Only seven states – Arizona, Maryland, North Carolina, New York, Ohio, South Carolina and Virginia – provide complete information about a doctor's history of sanctions, Public Citizen found.

Hawai'i received a "D" for the information its provides on its Web site. Other states receiving that grade are Alabama, Arkansas, Georgia, Kansas, Mississippi, Nebraska, Oregon and Rhode Island.

The Web site rankings came as the Federation for State Medical Boards reported today that regulators issued 4,662 disciplinary actions against the nation's doctors last year, a slight increase from the previous year.

Some doctors may have been sanctioned more than once. Sanctions can range from revoking or suspending a license to a written reprimand. Substance abuse, unprofessional conduct and prescribing violations constituted reasons for many of the most punitive sanctions, the federation said.

Arizona, which issued 10.52 severe sanctions per 1,000 doctors, did the best job, the group said. It was followed by: Oklahoma, Alaska, Iowa, and Kentucky.

Washington, D.C. had the lowest rate of doctor sanctions ­ fewer than 1 severe sanction per 1,000 doctors ­ followed by Hawai'i, Delaware, South Dakota and South Carolina.

That disparity has changed little in recent years, and Public Citizen annually argues that patients who live in states with less aggressive medical boards are more at risk for doctor-caused injury.

But there too is a major gap, Public Citizen said ­ arguing that states with the best disciplinary records issued 14-fold more sanctions that the worst-performing medical boards.

Now the consumer group says problems with the new Web sites ­ touted as ways to provide patients more information about questionable doctors ­ add to the concern.

It ranked the Louisiana and North Dakota Web sites the worst, for failing to provide anything more than names of doctors who had been disciplined.

To learn more, patients must contact those medical boards ­ and North Dakota's site warns that doctors can be told who requests information about them.

Worse, the group said, Web sites for Montana and South Dakota don't list any information about disciplinary actions.

"State boards need to evaluate whether they are effectively disciplining doctors and whether the public is able to get access to that information," said Public Citizen's Dr. Sidney Wolfe.

Experts agree the vast majority of the nation's more than 600,000 doctors are competent and law-abiding. But how to ensure physicians are competent and help patients choose a good one is under increasing scrutiny.

The federal government keeps a comprehensive list of doctors who have been sanctioned by state licensing boards, as well as malpractice payouts and hospitals' own discipline of staff doctors. But by law this National Practitioner Data Bank is kept secret, with only hospital administrators and licensing boards given access.

Patients can ask for a doctor's records from state medical boards, but the quantity and quality of information varies widely.

Each state has different laws governing doctor regulation and vastly different budgets to pursue cases, so it's hard to say one does a better job based on numbers of sanctions, said Dale Austin of the Federation of State Medical Boards.

As for Web sites, federation guidelines urge that they provide a description of a doctor's disciplinary action, and instructions for patients to contact each board for details.