State toughens oversight of doctors

Though she only needed the physical exam so that she could work as a supermarket cashier, Stephanie said that Dr. David Ingalls forced her to undergo a breast exam, tearing her hospital gown and taking down her bra strap in the process.

The episode in the summer of 1985 was nearly forgotten until a state investigator looking into other abuse complaints against Ingalls asked Stephanie -- who asked that her last name not be used -- to tell her story.

Next week, based on the accusations of Stephanie and two other women who say Ingalls abused them as teenagers, Ingalls will lose his license to practice medicine unless the Supreme Judicial Court intervenes.

"His mistreatment of pediatric patients, one of whom had psychiatric problems, as well as the expressly sexual nature of many of the incidents [is] a complete abuse of patient trust," wrote Dr. Martin Crane, chairman of the state Board of Registration in Medicine in ordering Ingalls's license revoked last month.

The tough action against Ingalls, who faced no criminal charges or past board discipline, marks a turnaround for the Board of Registration, whose director resigned in 1999, in part because the board repeatedly failed to discipline a sexually abusive doctor. The board had dismissed 15 complaints over the years against Dr. Marcos Ramos of Boston University Medical Center, who was sentenced to prison in 2001 for indecent assaults on eight female patients.

Ingalls, a 58-year-old family practitioner, is the 21st doctor the board has punished for sexual misconduct in the past three years, compared with just eight in the four years before that. Partly, the increase reflects a surge in sexual abuse complaints that followed the much-publicized Marcos case. But it also represents what malpractice attorney Mark Breakstone calls a "newfound zeal for the protection of public health" at the board.

Since Nancy Achin Audesse took over as director in October 1999, sexual misconduct cases have gotten a higher priority and investigators are instructed to check out every complaint, say board staff members. In the Ingalls case, the board waived its normal rule against considering complaints that are more than six years old, allowing staff members to show a long-term pattern of abuse. They also invited Stephanie to tell the board how the alleged abuse had changed her life.

"They deserve immense credit and appreciation for the action they took," said Breakstone, of Breakstone, White-Lief & Gluck in Boston, who has no professional connection to the case. "This is a case that should not have been brushed under the rug and I really credit the board."

Defense attorneys say the board's willingness to consider old allegations puts defendants at a disadvantage, especially when there are few written records to reconstruct events. In the Ingalls case, Stephanie's family went to police about his conduct in 1985, but dropped the matter before criminal charges were filed. Stephanie said she did not press charges because Ingalls agreed to psychiatric counseling and a chaperone with female patients. Ingalls says there was no such agreement.

"Do you think that anybody in [Ingalls's] office can possibly remember July 1985?" said Paul Cirel, who represents Ingalls and has appealed the board's decision to the Supreme Judicial Court. "It's a great disservice to any defendant to be asked to defend that case."

Ingalls's punishment has prompted a cascade of memories about Ingalls, who grew up in Newburyport and has practiced medicine in the quaint seacoast town since 1980. Many patients have rushed to his defense, writing letters to the local newspaper or speaking out publicly.

"I think Dr. Ingalls has been the ideal family practitioner," said Peter Erickson of Newburyport, whose daughters, ages 21 and 23, have been patients of Ingalls for 17 years. "I believe that I know the man well enough to believe in my heart of hearts that these charges are absolutely false."

But other patients remembered Ingalls more darkly.

"Those girls are telling the truth. He hasn't changed his pattern in over 20 years," said Dora Smith, 35, who said Ingalls rubbed his crotch against her on more than one occasion and gave her improper breast exams when she was a student at Newburyport Middle School.

Smith said she never even told her mother about Ingalls's behavior, but she wrote a letter to the Board of Registration in Medicine outlining her treatment after she heard of the charges against him.

Cirel said he could not respond to Smith's allegations, but stressed that her claims are decades old and have never been investigated.

The abuse charges against Ingalls came to the board in late 1999, just after Achin Audesse arrived, and the board was still reeling from widespread criticism that it was too slow and too soft on doctor misbehavior. By that time, the board had a backlog of almost 700 cases, but also a new policy that certain charges, including sexual abuse, would be investigated right away.

An investigator in the Essex district attorney's office had been looking into charges that, from 1996 to 1998, Ingalls had repeatedly fondled an emotionally disturbed teenage girl who lived at a boarding house for adolescents called Solstice House.

The girl, who suffered from bipolar disorder as well as attention deficit hyperactivity disorder, said Ingalls touched her breasts on several occasions -- once when she was at his office for a sprained ankle and another time for a sore throat. He had also required the girl to undergo a mammogram -- highly unusual for a 17-year-old -- though Ingalls later said it was a mix-up based on the charts of an older woman.

The Essex County investigator believed the girl's assertions -- and suspected she was not the only victim -- but wanted the regulatory board to handle it rather than the courts, Achin Audesse said. "The potential for damage or pain for the complaining witness can be very high in a criminal case," she explained.

That's when the board contacted Stephanie, who said she had gone on with her life hoping that Ingalls had gotten psychiatric help -- but fearing he had not. When she got the letter, she recalled, "I got goosebumps. It was like, `Oh my God, I knew this day would come.' "

Together, Stephanie, the patient from Solstice House, and another girl who said she was molested by Ingalls in 1995 at age 13, persuaded an administrative magistrate who heard the case that Ingalls "took advantage of the ages and immaturity of these three young patients."

Ingalls disputed all the charges, suggesting, for instance, that Stephanie had felt his pocketknife against her rather than his penis. Nonetheless, the medical board voted on Nov. 19 to revoke his license.

"I'm so proud of these girls," said Achin Audesse.

Breakstone said the same thing about Achin Audesse and the board.

"For decades, we had a moribund board which only responded to the most egregious and flagrant violations," he said.

"The most remarkable aspect of this decision is that the board had the confidence to open up a matter which was 15 years or more older." The case is not quite closed. Next Wednesday, Cirel is scheduled to argue for a stay of Ingalls's punishment while he works on an appeal. But Achin Audesse is confident: The court has not reversed a single sexual misconduct penalty since she became director in 1999.

Scott Allen can be reached at allen@globe.com.