In Minnesota, a doctor has to meet the minimum standard to avoid state discipline. And when a physician is caught making a mistake, the Minnesota Board of Medical Practice often gives second chances.

Take the case of Dr. James P. Wasemiller.

Over 35 years, the Red River Valley physician has defended a dozen malpractice claims in two states, lost private malpractice insurance because he was considered too much of a risk and forfeited his surgical privileges at a Minnesota hospital, records show. He even failed parts of a clinical skills test requested by the state medical board.

Despite his record, Minnesota regulators didn't suspend him until 2011, when he violated terms of a board order that allowed him to keep working as long as he practiced with other doctors who could supervise him, among other restrictions.

Board officials wouldn't comment on the case. But they said physicians cannot be disciplined as long as they meet certain minimum standards as determined by the board on a case-by-case basis, even if physicians fail parts of a state-ordered skills test. The standards are not written down.

The board enforces "the minimum standard of care, not the top-notch quality we'd all like to have," said Ruth Martinez, who supervises the board's complaint review unit.

Wasemiller, 65, declined to comment.

"I would say the great majority of his patients are very loyal to him, and he would have what most people would consider an excellent bedside manner," said North Dakota attorney Don Krassin, who has known Wasemiller for nearly 30 years and has represented him on personal and professional cases.

Doctor kept working despite discipline in two states

The son of a doctor, Wasemiller was first licensed in 1976 and spent most of his career working in two small border towns: Wahpeton, N.D., and nearby Breckenridge, Minn. He has handled everything from the delivery of babies to the lancing of boils.

His legal troubles go back as far as 1984, when a 25-year-old woman died from blood poisoning after Wasemiller performed gastric bypass surgery on her, according to court records. A lawsuit filed by the woman's family was settled for more than $100,000. Altogether, nine claims against Wasemiller have been settled out of court and Wasemiller won at least two jury trials.

Much of his legal trouble has involved weight-loss surgeries such as gastric bypass, which involves stapling the stomach to create a smaller "pouch" for digestion. By creating a smaller opening for food, patients feel "full" sooner and ingest fewer calories.

In 1999, Terri Little went to Wasemiller for the procedure at a North Dakota hospital. Within hours, infection set in. After Little's condition continued to deteriorate, Wasemiller removed most of her stomach, court records show. She was later transferred to the Mayo Clinic after being diagnosed with an abdominal infection and "possible leakage" from surgery, court records show.

At one point, the infection was so bad "they couldn't sew me back up," Little said. "They had to leave my whole stomach open. All my intestines had to be just bare."

Little said she's had "multiple" surgeries to repair damage from the initial operation. She said she still has trouble eating and can't hold a steady job "because I never know when problems are going to hit." She believes her stomach "looks horrifying."

"It's been a long road," said Little, 53, who sued Wasemiller and obtained an out-of-court settlement. "I've pretty much gotten used to it and go with what I have. But I consider myself very lucky. ... He took a huge hunk out of me."

In court pleadings, Wasemiller acknowledged that Little developed a "severe medical complication" after he operated on her, but he defended his work and denied responsibility for any subsequent injuries. He said Little was aware of the risks when she consented to the procedure and caused or contributed to any subsequent problems because she "failed to exercise proper care for her own health and well-being."

The Minnesota board first disciplined Wasemiller in 1992 for unprofessional conduct and inappropriate prescription practices. North Dakota's medical board later disciplined him for the same conduct.

Several years later, both boards lifted the restrictions. There is no record of additional scrutiny by the Minnesota board until it met with Wasemiller in 2006 to discuss a complaint alleging he improperly performed weight-loss surgery in 2002. After discussing the case with Wasemiller, the board took no action, records show.

The board launched another investigation in 2008, after finding out an insurer dropped Wasemiller from its network for excessively prescribing narcotics, records show.

A review of his work showed that Wasemiller "often failed" to provide adequate patient care and treatment. He also was faulted for "routinely" prescribing narcotics without assessing patients for chemical dependency risk, records show.

In September 2010, Wasemiller met with the board's complaint review committee to discuss its concerns. He denied providing inappropriate prescriptions, but he acknowledged that he "may have occasionally neglected to document his patient records." Two months later, Wasemiller took a clinical skills assessment at the board's request, and the test showed that he lacked satisfactory medical judgment, reasoning skills and sufficient knowledge of general practice.

After reviewing the results, regulators reprimanded Wasemiller but allowed him to keep working if he accepted certain restrictions on his practice and attended various courses, including family practice medicine and pain management. Wasemiller failed to comply. In November, the board suspended his license indefinitely, which means Wasemiller cannot practice in Minnesota without petitioning the board for reinstatement.

The North Dakota board also is reviewing Wasemiller's license and is expected to impose discipline soon, executive secretary Duane Houdek said.