Stephen X. Giunta, an Alexandria plastic surgeon, was placed on probation by the Virginia State Board of Medicine in 1994 after it found he had "improperly performed" a routine nose operation that resulted in the death of a patient.

Under the terms of the probation, Giunta had to undergo a comprehensive review of his medical practice by a three-member committee of doctors.

A year later, Giunta, who had been reprimanded by the board in 1987 for deceptive advertising, was taken off probation and issued an unrestricted license.

His name surfaced in a list of doctors in the country who have been disciplined by either state boards or federal agencies since 1981. The list, titled "13,012 Questionable Doctors," was published last month in three volumes by Public Citizen's Health Research Group.

His case, said Sidney M. Wolfe, the consumer advocacy group's director, is typical of the way medical boards across the country discipline doctors and points up serious deficiencies in protecting consumers from faulty medical care.

Probation is the most common punishment meted out by state medical boards, which license doctors, Public Citizen found.

"That's true for doctors found guilty of sexual abuse, substandard care, criminal offenses, prescription violations or drug or alcohol abuse," said Wolfe, who is a medical doctor.

Giunta, who practices in his Alexandria clinic, declined to comment for this story. A woman who identified herself as his office manager, but did not give her name, said he was unlikely to talk to the news media.

According to Public Citizen's analysis, only one-third of the 1,622 doctors who had been disciplined for substandard care, incompetence or negligence nationwide since 1993 had to stop practicing, even temporarily. Less than 10 percent of the errant doctors had their licenses revoked, Wolfe added.

Another problem with the nation's system of policing doctors is that physicians in one jurisdiction can move to another state and set up a practice.

J. Ricker Polsdorfer, a physician whose right to practice in Indiana was restricted in 1993 because of his treatment of a patient who developed life-threatening sores, was hired as the Peace Corps regional medical officer in Zimbabwe. He was named in the Washington section of the book because his address was listed as the State Department. Peace Corps officials said he was hired in 1993, with valid licenses to practice medicine in California and Washington state. He left last summer when the Peace Corps reduced the number of doctors it employed in the region. He could not be reached for comment.

"Medical boards are much too forgiving," Wolfe said. "Many still see their priority as rehabilitation, and their disciplinary actions are too light."

Yet others in the medical community think rehabilitation and retraining are just what state boards should be doing more of to reduce medical mistakes. Lucian Leape, a professor of health policy at Harvard University's School of Public Health, agreed that state boards are ineffective. But the reason, he said, is that they have no authority to use such intermediate tools as counseling, retraining and reforming to get doctors to practice better medicine.

"Everyone thinks of it as as an all-or-nothing situation in which a doctor should lose his license if he makes a mistake. We don't treat anyone else like that," said Leape, a surgeon who switched to policy research to find ways to prevent medical errors.

"What we want to do is to get doctors to examine their mistakes and figure out what to do to correct them," Leape said. "Instead, we have created an atmosphere in which doctors are afraid to talk about mistakes, which is just what they should be doing."

The Federation of State Medical Boards, which issued its 1995 report less than a week after Wolfe released his study, defended its performance. Robert E. Porter, president of the Texas-based federation, said a total of 3,375 doctors had received stiff disciplinary penalties from state boards last year -- a 7.4 percent increase over the year before.

The state boards suspended or revoked licenses in 39 percent of the cases and restricted the licenses in another 34 percent.

"In looking at the five-year period beginning in 1991, we have witnessed a 47.2 percent increase in the number of physicians with actions {taken against them} across the country," said Porter.

He called the increase "significant" and credited it to "the diligence of the members and staffs of state medical boards who are charged with protecting the public from incompetent or errant physicians, often with inadequate resources to manage the number of complaints received."

While acknowledging improvement, Wolfe said the boards still do not do enough. "Though it has been vastly improved during the past 15 years, the nation's system for protecting the public from medical incompetence and malfeasance is still far from adequate," he said.

"Most importantly," he said, "most state medical boards have not refined the art of speaking to their primary constituency, the public."

A report in December by the inspector general of the federal Department of Health and Human Services, June Gibbs Brown, also found that state boards were lax in identifying doctors who give poor care to Medicare recipients. She said peer review organizations established to find "poorly performing physicians or hospitals" get "few leads from the medical community," including state boards.

Public Citizen ranked the D.C. Board of Medical Examiners at the bottom of the list for its willingness to discipline doctors. While the national average was 4.29 serious disciplinary actions per 1,000 doctors, the District reported 0.48 actions per 1,000 doctors.

James Granger Jr., acting executive director of the District of Columbia Board of Medicine, disputed the Public Citizen ranking, which was based on the number of serious disciplinary actions taken by the board in 1994 as reported by the Federation of State Medical Boards. Under Granger's calculations, the District board would have ranked next to last instead of last, ahead of Hawaii.

"I think we do an exceptional job considering the resources, which are a problem," Granger said. "We need a computer, we need people."

There are six people in the city organization that is responsible for policing 10 professions, including doctors. While there are a few personal computers, the board has none to keep track of licenses. Nor are there investigators dedicated to going after errant doctors.

While the District board didn't discipline many doctors, its net dragged in some well-known practitioners for minor administrative offenses. The list included the chairman of obstetrics and gynecology at Georgetown University Medical Center, John T. Queenan, and the chief of epidemiology at the D.C. Health Department, Martin E. Levy. They were both fined for failing to renew their licenses and practicing without a valid license.

"It was an outrage," said Levy, who argued that he had never gotten a renewal notice. "I was embarrassed. I paid a big fine."

Queenan, responding through the Georgetown public relations department, said he filled out and paid for what he thought was his medical license but instead it was a license to have an office in his home. When notified that his license had expired, he paid a fine and the license was reinstated, a public relations officer said.

"D.C. regulations place the responsibility for renewing on the licensee. Every doctor has a license that shows its expiration date," replied Granger.

Wayne D. Blackmon, a psychiatrist who heads the private Medical Society of the District of Columbia, called the Public Citizen listing "noble in intent but misguided in implementation," largely because it publishes the names of Washington doctors who failed to renew their licenses. He said the D.C. Medical Board doesn't have enough money to buy postage stamps to mail license renewal notices, so the medical society is doing it. "It's horrible," he said.

Maryland ranked 21st among the states, with 5.4 serious disciplinary actions per 1,000 doctors, and Virginia ranked 30th, with 3.76 serious disciplinary actions per 1,000 doctors.

By way of contrast, the top-ranked state, Wyoming, had 12.41 serious disciplinary actions per 1,000 doctors.

All in all, the number of doctors who had been disciplined for practicing poor medicine amounts to just 2 percent of the nation's 620,000 physicians.

"A tiny fraction of doctors are doing a tremendous amount of damage," Wolfe said.

The Public Citizen book, which was published last in 1993, is the only publicly available listing of doctors who have been disciplined for poor medical practices.

The federal government maintains the National Practitioner Data Bank, which lists doctors who have been disciplined or who have lost malpractice suits. By law, however, the public is not given access to that list, which is available only to state medical boards, hospitals and health maintenance organizations.

Even so, the American Medical Association's House of Delegates voted in 1991 to do away with the list, which includes doctors who have lost or settled malpractice suits as well as those who have been disciplined.

"The AMA seems to want to protect the minority of American physicians about whom there is data in the practitioner data bank from the scrutiny of their own patients and other physicians," Wolfe said.

"He's wrong about that. We do not want to protect any bad doctors. The AMA has deep concerns about the small percentage of doctors practicing substandard medicine," replied James Stacey, an AMA spokesman. Copies of individual state lists are available for $15 from Public Citizen Publications, 1600 20th St. NW, Washington, D.C. 20009. CAPTION: DISCIPLINARY ACTIONS TAKEN AGAINST DOCTORS CITED FOR SUBSTANDARD CARE, INCOMPETENCE OR NEGLIGENCE ACTION PERCENTAGE Probation 26% Fine 14% Reprimand 10% Suspension of License 9% Restriction of Practice 8% Revocation of License 7% Surrender of License 5% Emergency Suspension of License 2% Other Actions 20% CAUSES FOR WHICH DOCTORS WERE DISCIPLINED Disciplinary action taken by another state or agency 25% Criminal conviction 15% Substandard carte, incompetence or negligence 12% Misprescribing or overprescribing drugs 11% Drug or alcohol abuse 9% Professional misconduct 7% Noncompliance with a board order 6% Noncompliance with a professional rule 5% Practicing without a license 3% Providing false information to medical board 2% Sexual abuse of or sexual misconduct with a patient 2% Mental or physical impairment 2% Loss or restriction of hospital privilege 1% Insurance or Medicare/Medicaid fraud 1% Falsifying/altering medical records or reports 1% Overcharging 1% Exceeding professional limitations 1% SOURCE: "Questionable Doctors," Wolfe Et Al March 1996