The state requires 40 hours of continuing medical education every two years, and many specialty boards are tightening their rules, increasingly requiring members to recertify periodically. But most board-certified doctors in practice before 1996 are "grandfathered in." The federal database doesn't list a single case of specialty board discipline in Utah in the past 12 years. There are also fly-by-night "boards" that don't test competency, Utah Medical Association spokesman Mark Fotheringham warns. They sell "certification" and they're "not worth the paper they're printed on," he says.

DOPL's 16 investigators — who handle all licensing, from hair dressers to brain surgeons — take an average of 150 days to complete an investigation, but some may drag on for a year or two. Too many cases for too few staffers, and reluctance of physician colleagues to say bad things about each other, are among factors that slow investigations. History shows it could take another year or more, once the doctor hires a lawyer, for discipline to be meted out. Meanwhile, the doctor, innocent until proven guilty, continues to practice.

Some observers say that DOPL is thorough and tough. "What happened to me was so traumatic and damaging — and not just to me but to the people around me," says one practitioner who ran afoul of DOPL in the 1990s. He said today's DOPL is more compassionate.

Others see DOPL as too narrow in its focus. "It's nearly useless to check with DOPL to find out if a doctor is good or bad," argues malpractice attorney Frank Carney, because DOPL "only covers egregious deviations from proper care." DOPL's mission, set forth in state statute, requires that doctors provide only a minimum standard of care. A doctor doesn't have to be a good doctor. He just can't be a really, really bad doctor. To discipline, DOPL must show that the doctor exhibited "gross" negligence or unprofessional conduct, or a pattern of such behavior — allegations that must be verified by another physician.

Efforts to make it easier to discipline have been strongly opposed by the state's strong doctor lobby, says a DOPL insider. Insiders also admit they don't prosecute a case they're not sure they'll win, since proving a case requires money, effort and time.

And, too, DOPL is sometimes hampered when a doctor is arrested for a crime but his sentence is plea-bargained by a county attorney. "That hurts us when we try to discipline them," says Dan T. Jones, DOPL bureau manager over dentists, chiropractors and a handful of other professions.