To become licensed as a nurse, a social worker or even to drive around dead bodies in Maryland, a criminal background check is required.
But not to get a doctor's license.
Instead, the state Board of Physicians asks would-be doctors to voluntarily disclose arrests and convictions.
That could change as soon as next year. Already considering a background check policy, the board may move more urgently following news that it granted a medical license to a doctor with a previous rape conviction who now has been charged with sexually assaulting a patient in Allegany County.
State health officials won't say how Dr. William Thomas Dando obtained his license in 1996, less than a decade after he was found guilty of breaking into a woman's home and raping her at gunpoint. But the state's top health official acknowledged that it's likely because they weren't aware of it.
"It's hard to imagine a board knowingly doing that," Health Secretary Joshua Sharfstein said of the state's granting the license.
Patient and physician advocates questioned how it could have occurred.
"We entrust physicians with our bodies, and we don't want to entrust people who commit sexual assault," said Lisae C. Jordan, executive director of the Maryland Coalition Against Sexual Assault. "Clearly the voluntary disclosure is not working."
Even nonviolent offenses like drunken driving or other misdemeanors can be enough to make the board reconsider awarding a license, or to choose to take a license away, said Gene Ransom, executive director of MedChi. But Ransom said he could think of only a handful of cases in which someone with a felony conviction was granted a medical license during his 17-year career at the state medical society.
"There better be a really good explanation," Ransom said of Dando's licensure. "They're very hesitant to give anybody a license who has committed a felony."
Christine Farrelly, the board's acting executive director, said officials there are discussing a background check policy that could be proposed in the fall, amid a broader set of reforms in recent years to address problems including lengthy backlogs of complaints.
State auditors and the state health department have recommended before that the board use background checks before licensing doctors. Licensing boards overseeing nurses, therapists, social workers and mortuary drivers all have moved in recent years to perform background checks.
"Data suggest that a small number of physicians do not self-report criminal convictions as required on license application and renewal forms," auditors wrote in a 2007 review of the board.
But the physicians board has resisted adoption of a background check policy, said Sen. Joan Carter Conway, who said she has raised the issue amid other medical regulation reform. Dando's case likely will erode any resistance, the Baltimore Democrat said.
"Something had to happen to bring this to light. If he hadn't had this incident, they probably would still not know to this day" about Dando's rape conviction, she said. "I think this will push it."
Maryland was one of 13 states that did not conduct background checks on physicians as of September 2013, according to the Federation of State Medical Boards.
The application to get a doctor's license in Maryland includes a section regarding a person's character and fitness to work as a physician. Among the questions is one about past arrests, guilty pleas and convictions; if any are disclosed, Farrelly said, the board may request additional information and review them on a case-by-case basis.
But state law prohibits board officials from disclosing how individual physicians answered such questions, she said. She would not say how Dando answered the question.
The board does not discuss its investigations unless they result in disciplinary actions.
Dando, 59, was indicted by a grand jury May 23 on two charges related to an incident in April at an urgent-care center in LaVale, just west of Cumberland. A 41-year-old woman told police she was assaulted in a locked examination room. Dando was released and is scheduled to appear in court next month.
Dando could not be reached for comment. His license remained active Wednesday, according to the board's online records.
The board disciplined Dando in 2010 for failing to meet standards of care in how he treated seven patients. Several of the cases, but not all, involved the prescription of medicine. In one case, he prescribed excessive amounts of Xanax, a controlled dangerous substance used to treat anxiety, to a patient; in others, he prescribed addictive painkillers to patients despite addiction concerns. The board placed him on probation, which ended last year.
Other doctors have lost their licenses for allegations of sexual misconduct, Ransom said.
Frederick County physician Dr. Michael Rudman appealed May 28 to the state's highest court to regain his license, revoked in 2006 after he entered an Alford plea to charges of sexually assaulting a female patient. Such a plea means he didn't admit guilt, but acknowledged that there was enough evidence to convict him.
Rudman was given probation before judgment, and his conviction was expunged after he served his probation. The board's revocation of his license was reversed after Rudman challenged it in Frederick County Circuit Court, but Rudman lost it again in 2012 on an appeal by the board.
The license of former Baltimore Behavioral Health Inc. physician Dr. Benigno P. Lazaro Jr. was revoked twice for sexual contact with patients, first in 2005, for a period of two years, after he was found to have engaged in sexual misconduct with patients in Ohio. He joined the Baltimore drug treatment and mental health clinic in 2009, soon after his license was reinstated, but it was revoked a second time after he made sexual advances toward a 22-year-old relapsed heroin addict in an exam room at BBH, according to the board.
Dando was sentenced to 10 years in prison in 1987 after pleading guilty to breaking into a woman's home and raping her in Ocoee, Fla., in December 1986. At his sentencing hearing, a psychiatrist told the judge that Dando, stressed by his medical licensure exams, was drunk and sexually frustrated after a visit to a strip club when he followed the woman and her 12-year-old daughter home.
He was released from prison early for good behavior in 1991. He obtained his license to practice medicine in Maryland five years later, eventually establishing Baltimore Cosmetic Laser Center on Frederick Road in Catonsville. He joined MedExpress Urgent Care Center in May 2013.
MedExpress hires an outside company to conduct background checks on employees, a spokeswoman said, but she declined to say what, if anything, it revealed in Dando's case.
Despite the recommendations of state auditors that it implement background checks, the issue has been overshadowed by other issues at the Board of Physicians.
A 2011 state audit found that the board only closed about half of more than 1,700 complaints it received in fiscal year 2011. A 2012 report written by Jay Perman, president of the University of Maryland, Baltimore, made more than a dozen recommendations to remedy the situation.
A board update provided to the legislature in October 2013 said officials had heeded many of the calls, including establishing dual disciplinary panels that aim to speed review of complaints. But the board has faced difficulty transitioning to the new disciplinary system because of leadership changes and staff vacancies, the report said.
Sharfstein said with the complaint backlogs shrinking, background checks are rising on the board's agenda.
"The board has been doing a much, much better job over the last several years," he said. "This raises an issue that we have been in the process of discussing with the board."
A formal proposal could be made in the fall to the General Assembly, Farrelly said.
MedChi hasn't taken a formal position on background checks and would have to debate the specifics of any proposal, Ransom said. The coalition against sexual violence recently helped push for background checks of counselors and therapists, and Jordan called extending the requirement to doctors "a natural expansion of that policy."
Patients expect state licensing boards to do more to protect them, including making complaints against doctors public, according to polling by the Safe Patient Project at ConsumersUnion, an advocacy branch of Consumer Reports, said Lisa McGiffert, the project's director.
"I think most patients would expect that when a doctor gets a license there is some kind of background check that would include a criminal background check," she said. "The public probably expects that that is happening."
The Orlando Sentinel contributed to this article.
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