad result may have been influenced by extenuating circumstances — as well as by many different people, since medicine is not always practiced one-on-one. It is for those very reasons that malpractice lawsuits aren't necessarily a good measure of whether a doctor's "good" or "bad."

Incompetence may be a matter of chronic ineptness, or of advancing age. "Aging, which eventually affects every physician," writes Dr. Gregory Skipper, medical director of the Alabama Physician Health Program, "causes decreased memory and motor function, sometimes to a dangerous degree, and some physicians are unwilling to appropriately decrease their practice commensurate with their decreasing ability. How is the public to be protected?" DOPL may not know about such a doctor if a complaint isn't filed. It only found out one Utah doctor was suffering from dementia when he didn't properly keep track of the drugs in his office.

Competency cases "are a judgment call," says licensing board member Babitz, and "that means that a colleague of the physician in question has to be willing to criticize their performance." There are social and legal constraints to that kind of finger-pointing, such as fear of lawsuits, says Babitz, who adds that "fortunately, I don't think that there are many incompetent doctors who are practicing."