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Oregon Medical Board: Agency History

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Written 2003


Note: The Oregon Medical Board previously was called the Board of Medical Examiners.


Introduction
The Board of Medical Examiners has been responsible for regulating the practice of medicine in Oregon since 1889. Originally the Board monitored medical doctors. Over the years several allied health care professional groups have been added to the Board’s responsibilities. Today the Board of Medical Examiners oversees the licensing and professional conduct Oregon’s physicians, podiatrists, physician assistants, and acupuncturists, as well as some emergency medical technicians.


The current Board consists of eleven persons appointed by the governor, and includes seven medical doctors, two doctors of osteopathy and two public members. The Board of Medical Examiners administers the Medical Practice Act (ORS 677), establishes rules and regulations guiding the practice of medicine, and investigates and disciplines violators.

 

Much of the Board’s work is accomplished by committee. The full Board meets quarterly to issue licenses and consider the activities of its committees. Each Board member is assigned to at least one of the following committees: the Committee on Investigations, the Committee on Administrative Affairs, the Committee on Legislative and Public Policy, and the Advisory Council on Podiatrists. Other committees include the Committee on Physician Assistants, the Committee on Acupuncture, and the EMT II-IV Advisory Committee.

 

The Board of Medical Examiners is completely self-supporting with all income generated from examination, licensing, and registration fees collected from its licensees. Current programs include the Executive Director, Administrative Services, Licensing, Investigations, and the Diversion Program for Health Professionals.

 

History
The Legislative Assembly created the Board of Medical Examiners in 1889 to regulate the practice of medicine. The original statute required the governor to compose the first Board of "three persons from among the most competent physicians of the state."


To become licensed, a physician was required to show his diploma from a medical school or pass a test given by the Board. A "grandfather" clause was included to allow practitioners already in the state to become licensed by signing their county registry of physicians within two months of passage of the law.

 

In 1895 the Legislative Assembly amended the Medical Practice Act so that applicants were required to submit data on their educational background as well as pass a comprehensive examination. Board membership was expanded to five: "three regulars, one eclectic and one homeopathist." The revised law included a definition of unethical behavior that included "employment of cappers or steerers (payment of a patient for a testimonial), moral turpitude, betrayal of professional secrets and obtaining a fee for care of an incurable disease.” A grandfather clause exempted many from the new regulations. The Board’s responsibilities were extended in 1907 when the osteopathic profession was included within its regulatory scope. The addition of an osteopathic physician increased Board membership to six.

 

In 1929 the Oregon State Medical Society petitioned for a referendum to be included in the general election of 1931. The proposal required license applicants to pass a uniform examination testing their knowledge of the basic sciences. The test was to be prepared and administered by a group of non]partisan educators. Persons already licensed were unaffected. The Legislative Assembly adopted a version of the act in 1931.

During the 1940's, the Board began to place physicians on probation for violations of the Medical Practice Act. This increased enforcement of regulations, and the Basic Science Examination, combined to make Oregon among the more difficult states in which to obtain a license to practice medicine.

 

A shortage of physicians in the state in the early 1970's prompted the Legislative Assembly to repeal the Basic Science Law in 1973. By removing this step in the licensing process, the Legislative Assembly and the Oregon Medical Association hoped to lure additional doctors to the state's rural and other under-served areas. The examination that the law had mandated was now seen as archaic or irrelevant since most components of the test had been incorporated into other credentialing exams.

 

As a result of the doctor shortage and other societal changes the Board assumed responsibility for regulating five additional professional groups. In essence, the Legislative Assembly modified the traditional definition of the practice of medicine to include emerging health care professions. The first group of new licensees to come under the Board's purview was physician's assistants. A physician's assistant (PA) is a dependent practitioner who may not function without a supervising physician. The 1981 Legislative Assembly passed a bill enabling a PA to write prescriptions for certain drugs. The legislation also allowed PA's to practice in medically under-served areas without the physical presence of a supervising physician with the approval of the Board. Prescribed by statute, the Physician's Assistant Advisory Committee assists and advises the Board, reviews license applications, and makes policy recommendations regarding PA's.

 

In 1973, the Legislative Assembly added acupuncturists to the Board's responsibilities. A six]member Acupuncture Committee is appointed by the Board consisting of four physicians, including a Board member, and two acupuncturists. The committee reviews applications, develops and administers written and practical examinations, and makes recommendations for Board approval or denial of applicants for registration.

The advanced emergency medical technicians (EMT II, III, and IV's) came under the Board in 1975. EMT I regulated by the State Health Division. The Emergency Medical Technician II – IV Advisory Committee has the same scope of duties as the other allied health committees.

 

Nurse practitioners who prescribe drugs came under the scrutiny of the Board in 1979. The autonomous Advisory Council for Nurse Practitioners granted prescription privileges. The Board provided staff support (essentially investigators) to the Council, ratified actions of the Council, and could suspend or revoke prescription privileges based on proof of abuse.

 

In addition to adding the aforementioned allied health professions to the Board's licensing duties, the Medical Practice Act was amended in 1975 to substantially increase the Board's powers in disciplinary matters. It became possible to suspend summarily the license of a doctor if it was found that he posed an immediate danger to the public. Failure to appear for an informal hearing became cause for license suspension or revocation. The same amendment assured confidentiality for anyone who files a complaint against a physician. It also made it mandatory for doctors to report any colleague whose ability to practice was in question. As a result, complaints have increased dramatically since 1975. Hospitals and insurance companies were included in the mandatory reporting law in 1977. In 1979 the Legislative Assembly added a public member to the Board.

 

The Board of Podiatry was dissolved in 1981 and its license applicants were put under the jurisdiction of the Board. The Advisory Council on Podiatry advises the Board on disciplinary matters relating to podiatrists, and recommends rules, regulations and legislation pertaining to the practice of podiatry. The Board may approve or deny recommendations of the council, including those relating to licensure of individual podiatrists.

 

The 1985 Legislative Assembly increased the number of Board members to nine and deleted the requirement for an alternate member. The nine-member Board was to consist of six persons having a degree of Doctor of Medicine, two persons having a degree of Doctor of Osteopathy, and one public member representing health consumers.

 

The 1989 Legislative Assembly established a Diversion Program Supervisory Council consisting of five members appointed by the Board for the purpose of developing and implementing a diversion program for chemically dependent licensees regulated under the Medical Practice Act. The council was authorized to appoint a Medical Director, subject to Board approval, to administer the program. Under this program an individual licensee voluntarily seeking treatment is protected from disciplinary action from the Board as long as they participate in a specified treatment and continuing care program. The Board refers some licensees for treatment in lieu of disciplinary action. The statute specified that all records of the council were confidential and not subject to public disclosure nor admissible as evidence in any judicial proceeding.

 

The 1989 Legislative Assembly also authorized the Board of Medical Examiners to accept a certificate issued by the National Board of Medical Examiners of the United States or the National Board of Examiners for Osteopathic Physicians and Surgeons or the Medical council of Canada in lieu of its own examination. 1989 also saw another increase in the number of Board members, this time to eleven.

 

The 1991 Legislative Assembly created the Respiratory Care Practitioners Committee consisting of five members appointed by the Board. The committee’s duties were to review and recommend approval or disapproval of all applications for licensing and renewal of Respiratory Care Practitioners. The Committee was instructed to recommend to the Board a licensing examination meeting nationally recognized standards and continuing education requirements for renewal of a license.

 

The 1997 Legislative Assembly abolished the Respiratory Care Practitioners Committee in the Board of Medical Examiners and transferred its powers, functions, and duties to the newly established Respiratory Therapist Licensing Board under the Health Division in the Department of Human Services (OL 1997, Ch. 792).

 

Current Organization

Medical Examiners Board
The Board consists of eleven members appointed by the Governor. The full Board meets quarterly and works largely through subcommittees that include one or more Board members. Current committees include the Committee on Investigations [4 MD/DO Board members, 2 Board public members], the Committee on Administrative Affairs [5 Board members], the Legislative Advisory Committee [3 Board members], the Acupuncture Committee [3 acupuncturists, 3 MD/DOs, 1 Board member], the Physician Assistant Committee [2 PA’s, 1 MD/DO, 1 pharmacist, 1 Board member], the Podiatry Advisory Council [3 podiatrists, 1 MD/DO Board member, 1 public member], the EMT Advisory Committee [3 EMTs, 2 MD/DOs, and the Editorial Committee.

 

Executive Director
The Executive Director’s office includes the Director and two Medical Directors. The Director determines policy and program priorities, and oversees all Board and agency operations including legislative liaison and public outreach. The Board Medical Director provides medical expertise to the Board, Investigations, and other agency staff. The Diversion Program Medical Director oversees the Diversion Program for Health Professionals, which is described separately.

 

Administrative Services
Administrative Services provides business and technical support to the Board. It also performs license registration, license renewal processing, and provides information to the media and the public.

 

Licensing
Licensing is responsible for ensuring that every applicant granted a license meets all requirements for education, clinical training, examinations, and conduct. The Federation of State Medical Boards administers licensing examinations. Completed applications are sent to the appropriate committee for formal review and recommendation to the full Board. Approved applications are scheduled for review by the full Board.

 

Investigations
The Investigations program receives complaints against licensees from patients, pharmacies, insurance companies, hospitals, nursing homes, physicians, nurses and others in the health care field. It conducts investigations in cases where a violation of the Medical Practice Act appears to have occurred. If the Medical Director and/or the Executive Director determine the inquiry has revealed deficiencies a more involved and comprehensive field investigation is done. If the Investigative Committee finds the licensee to be in violation of the Medical Practice Act the committee recommends to the full Board that disciplinary action be taken. Licensees may then request a formal hearing before a hearings officer. The hearings officer submits a Proposed Order to the Board to review and the Board issues a Final Order.

 

Diversion Program for Health Professionals
The Diversion Program Supervisory Council consists of five members appointed by the Board for the purpose of developing and implementing a diversion program for chemically dependent licensees regulated under the Medical Practice Act. The Diversion Program gives practitioners a way to get help for substance abuse disorders without coming under disciplinary action. The program initiates interventions with abusers, in cooperation with family and colleagues; assesses each abuser and refers him/her to an appropriate treatment program; coordinates continuing care or rehabilitation following treatment; monitors each individual’s return to practice; makes recommendations to the Board regarding appropriate licensure of chemically dependent practitioners; and manages continuing care monitoring of Board mandated probationers.

 

The program maintains offices separate from the Board. The identity of voluntary participants is completely confidential and is not known to the Board or Board staff.

 

Chronology

1889

  • The Board of Medical Examiners was created to regulate the practice of medicine in Oregon. The Board was to consist of three persons from among the most competent physicians of the state.

1895

  • Applicants were required to pass an examination.

1907

  • Osteopathic physicians were included in the scope of the Board’s responsibility. The Board membership increased to six.

1931

  • Applicants were required to pass an examination on the basic sciences.

1940s

  • The Board stepped up enforcement of the Medical Practice Act by placing violators on probation.

1971

  • Physician’s Assistants were placed under the Board’s purview in a further effort to provide quality medical care, particularly in under-served rural areas. A Physician’s Assistant Advisory Committee was established to advise the Board.

1973

  • Acupuncturists were added to the Board’s authority, and the Acupuncture Committee was created to advise the Board.
  • The law requiring the basic science examination for physicians was repealed in an effort to relieve a physician shortage.

1975

  • Advanced emergency medical technicians became the responsibility of the Board, and an Emergency Medical Technician II-IV Advisory Committee was set up.
  • The Medical Practice Act was amended to substantially increase the Board’s powers in disciplinary matters. Confidentiality was assured for anyone filing a complaint against a licensee.

1979

  • Nurse practitioners prescribing drugs came under the Board. An autonomous Advisory Council for Nurse Practitioners granted prescription privileges.
  • A public member was added to the Board.

1981

  • The Board of Podiatry was dissolved and Podiatrists were placed under the Board of Medical Examiners. An Advisory Council on Podiatry advises the Board.

1985

  • It was stipulated that the public member of the Board was to participate whenever the Board or any of its committee’s sat in an investigative capacity.

1989

  • A Diversion Program Supervisory Council was established to develop and implement a Diversion Program for Health Professionals. The program was to work with volunteers, and practitioners referred by the Board, to oversee their treatment for chemical dependency. The statute stipulated that all records of the council were to be confidential and not subject to public disclosure, nor admissible as evidence in any judicial proceeding.
  • The Board was authorized to accept a certificate issued by a national examiner’s organization in lieu of its own examination.
  • A second public member was added to the Board, with the stipulation that the public members were to be members of the Investigative Committee of the Board.

1991

  • The Respiratory Care Practitioners Committee was established, under the Board, to oversee the examination, licensing, and regulation of Respiratory Care Practitioners.

1997

  • Respiratory Care Practitioners Committee was abolished in the Board of Medical Examiners and its duties and function were transferred to the newly established Respiratory Therapist Licensing Board under the Health Division in the Department of Human Services.

Primary Agency Statutes and Administrative Rule Chapters

Oregon Revised Statute (ORS), Chapter 676 – Health Professions Generally

Oregon Revised Statute (ORS), Chapter 677 – Regulation of Medicine, Podiatry and Acupuncture

Oregon Administrative Rule (OAR), Chapter 847 – Board of Medical Examiners

 

Bibliography
Board of Medical Examiners web site <http://www.bme.state.or.us> Accessed on June 16, 2003.

Legislatively Approved Budget, Board of Medical Examiners, 1995-1997.

Oregon Revised Statutes, Chapter 677, 1995.

Oregon Administrative Rules, Chapter 847, 1995.

Oregon Blue Book, 1995-96.

“Regulations, Rights and Responsibilities: A Handbook for Physicians Practicing Medicine in Oregon”.

“Board of Medical Examiners Management And Operations Review,” April 1996. Talbot, Korvola & Warsick, LLP.

Oregon Laws: O.L. 1953, c. 159; O.L. 1955, c. 157, 282, 317; O.L. 1957, c. 681; O.L. 1961, c. 257, 400; O.L. 1967, c. 470, 637; O.L. 1969, c. 314, 684; O.L. 1971, c. 649, 650, 734; O.L. 1973, c. 31, 427, 792; O.L. 1975, c. 693, 695, 776, 796; O.L. 1977 c. 448, 520, 657, 686, 842; O.L. 1979, c. 27, 388, 562, 778; O.L. 1981, c. 220, 339; O.L. 1983, c. 486, 740; O.L. 1985, c. 322, 747; O.L. 1987, c. 377, 379, 720, 726; O.L. 1989, c. 705, 782, 829, 830; O.L. 1991, c. 67, 314, 325, 485, 703, 772; O.L. 1993, c. 16, 57, 378; O.L. 1995, c. 374, 380, 684, 695; and O.L. 1997, c. 527, 792.