Dr. Martin McDonald was already on probation with the healing arts board for giving his office manager thousands of doses of generic Xanax when he admitted to Missouri regulators in 2007 that he had another problem.
The Bootheel-area physician had to answer to the Board of Registration for the Healing Arts for having sex with a patient and fondling another patient's breasts.
McDonald told the board he was a diagnosed frotteur: a person with intense urges to touch and rub the sex organs of nonconsenting victims.
If the board considers a doctor to be a threat to public safety, it can immediately suspend his license to practice. It's called a summary suspension - a process that almost every state uses to protect patients first and ask questions later.
The board didn't stop McDonald from seeing patients. It extended his probation to 2017.
The Missouri board hasn't used its emergency power to suspend a doctor's license in at least 25 years. It hasn't even tried, according to the executive director, because board members believe it's too hard to prove patients are at risk.
Earlier this fall, the Dunklin County prosecutor charged McDonald with sexual abuse for improperly touching the breasts of three patients over the summer, and said more charges are possible.
McDonald, 52, of Wappapello, did not respond to interview requests. His lawyer, Jasper Edmundson of Poplar Bluff, said he would plead not guilty.
Edmundson said he heard patients had "axes to grind" with his client because he wouldn't fill their prescriptions. "He's always behaved like a gentleman around my staff."
After he was charged, the medical board in November suspended McDonald, saying he had violated his probation agreement to treat female patients in the presence of chaperones and to perform proper breast exams only as needed.
McDonald's patients said they were outraged that it took charges on sex crimes before the board suspended his license. One said the board should have allowed an admitted sexual deviant to continue practicing only under one condition:
"If they want to make us vulnerable to people like that, then they should have to send their families there," said Linda Pearson, a patient of McDonald's who was not one of the victims.
The Missouri board often doesn't seek action against a doctor until police, drug enforcement agents or other states' medical boards have done so, a Post-Dispatch investigation found.
Dr. Wayne Williamson is still licensed, although he is in federal custody for dealing drugs in Kansas City. The healing arts board postponed its case against him during the federal case. Dr. Robert Egan was fired from St. Anthony's Medical Center in 2005 for covering up a colon surgery error and performing an unnecessary surgery, but the board waited for five years to file a complaint while he sued the hospital. The complaint is still pending.
The lack of urgency when disciplining doctors is another way the state fails to protect patients. On Sunday, the Post-Dispatch reported that the Missouri healing arts board has one of the worst records in the country for doctor discipline, while keeping most of its proceedings and records private.
It is not a new problem. In 1996, the board took criticism from doctors and vowed to speed up its proceedings because "justice is better when it is administered with dispatch," Dr. Nicholas Robinson, board president, wrote in a newsletter for doctors.
‘DELAY, DELAY, DELAY'
Tina Steinman, the board's executive director, says that every time the board meets, members discuss at least one doctor who is so dangerous that they would like to strip his license at once. But they never have.
"The board can't deal with that because they don't have enough power," said Dr. Daniel Scodary, who served on the board at the time McDonald admitted he was a sexual deviant. "Even if they wanted to stop a doctor who they thought was extremely dangerous, it's virtually impossible."
Instead, the board launches investigations in which doctors' attorneys can stretch out the proceedings indefinitely. The doctors' strategy is "delay, delay, delay, contest, contest, contest," said Mark Tucker of St. Louis, who served as the board's public member from 2003 to 2008.
Cases can take one to three years to investigate, and the appeals process can last 10 years. Doctors usually continue practicing throughout the process.
Often, the board chooses to settle a case with a light reprimand or nonpublic letter of concern just to get something on the doctor's record, Tucker said.
"The doctor may have unlimited sources of income, but the board doesn't," he said.
The board also takes a doctor's schedule into consideration when planning its quarterly meetings. Sometimes the board must wait a few months to meet with a doctor because he or she is on vacation, for example, Tucker said.
One doctor under investigation for abandoning his practice was given a pass - because he was out of the country. In May 2009, the board learned that a doctor in Versailles, Mo., allowed a nurse to run his clinic and treat patients - delivering babies, suturing wounds and prescribing drugs.
A board investigator made an unannounced visit to the clinic, and Dr. Ross Duff wasn't there. He was on a medical mission to Romania. The investigator told Duff the interview could wait until the doctor returned in June.
More than a year later, the board reprimanded Duff for allowing the nurse to treat patients and deliver more than 20 babies.
The Missouri healing arts board placed Dr. Michael Impey on probation in 2006 after he admitted to years of abusing prescription painkillers and falling asleep during patient exams.
Later that year, a patient said Impey perforated his colon during a colonoscopy at Des Peres Hospital. The man had a foot of his colon removed in a follow-up surgery to repair the damage. The patient's lawsuit against Impey was settled for an undisclosed amount.
That patient's lawyer, Paul J. Passanante, said the board exists to protect patients, not doctors, and should have stopped Impey in 2006. If it had, "my client would not have sustained serious, life-threatening injuries."
"I believe that any time the board receives information that a physician is addicted to narcotics and falling asleep while consulting with patients," Passanante said, "the board has a duty to use the summary suspension power to immediately suspend that physician's privilege to practice medicine, and shift the burden to the physician to prove that he can do so safely."
Impey said he agreed with the medical board's decision to revoke his license in 2008.
"They gave me a chance to change things, and I think that I basically didn't take the opportunity to make things better," he said.
Impey, 58, said he is considering applying for a new license when he becomes eligible in January.
"I've done everything I should be doing in order to put my life back together and stay in recovery."
SECOND CHANCES
Missouri health regulators had long known that Dr. Martin McDonald was a potential threat to the community. In 2000, he was prohibited from dispensing controlled substances after giving 4,000 tablets of generic Xanax, an anti-anxiety drug, to his business manager. The healing arts board put him on probation for seven years, starting in 2002.
In January 2007, McDonald came before the board for violating that probation. He repeatedly gave a patient unnecessary and improper breast exams and had a sexual relationship with another patient, violations of medical practice laws.
McDonald told the board he received eight weeks of treatment in Atlanta and was "continuing to actively work with counselors and stuff to make sure that this never happens again."
The board's lawyer at the time, Sreenu Dandamudi, told board members that McDonald "definitely preyed on the vulnerable."
"He had his second chance, and he doesn't seem to have changed for the better after that," Dandamudi warned, according to a transcript of the public hearing.
The board gave McDonald another 10 years of probation and ordered him to have a female chaperone when examining female patients and to follow proper protocol for breast exams.
During the sexual abuse investigation last summer, one of McDonald's patients, who was pregnant, told police the doctor sucked milk out of her breast on a house call and told her "he liked breast" when she ordered him to stop, police records said.
Another patient, Rebecca Whitmer, said that when she went to the Plunkett Family Care Center in Poplar Bluff in September for a sinus infection, McDonald "sticks his right hand underneath my shirt ... twisting his hand to get it underneath my bra."
Whitmer asked McDonald what he was doing, and he told her he was checking her breathing, but she said he did not use a stethoscope.
"That doctor fondled me," said Whitmer, 44. "He was just feeling."
Connie Head saw McDonald once a month at the Pehlman Family Clinic in Malden to be treated for anxiety. She disliked how McDonald would expose or touch her breasts during appointments, so she wore a girdle to her appointment in August. McDonald pulled her left breast out of the girdle by her nipple, the woman said. Head said she left the office crying in pain.
The women said there was no female chaperone present during the exams. Staff at both clinics declined to answer questions.
Head, 41, said she was angry she hadn't been told about McDonald's previous offenses. She said it didn't make her feel better to hear that McDonald had been in treatment.
"No, no, no, no, no," she said. "You don't let him practice."
Poplar Bluff Deputy Police Chief Jeff Rolland said police wish they had known that McDonald was already on probation for similar mistreatment of patients.
"I think the community would appreciate knowing that element is in their community, especially if one's a doctor," Rolland said.
DRUGS AND MONEY
Some doctors, such as Dr. Theodore W. Roberts, 73, spend their entire careers in trouble with the courts and medical board without being away from practice for very long. Roberts' record includes one criminal conviction, three other criminal charges, two revocations of his license, four probations, two suspensions and two reprimands.
Roberts said he couldn't calm his irritable 6-month-old stepson in his suburban California home in 1974, according to court records.
Within an hour, Roberts injected the infant with sedatives, 75 milligrams of Demerol and 50 milligrams of Phenergan. A safe dosage would be about 10 milligrams of each, another doctor testified in Orange County Superior Court, saying Roberts gave the baby a lethal dose.
The baby recovered, but authorities were alerted and Roberts ultimately was convicted of child endangerment, sentenced to six months in jail and ordered to surrender his California license.
Roberts moved to Missouri, where he already was licensed. In 1983 that license was revoked because of the California conviction.
It was reinstated four months later, and Roberts went to work at Jefferson Memorial Hospital in Crystal City. In 1985, Missouri regulators pulled his license again, saying he was addicted to drugs and prescribing them to himself. The medical board gave Roberts his license back on a probationary status in 1988.
Roberts lost his privileges at Missouri Delta Medical Center in Sikeston, Mo., in 1997 after he failed to respond three times when nurses called him to care for newborn and pediatric patients. He also failed to treat a diabetic child he admitted to the hospital, and another doctor stepped in, according to board records. He received a reprimand from the board in 2000.
In 2003, Roberts was reprimanded by the board when he allowed his physician's assistant at River City Health Clinic in Cape Girardeau to overprescribe painkillers to several patients.
Robin Pettit sued Roberts and his assistant in 2004, saying the doctor had treated her for terminal brain cancer, put her on heavy sedatives and sent her home to die. Pettit's lawsuit alleges her lung cancer went untreated because of the misdiagnosis. The suit against Roberts was dismissed because Roberts didn't have sufficient assets or insurance, according to Pettit's lawyer, Marty Perron of St. Louis.
"The only time (doctors) get in trouble ... is for something having to do with drugs or management of money," said Perron. "Simply providing bad care on a regular basis does not get you in trouble."
In 2006, the medical board put Roberts on seven years' probation after he was charged with drug-related crimes in Scott County. His license was suspended for four days in 2009 when he failed to pay taxes.
Roberts came before the board again in April for failing to follow through with drug rehabilitation. The board added another year to Roberts' probation term, extending it to 2014.
Roberts did not respond to repeated attempts to interview him.
He is now accepting new patients at his family practice in Sikeston.

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