Oklahoma lawmakers are deciding this year who should regulate doctors and their medical licenses: Industry experts or the state’s top elected officials.
Sen. Julie Daniels, R-Bartlesville, is pushing for changes to the state’s medical licensing board. She argues the current structure lacks transparency and accountability, and it gives an unfair, anti-competitive advantage to a small group of people in the state’s medical industry.
She put a bill forward this year that would make several changes to the board’s composition. But opponents argue those changes would give the governor too much power and make the board too political.
As lawmakers consider this bill, the governor’s authority over state agencies remains in flux. Before Gov. Kevin Stitt took office, Oklahoma’s state agencies were mostly governed by independent boards and positions. After several financial scandals, the Legislature voted to give the governor significantly more power over the agencies — for example, hiring and firing power over agency directors. This year, lawmakers are working to claw some of that authority back.
The State Medical Board of Licensure and Supervision determines who in Oklahoma gets a license to practice. It also administers disciplinary actions, such as license revocations.
Members of the board — most of whom are doctors — investigate complaints. Those complaints vary in nature. Some wouldn’t require in-depth medical education or experience in the industry to investigate, such as accusations of sexual abuse or insurance fraud. Others, such as allegations of misdiagnosis, medical malpractice or poor prescribing practices, would require expert knowledge.
Under current law, the governor appoints those doctors using a list of nominees provided by the state’s physician trade group, the Oklahoma State Medical Association. Daniels’ Senate Bill 303 would nix the nominee list and cut OSMA out of the appointment process. It would also allow the Speaker of the House and the Senate President Pro Tempore to appoint one member each. She authored a similar bill last year, and it failed.Senate Bill 303
During SB 303’s committee hearing earlier this month, Daniels said this policy would make the unelected board more accountable.
“It is a separation of powers issue,” Daniels said. “Because the governor is elected and accountable to the people for everything the executive branch does.”
Without direct appointment authority, she said, the governor can’t truly hold the unelected members accountable.
This is one of several bills Daniels has put forward that would shift power away from an independent licensing board and toward the governor. Throughout the hearing, she referenced a report to the Legislature by the agency known as LOFT — the Legislative Office of Fiscal Transparency, a committee that works for lawmakers and conducts audits and reviews for them.
That report, which came out in October 2022, found Oklahoma was one of only five states with licensing boards that are so autonomous. They’re unelected; they have their own staff; they lease their own office space. According to the report, most states have a central licensing agency under the state’s executive branch.
She also said the current structure gives OSMA too much power, and allows it to create an anti-competitive atmosphere in the state. She noted specifically the state’s physicians assistant association is suing the board alleging unfair practices.
Opponents’ concerns
During the hearing, several members raised concerns about the proposal to shift power toward elected officials. Sen. Rob Standridge, R-Norman, said several other agencies and boards use the patronage system, where top-ranking officials like the governor get to have total control over appointments. But, he said, there’s a reason the medical board doesn’t operate that way.
“Intentionally, our founders and those that followed set up these boards to get away from patronage — to put these boards in the hands of the experts in these various fields,” he said.
Dr. David Holden is the president of the Oklahoma State Medical Association. He said it’s important to have a diversity of experience on the board. Under current law, four of the 11 members are not doctors.
“But being a physician is a unique experience,” he said. “When decisions are made regarding a medical practice, it’s vital to have somebody with a professional viewpoint that understands the intricacies of that decision… A physician can offer professional perspectives on a situation that they’re reviewing that other professionals can’t.”
He also said that a governor likely isn’t embedded in the medical community.
“Associations, like the Oklahoma State Medical Association, are familiar with physicians in the organization — and even those who aren’t,” he said. “It can offer perspectives on who would be qualified to do it [sit on the board], who is willing to do it. And have they demonstrated, in their practice, a dedication to improving their profession and the health of their area?”
He said without the list, the burden of finding those people would fall on the governor’s staff.
Like Standridge, Holden said Daniels’ bill would shift the board to a patronage system.
“Then these just become political appointees,” he said. “Literally, that’s all they are. That doesn’t serve the state. It doesn’t serve the people of Oklahoma. And it doesn’t serve the practice of medicine.”
Governor’s authority in flux
In 2018, before Stitt was elected, the Legislature began consolidating power into the governor’s office.
The idea: Oklahonma’s executive branch needed to operate more like a business, and the governor needed to operate more like a CEO. Similar to Daniels’ argument about the medical board, supporters said that the move would make agencies more accountable to the people because it would shift power to an elected official, who voters can replace if they’re unhappy. Until then, several departments — including the Department of Tourism and Recreation and the Oklahoma Health Care Authority — operated under independent governing boards.
But after several major scandals in the agencies overseeing tourism and health care, lawmakers are considering giving those boards authority again.
In 2022, law enforcement began investigating the state’s tourism department over a nearly $17 million deal with a local barbecue restaurant chain after accusations of mismanagement.
Senate Appropriations Chair Roger Thompson, R-Okemah, filed Senate Bill 4 late last year. It would rescind the Governor’s authority to hire the Tourism and Recreation Department’s director, and would reinstate the agency’s governing board. SB 4 passed out of committee in early February and is waiting on a floor vote.
Swadley’s Bar-B-Q entered into an exclusive contract in March 2020 with the state Department of Tourism and Recreation to provide restaurants at five state parks, according to a release by Attorney General Gentner Drummond’s office. The state canceled its contract with Swadley’s in April 2022 following allegations of fraudulent activity and improper bidding practices. During the same month, Tourism and Recreation Director Jerry Winchester resigned from the agency and the state filed suit against Swadley’s for breach of contract. In all, Swadley’s received $16.7 million from the state to renovate and operate restaurants at selected state parks.
Another lawmaker filed a bill that would revoke some of the governor’s new power over the Oklahoma Health Care Authority, which manages the state’s Medicaid program, SoonerCare. Under Stitt, the agency is working to fundamentally transform how Medicaid works in the state, bringing in private health insurance companies to oversee residents’ coverage. The multi-billion dollar proposal has been controversial, and it has garnered heavy criticism from the state’s medical industry.
In 2021, Stitt sparked some outrage when he fired the only two doctors on the Health Care Authority’s advisory board. Democratic lawmakers argued that the Legislature should limit the governor’s power over the board, and Rep. Monroe Nichols, D-Oklahom authored a bill to do so, but it failed. House Bill 2971 didn’t get a committee hearing before the Legislature’s deadline this month.
There have been no pushes to give the Oklahoma State Department of Health’s advisory board its power back, but the department has been mired in several multi-million dollar scandals under the Stitt Administration.
The legal fight with physicians assistants
Daniels argues the current structure unduly empowers people who are in good standing with OSMA and props up the status quo.
“The unelected members of boards and commissions are taking action for which the governor cannot be accountable, and for which, I think, lead to situations where we have today, the physicians assistants academy suing the physicians supervisory licensure board,” she said.
Last month, the Oklahoma Academy of Physicians Assistants submitted a petition to the state’s supreme court, asking it to change some regulations the board put on physicians assistants and their prescribing practice.
That lawsuit hinges on the power to prescribe controlled substances like hydrocodone, fentanyl and methadone. Attorneys for the medical board argue state law allows PAs to prescribe the drugs for “on site” use only — for example, a morphine drip at a hospital. The medical board is charged with regulating PA prescription practices because PAs are writing those prescriptions under a physician’s supervision.
Attorneys for the academy argue a 2022 bill altered that prescription authority to allow PAs to write prescriptions for take-home medications, but the medical board argues that’s a misreading of the law.
The attorneys for the academy of physicians assistants say SB 1322, which passed last year, updated that authority.
During the bill’s Senate Committee hearing, author Sen. Adam Pugh said the bill allows physicians assistants to sign death certificates, but that it does not affect which medications they can prescribe.
“This does not change any of their prescriptive authority, so they would still be operating within their agreement they have with their [supervising] physician” he said in recording of the hearing on Feb. 9, 2022.
Daniels said during the hearing the medical board is inappropriately barring the physicians assistants from prescribing those drugs.
The State Supreme Court hasn’t announced whether it will hear the lawsuit.
Senate Bill 303 passed out of the chamber’s health committee on February 16, but it had its title stricken. That means it’s still in a draft process and could change some.
