"In Utah, if I saw (a disciplinary action) so much as filed (by DOPL), I'd run the other way, because it's so hard to go through the hoops to get it filed," says a former DOPL insider, who adds that "it's easier to go after nurses and social workers than doctors. A physician can put a hundred thousand (dollars) into his defense, or whatever it takes."

Dr. Richard Sperry, chairman of the PLB, acknowledges DOPL's limitations. "I think we agree to license some people, as a licensing board, that most of us around the table would never choose to have work on us or a family member. It's tough as a board to put that aside. We have to be reminded the standard isn't 'Would you choose this person?' "

In some ways, DOPL is like a mother whose three children are all clamoring for her attention. One child is the aching, diseased public. Another is the doctor whose livelihood is at stake. The third is a health-care system that needs doctors to keep it running. The good mother wants to keep everybody happy.

"It's such a delicate balance," says Dr. George Van Komen, a past chairman of Utah's Physician Licensing Board and former president of the national Federation of State Medical Boards. "These are physicians — colleagues — who have the same training you have. You know how hard they worked to get where they're at. You would like to see them succeed in medical practice. But we do not want to run the risk of harming the public."

Some doctors would like to be tougher on colleagues whose actions or lifestyles could harm patients. But they say they often are constrained by agreements worked out when the lawyers for both sides weigh in. The result is, essentially, a plea bargain.

Consider the case of Dr. Layfe Anthony. In February 2002, Anthony pleaded "no contest" to a charge of negligent homicide in the death of a Bunkerville, Nev., woman who came to him for outpatient liposuction in late 1999. That night, the DOPL file states, Anthony allowed her husband to pick up a syringe filled with medication for her uncontrolled pain, and take it back to Nevada to inject her. She died the next day. DOPL says Anthony did not have a nurse anesthetist present and did not monitor her vital signs during the procedure. A second liposuction patient died in 2000.

DOPL took action against his license eight months after the second death, issuing an emergency order barring him from doing surgery or prescribing controlled substances. DOPL later handed down a five-year probation.

Anthony "should have had his license revoked," argues licensing board member Dr. David McCann. Under probation, he is still allowed to practice but only under the supervision of another physician. Anthony declined to be interviewed for this story. His attorney, Peter Stirba, however, says that Anthony is a model probationer.