This is part of a special investigative series by The Atlanta Journal-Constitution. For the full series, visit ajc.com/doctors.
Dr. Mark Knight calls himself an artist, one whose “gifted hands” sculpt bodies to perfection.
Sometimes, though, Knight’s hands strayed. So last year, regulators placed the plastic surgeon from Southern California on probation for sexual misconduct with patients. He will be subject to restrictions on his practice and close monitoring until 2020.
But when patients come to his office for breast enlargements and tummy tucks, liposuction and eyelifts, Knight doesn’t have to tell them about his disciplinary status. Or about the woman he kissed while examining her surgical scars. Or the patient with whom he had sex on an examination table while her husband waited outside with their children.
Knight’s freedom to see patients without disclosing his tarnished record underscores the opaqueness of the physician discipline system across the United States, a national investigation by The Atlanta Journal-Constitution found. (Read the entire series, including cases and resources for patients at ajc.com/doctors.)
The Journal-Constitution identified more than 2,400 doctors disciplined for sexual misconduct involving patients since 1999. Half are still licensed.
But no state routinely requires doctors to tell patients when they have faced disciplinary action, the newspaper found. Four states post no disciplinary records online, and eight purge cases after as little as five years. Twenty-one states sometimes handle physician misconduct with secret orders that allow doctors to return to practice with no public hearings or public scrutiny. Cases like Knight’s loomed over a contentious effort to make California the first state that requires doctors to tell patients about being on probation. Consumer groups argued that patients deserve transparency from the physicians in whom they place so much trust.
“From a patient’s perspective, he just looks like a doctor practicing medicine,” said Lisa McGiffert, director of the Safe Patient Project, an affiliate of the advocacy group Consumers Union that pushed the notification proposal. “But there is a big difference between a doctor on probation and a doctor not on probation.”
(Read about transparency and secrecy in your state.)
Medical regulators opened an investigation of Mark Knight after he performed liposuction and breast enlargement surgery on a 36-year-old in late 2007.
Two weeks after the procedures, Knight’s office canceled the woman’s appointment for a follow-up examination, according to medical board records. So she was surprised when, later the same day, Knight texted her to set up a late-afternoon office visit. When she arrived, everyone had left for the day, except Knight.
In the examination room, the woman told regulators, Knight asked her to undress. As they talked about whether her breasts were now too large, she said, Knight began massaging the liposuction scars on her abdomen. Then he leaned over and kissed her on the lips.
The patient said she pushed Knight away, but he kissed her again. When he tried a third time, she dressed and left.
When another woman went to Knight a year later, she knew nothing about the first patient’s experience.
The 32-year-old had extensive scarring in her midsection following a hysterectomy and other procedures to treat ovarian cancer. To minimize the scars, Knight performed an abdominoplasty, or tummy tuck.
The woman returned for three post-surgery exams. The third was scheduled late one day in January 2009, just before closing time.
Knight’s office manager left shortly after the patient arrived. Her husband waited in the car with their children. She and Knight were alone.
After he told the woman to change into a robe, Knight left the room and returned several times. Finally, the woman said, Knight came in, pulled her close and kissed her on the lips. He lowered his pants, exposed his penis and, medical board records say, initiated intercourse.
Outside, her children needed to use the bathroom. When her husband brought them into the office, he heard moaning from an exam room. He looked inside and saw his wife on the table, naked. The doctor was standing between her legs.
In a lawsuit, the woman and her husband said Knight “forced himself” on her and described the episode as “sexual battery.” Knight denied the allegations in the lawsuit, which the couple later dropped.
Knight, 47, did not respond to emails and telephone messages requesting an interview. A man who answered Knight’s cell phone one day last month would not identify himself. After a reporter asked about the sexual-misconduct allegations against Knight, the man hung up and did not answer subsequent calls.
Knight surrendered his medical license in late 2010. But his deal with the medical board allowed him to get it back as soon as the board would allow.
‘A lot of money’
By coincidence, not long after Knight gave up his license, California consumer advocates began noticing a pattern in medical board cases. Doctors committed sex offenses and other violations, but the board placed them on probation. And while the doctors had to report their probation to hospitals where they had privileges and to their malpractice insurers, they weren’t required to tell their patients anything.
After the medical board rejected a petition to require written notification to patients by doctors on probation, patient advocates turned to lawmakers. State Sen. Jerry Hill introduced a notification bill in February and said he knew it would face opposition from medical lobbyists.
“They throw around a lot of money,” Hill said. “And they can play rough sometimes in elections.”
The California Medical Association considered the bill “in direct violation of due process rights,” Laura Braden Quigley, the organization’s vice president of communications, said in a statement. It “does nothing to increase patient safety and arbitrarily ignores most providers in the continuum of care.”
On June 1 in Sacramento, the association issued a “Senate floor alert,” urging defeat of the patient-notification bill. More than half a dozen of the association’s lobbyists stationed themselves just outside the Senate chamber while, inside, Hill made an impassioned argument for his bill.
Citing research that found one in six doctors on probation re-offend, Hill asked his colleagues: “Would you want your daughter, your son, your significant other, your parents – or your constituents – to be seen by that one, without their knowledge?”
Other lawmakers, though, said doctors would have to disclose allegations without having a chance to defend themselves at the medical board.
“To say we’re going to essentially undermine due process because the medical board isn’t doing its job is, I think, a mistake,” said Sen. Hannah-Beth Jackson. “We must allow due process to take place. … To shortcut it and to shortchange doctors undermines the integrity of our system of justice.”
The bill fell six votes short of passing.
Hill plans to introduce it again next year.
For now, doctors like Mark Knight may tell patients as much or as little about their disciplinary status as they choose.
Knight resumed practice in 2015 after telling the medical board that giving up his license had been a “wake-up call.”
When his patients accused him of sexual misconduct, he was experiencing “personal emotional upheaval,” an administrative law judge wrote. Knight’s brother had died of cancer, his daughter of sudden infant death syndrome. He and his wife separated although they reconciled in 2008, before the second sexual misconduct episode.
The judge said Knight “earned another chance” to practice, and recommended he get his license back. The board concurred.
Board documents do not reflect any consideration of how the women who filed complaints would feel if Knight returned to practice. Records said Knight wanted to “make amends” with the women, but he told the board he had not approached them.
He cited “medical/legal reasons.”
On his website, Knight offers an explanation, of sorts, for his four-year absence from medicine. His version is highly selective, putting him in the best possible light, considering the circumstances.
He writes that he became “intimately involved with a woman who was my patient.” Then, he says, after the relationship was reported to the medical board, he retired from medicine.
Knight does not mention that the woman accused him of assaulting her. He says nothing about the other victim. He leaves out the medical board’s sanctions.
Instead, he says this:
“I have returned to the practice of medicine, having heeded these eternal words: ‘Physician, heal thyself.’ I have no arrogance, illusions, or ego intervening in the process of my patient care.
“I am human, just like you.”