PORTLAND, Oregon — The Oregon Medical Board should make systematic changes to consistently and equitably discipline health care professionals in order to protect patients, according to an Oregon Secretary of State audit released on Wednesday.
The agency has formal policies and procedures in place to investigate medical complaints, but its current process for comparing disciplinary decisions is "generally informal and intermittent," the audit states. Auditors also said OMB's current data system doesn't allow the agency to easily analyze its decisions to discipline health care professionals.
"While OMB has done qualitative reviews to try to ensure consistency, the database hinders OMB's ability to conduct routine, systematic data analysis to help assure the public and licensees that similar cases result in consistent and equitable disciplinary outcomes," the audit said.
Olivia Recheked, audit manager for the Oregon Audits Division, said the OMB relied on recall to make comparative decisions.
"We had found that sometimes when they’re making decisions, they’re looking for similar cases by memory - the medical board managers or staff would remember similar cases and then propose those for the board to look into to inform decisions, there was no systematic process or structure in place" Recheked said. "Right now the board cannot readily assure the public that their decision-making is equitable and consistent."
The medical board is entrusted with protecting patients while licensing and overseeing different groups of health care professionals in the state. One of its key roles is to investigate complaints against licensees, conduct investigations when there's a potential violation of Oregon's Medical Practice Act, and impose disciplinary action. The agency receives about 700 to 800 complaints each year, according to the audit.
"When we looked at other states we found out a lot of them had more formal policies in place to ensure that when you have cases that are similar, you’re coming out with similar disciplinary decisions on those," said Steven Winn, principal auditor.
The report urged the board to do more to protect patients and maintain public trust, including implementing better disciplinary guidelines and routinely analyzing its disciplinary decisions for equity and consistency, the audit states.
"If licensees are disciplined inconsistently or inequitably, especially as the result of racial bias or discrimination, it can have the effect of limiting the representation of people of color in medical professions," the audit states. "This can contribute to continued disparities in medical treatment and health outcomes for these communities."
"The OMB is committed to consistent and equitable outcomes in our investigations," OMB Executive Director Nicole Krishnaswami wrote in a letter responding to the audit. "We agree with the report's findings and the four recommendations which directly align with the OMB's mission and values."
Oregon Secretary of State LaVonne Griffin-Valade released a statement.
"Oregonians count on state government to regulate health care professionals in a manner that’s fair and equitable," Griffin-Valade said. "Much like the Oregon Medical Board, our office is committed to seeing state government protect public health and maintain trust."
The audit comes months after a KGW investigative documentary, Sick Medicine, examined what happens when state medical boards fail to stop doctors accused of significant wrongdoing from practicing medicine. The documentary uncovered cases where doctors were allowed to continue practicing medicine even after being credibly accused of serious misconduct, including sexual abuse or gross negligence that lead to the death of a patient.
In some cases, doctors escaped their troubled pasts by simply moving states and continuing to practice medicine. KGW analyzed OMB records and found that of the 144 medical professionals disciplined in the state between 2012 and 2022, 28 of them went on to practice medicine in another state.
Over the course of the investigation, KGW requested an interview with the OMB and contacted each member individually. The OMB declined an interview.