For 11 years, the state's medical system permitted a Tidewater surgeon to keep practicing  despite the deaths of three of his patients, falsified billing records, a patient having the wrong organ removed and grave complications for others in his care.

In 1997, Virginia Beach's Sentara Bayside hospital warned a Chesapeake hospital that Dr. Robert G. Brewer had resigned from its staff rather than face suspension for poor medical care.

Yet Brewer was given provisional staff privileges at the Chesapeake Hospital a few months later, even as Sentara was reporting Brewer's "unethical conduct" to the Virginia Board of Medicine.

Finally, in 2001, the Board of Medicine held a public hearing and then announced that Brewer had surrendered his medical license.

The board refused to disclose whether its inquiry had begun in 1997, in 1990 when a patient sued Brewer for malpractice, or in 1992 when a patient died in surgery.

As The Virginian-Pilot's Liz Szabo reported after an 11-month investigation, the Board of Medicine wouldn't reveal when it got its first complaints about Brewer or what the complaints were, much less when it initiated its inquiry.

When her Freedom of Information requests got rebuffed, Szabo turned to bankruptcy filings, lawsuits, property records, death certificates and patient medical records to expose a medical system "shrouded in secrecy and reluctant to root out its worst offenders."

As Szabo discovered, state medical board disciplinary cases can quietly continue for years, "leaving patients no way to learn that the physician to whom they've entrusted their lives is under investigation."

The state legislature's watchdog agency warned in 1997 that the medical board was taking too long to investigate complaints against incompetent doctors. Inquiries were lasting up to five years and patients were being endangered, the Joint Legislative Audit and Review Commission reported.

JLARC also noted that the medical board could sanction physicians only for gross negligence, defined as persistently outrageous behavior.

Six years later, freshman Del. Winsome Sears, R-Norfolk, is determined to reform the state's system of disciplining incompetent doctors, with or without the backing of the Medical Society of Virginia or the Virginia Hospital Association. Sears was motivated by Szabo's report. "This is not just about protecting a doctor's ability to make a livelihood," she said. "The greater good is protecting the public health."

In an editorial in late December, The Virginian-Pilot noted that private discipline is reasonable in relatively minor cases, when a doctor makes a rare mistake in which a patient is not seriously harmed.

But the Board of Medicine needs to investigate single acts of simple negligence, and the public needs to know about those inquiries, whenever there's probable cause to believe a doctor has "caused serious patient harm through negligence."

The Board of Dentistry and almost every other health board in Virginia uses a "simple negligence" test, according to Robert Nebiker, director of the Department of Health Professions.

In Maryland and North Carolina, that's the threshold for disciplining doctors.

Hal Greer, who led JLARC's 1997 study, said he was surprised and frustrated that the proposed reforms were blocked in the General Assembly.

Sears obviously does not intend for the medical lobby to block reforms this time around.

She wants to prohibit confidential consent agreements in single instances of patient harm, and she "should stand firm despite medical society opposition," the Pilot's editorial said.

"If the medical board is allowed to address any (serious) instance of simple negligence through a secret plan, then the public will be no further down the road to identifying dangerous or questionable doctors," the editorial said.

Noting that the medical society was arguing that the State Bar allows confidential agreements in disciplining lawyers, the editorial emphasized that the Bar generally allows private discipline only twice in a 10-year period, and only when there is little or no injury to the public and little likelihood of repetition.

The editorial also said it was highly suspicious that the medical society and the hospital association were opposing a portion of Sears' bill calling for a new JLARC review by 2006. Suspicious, indeed.

The editorial did back a compromise endorsed by Sears and the hospital association to aid hospitals in giving the Board of Medicine needed information about physician misbehavior. Sears originally wanted hospitals to turn over their incident reports; under the compromise, the medical board would be given a list of individuals to interview.

Belatedly, the Board of Medicine is moving toward fast Internet disclosure of disciplinary actions. But one Web site lists disciplinary actions only in the last 90 days, and another has woefully outdated information that's provided by physicians themselves, disciplined or not.