Singha v. North Dakota State Bd. of Medical Examiners

• Decision Date: 23 February 1998
• Docket Number: No. 970264,970264
• Citation: 574 N.W.2d 838
• Parties: Ebenezer M. SINGHA, Appellant, v. NORTH DAKOTA STATE BOARD OF MEDICAL EXAMINERS, and Rolf Sletten, Executive Secretary and Treasurer of the North Dakota Board of Medical Examiners, Appellees Civil
• Court: North Dakota Supreme Court

Page 838

574 N.W.2d 838

1998 ND 42

Ebenezer M. SINGHA, Appellant, v. NORTH DAKOTA STATE BOARD OF MEDICAL EXAMINERS, and Rolf Sletten, Executive Secretary and Treasurer of the North Dakota Board of Medical Examiners, Appellees

Civil No. 970264.

Supreme Court of North Dakota.

Feb. 23, 1998.

Roger R. Sundling (argued) and Alvin O. Boucher (argued), of Robert Vogel Law Office, Grand Forks, for appellant.

John M. Olson (argued), of Olson Cichy, Bismarck, for appellees.

MARING, Justice.

¶1 Ebenezer M. Singha appealed a judgment affirming an order by the North Dakota State Board of Medical Examiners denying his application for a license to practice medicine in North Dakota. Thereafter, he moved this court to supplement the record under N.D.R.App.P 27. We deny the motion to supplement the record. We hold N.D.C.C. § 43-17-18(3) requires a foreign-educated applicant for a license to practice medicine to demonstrate the kinds of courses taken at a foreign educational institution, when combined with the successful completion of three years of Board-approved postgraduate training, are substantially equivalent to the kinds of courses required at a reputable medical or osteopathic college in the United States and the successful completion of one year of Board-approved postgraduate training. We also hold the procedures of the Administrative Agencies Practice Act, N.D.C.C. Ch. 28-32, apply to the Board's consideration of an application for licensure. We reverse and remand for further proceedings.

I

¶2 Singha, a 1990 graduate with a "diploma in osteopathy" from the British School of Osteopathy (B.S.O.), applied to the Board in April 1995 for a license to practice medicine. As relevant to Singha's application, N.D.C.C. § 43-17-18(3) outlines certain requirements for licensure "[i]f the applicant is a graduate of a medical or osteopathic college that has not been approved by the board or accredited by an accrediting body approved by the board at the time the degree or its equivalent was conferred." The B.S.O. was not approved by the Board and was not accredited by an accrediting body approved by the Board when Singha received his diploma in osteopathy, and the essence of this case is whether Singha qualified for licensure under the educational requirements of N.D.C.C. § 43-17-18(3).

¶3 While attending the B.S.O., Singha received additional clinical training at hospitals in Pennsylvania, and he self-studied pharmacology and biochemistry. In 1991, Singha was accepted in a family practice residency program at the University of North Dakota Medical School. In 1991 and 1993, the Board assisted Singha in sitting as a courtesy candidate for a Federal Licensing Examination (F.L.E.X.) administered in Ohio. Singha successfully completed the F.L.E.X. in 1993, and in September 1995, he successfully completed the three-year family practice residency program at UND.

¶4 Since 1990, Singha had corresponded with the Board about the requirements for licensure in North Dakota, and the Board had never questioned his education at the B.S.O. until May 1995, when Rolf Sletten, the Board's executive secretary and treasurer, first raised a question in a letter to Dr. William Mann, the program director for the UND family practice residency program:

In your letter you refer to this resident as "Ebenezer Singha, M.D." and as "Dr. Singha". On the other hand, the American Osteopathic Association has recently advised us that: (1) the British School of Osteopathy is not approved by the AOA; (2) the curriculum taught in British osteopathic schools differs considerably from the curriculum taught in U.S. osteopathic schools; (3) graduates of British osteopathic schools do not train in surgery or write prescriptions; (4) British educated osteopaths are considered equivalent to physical therapists or chiropractors, and; (5) graduates of British osteopathic schools are properly addressed as "Mr. (or Ms.)" and not as "Doctor".

Point No. 5 appears to be supported by correspondence from the British School of Osteopathy. We have been provided with a copy of a letter written by M.E. Large, the registrar of that school, on November 12, 1990. Mr. Large states that "At Mr. Singha's request, I am writing to confirm the grades which he was awarded during the 4-year Diploma in Osteopathy course".

I note that in your letter you state that multiple faculty have looked over Dr. Singha's academic file. I am wondering if you can shed any additional light on this situation.

¶5 In July 1995, Singha appeared before the Board regarding his application. The minutes of the Board's meeting reflect:

Mr. Singha was admitted to the meeting room and was questioned by each of the Board members. This questioning was focused essentially on Mr. Singha's education at the British School of Osteopathy. Dr. Kempf asked Mr. Singha if he had advised the appropriate people at UND that his training had not been approved. Mr. Singha said that he had not. Dr. Morris asked Mr. Singha whether he held a degree which entitled him to be addressed as "doctor". Mr. Singha said that he does not. Dr. Rinn asked Mr. Singha if he was eligible for an osteopathic residency in the U.S. Mr. Singha said that he is not. Dr. Rinn asked Mr. Singha if the British School of Osteopathy teaches courses in patient care, surgery, pharmacology, and biochemistry. Mr. Singha said that it does not. Dr. Wolff asked Mr. Singha if he knows of any other graduate of the British School of Osteopathy who is practicing medicine in the United States. Mr. Singha said that he does not.

After further discussion, the Board tabled Singha's application until its November 1995 meeting and directed staff to request a formal " 'position statement' " from the A.O.A. regarding the B.S.O.; to ask the A.O.A. about alternative pathways for Singha's eligibility for licensure; to solicit a statement and any suggestions from the B.S.O.; and to ask the UND School of Medicine how Singha had been proctored and preceptored during his residency training.

¶6 In November 1995, the Board again considered Singha's application. The minutes of the Board's meeting state:

Mr. Sletten pointed out that all of those [requested] items had since been made available to the Board. He also noted that William S. Mann, M.D., had requested permission to appear before the Board on Mr. Singha's behalf.

Dr. Mann was admitted to the meeting room and was heard. Dr. Mann stated, among other things, that when Mr. Singha was permitted to write the FLEX as a courtesy candidate for North Dakota, he took that authorization as an indication that he had met the requirements for licensure. Following that presentation, the various aspects of Mr. Singha's application were discussed once again. (The most recent letter from the British School of Osteopathy was particularly noted.) ... Dr. Wolff moved that the application for licensure submitted by Ebenezer Singha be denied for the reason that Mr. Singha had not graduated from a school which qualified him for licensure. Dr. Kempf seconded that motion and a roll call vote was taken. The motion passed by a vote of 7 to 3.

On November 28, 1995, the Board issued a written order denying Singha's application, because he had "not met the educational requirements for licensure in that he does not possess a degree of doctor of medicine or doctor of osteopathy."

¶7 In December 1995, Singha's counsel requested "an official letter granting Dr. Singha's request for an appeal to the Board of its November decision." The Board treated Singha's request as a petition for reconsideration under N.D.C.C. § 28-32-14 and granted him a "limited hearing" to consider additional information pertaining to his degree from the B.S.O.

¶8 At a March 1996 meeting, the Board again considered Singha's application. The minutes of the Board's meeting provide:

[Singha's counsel] made a presentation to the Board on his behalf. After this presentation, [Singha's counsel] and the members of the Board discussed Mr. Singha's application, his education and his postgraduate training and reviewed the correspondence from Thomas F. Armour, II, D.O., correspondence from the British School of Osteopathy, correspondence and communications from the American Osteopathic Association, and correspondence from the University of North Dakota Medical School and the University of North Dakota Family Practice Residency Program. The Board devoted a considerable period of time to discussing Mr. Singha's application once again.

The Board thereafter moved to reconsider Singha's application "if [he] could procure a statement from the University of North Dakota Medical School or the AOA indicating that the education he had received at the British School of Osteopathy was substantially equivalent to the education he would have received at a medical or osteopathic school in the United States."

¶9 In May 1996, the Dean of the UND School of Medicine wrote the Board on Singha's behalf:

Based on our rather extensive observation and testing of Dr. Singha in the context of the residency program and the fact that he has passed the FLEX examinations (one measure of a candidate's knowledge of the basic and clinical sciences and of cognitive abilities required by a physician assuming independent responsibility for medical care), it appears that he has acquired through the totality of his training, a background that makes him comparable to physicians who have successfully completed our medical curriculum and our family practice residency program.

¶10 During a June 1996 conference call, the Board again discussed Singha's application, but refused to grant his application for licensure. In July 1996, Singha petitioned the Board for reconsideration and requested permission for Dr. Thomas Armour, an osteopathic physician who had preceptored Singha in Pennsylvania, to appear before the Board and discuss Singha's qualifications. In a previous letter to the Board, Dr. Armour indicated Singha's education was...