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Some physicians may lead a ‘double life.’ Meanwhile, victims feel shame and guilt.

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to rape.

Violators include a physician who served as team doctor for a professional basketball franchise, and another who was president of a psychiatric teaching hospital affiliated with Harvard University.

Also caught were the president-elect of a national medical society, who resigned before he could take office; and the then-CEO of a New York hospital, found to have violated several patients, including a 15-year-old he saw in the emergency room after she attempted suicide. He told the AJC the allegations were false. But regulators found he exposed and touched the girl’s breasts for no legitimate medical purpose after telling her, “It’s time to go under the cover.”

Other notables: a medical expert who was sought for interviews on national television, charged with drugging women with spiked drinks; and the author of a book on how doctors should make a healing bond with patients. He was arrested in New York and is charged with ejaculating on the face of a sedated patient in the emergency room. He has pleaded not guilty.

The charm and clinical skills that win doctors the support of their communities also can allow them to manipulate and exploit patients. They may not even see themselves as offenders but as sexually desirable men — they’re almost always men — with a keen sense of patients’ needs.

Often, they are exposed only when accusations become too numerous to ignore, as with entertainer Bill Cosby, or when a highly credible patient gets the courage to come forth.

That’s because some victims feel shame and guilt, wondering if they did something wrong. Others are even confused as to whether an assault took place at all, since the doctor is an expert and is supposed to touch them. Many believe if they do cry out, authorities will take the doctor’s word over theirs.

It took a police undercover investigator willing to subject herself to abuse to finally catch a New Jersey eye doctor who had fondled the breasts of multiple patients. A patient in California recorded an examination on his cellphone to report his doctor for fondling him. That doctor, like many, seemed to target a vulnerable patient. The man was a Spanish-speaking workers’ comp patient, not one of the NHL players the orthopedic surgeon also treated as a team doctor.

Physicians who sexually abuse and violate patients may live “a double life, totally unknown to spouse, friends, or colleagues,” wrote John Sealy, who directed a sexual addiction and offender recovery unit in California and researched at UCLA.

Other times, colleagues know — or should know — a doctor is violating ethical boundaries intended to protect patients, as years go on and his misdeeds get worse as he gets more autonomy in his career.

Such a scenario plays out in medical board files, court records and other previously unreleased documents detailing the career of Louis Bair in Grand Junction, a sprawling town amid the mesas of western Colorado.

Another side revealed

Bair went to medical school in Missouri, then came to Grand Junction in the early 1990s to intern at Community Hospital. He made friends among the hospital staff and other doctors in town.

By 2002 he was chief of staff at Community Hospital. He became president of a medical practice called Desert Sun. Through the hospital, he contracted to provide student health services for a local college. He and his then-friend Dr. Kent Black opened a separate urgent-care practice.

Co-workers and patients described Bair as the consummate professional, both a talented clinician and caring. He had practiced in Grand Junction for a decade when Colorado Gov. Bill Owens named him to fill a vacancy on the state medical board.

Bair was assigned to one of the board’s two panels of inquiry, members of which had the job of judging the competence and propriety of their peers.

“I thought he was always appropriate, a good solid member, with good judgment and clear thinking,” Dr. Thomas Chiavetta, who served on the board with Bair, said in an interview.

Back in Grand Junction, however, a number of Bair’s relationships — with patients, and with co-workers — were becoming increasingly complicated, as he interspersed sexual advances with crucial medical care.

Black, whose relationship with Bair eventually soured, would later recount to investigators Bair’s sexual remarks concerning female staff and patients, especially those he saw from the local college.

“‘You see the butt on her? The ass on her?’’’ Black recalled Bair saying, a sheriff ’s transcript states.

Other co-workers and patients would later tell authorities numerous stories of Bair’s improprieties: asking female staff members to measure his penis; remarking after an examination on a patient’s “pretty” vagina, then calling the woman to repeat the comment; sending text messages of a sexual nature to one patient five to 10 times per day for days following a gynecological exam; and viewing pornography in his office.

Black recalled Bair worrying about a patient he was dating: “‘What if the board finds out? I mean, what do I do? I just can’t help myself. She is just so good-looking.’”

Yet, at the time, many excused Bair’s behavior, deferring to his reputation and abilities.

He was a good doctor in the community who made poor personal choices, one patient on the receiving end of his advances told a sheriff ’s investigator.

“He’s a dedicated doctor,” another woman said in an interview. “I had a lot of respect for him. He was very assertive if you had a problem.”

Perpetrators test the waters

That woman was both a patient and a friend of Bair’s for years before he hired her in 2007 as an assistant at Desert Sun. In interviews with the AJC, she said the job meant a lot to her. Her education was interrupted after she was gang-raped at age 15, she said. After periods of what she described as instability and promiscuity, she found dignity working in the medical field.

But on her first day, she said, Bair slapped her on the butt and said he was “so glad” to see her.

Though it changed the relationship, the woman let it pass.

Such incidents can be grooming, where a perpetrator tests the waters to establish a general atmosphere of forced intimacy and to see if his target will protest, said David Lisak, a psychologist who has studied non-stranger rapists and victims.

The woman said she didn’t want to confront Bair. She was also dependent on him as a patient. Years before, he had prescribed the powerful painkiller OxyContin after diagnosing her chronic neck pain, then kept her on it despite her eventual complaints that she had been drugged so long she could no longer tell how much she really hurt. He’d give her a different dosage, she said, or change the drug combination.

Then one day after the office closed and no other witnesses were there, the woman told the AJC, Bair asked her to give him a testosterone shot. She spoke on the condition of anonymity to avoid embarrassing her family, but she said she gave the

It took a police undercover investigator willing to subject herself to abuse to finally catch a New Jersey doctor who had fondled multiple patients

same account to authorities.

She said Bair locked the door to an exam room and dropped his pants for the shot. Then, she said, he turned and asked her to measure his penis.

“I didn’t know what to do,” she said recently. “I was humiliated, embarrassed. I’m not the kind of person who can go, ‘Oh, how dare you.’”

He placed her hand on his penis, she said. She pulled it back. Then he grabbed her, groping her breasts and between her legs over her nurse’s scrubs. He masturbated. “He said, ‘Come on!’ — just begging me,” she said. She broke free and moved across the room, she said, but he grabbed her hand again and ejaculated into her palm.

“I kind of left my body during this time,” she said. “When he did this to me, it took me back. It took me back to when I was 15. That I had no control.”

Bair apologized, the woman said, and she accepted. Over time, memories of the incident would set off crying jags. Still she didn’t file a complaint. She didn’t want to lose her job.

Eventually, though, the medical board came to her. Someone else had reported him.

Denial and the narcissist

Often, despite significant evidence to the contrary, doctors balk at acknowledging they have done anything wrong, whether they have victimized a sole patient or hundreds. They may say they were helping their victims, or that they weren’t even doing anything sexual.

“What are you going to label as wrong?” Louis Bair said in a brief interview with the AJC. Sexual misconduct, he noted, “is a spectrum,” from violations like soliciting a patient for a date all the way to psychopathic crimes against patients. “That’s a big difference.”

In his fight to get his license back, Dr. Michael Sela in California said he had never been trained to understand that stimulating his gynecological patients’ clitorises during an exam was wrong. “Petitioner presented as a sincere, courteous, highly intelligent individual,” read the administrative law judge’s order proposing to reinstate his license.

Dr. Charles Crosby of Florida told a psychiatrist evaluating him that he had developed a special technique of touching a woman’s breasts to alleviate pain in other parts of the body, though his technique had not been adopted elsewhere in the medical community. The evaluator reported that even with the board bearing down, and even after reporting himself to the state’s impairment program for a fixation on working with breasts, Crosby had great difficulty accepting the wrongfulness of his actions.

In a recent interview, Crosby told the AJC that his insurance company determined heavy metal poisoning from living near steel mills impaired his behavior.

When he relapsed in 2003 and groped another woman, he blamed it on the aluminum contained in his new deodorant.

Denial, experts say, may be another element in the self-assured, somewhat narcissistic personality so common among physicians.

“You see with physicians that they’re in a highly skilled profession where room for doubt is minimal,” said Sam Slaton, chief operating officer of the Sante Center for Healing, a treatment center in Texas for doctors and others with behavioral problems such as substance addition and sexual boundary violations.

“They have to be authoritative — the expert,” Slaton said. To admit a behavioral problem and try to get help “is counterintuitive to the nature of a physician being the authority figure, one that can do on their own — one that is the 99th percentile.”

Board documents on accused doctors also show the destructive side of narcissistic traits, such as a lack empathy for others, a sense of entitlement and a grandiose but fragile ego — capable of erupting with outrage when challenged.

Doctors who abuse patients may be adept at assuming the right face for the right audience. Doctors’ poise and self-assurance sways peers and juries if they face accusations of misconduct.

Case files from around the country describe doctors who were accused in open court of abusing multiple patients, but still so valued or beloved that other patients rose up to fight sanctions with petitions or even a T-shirt campaign. In Kentucky, a judge forestalled restrictions on Dr. Eric Norsworthy’s license, noting that women patients packed the courtroom for him even though he was accused repeatedly over the years of fondling patients’ breasts. (A jury convicted him in 2010 of illegally accessing an accuser’s prescription records and sharing them with his lawyer, but Gov. Steve Beshear pardoned him last December.) Scores of Illinois patients signed a petition supporting pediatrician Kishor Jain, who pleaded guilty to unlawful restraint in a deal that dismissed felony sex crime charges involving the young mothers of his patients.

He bragged of prowess, ex-friend says

Bair, who was divorced four times, liked to revel in his sexual exploits, sipping scotch with his friend Kent Black, bragging about how good he was in bed, according to a transcript of an interview Black gave to sheriff ’s investigators.

Black said he knew Bair was dating patients as far back as the 1990s. But Black, who has since died, never reported him to the board, although Colorado doctors are required by law to report sexual misconduct.

Black recounted to the investigator that he once warned Bair that someday, someone would turn him in.

But by then, Black claimed, Bair had a ready response: That was “‘the benefit of sitting on the board,’ ” Bair quipped. “‘You can quash this stuff.’ ” And there were accusations. The hospital where Bair practiced was in his corner, though, in 2006, when two young women he worked with through the student health service accused him of sexual harassment. Bair said they lied. The complaint was settled in secret, then Community Hospital loaned Bair $125,000 toward the settlement, according to internal documents the AJC obtained.

The hospital also let Bair retain his admitting privileges for four more years.

That complaint was exactly the type that often gets forwarded to boards, if not by the hospital itself then by concerned colleagues or patients. Even if alerted anonymously, the board could seek out the hospital’s evidence and attempt to interview his co-workers. But Bair’s public record with the board from that time is spotless. If someone did tip the board, it imposed no public discipline.

But his continuing behavior was raising questions among colleagues. Financial disputes also brewed. Both Kent Black and Bair’s partners at Desert Sun believed Bair owed them large sums of money. Finally, confronted with specific allegations about Bair’s sexual conduct, his Desert Sun colleagues filed a report with the medical board.

‘Never wanted to harm anybody’

In the slow-motion world of physician disciplinary cases, Bair’s moved quickly.

In January 2009, Bair agreed not to practice while the investigation was underway, which allowed him to avoid the black mark of a board order temporarily suspending his medical license.

The investigation did not go his way. After 10 months, the Colorado attorney general’s office, acting for the board, accused Bair of sexual violations with five patients and other boundary violations with a sixth patient, with whom he took vacations.

The allegations included that during treatments Bair inserted his fingers into a patient’s vagina and rubbed her breasts and pushed another against a wall and had sex with her. The attorney general’s complaint said he asked a third patient to administer testosterone injections to his butt, then exposed his penis, asked her measure it and used her hand to masturbate. He kept that patient on OxyContin more than five years without documented justification, the complaint states. The patient-employee the AJC spoke with believes she is this third patient described in the complaint. The investigator’s notes are confidential, so her account could not be independently verified by the AJC.

Bair fought the complaint, although a judge found there was no real dispute that he had sex with two patients. The judge did not issue conclusions on the allegations involving the other four.

But rather than revoke Bair’s license, the medical board allowed him to “relinquish” it, a decision that avoided hearings and other legal battles. The board’s director, Karen McGovern, says this was the only way to take his license permanently, since “revocation” in Colorado can be lifted after two years.

The board then turned the case over to the sheriff ’s office in Grand Junction for a criminal investigation.

A former co-worker of Bair’s, Shauna Fordham, told a sheriff ’s deputy that Bair had abused women, and that some of them were burdened with an outsized sense of shame as a result and would not want to talk.

“They’re horrified first of all that they allowed it to happen,” she said. “Either their husbands don’t know, or nobody really knows.”

Bair, Fordham said, “destroyed a lot of people’s lives.”

“You know, my big hope is that he honestly sees the inside of a jail for a while,” Black told the sheriff ’s investigator, according to the interview transcript.

The sheriff ’s investigator seemed to put the matter aside, however, never interviewing numerous key witnesses. The investigator’s supervisor says he doesn’t know why that happened. The investigator no longer works for the sheriff ’s office and did not respond to messages or a note left at her home.

In public releases, the medical board gave few details about Bair’s behavior, bound by strict state law protecting doctors’ confidentiality, according to McGovern. Even people who had voiced concerns to authorities remained unaware of the most serious allegations.

The lasting effects may be felt only by Bair and by his accusers, in profoundly different ways.

One day this spring, a man came to the door of Fordham’s secluded home in Colorado.

“She’s not going to talk to you,” he said. “She’s had threats made against her. She’s been through hell and back. She should be a hero. But people came out for him. He should have been prosecuted.”

A few miles away, Bair came to the front door of his mother’s southwestern ranch home in a T-shirt and shorts. Bair, now 55, takes care of her.

Bair was reluctant to talk to a reporter, but at the mention of losing his medical license, he bristled.

“I relinquished it,” he said. “I was never charged with anything. I didn’t do anything criminal. They investigated. I walked away from all that.”

He’d rather not speak about the past, he said. He made bad decisions he would change if he could, but never with ill intent. “I would never have wanted to harm anybody,” he said. And the community treats him fine. “I run into my patients all the time,” he said. “I don’t know anybody I’ve seen that’s given me the cold shoulder.”

ILLUSTRATIONS BY RICHARD WATKINS

Bair