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WHY THE DOC GOT OFF WITH A WRIST-SLAP

If guilty of what state officials accuse, a Grand Island doctor should not just be practicing under the supervision of colleagues for the next four years. He should not be practicing at all.

The state's imposition of four years of probation and a $10,000 fine sounds like hardly enough of a sanction on Dr. Rafael G. Cunanan Jr. Nor is it enough protection for a public that still may encounter him.

And it red-flags one of the apparent weaknesses that still exists in New York's process of disciplining doctors: an inability to alert the public quickly about problem physicians.

In effect, Cunanan took a plea bargain after state investigators accused him of performing abortions on women without ever doing pregnancy tests or giving the women the opportunity to decide whether they wanted to continue their pregnancies.

Beyond that, state probers concluded that Cunanan mistakenly sterilized one patient, misinformed her about what had happened and then gave the women $100 while asking her not to tell her mother. The investigators concluded the payment was an attempt to buy the woman's silence about his dreadful mistake.

It is hard to imagine any more traumatic experience for a woman and her family than to go to a doctor and find out after the fact that he has terminated a pregnancy without asking or that she has been sterilized without her knowledge.

One such incident would be grounds for severe punishment. To have three such instances, and to compound it with a gross ethical lapse, is practically begging to have one's license lifted.

That is what the state accused Cunanan of. But instead of trying to prove the case, investigators let him plead guilty to negligence in connection with two or more of the cited incidents.

Confidentiality laws preclude state officials from talking about the case -- a questionable rule in itself. Officials do note that timely notification of the public is always one big factor in deciding whether to reach a plea deal or proceed with a full-scale hearing and possible appeal.

This agreement allowed the state to alert the public immediately about Cunanan, whereas they say that going through a trial and appeal could take more than a year and that such appeals remain confidential until their conclusion.

Legislation passed last year did open up the disciplinary process somewhat, putting more emphasis on the public's right to be alerted sooner about bad doctors. But if achieving quick public notification remains a major factor when investigators decide whether to proceed with a case or strike a deal, the law obviously needs more work.

State officials insist that Cunanan didn't get off easily. In addition to the fine, the deal calls for close monitoring of his activities and patient records and 400 hours of training. And the publicity may mean that Cunanan -- chief of obstetrics and gynecology at Niagara Falls Memorial Medical Center and medical director of Planned Parenthood of Niagara County -- will find it hard to get picked up by insurance companies or health-maintenance organizations.

But considering what he admitted to with his guilty plea, medical consumers could reasonably have expected this case to have an outcome that provided more protection and punishment -- and deterrence for other doctors -- than this deal achieved.

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