LEWES, DEL. — Caught in the act, Dr. Earl Bradley needed to think fast.

“What the hell are you doing, you bastard?” his patient’s mother had screamed when she found Bradley with his hand in her daughter’s diaper. Trailing her to the parking lot, Bradley was insisting she hadn’t seen what she thought she saw.

Now the police were coming. Without a plausible story, Bradley could be in serious trouble.

Then, a flash of perverse genius. Bradley would say the mother — poor, young, unwed — must have been trying to extort money from him.

It worked.

A detective wrote that, compared to the doctor, the mother was “not credible.” A medical board investigator found that Bradley “specialized in welfare … patients,” so a shakedown was “a distinct possibility.”

The case was closed. And the doctor who would become one of the nation’s most prolific sexual predators moved on.

For 15 more years, Earl Bradley raped, molested and sodomized a generation of his pediatric patients along the Delaware seashore.

He recorded 13 hours of the assaults on video, some so violent he had to resuscitate the victims.

He eluded investigators and gossips, even as, behind his back, colleagues called him the “pedophile pediatrician.”

Before he finally went to jail in 2009, he victimized 1,200 children, maybe more.

Their average age was 3.

The youngest was 3 months old.

And yet, despite its horrific details, Bradley’s case is hardly the anomaly it seems. Rather, it epitomizes the medical culture that enables and excuses sexual misconduct by physicians across the nation, an investigation by The Atlanta Journal-Constitution found.

The AJC examined more than 100,000 disciplinary records and other documents from state medical boards. Again and again, the newspaper found, a profession that prides itself on self-policing empowers even its most dangerous practitioners.

Regulators, who often are doctors themselves, try to keep accused physicians in practice. The prescription for rehabilitation may amount to little more than a weekend-long seminar on appropriate “boundaries.” Secrecy pervades the disciplinary process, shielding doctors from embarrassment while keeping patients uninformed.

The very nature of medical practice also provides cover for doctors who abuse. Sexual misconduct often occurs in a unique sanctum: the examining room. There, intimate encounters not only are unavoidable, they are sometimes necessary. Patients may have trouble discerning between appropriate examination and gratuitous touching, and many accept, without question, the judgment and behavior of a well-trained, highly educated professional.

Reported cases of doctors sexually assaulting children are unusual; vulnerable victims are not. Most are adult women, especially those who are poor or dependent on narcotic painkillers or lacking the credibility or social standing to pursue legal action.

“People talk about the thin blue line of policing. It’s nothing compared to the medical profession.” Kenneth Brown, Police Chief of Milford, Delaware

Still, perhaps more than any other, Bradley’s case underscores how American medicine so often puts doctors’ interests ahead of patient protection. If such an extreme predator could get away with assaulting patients for years without consequence, how likely are more typical offenders to draw attention of regulators?

Through interviews, police reports, court files and other public records, the AJC documented eight instances in which Bradley was the subject of accusations between 1994 and 2008. Each time, in ways that echo through hundreds of other cases the newspaper examined, Bradley avoided punishment.

Investigators sometimes doubted his accusers. Other doctors kept his transgressions confidential. The head of the state medical society dismissed Bradley’s troubles as a “family matter.” Prosecutors thought his victims were too young to appear in court, and even if they had testified, it would have been their word against Bradley’s — against the doctor’s.

The esteem and credibility so readily granted to physicians were evident in the reaction a Delaware mother got when she told a friend Bradley had molested her daughter. The friend replied, “He’s a doctor — are you sure?”

That deference impedes efforts to bring abusive doctors to justice, said Kenneth Brown, the police chief of Milford, Del., whose 2005 investigation of Bradley concluded with no charges filed.

“People talk about the thin blue line of policing,” Brown said recently. “It’s nothing compared to the medical profession.”

Alan Judd / AJC Kenneth Brown, the police chief in Milford, Delaware, was the detective who investigated an abuse allegation against Dr. Earl Bradley in 2005.

‘UNCONSCIONABLE’

Earl Bradley arrived in Lewes, a small seaside town in southern Delaware, in 1994. The mother’s accusation that he touched a 21-month-old inside her diaper still was unresolved in Philadelphia. Nevertheless, Delaware regulators granted Bradley a medical license, and the state’s third-largest hospital, Beebe Medical Center in Lewes, gave him a job.

“What he did was horrific. What they did was unconscionable.” Bruce Hudson, lawyer for patients in a class-action lawsuit over Bradley’s abuse

By then, Bradley’s false narrative was as good as fact.

“At that time, they thought it was just someone trying to extort money from him,” Dr. James Marvel, a two-time president of the Medical Society of Delaware and one of the doctors who helped bring Bradley to Lewes, later told the police.

Still, nurses, other doctors and patients’ parents soon noticed that something about Bradley seemed off.

He was perpetually disheveled, his beard untrimmed and his hair shaggy and matted. Invariably, he dressed in surgical scrubs, often soiled with blood and other fluids. He rarely made eye contact with adults. He connected only with their children.

But it was his intimate examinations of little girls that became the subject of chatter at doctors’ cocktail parties, said Bruce Hudson, a lawyer who represented patients in a class-action lawsuit over Bradley’s abuse.

“They would say, ‘If your daughter has an ear infection, take her to Bradley and she’ll get a free vaginal exam,’” Hudson said. “What he did was horrific. What they did was unconscionable.”

Almost every year, complaints emerged about Bradley’s conduct.

In 1996, a nurse at Beebe told her supervisor the doctor routinely used catheters to obtain urine samples from little girls — newborns to 12-year-olds — without medical justification. She said Bradley made the older girls undress and squat on their hands and knees as he inserted a catheter from behind.

The hospital assigned a senior physician to investigate through a process known as peer review. In hospitals across the country, such assessments take place in private, under the theory that confidentiality encourages candor as doctors evaluate their colleagues. But the process also shields misconduct from public scrutiny. In 17 states, even medical licensing boards investigating complaints against a doctor cannot obtain transcripts of testimony presented during a peer review.

In Bradley’s case, a panel of physicians concluded his use of catheters was “not medically improper, per se,” according to documents released years later. It was hardly an endorsement, but it was enough to conclude another investigation of Bradley’s behavior with no sanction and no public attention.

As the leader of the peer review panel wrote in a memo that later became public, “We all agreed that this was a highly sensitive and confidential matter.”

Bradley made sure it stayed confidential. He threatened to sue the hospital, claiming his enemies had conspired to force him off the staff by attacking his reputation. Months later, though, other doctors elected him the hospital’s chief of pediatrics. He served two terms of two years each.

In 2001, Bradley opened his own practice in an old house on the coastal highway in Lewes. He called it BayBees Pediatrics.

Jennifer Corbett, The News Journal / AP In this photo taken Wednesday Dec. 16, 2009, Dr. Earl B. Bradley's BayBees pediatrics is shown in Lewes, Del. Police said the doctor used video cameras to record some of the brutal attacks in exam rooms.

He spent years tricking out the office, erecting a miniature Ferris wheel, installing a carousel and decorating with life-size Disney figures. One room became a movie theater and another an ersatz planetarium. In the latter, Bradley turned out the lights to show children his glow-in-the-dark constellations.

After every examination at BayBees, Bradley offered patients a toy or a lollipop or maybe a Popsicle. Often, he carried children to his basement or to another building on the property while parents checked out at the front desk.

Bradley hired his older sister, Lynda Barnes, as office manager. But by 2004, she had grown so concerned about his odd behavior that she reported him to the state medical society.

She sent the society a letter saying her brother had a mental illness he wasn’t managing well, was spending far beyond his means, and had physically abused his son, then a teenager.

And, she wrote, parents had accused Bradley of “handling their daughters with improper touching.” She feared he was headed toward a “very public collapse or prosecution by parents.”

The medical society gave the letter to its president: Dr. James Marvel, who had helped bring Bradley to Delaware a decade earlier. Marvel did not respond to requests for an interview.

In 2005, according to police reports, Marvel told a detective he did nothing to investigate Barnes’ letter. In his judgment, Marvel reportedly said, Barnes’ complaint was merely “a family matter.”

‘WEIRD AND DISGUSTING’

At first, Bradley impressed everyone. When an expectant mother met with him in 2002, he readily calmed her anxieties about giving birth for the first time. He seemed to have a medical study at his fingertips to back up every point.

“It blew my mind,” the mother said in an interview. “So we picked him.”

“He made the parents think he cared so much about their kids’ well-being.” Mother who asked not to be identified to protect the privacy of her daughter

Over the next three years, Bradley lavished compliments on her daughter: How beautiful. How special. He cradled the girl in his arms and kissed her cheeks.

“He made the parents think he cared so much about their kids’ well-being,” the mother said. She asked not to be identified to protect the privacy of her daughter, now a teenager. “As weird as he was, he’s going to give my child more attention than any other pediatrician.”

Maybe too much attention. At nearly every visit, the mother said, Bradley examined her daughter’s vagina. She thought it was odd, but with all the studies he cited and all the confidence he exuded, she didn’t challenge him.

On March 29, 2005, the girl was scheduled for her 3-year-old routine checkup. Bradley had temporarily moved to Milford, a 20-minute drive from Lewes, during renovations at his office. The mother took her 1-year-old son along for the ride.

When he finished the exam, Bradley asked, “Can I get them a lollipop?”

“Sure,” the mother answered.

She turned her back as she wriggled her son into his coat, and Bradley walked away with her daughter. Just as she started looking for them, she saw Bradley leading her daughter back down the hall.

Outside, the mother was strapping her daughter into her car seat when the girl asked an odd question:

“Why did Dr. Bradley kiss me like a dog?”

“Every single person either couldn’t do anything about it, didn’t do anything about it, didn’t believe a 3-year-old, or thought we were the crazy ones.” Mother who asked not to be identified to protect the privacy of her daughter

The mother reeled as she grasped what this meant: The doctor had put his tongue in her daughter’s mouth, had violated her in a profound way. The mother began trembling – an involuntary, uncontrollable reaction that, more than 11 years later, recurs when she talks about Bradley. She drove home, told her husband and called the police.

The case went to Kenneth Brown, then a detective for the Milford police, now the chief.

Brown never doubted that Bradley molested the girl.

“A 3-year-old is not making that up,” he said recently. “That comes from somewhere.”

Brown worked on the case for a month. A former BayBees employee described Bradley as “weird and disgusting” but didn’t point to anything illegal. Parents talked about feeling uneasy over how Bradley touched their daughters. Other doctors repeated stories about his lengthy, and apparently unnecessary, vaginal exams.

One doctor told Brown his own daughter, 7 years old at the time, underwent an exam in which Bradley inserted his ungloved fingers into her vagina. When the girl screamed, Bradley told her mother he was just checking to see whether the hymen was intact.

Before he talked to Brown, this doctor had told no one outside his medical practice about the episode.

What struck Brown, he said recently, was that so many people suspected Bradley was doing something wrong but had kept their concerns to themselves. Brown said he encountered so much resistance that it seemed no one – not hospital officials or other doctors or patients’ parents – wanted him to find evidence implicating Bradley.

“I’m just a small-town detective with one little case,” Brown said. But he found himself up against “a system meant not to harm a doctor.”

Brown took his findings to the Delaware attorney general’s office, which supervises criminal cases across the state. Lawyers there declined to prosecute Bradley for molesting the 3-year-old. With so young a victim and no physical evidence, they concluded, convicting Bradley would be all but impossible.

The girl’s mother considered reporting Bradley to the Delaware Board of Medical Practice, which licenses and disciplines the state’s doctors. But, like many other state medical regulators, the agency wouldn’t accept anonymous complaints. Also like others, it didn’t investigate before giving doctors the names of their accusers.

Already, the mother said, other doctors had been dismissive when she told her story. Even friends questioned whether Bradley really did anything wrong.

So, fearing Bradley would somehow retaliate against her family, the mother dropped the matter.

“Every single person,” she said, “either couldn’t do anything about it, didn’t do anything about it, didn’t believe a 3-year-old, or thought we were the crazy ones.”

AP Photo / Gary Emeigh Detectives with the Delaware State Police escort Dr. Earl B. Bradley after his arrest in December 2009.

AP Photo / Gary Emeigh Detectives with Delaware State Police escort Dr. Earl B. Bradley after his arrest in December 2009.

‘VIOLENT, BRUTAL, FORCED’

Twice in 2008, just as in 1994 and 1996, 1998 and 2000, 2004 and 2005, new allegations surfaced against Bradley. But, as before, nothing came of them.

Then a 2-year-old told her mother that Bradley “hurt” her when he took her to his office basement. A medical examination confirmed she had been molested.

Early on Dec. 16, 2009, detectives from the Delaware State Police arrived at Bradley’s faded white clapboard house, just a block from Beebe hospital. They led him away in handcuffs and a denim Mickey Mouse jacket.

Chuck Snyder/AP photo Dr. Earl Bradley spent years tricking out his office with a carousel, a miniature Ferris wheel and other amenities that appealed to children.

At BayBees Pediatrics, officers fanned out through the rambling complex: the old house that served as the main office and three smaller outbuildings in the rear. They found video cameras all over: in an examination room, in Bradley’s private office, in the basement. They also found dozens of digital storage devices. Among them were five thumb drives hidden atop a door frame.

The next day, a detective from the high-tech crimes unit began examining the digital evidence. The first file on the first thumb drive was a video recorded in September, three months earlier.

For the first minute or so, it showed nothing alarming.

But then, Detective James Spillan saw Bradley removing the diaper of a very young child. The girl cried for her mother.

Spillan eventually catalogued 13 hours, 35 minutes and six seconds of video in which Bradley documented his abuse. Some scenes lasted several minutes, others only a few seconds. Bradley made the first recordings in December 1998; the last, in December 2009, three days before his arrest.

The video showed Bradley violently assaulting 86 children, all girls except for one. Spillan later testified in court about watching the rapes of children in diapers, many of them screaming and trying to get away. Bradley raped one girl, on video, four times before she turned 2.

“You can see the child has a Popsicle in her hand during the course of some of the rapes,” Spillan said. “I was not prepared for it. It was a violent, brutal, forced attack.”

“I was sitting there reading People magazine while he was raping my daughter. What the hell’s wrong with me?” Father to one of Bradley’s victims

The discovery of the video sent the case into a different realm. Until then, other doctors, hospital executives and many parents had viewed Bradley more as an eccentric than a predator, although one who may have been “careless” with little girls, as a colleague put it. In reality, he had been a serial child molester all along.

Delaware’s attorney general at the time, Beau Biden, the son of Vice President Joe Biden, instructed an assistant attorney general to set up an office in Lewes to identify victims and notify their families. Patricia Dailey Lewis ended up living there for six months, meeting day after day with stunned, grieving parents and grandparents.

“Many people just broke down,” Lewis said in an interview. She is now the executive director of the Beau Biden Foundation for the Protection of Children, created after Biden’s death from a brain tumor in 2015.

Some parents “just didn’t want to know,” Lewis said. “They could not bear the thought they had put their children in the hands of a rapist.”

One father told her: “I was sitting there reading People magazine while he was raping my daughter. What the hell’s wrong with me?”

Others defended Bradley. At a town-hall meeting, a man approached Lewis and backed her against a wall.

“I ought to punch you in the face,” he said. “You’re ruining the career of a good man.”

Two of the man’s daughters, authorities later determined, appeared on Bradley’s video.

NO DEFENSE

Bradley offered no defense when he went on trial in 2011. A judge sent him to prison for life, with no chance for parole. Bradley is now 63 years old.

In private, he “continued to maintain he didn’t do the things he was accused of,” said Jim Barnes, Bradley’s brother-in-law. Barnes’ wife, Lynda, died last February. Even though she reported Bradley to the state medical society in 2004, “she loved and stood by her brother,” Jim Barnes said. “Once he was in jail, she helped him as best she could.”

In public, Bradley said nothing about his case, except in court papers regarding his unsuccessful appeals. But in October, Bradley responded to an interview request from the AJC with a two-page handwritten letter.

He did not directly address his guilt or innocence. “Allegations of sexual abuse are of a category similar to Salem witch hunts and McCarthyism,” he wrote. “The end — conviction — justifies the means in public opinion.”

Bradley’s letter reflects the same self-assuredness about constitutional law that he once exhibited about pediatric medicine. He contends the police had no authority to confiscate the digital storage media from his office or to examine the video it contained.

“My conviction and incarceration (are) based upon unconstitutionally seized evidence,” Bradley wrote. Delaware’s courts “ruled with deception, dishonesty, sophistry and without integrity.”

Bradley said nothing about the content of the seized video, nothing at all about the children it showed him assaulting.

NO APOLOGIES

For Bradley’s victims, apologies have been hard to come by.

In November 2012, a Delaware judge approved a $123 million settlement of a class-action lawsuit against Beebe hospital, the state medical society and several doctors, some of whom allegedly referred patients to Bradley even after hearing jokes and rumors that cast him as a pedophile.

Alan Judd/AJC Beebe Medical Center hired Dr. Earl Bradley in 1994 and later became a defendant in a class-action lawsuit filed by Bradley’s victims.

The settlement provided victims with as little as $1,000 and as much as $400,000, depending on the severity of their abuse. Authorities approved payments to more than 1,200 former patients, said Bruce Hudson, one of the victims’ lawyers. “We think there were more that just didn’t come forward.”

“They had to have known. They did nothing. They did nothing. Nothing.” Patricia Dailey Lewis, Former Delaware assistant attorney general

The lawsuit’s resolution required no public expression of remorse by the people who failed to stop Bradley. Nor did they offer any.

The defendants’ only public comment came in a joint statement in 2012. They settled “without any admission or findings of liability,” according to the statement, and paid damages only “in the best interest of the victims of Bradley’s horrific acts and their families.”

Their failure to apologize still angers Patricia Dailey Lewis, the former Delaware assistant attorney general.

“Some of them had to have known there was a reasonable suspicion of child abuse,” Lewis said. “They had to have known. They did nothing. They did nothing. Nothing.”

But the absence of accountability may be the strongest link between Bradley’s case and others involving sexual misconduct.

Time and again, state medical regulators allow doctors who assault patients to enter into consent agreements, under which many continue to practice – but don’t have to admit wrongdoing. These agreements bring investigations to a halt, reducing the likelihood that other victims might be identified and additional sanctions imposed. Criminal charges are rare; convictions, rarer still.

Delaware’s medical board entered into a consent agreement with Earl Bradley on Feb. 19, 2010. That was two months after his arrest, and almost 16 years after the first accusation that he molested a patient.

The agreement revoked Bradley’s medical license, but said almost nothing about his offenses.

“No inference of guilt,” it said, “is evidenced or implied.”