All states have a Medical Board that oversees the practice of medicine. In Oregon it is the eponymous Oregon Medical Board and the:

mission of the Oregon Medical Board is to protect the health, safety, and wellbeing of Oregon citizens by regulating the practice of medicine in a manner that promotes access to quality care.

Every quarter the OMB sends out a newsletter that includes Board Actions and there is a monthly Board Action Report. Both are available on the home page of the organization.

see2Sometimes the reasons for the actions are obvious (inappropriate prescribing) and sometimes not so much (unprofessional behavior, whatever that might be). There are over 12,000 physicians in Oregon and but only a handful of actions, but I can find no statistics on their work. It can’t be an easy job to oversee other physicians. The actions induce a queasy curiosity about what it takes to kill a medical career and how ostensibly-bright people can really mess up.

Naturopaths have a similar board, the Board of Naturopathic Medicine. The BNM is a different website than the OMB. With a “Find a Physician (ND)” option as well as an “About Naturopathic Medicine” it as much more of partisan promoter of naturopathy as an oversight organization, despite their vision:

To protect the health, safety and welfare of the public in the matters of care provided by Naturopathic physicians in Oregon.

Which could only realistically be met by dissolving the organization and preventing the practice of naturopathy. But that’s me.

They do mention that their role is to:

… remain neutral as possible when carrying out regulatory functions

Which to my mind runs contrary to the boosterism that permeates the site.

But I wondered. What kind of actions does the Naturopathic Board take in response to practice complaints? The Medical Board, as a rule, is not involved with specific issues of malpractice and poor care. That is left to hospital peer review and the legal system. The Medical Board tends to look at inappropriate opiate prescribing, moral turpitude, and general unfitness to practice. Moral turpitude:

Crimes involving moral turpitude have an inherent quality of baseness, vileness, or depravity with respect to a person’s duty to another or to society in general.

You have to go pretty low to meet that standard and show up in front of the Board, but perhaps not to be the POTUS. The ‘T’ stands for turpitude?

Issues concerning individual patient/standard of care do not appear before the Board, and would not be issue for ND’s anyway as their white paper proudly states:

There is no naturopathic-specific standard of care. Naturopathic doctors are taught and held to the same standards of care as conventional providers.

Um, no. Most “conventional providers” do not offer the breadth of pseudo-medicine that defines the practice of naturopathy and makes their vision just one of the many fantasies of naturopathy. But that is neither here nor there. Just what kind of issues does the board find worthy of intervention with its practitioners?

But first how to find those actions? Transparency and ease of use, at least in comparison to the Medical Board, is not the strong suit of the site.

Unlike the Medical Board, there nothing on the home page.

The “Concern/Complaint” page does not have a search or results link.

If you go to the “Licensee Directory” page and search for a practitioner, you will find a link for a malpractice claim (more a disciplinary action) if you have a specific ND in mind, but who wants to search through every ND to find a handful of actions?

So I sent an email to the Board asking where a summary statement could be found and they directed me to their newsletter. Of course. Just like the Medical Board. So I looked a few.

2016 – Not out yet. Unlike the Medical Board they do not need to publish monthly updates. So we will see if any NDs warranted a Board evaluation in the last year.

2015 – No actions. A good year for Board. No transgressions. Or none reported.

2014 – Six actions. Two unknown, four for inappropriate opiate prescribing.

2013 – No newsletter. Another good year. Or none reported.

2012 – Seven actions. Two for opiate prescribing, one for treating minors, one for a DUI, one for a drug and firearm issue.

2011 – Five actions. One action, I would opine, sets a dangerous precedent for the ND Board. To me it sounds like the reasoning could be applied to most ND practices, since they note the:

continued practice of naturopathic medicine constitutes a serious danger to the health and safety of the public… and (he) did not use conventional, scientific or otherwise established methods to diagnose or treat the patients conditions…(and) presented himself as a medical specialist in diagnosing and treating difficult cases and conditions…

That’s naturopathy in a nutshell. Based on the ND websites, virtually every ND could be reported to the Board using this opinion as the criteria. Given the usual pseudo-medical and pseudo-scientific grounding of standard naturopathic practice, it is hard to imagine how far off the map the practice of this ND must have been for another ND to find it wanting.

One action was for giving HcG at a weight loss clinic without first examining the patients and another for lying on the application about a prior battery and a DUI. The reasons for the rest of the actions are opaque

2010 – Six actions.

At this point I gave up on the specifics as reading these legal documents is not very interesting. But it gave me a flavor for what the board has done, fairly similar to the actions of the medical board, but more difficult to find. Not in the bottom of a locked filing cabinet, stuck in a disused lavatory with a sign on the door saying “Beware of the Leopard hard to find. But not as easy as the OMB.

The Board meets 6 times a year. An outgoing board member notes that by:

…abiding by our statutes and providing appropriate care, we are maintaining a high standard for our profession so that our licenses are respected.

Cases come to the Board when someone has filed a complaint.

That someone can be a patient, family member, pharmacist or other provider.

Our investigator does an investigation and writes a report which DOES NOT INCLUDE THE NAME OF THE DOCTOR. Discussing these reports and deciding what to do makes up the bulk of our meetings.
If you have never been on the Board you will never know: how many cases are dismissed with NO action! [Bold in the original]

With several years with no newsletters, I do idly wonder how many cases HAD an action and I just can’t find them. Is absence of evidence evidence of absence? Color me skeptical.

As part of the Great Legislative Mistake where the Oregon legislature gave NDs the legal designation of primary care providers, they included a peer review committee.

The Oregon Board of Naturopathic Medicine shall appoint a peer review committee consisting of five members. The peer review committee shall evaluate complaints against naturopathic physicians which are referred to it by the board, and make recommendations to the board regarding those complaints. The board exercises ultimate authority and control over all complaints considered by the committee, approving or disapproving the recommendations of the committee.

Senate Bill 22 would remove that provision:

Repeals provision establishing peer review committee for purpose of evaluating complaints against naturopathic physicians and making recommendations to Oregon Board of Naturopathic Medicine about those complaints.

Why this is at the request of Governor Kate Brown for the Board of Naturopathic Medicine I do not know and cannot find out from the site or Google. I am sure there is a perfectly good reason why, I just can’t think of one beyond removing an un-needed extra layer of bureaucracy. Currently an investigator does an investigation and reports to the board where, as I read the bill, an investigator would report to the peer review committee who would then report to the Board.

It kind of makes sense. You have the Board, consisting of 5 ND’s and two members from the public. Add another committee with another 5 ND’s and you get? Nothing plus nothing is still nothing as far as protecting the public is concerned.

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and  the President of the Society for Science-Based Medicine where he blogs under the name sbmsdictator. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His growing multi-media empire can be found at edgydoc.com.