Cairo, Ga. — Almost every day, patients line up at Dr. Andrew Dekle’s clinic, some arriving at the nondescript metal building behind the Grady County courthouse before it opens.

For many, the daily crush of teachers, truckers and farmers is the best measure of the 65-year-old physician, known for his willingness to see patients on short notice and treat even those without the means to pay.

“It doesn’t matter whether you have the money. It doesn’t matter whether you have insurance,” said Kim Johnson, a nurse who has worked in Dekle’s office and has also been a patient.

But others can’t shake the image of another group of patients, women staring blankly at a camera as the doctor who was supposed to care for them preyed on their addictions by demanding they pose nude in exchange for their prescriptions.

RYON HORNE / AJC Sheridan, one of three women who testified for the government against Andrew Dekle, said she finds it hard to forgive a man she says caused her to become addicted to sedatives and painkillers and then used that to fulfill his sexual needs.

“I don’t even want to say `Dr. Dekle,’ because I can’t look at him as a doctor,” said Cindy Sheridan, one of those he victimized.

Dekle’s complicated legacy is a window into how the laws in Georgia and many other states are so open-ended that even felons who commit sex-related offenses can practice medicine. (Read more about how well state laws protect patients.)

Nearly two decades ago, Dekle was sentenced to four years in federal prison after a jury found him guilty of writing more than 120 illegal prescriptions for women who testified that the drugs were in exchange for sexual favors.

“The pimp with a prescription pad” is what one prosecutor called him during a trial in which it was revealed that more than 400 sexually explicit photos of female patients and other women had been discovered in his office.

In some states, where legislatures have enacted laws prohibiting doctors who commit certain crimes from practicing, Dekle’s career would be over. But in Georgia, where the law gives the medical board the discretion to license anyone it sees fit, he was back in practice two years after leaving prison.

More than a dozen years later, that decision still leads some to wonder what the board was thinking.

“It’s particularly damning that he was using his ability to write prescriptions to further his sexual activities,” said Chris Dorsey, the Georgia Bureau of Investigation agent who led the probe that sent Dekle to prison. “A doctor burglarizes a house and then pays his debt to society, could he be a good doctor? I could argue it both ways. But when you have someone who abused everything centering on a medical practice to victimize all these people, that’s really a separate issue.”

Ryon Horne/AJC

Few barriers for felons

The Atlanta Journal-Constitution’s national investigation of doctors and sex abuse found that only six states have laws requiring permanent license revocation for physicians convicted of felonies involving sexual misconduct. Most states leave decisions to their medical boards and the doctors who dominate them. And that has allowed dozens of physicians to hold licenses despite convictions for sexual assault, sexual battery of patients, child pornography and other sex-related crimes, the AJC found.

Even in the states where laws bar felons from practicing, there are differences in what is considered disqualifying. Minnesota permanently bars all physicians convicted of felony sex offenses. California requires it only for registered felony sex offenders. In Michigan, permanent revocation is automatic only when doctors are guilty of criminal sexual misconduct involving patients.

Aaron Haslam, the former executive director of the Ohio medical board, said boards should have some flexibility in dealing with criminal matters — but not in cases where drugs are swapped for sex.

“I definitely think there should be a bright line there,” said Haslam, a former federal drug prosecutor. “That’s just a no-no. You’re fueling every kind of problem this country is fighting right now: drug addiction, drug trafficking and, in some respects, sex trafficking.”

The AJC’s review of medical board disciplinary actions across the country found more than 450 cases in which doctors had sexual contact with patients while also prescribing controlled and addictive substances for them. In more than half, the physicians were allowed to continue practicing.

Although it’s rare for medical regulators to allow doctors convicted in drugs-for-sex cases to keep their licenses, the AJC found instances in Texas, Virginia, West Virginia and Kentucky where physicians with convictions similar to Dekle’s were allowed to remain in practice.

Forfeiture disregarded

Dekle’s case raises particular questions because the jury not only found him guilty, it voted to require him to forfeit his medical license because of the role it played in his crimes.

Miriam Duke, one of the prosecutors in the case, said the forfeiture, while not legally binding on the Georgia medical board, should have sent the message that the government believed Dekle had no business being a doctor.

“My thinking was he would never practice medicine in the state of Georgia,” she said. “I certainly think the evidence warranted such a finding.”

Sheridan, one of three women who testified for the government, said learning that Dekle had regained his license “made me sick to my stomach.”

She finds it hard to forgive a man she says caused her to become addicted to sedatives and painkillers and then used that to fulfill his sexual needs.

“He hurt a lot of people,” she said in a recent interview. “(For) my children, it was horrible, because I wasn’t in any shape to take care of them.”

Dekle declined to be interviewed, writing in an email to the AJC: “There is no need for you to continue to contact my office in any way. I have absolutely nothing to say to you.”

Prescriptions bring scrutiny

In Cairo, a South Georgia town perhaps best known for its once-thriving cane syrup industry, Dekle has always been something of a local hero, a product of the surrounding farm country who went to medical school and returned.

His familiarity with the community and his reputation for treating people regardless of their circumstances helped him build a practice that quickly grew to include offices in both Cairo and nearby Thomasville.

But it wasn’t long before authorities began looking closely at the prescriptions he was writing and finding reason to be concerned.

In 1982, just a year after opening his practice, Dekle was indicted by a Grady County grand jury on four counts of unlawfully writing prescriptions for Demerol and morphine. Two related charges dealt with his record-keeping.

All felonies, the charges carried sentences that included heavy fines and prison, but the prosecution ended less than two weeks after the indictment was handed down when the county’s district attorney at the time declined to pursue it.

According to court records, the DA, Gilbert J. Murrah, based his decision on the fact that Dekle had agreed to a medical board order requiring him to surrender his permit to write prescriptions for controlled substances.

“The state believes that a nolle prosequi of said indictment is … in the best interests of the citizens of Grady County and the State of Georgia,” Murrah wrote in a motion seeking the dismissal of the charges.

Murrah, now practicing law in Bainbridge, did not respond to repeated inquiries from the AJC.

The medical board lifted its sanctions in 1987, but new and more serious allegations would later lead to another investigation, one that couldn’t be dismissed with the stroke of a pen.

“What (the medical board) previously uncovered was, yes, (Dekle) was illegally prescribing drugs,” Dorsey said. “But neither the local DA nor the medical board wanted to get into the whys and wherefores. In our case, we laid out the whys and the wherefores.”

Special to the AJC Site where Dr. Andrew Dekle practiced when he was indicted on 131 counts.

A cache of photos

Late on a November afternoon in 1994, Dorsey visited “The Health Center,” the clinic Dekle operated in Thomasville, armed with a search warrant. It was based on a woman’s allegations that Dekle had been providing prescription drugs for her if she agreed to have sex with him or let him take nude photos.

Dorsey quickly moved to an upstairs room that had a bed, a desk and a filing cabinet. In the cabinet, he found a box of condoms. He also found a box with two photo albums. In the albums, he found a cache of photos and negatives.

All told, he would later testify, there were between 400 and 450 photos of 16 or 17 women, most of them Dekle’s patients, in various sexually explicit poses.

“It was a little overwhelming but not shocking,” the agent said recently. “You had years of hearing different things but not knowing the depth of it.”

After identifying as many of the women as he could, Dorsey obtained their medical records and began to track their prescriptions. Plotting it all on a spreadsheet, he found that Dekle had prescribed immense amounts of addictive drugs for some of the women and had started doing it just two years after the medical board order stemming from the 1982 indictment was lifted.

One of the women who stood out was Sheridan, then living in Greeley, Colo., where she was in counseling and working to overcome her addiction.

Sheridan, who agreed to allow the AJC to identify her in this story, said Dorsey told her, “Do you know that between 1989 and 1991 you were prescribed enough pills to kill 200 people?”

A deal was worked out for her to testify.

“Every night when I go to bed I think about Dekle and only pray that time will help fade the memory,” she wrote in a narrative detailing her dealings with the doctor before testifying. “Please help me!”

‘Not the life I wanted’

“When I was as high as I was on pills, yes, I probably was smiling.” Cindy Sheridan response during cross-examination in Dr. Dekle’s trial

As a matter of law, the federal government’s case against Dekle was about dispensing controlled substances without a legitimate purpose. But as his trial played out over eight days in the old federal building in Thomasville, it quickly became apparent that the real story was something else: sex.

“You could not get away from it,” said Patti Dozier, a reporter for the Thomasville Times-Enterprise who covered the trial. “That’s what it was all about — sex for drugs.”

Sheridan testified that she was deeply depressed by what she was doing with Dekle but was so addicted to the sedative Xanax and the painkiller Lorcet that to keep up the flow of prescriptions she submitted to his demands.

Special to the AJC

Then using her married name, Cindy Beasley, she described for the jury how she consumed all 50 of the Xanax tablets from one prescription, hoping it would kill her. But her husband got her to the hospital in time for the pills to be pumped from her stomach. When she woke up and realized her suicide attempt had failed, she was so angry she pulled the IV tubes from her arms.

Special to the AJC

“This was not the life I wanted,” she testified. “I stayed depressed all the time. I was on pills all the time, and so I tried to just end it.”

When she was cross-examined, she was asked why, if she was so depressed, she was smiling in one of Dekle’s photos.

“When I was as high as I was on pills, yes, I probably was smiling,” she replied.

Another woman testified that Dekle gave her injections that combined a painkiller, Nubain, and a sedative, Vistaril, if she had sex with him or allowed him to take photos of her.

On one such occasion, she said, she posed for the married doctor after he called and said he had a roll of film from Christmas he wanted to finish.

“I was addicted to drugs and I wanted another high and I knew if I let him take the pictures, he would give me a shot,” she told the jury.

In his testimony, Dekle acknowledged having sex with Sheridan and other female patients as well as taking their photos. But he insisted those acts were unrelated to the prescriptions, which he described as medically justified.

“My testimony is that my conduct has not influenced the manner in which I cared for these patients,” he told the jury.

Community support

When Dekle was sentenced, his supporters flooded U.S District Judge W. Louis Sands’ office with letters.

“I think the community is always affected,” Sands said, addressing Dekle from the bench. “But in this situation, it is doubly so because of the expressions (of support) and the clear concern of people who obviously think a lot of you and are appreciative of what you have done … for the communities where you lived, where you grew up and where you later came back to serve.”

A former Grady County sheriff showed up to testify as a character witness, stating that he had known Dekle and his family “out in the okra field” since the 1960s.

Atlanta psychiatrist Gene Abel, who had been treating Dekle, testified that sending him to prison would halt the progress he had made.

“This man has had over 150 sessions of therapy,” Abel told the judge. “I hate to see him go into an environment where violence is kind of a frequent occurrence.”

None of it had an impact, however, as Sands granted the government’s request for an upward departure from the sentencing guidelines to account for Dekle’s treatment of Sheridan.

“The court believes by a preponderance of the evidence in … the psychological damage she has suffered,” the judge said.

The board weighs in

Georgia medical board records show Dekle voluntarily surrendered his license after he was sentenced to prison. When he initially applied for reinstatement after his release, he was rejected, but the board changed its stance six months later. Meeting minutes show the board reissued Dekle’s license after he appeared and “gave a statement” as well as answered questions, but the minutes make no mention of what was said.

As conditions of reinstatement, Dekle was placed on five years’ probation with restrictions that included continued psychotherapy and a limit of 40 working hours per week. Board records show he complied.

Dr. Eddie Cheeks, an Augusta OB/GYN who was the board’s president when Dekle was returned to practice, refused to discuss the decision, referring all comment to the current board.

The current chairman, Dr. John Antalis of Dalton, said in a recent interview that, while the board has leeway in deciding who can practice, it is presently “very, very hard” for a doctor convicted of a sex-related felony to be licensed in Georgia.

“In the five years I’ve been on the board, we’ve been pretty firm about felonies in general,” he said.

RYON HORNE / AJC Kim Johnson, who has known Dekle for more than 20 years as both a patient and a nursing student training in his office, says she knows he made some “bad choices,” but that he is “bigger than anything he did wrong.”

Putting aside the past

Patients contacted for this story said they know bits and pieces of Dekle’s criminal history but don’t particularly care about it. This is a doctor who goes the extra mile, they said, and that’s what matters most.

“He’s always been just a good friend,” said Sarah Touchet, a 75-year-old Cairo resident who has been a patient since the 1980s. “He’s taken care of a lot of people and never charged them a dime.”

Despite Dekle’s conviction, Touchet said she still doesn’t believe he did anything wrong.

Johnson, who has known Dekle for more than 20 years as both a patient and a nursing student training in his office, said she realizes he made “bad choices,” but she doesn’t believe that should outweigh his value as a physician.

“I know part of him, and, to me, that part of him is bigger than anything he did wrong,” she said.

Dorsey, who has lived in Cairo for 33 years, said he has friends who are Dekle’s patients, and, to a certain degree, he understands.

“You’ve got to realize the dynamics,” he said. “Take out this dark part of his life, he is a very smart, talented physician.”

But the veteran GBI agent said he, for one, can’t forget that dark side — the photos, the trial and the despair of the women who testified — and often wonders how it wasn’t enough to end a doctor’s career.

“You can expect a defendant to make any kind of run he can,” he said. “But that’s not possible without the board opening a window and letting him through. It’s that simple.”

— Staff videojournalist Ryon Horne contributed to this article.