Some have been rejected by a string of hospitals or insurance companies.

Among those still licensed:

– A Norfolk physician who injected cancer patients with medicine made with tiny amounts of their own feces.

– An Abingdon surgeon who accidentally cut out most of a woman’s bladder and lost another patient just hours after a hysterectomy.

– A Winchester ear, nose and throat specialist who fondled six young boys during office visits.

– A Norfolk doctor imprisoned for murdering his wife with a .22-caliber rifle.

An analysis of the National Practitioner Data Bank, which tracks physicians, found at least 70 Virginia doctors who have been disciplined five or more times by state and federal authorities, hospitals or professional societies. Only 28 of them lost their licenses.

The Board of Medicine’s executive director, Dr. William L. Harp, says state law forbids him or any board member from discussing individual cases or decisions.

Robert Nebiker, director of the Virginia Department of Health Professions, which includes the Board of Medicine, says he does not feel comfortable “second guessing” past decisions without reviewing all the evidence.

He says the board takes its responsibility for policing doctors seriously and revokes licenses only after careful consideration.

“A lot of money goes into making a health-care professional, and there aren’t enough of them to go around,” Nebiker says. “So when you kill one off, you are potentially losing a scarce resource.”

The Virginia Board of Medicine, a state body whose 18 members are appointed to four-year terms by the governor, licenses more than 25,000 physicians and osteopaths. It can vote to reprimand doctors, fine them, place them on probation, suspend them or revoke their licenses.

Nebiker notes that the worst examples of physician misconduct represent a small fraction of the total number of cases that the board reviews.

Although patient advocates stress that the vast majority of doctors are capable and honest, they compare impaired or unethical practitioners to drunken drivers — few in number but a threat to many people.

The General Assembly is considering a bill introduced by Delegate Winsome E. Sears of Norfolk and another by Gov. Mark R. Warner that address how the state medical board operates.

“We’re trying to rein in the bad doctors, but at the same time you have to rein in the Board of Medicine and the hospitals,” says Sears, a Republican. “This is about saving lives.”

Sears, who became interested in the issue last year after reading a report in The Virginian-Pilot about an incompetent Virginia Beach surgeon, said there have been wide-ranging problems with doctor discipline for years.

“It’s not just about one doctor,” she says. “It’s a whole host of people.”

In 1999, an audit by the Joint Legislative Audit and Review Commission, the watchdog arm of the General Assembly, concluded that “the Board of Medicine does not adequately protect the public from substandard care by physicians.”

For too long, critics say, the medical system has focused on protecting careers rather than consumers.

“The patient should always be put first,” says Dr. Alan Levinstone, an internist on the ethics committee at Inova Fair Oaks Hospital in Northern Virginia. “It’s not just the Board of Medicine. It’s the politicians and the people in Virginia who have not demanded a better system.”

Virginia law makes it difficult for the Board of Medicine to revoke a physician’s license.

Nurses, dentists and others can lose their licenses for “simple” negligence, such as a single careless act. But doctors must be found guilty of “gross” negligence, such as a pattern of several serious mistakes.

A dozen patients suffered serious complications and another died after surgery by Dr. Judith Goettert, according to a board order, a formal document in which medical officials record their legal findings and disciplinary actions.

The October 2000 order catalogs Goettert’s mistakes:

– Accidentally removing most of a woman’s bladder.

– Operating on a pregnant woman after “overlooking” her pregnancy test.

– Accidentally tying off a woman’s ureter, the tube that carries urine from the kidney to the bladder.

– Perforating the uteruses of three patients.

– Dropping a uterus on the floor during a hysterectomy, then contaminating her gloves and sterile instruments by picking up the organ and placing it on a table, according to a hospital incident report. When meeting with the medical board, Goettert later said that she caught the uterus in her lap.

One of the doctor’s patients, Sharon Raye Santolla, died just hours after surgery.

In 1999, Goettert settled a civil lawsuit filed by relatives of Santolla, who died after a hysterectomy at Russell County Medical Center in Lebanon, Va. Goettert agreed to pay the woman’s family $225,000.

“People like this should not be allowed to practice medicine,” says Charles Inlander, president of a national consumer group called the People’s Medical Society. “It certainly isn’t very reassuring to people like you and me. There should be no room for this in medicine.”

In 2000, the medical board placed Goettert on probation and allowed her to continue practicing, with the exception of obstetric and gynecology surgery.

Last year, Goettert told the board that she had given up obstetric and gynecological surgery, no longer had hospital privileges and planned to see patients only in her office. She said she was pursuing not only conventional medicine but homeopathy, a widely disputed type of treatment in which minute quantities of natural substances are administered to improve the body’s defense against disease.

Goettert declined to be interviewed for this story.

On Aug. 6, 2002, the board ended her probation and restored her license to “full and unrestricted status.”

Sen. Janet Howell, D-Reston, says such stories demonstrate the need for change.

“It has been clear for some time now that Virginia is protecting physicians more than patients,” Howell says. “The upshot has been true horror stories of patients suffering from actions of physicians. … It always seemed that the department bent over backward to defend the doctor.”

Even doctors whose records meet the “gross negligence” standard are sometimes allowed to keep practicing.

Dr. Anthony A. Dunkwu of Alexandria received only a public reprimand — the mildest type of sanction — after botching an abortion.

Dunkwu scheduled the procedure in March 2000 after estimating that his patient was about 10 weeks pregnant.

Although he performed a pelvic examination, he did not order a sonogram, according to a board order. Medical experts say sonograms are not required in the first trimester, although some abortion providers say they perform them routinely. Experts say the procedures are recommended in the second trimester.

Dunkwu began the procedure in his office using a local anesthetic. The abortion quickly went wrong.

The board order states that Dunkwu believed he might have perforated the woman’s uterus and stopped the procedure. A member of his staff took the patient to Inova Alexandria Hospital so that he could complete the abortion under general anesthesia.

Dunkwu examined the woman again. This time, he estimated her pregnancy at 12 to 13 weeks. According to the board order, “Dunkwu could feel a separate mass, which he identified as a fibroid,” a common type of benign uterine tumor.

He cut open the woman’s abdomen and, according to the board order, discovered that the “mass” he had mistaken for a tumor was actually the uterus. He cut open the woman’s uterus and removed a lifeless male fetus weighing about 2.7 pounds. Dunkwu estimated that it was 20 to 22 weeks old. In fact, the fetus was 30 weeks old. Babies delivered prematurely at that age and size usually survive.

Alexandria Hospital placed Dunkwu’s clinical privileges on probation for 29 days, the board order shows. Punishments that last 30 days or longer generally have to be reported to the National Practitioner Data Bank, a registry created by Congress in 1990. Only about 40 percent of hospitals have ever filed a report.

In 2001, when Dunkwu faced the Board of Medicine, he admitted to making “an unintentional mistake.” He also noted that he had begun routinely performing sonograms for more of his patients considering abortion, according to the board order.

An informal board committee found Dunkwu to have been “grossly careless,” according to the board order, and reprimanded him.

Dunkwu did not return telephone calls for this story.

Some state officials have questioned the medical board’s decision.

“In cases like this, the public is not being protected at all,” says Delegate Robert G. Marshall, a Manassas Republican. “We are elected to be guardians of the public good. If we are not going to pay attention when the public is not being protected, then we bear responsibility and we should pay.”

Virginia’s medical board is not limited to disciplining doctors for incompetence. Only 3 percent of investigations involve medical care alone, according to the 1999 state audit.

The board also can act in cases of unprofessional conduct. For example, doctors can lose their licenses for selling drugs or assaulting patients.

A review of the cases of more than 600 doctors and thousands of pages of records, however, found that the agency allows more than 40 doctors to practice medicine despite offenses such as sleeping with patients, seducing teenage girls or sexually harassing co-workers. About 90 doctors hold licenses in spite of substance abuse or improperly prescribing drugs.

According to board orders:

– Dr. Daniel M. Calhoun Jr. struck a surgical patient at Riverside Regional Medical Center in Newport News in 1992. In 1994, he struck a surgical patient, swore and knocked surgical instruments to the floor.

– Dr. Fang S. Horng, a Luray surgeon, fathered a child with a patient.

– Dr. Antony Joseph, a Richmond psychiatrist, impregnated a former patient and then told her to “get rid of it.”

And then there is the case of Dr. Byron B. Timberlake. Board members concluded that he fondled six boys between the ages of 6 and 13.

The board could have taken Timberlake’s license but instead allowed the Winchester ear, nose and throat specialist to continue practicing.

The abuse began nearly a decade before Timberlake appeared at a formal hearing of the medical board in 1985, according to an official board order.

Timberlake saw an adolescent boy 22 times between 1975 and 1977, according to the board order. On nearly every visit, he took the child to an operating room alone. Out of sight of the boy’s parents or his staff, he fondled the boy’s genitals and, on one occasion, placed his ear on the child’s belly below the navel.

Timberlake got another child alone by telling his mother that he planned to check the boy’s lungs in a different room.

Board officials ruled that Timberlake’s bizarre behavior had nothing to do with a legitimate exam. Officials found that he routinely examined boys’ genitals behind closed doors while a nurse or other staff member waited outside.

At his hearing, Timberlake testified that he preferred not to examine children in front of their mothers or chaperones because “the male adolescent patient would feel awkward and embarrassed.”

Timberlake did not return telephone calls for this story.

He was arrested in December 1983 and charged with committing aggravated sexual battery on a child under 13. A jury found him not guilty in June 1984.

The family of an 11-year-old boy filed a civil suit against Timberlake in 1985. The doctor settled the suit two years later.

In the lawsuit, filed in Winchester Circuit Court, the boy’s family charged that the “conduct of the defendant was of such a nature as to shock the conscience of reasonable men.”

Yet the board was forgiving.

Medical officials found Timberlake “guilty of fraud or deceit” and unprofessional conduct, ruling that his treatment of the six children was “contrary to the standard of ethics,” according to the board order. He was further found to have practiced medicine “in such a manner as to make his practice a danger to the health and welfare of his patients.”

Authorities revoked Timberlake’s license but immediately “stayed” the revocation, placing the doctor on indefinite probation, according to the board order. Officials ordered him not to treat boys under 18 and to see a psychiatrist.

The board commonly issues one sanction and replaces it with another if it believes there are mitigating circumstances, director Nebiker says.

The next year, in 1986, the board allowed Timberlake to begin treating young boys again. Officials required that such visits take place “in the presence of an appropriate chaperone, preferably a parent,” according to a board order.

To protect the identity of her son, the mother who sued Timberlake asked that her name not be used. She is still angry that the board allows Timberlake to practice and worries that other parents may not be aware of his history.

“We had such a sound case,” she says. “It’s just astounding.”

In 1990 — five years after the board found him guilty — Timberlake was taken off probation, and his license was “reinstated with all attendant rights and privileges,” a board order shows. There are no restrictions on his ability to see children.

Dr. Vincent J. Speckhart’s unusual brand of medicine has attracted the attention of state investigators.

At one time, the Norfolk oncologist treated cancer patients with vaccines made with minute quantities of their own urine and feces, a board order shows. He also has used a non-standard, experimental procedure called “electro-acupuncture of vol,” in which machines are supposed to measure patients’ electrical activity as a way to diagnose disease.

In 1993, the board concluded that some of Speckhart’s treatments had no “accepted therapeutic purpose” and were “contrary to sound medical judgment,” according to an official order.

The board found that Speckhart, who declined to comment, violated Virginia law, conducted his practice unethically and endangered patients, according to the order. He was instructed to stop using the unusual vaccines and to use the acupuncture procedure only as part of formal clinical trials.

The board voted to arrange an audit of Speckhart’s practice and placed him on probation, which lasted until 1998.

Speckhart was quoted in The Virginian-Pilot after his 1993 hearing as saying, “I am grateful to the board for its concern, patience and diligence in looking after their patients. I feel vendicated … I am a good physician.”

The family of Navy Cmdr. Robert A. Rizzi, a 48-year-old cancer patient who died after being treated by Speckhart, filed suit against the physician in Norfolk Circuit Court. In 1996, a jury in 1996 found in the family’s favor.

The lawsuit asserted that Rizzi, a Hampton Roads father of three, died as a direct result of Speckhart’s “failure to comply with the applicable standards of care.”

Rizzi’s widow says she’s shocked that Speckhart is still practicing.

“When you have a family member with cancer, you’re pretty desperate,” Victoria Rizzi says. “He sure had us fooled.”

The Internal Revenue Service accomplished what the Board of Medicine had long refused to do — keep Dr. Salih M. Zamzam away from patients.

Zamzam had been investigated repeatedly throughout the 1990s. For years, the board chose not to suspend his license, even after concluding that he may have contributed to a patient’s death.

The Grundy surgeon was finally removed from practice in 1997 when he was incarcerated after his conviction for felony tax evasion. Yet charges about his ethics and competence date to 1990.

That’s when Zamzam groped three female patients under the pretext of legitimate medical exams, according to an official board notice that spelled out the charges against him. In one of the cases, prosecutors charged, Zamzam pulled a woman’s pants down to her knees and, while standing behind her, reached under her clothes to grope her breast and pressed his penis against her buttocks.

In 1993, Zamzam — whose practice ranged from gynecology to orthopedic surgery to ear, nose and throat operations — signed a consent order, which is somewhat like a no-contest plea. The board placed his license on indefinite probation.

In its final order, however, the board deleted all of the graphic details of Zamzam’s behavior toward the three women. Instead, it recorded only that he “acted unprofessionally and in a sexually inappropriate manner.”

The terms of Zamzam’s probation required him to use a female chaperone when treating women and to comply with other restrictions.

In the same consent order, the board found that Zamzam had improperly prescribed Methadone — used as a substitute for heroin when treating addicts — along with a barbiturate called Butalbital.

“This treatment was without accepted therapeutic purpose and injurious” to the patient, who died two days later of “multiple drug poisoning,” the board order states.

Two years later, board prosecutors accused Zamzam of performing a mastectomy on a woman’s right breast based partly on the results of a mammogram without performing a biopsy to verify that the woman really had cancer, according to an official notice. Fewer than 30 percent of women with suspicious mammograms actually have the disease.

The woman was cancer-free, and Zamzam had needlessly cut off a healthy breast, the notice states.

In 1995, the board issued an order faulting Zamzam in his administration of drugs but postponed a decision about the mastectomy. Board officials voted to allow an audit committee to review the case and decided that Zamzam should remain on probation.

In a recent telephone interview, Zamzam said he offered to perform the mastectomy in part because the woman was small-chested and a biopsy would have “deformed” her breast. The woman already had lost one breast to cancer.

“I said, ‘If you let me do the mastectomy, you don’t have to worry about further follow-ups or breast exams every year,'” Zamzam said. “The board won’t listen to the facts. This lady was sort of money hungry. She would have been happy to have had cancer so she could collect money from the insurance company.”

Authorities in New York, where Zamzam also held a license, were far more severe than their Virginia counterparts.

When one medical board disciplines a doctor, officials in other states where he or she holds a license typically sanction the practitioner as well. Based on Virginia’s findings, a hearing committee in New York voted to revoke Zamzam’s license, ruling that “the serious nature of the offenses and the absence of mitigating factors made revocation the only appropriate sanction.”

Virginia’s board finally suspended Zamzam’s license in 1997, after the doctor was convicted of tax evasion in U.S. District Court in the Western District of Virginia.

Zamzam said he served two years in jail because of the conviction. He blamed his tax problems on his accountant, who has since died.

Zamzam petitioned the board for reinstatement in 1999. By then, a board order states, he was on supervised release from prison.

The board — which had finally made a decision on the mastectomy case, finding Zamzam negligent — rejected his request.

Zamzam applied for reinstatement most recently in 2000. The board turned him down.

He says he hasn’t given up hope, however. He plans to take a standardized competency exam for practicing doctors to prove his fitness to Virginia officials.

“If they really cared for the public and the patients, they would almost immediately reinstate my license,” Zamzam says. “Almost every day I get 20 calls from patients asking me, ‘When are you coming back?’ “

Current Virginia law allows doctors whose licenses have been revoked to apply for reinstatement after only one year. In some cases, that leniency allows even those convicted of violent crimes to quickly return to practice.

A review of public board documents turned up more than 30 convicted felons licensed by the state of Virginia.

State law requires health officials to suspend the license of any doctor convicted of a felony, Nebiker says. But Virginia also demands that the board give the doctor a fair hearing at its next meeting, where the practitioner can ask to be reinstated.

“Obviously, when anyone is convicted of a felony it’s serious, and it indicates conduct that you may not want in someone providing you health care,” Nebiker says. “I could certainly understand why someone might be concerned about it.”

The majority of felons licensed by the Virginia medical board committed nonviolent offenses such as tax evasion.

Dr. Julian B. Schorr’s license was revoked in 1979 after a Norfolk Circuit Court jury convicted him of second-degree murder.

Schorr was sentenced to eight years in prison after shooting his wife twice in the chest with a .22-caliber rifle in their home. Schorr admitted to the January 1978 shooting but claimed he fired in self-defense after his wife attacked him with a knife during an argument.

The couple had played a prominent role in the Norfolk-area community. Schorr, who had directed the Tidewater Regional Red Cross Blood Program, was also a professor at Eastern Virginia Medical School and sometimes served as a consultant for medical cases around the world.

Board members voted to revoke Schorr’s license shortly after his conviction.

At the hearing, some doctors said they were sensitive to criticism that — even then — the board was too lenient with physicians. Dr. Eugene O. S. Stevenson of Fairfax was quoted in The Virginian-Pilot at the time as saying that the board should send a message that it was committed to rooting out bad doctors.

“We have child molesters, murderers and frauds whose licenses have not been revoked,” Stevenson said. “This is one of the reasons that this board has received criticism for not taking strong positive action.”

Schorr served two years in prison. Nine years after his wife’s murder, however, the board voted to reinstate his license and place him on probation. In 1990, the state board voted to end Schorr’s probation and reinstate him without restriction.

In an interview, Schorr says he now works part time practicing sports medicine in Scarsdale, N.Y., an affluent Manhattan suburb, and serves as a pediatrician for a foster-care agency in Irvington, N.Y. He says the board made the right decision.

“The crime I committed was a domestic crime which has an almost zero rate of recidivism, and it was not connected to my medical career,” Schorr says. “I paid my penalty to the community. I was a good physician.”

Unlike Timberlake and Zamzam, who were never found guilty in a criminal court of harming patients, Dr. Asa Talbot was convicted of sexually abusing those in his care during exams.

In 1988, Talbot was convicted by a U.S. District Court in Tennessee of one count of aggravated sexual battery and another count of sexual battery, according to court records.

Talbot pleaded guilty to fondling two underage girls from May to June 1985 while serving as an Army medical officer at Fort Campbell, Ky., according to a board order. Talbot fondled a 17-year-old girl during an examination after a tonsillectomy. He also groped the pubic area of an 11-year-old girl during an ear, nose and throat examination.

This wasn’t the first time Talbot had been accused of sexual misconduct.

A board order reports that he was accused of kissing a patient as she came out of anesthesia in 1977 while he was in private practice in Harrisonburg. Talbot denied the allegations, which were never proven.

In 1979, executives at Rockingham Memorial Hospital in Harrisonburg found that Talbot conducted himself “in an inappropriate and unprofessional manner” with two female patients, according to the board order. The hospital placed his privileges on probation for a year and required him to have a chaperone when examining women or girls.

Talbot was reprimanded by the commanding officer at Fort Campbell for his behavior toward three female subordinates in 1984 and 1985, according to the board order. He repeatedly made offensive sexual comments to the women, solicited sexual favors, and kissed and fondled them. After his conviction, Talbot was dismissed from the Army with a “less than honorable” discharge, according to the board order.

The Virginia Board of Medicine revoked Talbot’s license in 1988, then restored it two years later and ordered him to undergo counseling and fulfill other requirements. A board order shows that Talbot’s probation ended in 1994.

Today, Talbot works in Jolivert, Haiti, at Missions of Love Inc., a religious charity.

Dr. Robert Johnson, the mission’s president, says he’s aware of Talbot’s conviction. Talbot uses a chaperone when treating children, Johnson says.

“We count him to be a real asset to our mission,” Johnson says. “He has a very special place in his heart for Haitians, especially the children.” S

Liz Szabo is a reporter with The Virginian-Pilot, in which this story first appeared. Computer-assisted reporting specialist David Gulliver contributed to this report.