Corporations, both for-profit and nonprofit, are required by law to have a board of directors. State law has determined that the board is responsible for the health of its organization, and directors have legal obligations to uphold the board’s corporate governance function. In a similar vein, doctors have a medical board that oversees rules regarding whether or not a physician can practice medicine. The role of the Oregon Medical Board (OMB) is to license, regulate, and take disciplinary actions, if necessary, when complaints are made against healthcare workers, including physicians.
When a Physician has a complaint, or many complaints filed against them, the question then becomes, what will be done, or what must be done by the medical board in order to ensure the health and wellbeing of the patients cared for by these physicians? Using examples from two different cases the actions and determinations of the Oregon Medical Board will be examined to look at how a complaint is handled, and what the process looks like.
What is the Oregon Medical Board and What is its Purpose?
The Oregon Medical Board serves for the most part to license healthcare providers such as Medical Doctors (MD), Physicians Assistants (PA), and Acupuncturists (LAc).
In conjunction with licensing, the Oregon Medical Board conducts investigations; imposes disciplinary action; and supports rehabilitation, education, and research.
The Oregon Medical Board is also responsible for establishing the scope of practice for Emergency Medical Services Providers.
How is a Complaint Made?
If a patient has concerns that a healthcare worker has treated them negligently, or acted inappropriately, it is possible to submit a complaint about the healthcare worker involved in the incident. In order to file a complaint, a process must be followed. The person wishing to make a complaint must do so in writing and then submit the complaint by mail.
The following information must be included in the complaint:
- Full name of the healthcare worker whom the complaint is being filed against.
- Name of the patient who is filing the complaint, as well as their mailing address, telephone number, and date of birth (or the information of the person filing the complaint on the patient’s behalf).
- A description of the incident including the date(s) of occurance and location (ex. clinic, doctor’s office, hospital, or nursing home), and as accurate of detail as possible.
- If any other doctors treated the patient before or after the incident, include the names of these providers.
After the complaint is filed, the Oregon Medical board will notify the person filing the complaint as to whether or not an investigation into the healthcare worker and incident will be opened.
What is the Obligation of the Oregon Medical Board?
When a complaint has been made to the Oregon Medical Board, the only obligation the board has is to inform the person making the complaint of receipt and whether or not an investigation is pursuant. If The Board decides to undertake an investigation, the investigative process and results are both confidential, with one exception. If The Board takes formal disciplinary action against the healthcare provider, then that formal discipline is a matter of public record. But, far more common than formal disciplinary action is an informal corrective process, which remains confidential. The Oregon Medical Board does not have an obligation to investigate every complaint filed against a healthcare worker, instead it uses its discretion, taking into consideration the frequency and nature of incidents brought to its attention.
The Board prioritizes investigations concerning gross negligence, repeated acts of negligence, and sexual misconduct with a patient. These concerns directly oppose the Medical Practice Act. Needless to say, concerns about financial issues or about the conduct of the office staff must be dealt with by the provider themselves, and would not be investigated by The Board because they are not often violations of state law.
Worth noting, the discretion of The Board relies only on colleague to colleague oversight, this means members of The Board works alongside those they are tasked with overseeing. This has raised questions around the efficacy of The Board by outside parties, including medical malpractice attorneys who are often left to legally pick up the pieces after negligent physicians are not adequately held accountable to the rigors of their profession by the body responsible.
What Are the Possible Outcomes of Investigations?
During the course of an investigation, evidence will be used to determine the appropriate outcome. If the investigation fails to find evidence to further the case against the healthcare worker, the investigation may close with no formal action taken. The lack of evidence of a violation means the healthcare worker will continue to practice as usual.
If the investigation does yield evidence to support the claim, there may still be no formal action taken against the healthcare worker. If no formal action is taken this means there was evidence, but not enough to continue to investigate and a Letter of Concern is issued to the healthcare worker, and they return to practice as usual.
A case with significant evidence to support a complaint may end in a Corrective Action Agreement. In this case, the evidence found against the healthcare worker being investigated was concerning enough to The Board to take action. At this point an agreement is entered into between the The Board and the healthcare worker, in which The Board will allow the healthcare worker to return to practice as usual, but only if they agree to take certain actions or steps. An example of this would be a physician committing to continuing education in areas of concern.
The next step in this process often includes using documentation from one of the first three outcomes. At this point, there is enough evidence for the Board to take disciplinary action via a Stipulated Order. A Stipulated Order means, if the physician wishes to continue to practice, they must follow certain terms and conditions which may include suspension, fines, reprimands, and education.
The most severe disciplinary action that can be taken by the Board is a hearing, followed by disciplinary action. At this point, the disciplinary action could include license suspension or revocation, but not necessarily so.
Complaint and Outcome
The Oregon Medical Board takes on a three pronged role when dealing with complaints against healthcare providers. The first step in the process is to conduct an investigation; the second step is disciplinary action; and the third, rehabilitation. This means that the Oregon Medical Board has full control and oversight of the process. Unpredictably, each case is handled much differently.
Examples of Board Rulings
In 2009, a physician was on call at a hospital when he was alerted to come into work. However, never made it to the hospital; he ended up getting in a fight and spending the night in jail, drunk, instead. When the concern was brought before the Oregon Medical Board, it was found to be a “community ethics issue,” and no further action was taken.
Then, almost ten years later, In March of 2018, The Board encountered the same physician again. This time, the medical licence of the physician was revoked.
The Board published the following allegations on it’s website:
- provided false information on his October 29, 2013 renewal application
- committed unprofessional and dishonorable conduct by submitting a declaration to the Multnomah County Circuit Court, alleging the United States National Guard Office of Complex Investigations (OCX) investigation found the allegations against him unsubstantiated when, in fact, the OCI investigation found they were substantiated
- willfully divulged a professional secret without the patient’s consent, by publicly divulging Patient A ’s private health information
- committed unprofessional and dishonorable conduct
- refused to comply with a Board investigator’s request for documentation
- committed unprofessional and dishonorable conduct by asking witnesses not to cooperate with the Board’s investigation, to impede such investigation
- committed unprofessional and dishonorable conduct by belittling a patient, mocking his colleagues and Board staff, and making public comments (including to a reporter) that detracted from public trust in the medical community
The Board issued the Final Order due to unprofessional or dishonorable conduct. The Order then went on to revoke the physician’s Oregon medical license; and assess a $10,000 civil penalty; as well as the costs of the contested case hearing held in the matter.
This case is an example of how long it can take for meaningful disciplinary action to take place and how varied the outcome can be.
While working as a neurosurgeon in Oregon, yet another physician faced disciplinary action from The Board. A pretrial deposition indicated that he had ceased to perform neurological surgeries after his privileges were revoked at another hospital.
He was issued a Complaint & Notice of Proposed Disciplinary action both in 2014 and 2015 based on possible violation of the Medical Practice Act for “unprofessional or dishonorable conduct and gross or repeated acts of negligence.”
Despite having faced disciplinary action from The Board, he continues to practice medicine and neurosurgery at different facilities. In doing so, he allegedly injured a patient, causing him to suffer from Cauda Equina Syndrome (CES). CES is a serious condition in which the nerve roots at the top of the lumbar spine are compressed and interrupt the normal function of pelvic organs and lower limbs. In serious cases, this syndrome can even result in permanent paralysis of the legs.
This case is a prime example of the accountability and efficacy of The Boards rulings and actions.
The Oregon Medical Board: A Final Analysis
While the intention of medical boards, like the Oregon Medical Board, is to provide accountability to fellow physicians, unfortunately due to the makeup of the regulating body, processes are inefficient at best and outcomes are egregious and dangerous, at worst.
The Oregon Medical Board has at times taken the appropriate actions, but it has also allowed many dangerous and negligent physicians to continue to treat patients far beyond what is safe. Can we say the board is failing to perform its job? Regardless of the reason, the answer seems to be a resounding “yes”.
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