The state Department of Public Health, the body that investigates doctor misconduct, became aware of a troubling lawsuit and settlement in 2007.

A couple had sought the services of Dr. Ben Ramaley, a Greenwich obstetrician/gynecologist, to help them conceive in a 2002 fertility procedure. But the couple later knew something was wrong when their twin girls did not resemble them.

The couple sued Ramaley in 2005, claiming he had used his own sperm in the procedure. The lawsuit was settled within months.

In November 2009, Greenwich Time revealed that Ramaley was fined $10,000 and allowed to keep an unrestricted license after the state Department of Public Health found he used the “wrong man’s sperm” in the procedure, resulting in the twins being born without the DNA of their intended father.

Health department officials went no further, however, declining to order a DNA test to resolve the allegation that Ramaley was the girls’ father, even though they had the authority to do so.

Patient advocates and state lawmakers point to the Ramaley case as one of the most glaring examples of the failing system that investigates physician wrongdoing in Connecticut.