"We don't do things in lockstep. We want to be able to reflect what's needed for Utah," Howell said. "We gave it a lot of deliberation. I think we came to a fair decision."
Riley declined comment through her attorney, Erik Strindberg on Tuesday, saying she doesn't feel comfortable speaking because the matter isn't yet closed.
Riley was indicted on murder and conspiracy charges after she performed an August 2010 abortion at an Elkton, Md., clinic that left an 18-year-old patient with a ruptured uterus. The patient recovered and prosecutors eventually dropped the charges.
But Maryland regulators said Riley's decisions and actions during the medical emergency were lax and constituted unprofessional conduct that was grounds for revoking her license.
Specifically, the board said Riley had failed to ensure the Elkton clinic had an appropriate contingency plan for medical emergencies, used a private car not an ambulance to get her patient to a nearby hospital emergency room and delayed that transfer by an hour and a half.
Riley disputes the characterization that she delayed seeking emergency care and she has appealed that portion of Maryland's ruling, she told the Utah board last week.
Past convictions • Maryland officials also said Riley should never have been issued a medical license because she had failed to disclose felony convictions for fraud, forgery and larceny, which resulted in a prison sentence, a court martial and a dishonorable discharge from the U.S. Army. Riley also failed to disclose the specific details of her criminal past on her 1997 application to the University of Utah's medical school and in applications for medical licenses in Utah and Wyoming, investigators found.
In its 26-page ruling, the Maryland board said Riley's unprofessional conduct was "not remediable" and said it did "not believe that Maryland patients would be safe in the hands of this physician."
Utah regulators were not ready to reach that conclusion, although some board members questioned whether Riley's past dishonesty amounts to a "pattern of misrepresentation" that makes her a danger to patients.
Others on the 11-member board, however, noted that Riley had practiced medicine in Utah without incident for years and that Maryland's finding did not include any criticism of her skills as a doctor, nor had any allegations of malpractice been raised.
"This is my first complication in over 7,000 procedures," Riley told the Utah board. "It's unfortunate that it made national news and that it was a serious complication."
Utah practice • Riley was licensed to practice medicine in Utah in 2004. She worked at Wasatch Women's Center in Salt Lake City and in private practice, where she offered both routine care and hormone management for transgendered patients.
In her remarks to the Utah board, Riley said she was working as a contract employee for the Maryland clinic and had timed her trips east to coincide with weekends that her children were with their father, from whom she is divorced. Riley said she had only worked at the Maryland clinic one other time prior to the August 2010 incident.
Utah's Division of Professional and Occupational Licensing publicly disciplined Riley in 2010 for her licensing application omissions, but allowed her to continue to practice on a restricted license, including a prohibition on performing abortions. That restriction was lifted with the end of the Maryland investigation, although Riley said last week she has no plans to resume performing abortions.
But neither the controversy that surrounds abortion nor Riley's past lies were issues the licensing board could address, Jennie Johnsson, an administrative law judge for the Department of Commerce, said at the hearing.
The board was limited to considering the infractions cited by Maryland and could only decide whether Riley's behavior would also be considered unprofessional conduct in Utah, Johnsson said.
Any disciplinary action would also set a precedent for other Utah doctors that could leave them liable for decisions that could be out of their hands, Johnsson cautioned.
For example, a contingency plan may be "appropriate" in one setting but not in every medical facility: transporting a patient in a private car to an emergency room might be the right decision in a rural community such as Elkton but not in Salt Lake City. Riley told the board she moved her patient by car because Elkton's small hospital was just a few blocks from the clinic and because ambulance response times by the local volunteer fire department might be as long as 30 minutes.
One board member observed, "I would have done that if I were in Moab."
There was no board majority for taking away Riley's license or placing restrictions on her opportunities to work, Howell said. One board member abstained from casting a vote on the final proposal.
"It was interesting to see the way it evolved," Howell said. "In the end, I think we came up with something in the middle. Not everyone was completely happy with it, but we could live with it."