An investigation into sexual abuse by U.S. doctors has found that since 1999, more than 3,100 physicians have been disciplined for sexual misconduct, and, of those, 2,400 sexually abused their patients— and half of those doctors still are licensed to practice medicine.

That reality, unveiled in a scathing report by The Atlanta-Journal Constitution (AJC), leaves countless people at risk and stems from what experts view as a broken system that values doctors’ worth over patients’ well-being.

The AJC reviewed more than 100,000 disciplinary documents and other records from across the United States. Staff identified documented cases in every state. Sexual assault cases ranged from doctors molesting patients while under anesthesia and masturbation of the doctor in front of the patient, to exchanging drugs for sex and even rape. Doctors still allowed to practice included those who were reprimanded for public indecency and child pornography.

In every case, doctors either admitted their wrongdoing to state medical boards, or authorities believed patients’ accusations after investigating, the AJC reported. 

A culture of secrecy— distinct from that of schools and children’s groups— has generally compelled authorities to look the other way when patients accuse doctors of such crimes, the AJC reported, and trust of doctors and value of patient privacy has made it challenging for the public and medical community to know the potential extent of physician sexual abuse.

“There just isn’t accurate data,” Dr. Gene Abel, an Atlanta physician, an expert in evaluating sexual misconduct by professionals, told the AJC.

In part, the problem lies in states’ desire for return on investment, Larry Dixon, the executive director of the Alabama Board of Medical Examiners, suggested to the newspaper.

“If you graduate a class of more than 100 people out of the University of Alabama medical school, the resources that have been poured into that education almost demand that you try to salvage that physician— if it’s possible,” Dixon, who has led the Alabama board for 35 years, told the AJC.

In some states, like Kentucky, doctors whose licenses are revoked by the state medical board can legally petition for reinstatement two years later.

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The newspaper likened the U.S. doctor sexual abuse scandal to that of the Catholic priest scandal: While the majority of the nation’s doctors don’t sexually abuse patients, it may happen more often than people suspect.

“We are so reliant on them, we are so helpless and vulnerable and literally in pain often times when we go in there. We just have to trust them,” David Clohessy, executive director of SNAP, a group that supports and advocates for people sexually abused by priests, doctors and other professionals, told the AJC. “So when they cross the boundary and their hands go into the wrong places, we are in shock, we are paralyzed, we’re confused, we’re scared. We just do not want to believe, first of all, that a doctor is capable of this.”