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Oregon Medical Board should improve equity in doctor discipline, audit says

Medical board leadership agreed with recommendations to expand use of disciplinary guidelines and regular reviews to combat racism and ensure consistency
January 24, 2024

The Oregon Medical Board will improve its data system and disciplinary guidelines after state auditors recommended changes to ensure consistency and equity in how doctors are disciplined.

The medical board sets rules and investigates about 700 to 800 complaints a year filed against doctors, physician assistants, acupuncturists and podiatric physicians — a group of more than 25,000 licensees. 

A new audit released by the Oregon Secretary of State on Jan. 24 found that Oregon’s process is “generally informal and intermittent” in how it compares previous disciplinary outcomes to pending cases. Auditors looked at how other states, such as California and Washington, handle discipline and recommended Oregon follow suit. Specifically, other states use sanctioning guidelines or a disciplinary matrix to help make sure doctors are treated similarly for similar violations.

The push to ensure consistency could help combat racism, which the Centers for Disease Control declared a serious public health threat in 2021, according to the report. The CDC cited both interpersonal and structural racism, including in health care. Such racism can limit representation of people of color in medical professions, contributing to “continued disparities in medical treatment and health outcomes for communities of color,” the audit noted.

The 42-member medical board staff has been implementing changes to better combat disparities, including limited use of sanctioning guidelines, according to the report. But some changes are not happening as quickly as hoped, and the agency could do more, auditors found. They also recommended the agency modify its plans for a new data system to better capture details to allow regular, systematic reviews to ensure equity and consistency.

 Auditors tried doing their own review and found it challenging and of limited value due to the limited data available, according to the report. “Auditors reviewed a targeted selection of 28 case files that appeared similar in nature, or which included serious allegations. While no substantial discrepancies were found in these cases, the difficulty of identifying cases with similar complaint types in the data limited the number of cases auditors could realistically review and impaired the usefulness of both the analysis and any conclusions that could be drawn from it.”

Nicole Krishnaswami, executive director of the board, wrote in her formal response that the medical board appreciated the auditors’ work and agreed with the report’s recommendations.

But she struck a note of caution that using guidelines or a matrix can “actually result in inequitable outcomes ... The OMB will aim to write guidelines that attempt to control for inherent, systemic biases so that they do not result in disparate outcomes for historically disadvantaged licensees. The guidelines will be used as internal advisory communications to support board members in their deliberations, and the board will retain discretion to craft an appropriate resolution in each unique case – ranging from closure with no discipline to license revocation – after carefully considering each investigation’s specific circumstances.”

Secretary of State LaVonne Griffin-Valade issued a statement with the audit: “Oregonians count on state government to regulate health care professionals in a manner that’s fair and equitable. Much like the Oregon Medical Board, our office is committed to seeing state government protect public health and maintain trust.”

You can reach Nick Budnick at [email protected] or at @NickBudnick on