Saddoris v. Colorado State Bd. of Medical Examiners, 89CA0486
| Decision Date | 05 July 1990 |
| Docket Number | No. 89CA0486,89CA0486 |
| Citation | 802 P.2d 1136 |
| Parties | Theodora SADDORIS, M.D., and John L. Nieters, M.D., Petitioners-Appellants, v. COLORADO STATE BOARD OF MEDICAL EXAMINERS, Respondent-Appellee. . IV |
| Court | Colorado Court of Appeals |
Yu, Stromberg & Huotari, P.C., Frederick Y. Yu, Denver, for petitioners-appellants.
Duane Woodard, Atty. Gen., Charles B. Howe, Chief Deputy Atty. Gen., Richard H. Forman, Sol. Gen., James F. Carr, Kathie A. Clinton, Asst. Attys. Gen., Denver, for respondent-appellee.
Opinion by Judge TURSI.
Petitioners, Theodora Saddoris, M.D. and John L. Nieters, M.D., appeal the decision of the respondent, Colorado State Board of Medical Examiners (Board), denying their applications for licenses to practice medicine in Colorado solely on the basis that they were foreign medical school graduates whose medical school had not been approved to the satisfaction of the Board. We reverse and remand.
Plaintiffs are both licensed practicing physicians who graduated from the American University of the Caribbean (AUC) Medical School in Montserrat, British West Indies. In January 1987, they both submitted applications to be licensed to practice medicine in Colorado.
In April 1987, the Board initially denied their applications for medical licensure upon the ground that:
"[T]he Board possessed insufficient information to conclude that AUC Medical School conforms to the minimum education requirements established by the [Liaison Committee on Medical Education] or otherwise qualifies as an approved medical school, as required by Colorado statute and rules."
After reconsideration, this decision was confirmed on October 8, 1987.
Plaintiffs then timely requested and received a hearing before an administrative law judge (ALJ). The ALJ received evidence, heard testimony, and determined that, except for the lack of proof concerning the qualifications of AUC medical school, both plaintiffs had satisfied all the licensure requirements imposed on foreign medical school graduates and were otherwise qualified to receive a license to practice medicine in the state of Colorado.
It noted that, as stipulated by the parties, Saddoris had received her M.D. degree from AUC in January 1982. She had taken and passed all necessary examinations, including the Educational Commission for Foreign Medical Graduates (ECFMG) examination and the Federal Licensing Examination (FLEX). She had also served three years in an accredited residency program in internal medical at Deaconess Hospital in St. Louis, Missouri, and had become a certified diplomate of the American Board of Internal Medicine. Further, at the time of her application, she was licensed as a physician in the states of New Jersey, Missouri, and Indiana, where she was actively engaged in the practice of internal medicine.
Nieters was similarly qualified. He had received his M.D. degree from AUC in January 1983. He, too, had taken and passed all necessary examinations including the ECFMG and FLEX examinations. He also had completed over two years of an accredited post-graduate residency at Rutgers Medical School in New Jersey in the field of psychiatry. And, at the time of his application, was in the process of completing a second post-graduate residency in family practice at the Indiana University School of Medicine. He is licensed as a physician in the states of Missouri and Indiana.
Notwithstanding that the plaintiffs had "impressive credentials"; that they had satisfied the other requirements for licensure; that the Board had consistently licensed applicants from other foreign medical schools which do not meet LCME standards; and that "no student could possibly provide sufficient information to establish LCME accreditation," the ALJ concluded that she could not overlook or ignore the requirement in § 12-36-107(2), C.R.S. (1985 Repl.Vol. 5) that:
"No person shall be granted a license to practice medicine ... unless he is ... a graduate of an approved medical college, as defined in § 12-36-108...."
Since the plaintiffs had not met their "enormous burden" of proving that they graduated from an "approved medical college," the ALJ decided that their applications for licenses for practice medicine in Colorado had to be denied.
On January 19, 1989, the Board reviewed the ALJ's decision and considered the exceptions filed thereto. On February 10, 1989, it unanimously entered its final order which accepted the ALJ's decision and denied the plaintiffs' licenses to practice medicine in Colorado.
Plaintiffs argue that the Board and the ALJ erred in denying them licensure solely on the basis that AUC medical school did not meet the definition of an "approved medical college" pursuant to § 12-36-107(2) and § 12-36-108, C.R.S. (1985 Repl.Vol. 5). They maintain that the academic requirement of these sections does not apply to them since they were foreign medical school graduates and were only required to meet the standards set forth in 3 Code Colo.Reg. 713-3 pursuant to § 12-36-107.6, C.R.S. (1985 Repl.Vol. 5). Consequently, they assert that the Board erred in denying their applications for licensure upon this basis. We agree.
As noted by the ALJ, the crux of this dispute is determining which licensure requirements apply to plaintiffs' applications. Initially, both the plaintiffs and the Board agree that the plaintiffs' eligibility for licensure is governed by the "standards and procedures for the licensing of graduates from medical colleges ... outside the United States" as set forth in 3 Code Colo.Reg. 713-3 (effective November 30, 1983) and authorized by § 12-36-107.6.
These rules and regulations, as applicable to plaintiffs when they applied, provide:
"An applicant who has studied medicine at a medical college or school located outside the United States or Canada and who is not eligible for licensure pursuant to the Fifth Pathway Program as set forth in C.R.S.1973, 12-36-107.5, or pursuant to C.R.S. 12-36-107(1)(d), may be eligible for licensure for the practice of medicine if he:
1. Satisfactorily completes the examination of the Educational Commission for Foreign Medical Graduates; and
2. Submits evidence satisfactory to the Board that the Medical School from which the applicant graduated:
a. is approved by the Liaison Committee on Medical Education (LCME, a joint committee of the Association of American Medical Colleges, and the Council on Medical Education of the American Medical Association) or the American Osteopathic Association (AOA), or
b. conforms to the minimum educational standards established by the LCME or AOA, as determined by the Board.
....
c. The Board may approve a school based on its own investigation of the educational standards and facilities.
....
3. Satisfactorily completes two years of approved post-graduate training as defined in C.R.S.1973, 12-36-109 or 110; and
4. Satisfactorily completes the examinations required in C.R.S.1973, 12-36-107 of all applicants for licensure; and
5. Otherwise meets qualifications for licensure statutorily required for all applicants." (emphasis supplied)
Requirement "2" of this rule, which was added as an amendment in 1983, refers to the LCME and purportedly incorporates the minimum educational standards established by the LCME. The Board's reliance upon the LCME and its standards, however, is plainly deficient in this case.
The LCME approval requirement referred to in "2.a" cannot be used to deny licensure to plaintiffs. LCME does not accredit medical schools outside the United States and Canada. Moreover, according to the Board's own expert, the LCME accreditation standards were not adopted with the intent that they would apply to schools outside the United States and Canada.
Since AUC is a medical school located outside the United States and Canada, the LCME does not evaluate it. Accordingly, approval by the LCME is an impossibility and a fiction which could not have been intended to apply to foreign medical schools such as AUC. Hence, we conclude that requirement "2.a" cannot reasonably be applied against plaintiffs. Cf. § 24-4-104(2), C.R.S. (1988 Repl.Vol. 10A) (); Chenoweth v. State Board of Medical Examiners, 57 Colo. 74, 141 P. 132 (1913) ().
The Board has also inadequately incorporated the LCME standards and may not rely upon requirement "2.b" since it has failed, as required by § 24-4-103(12.5), C.R.S. (1988 Repl.Vol. 10A), to identify the LCME's standards by their correct title or by any date; to state that the rule does not include later amendments to the LCME; to maintain certified copies of any LCME standards; to make available to the public the applicable version of the LCME standards; or to specify the title and address of a Board employee responsible for providing information about obtaining or examining the LCME's standards. Hence, the sanction set forth in § 24-4-103(10), C.R.S. (1988 Repl.Vol. 10A) must be applied.
Under this statute, "[n]o rule shall be relied upon or cited against a person unless ... it has been made available to the public in accordance with this section." The purpose of this "statutorily imposed rule of evidence" is one of due process, to ensure that a correct current copy of regulations promulgated by administrative agencies will be available to members of the public. See People v. Bobian, 626 P.2d 1132 (Colo.1981).
In this case, therefore, the LCME's standards cannot be cited against plaintiffs, and we must read the regulations, 3 Code Colo.Reg. 713-3, exclusive of the LCME requirements.
The only remaining "approved school" requirement which the Board may rely upon to deny plaintiffs' applications is "2.c." Since, the Board...
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Colorado State Bd. of Medical Examiners v. Saddoris
...delivered the Opinion of the Court. We granted certiorari to consider whether the court of appeals, in Saddoris v. Colorado State Board of Medical Examiners, 802 P.2d 1136 (Colo.App.1990), erred when it held that section 12-36-107 of the Colorado Medical Practice Act, §§ 12-36-101 to -136, ......