In 1996, the Washington Department of Health charged Paula Bickle with practicing medicine without a license in connecion with the Cascade Park Health Group, which she owned and operated. Bickle, who originally was trained as a dental hygienist, was licensed to practice as a health assistant, which meant she could carry out certain tasks under the direction of a licensed physician. The records state that she had independently diagnosed and treated patients and submitted insurance forms under the name of a supervising physician who had not actually seen the patients on the relevant dates. In 1998, she settled the charges with an agreement under which she was assessed $5,000 and could provide various types of nutritional counseling but could not diagnose or prescribe treatment for any disease. In 1999, the Oregon Attorney General secured a stipulated judgment similar to the one in Washington. During the following year, however, state investigators concluded that she had continued to illegally diagnose, prescribe for patients, and even administered intravenous treatment (chelation therapy) without a physician on the premises. In 2000, Bickle agreed to stop these practices, pay a $7,500 penalty, and refrain from owning or managing any facility at which persons engage in the practice of medicine. She appears to have stopped seeing patients but now gives similar advice through Internet broadcasts that promote dietary supplements that she sells.
This Court has found that Plaintiff State of Oregon, acting by and through the Board of Medical Examiners (BME, hereafter) and represented by Assistant Attorneys General Daniel H. Rosenhouse and Warren G. Foote and Defendant Paula Bickle, pro se, stipulate and agree to the following:
1. The parties entered into a Stipulated Judgement and Decree (hereinafter "Decree") that was entered by this Court on April 29, 1999, in which certain conditions were imposed on the Defendant. Defendant consented to ongoing monitoring by the BME. The provisions of the Decree were specified to be enforceable via contempt proceedings and by other means allowed by law. The Decree of April 29, 1999 remains in full force and effect except to the extent it is inconsistent with the terms set out herein.
2. Defendant acknowledges,that she has been served with a motion to appear and show cause why she should not be held in contempt of court for violating the terms of the above-described Decree. In lieu of Defendant appearing before the Court pursuant to the motion to appear and show cause, Defendant admits to the following findings:
a. Defendant violated section 12(b)(2)
of the Decree by continuing to act
under the authority of a Medical Director who had terminated employment at Cascade Health Group.
b. Defendant violated section 12(b)(6) of the Decree by diagnosing, prescribing, and altering a course of treatment for disease or other physical conditions requiring a medical diagnosis.
c. Defendant violated section 12(b )(7) by undertaking invasive treatment of patients, by administering intravenous treatment (IV, hereafter) when a Medical Director, or other physician, was not on the premises throughout the time of treatment.
d. Defendant violated section 7 of the Decree by failing to notify the BME's Investigation Committee (hereafter Ie) in writing of changes in the identity and/or qualifications of her Medical Director.
Based upon the foregoing findings of violations and the stipulation of the parties,
IT IS HEREBY ORDERED AND DECREED as follows:
1. Defendant specifically consents to the continued jurisdiction and venue of this Circuit Court under this Stipulated Order and Supplemental Judgment and Decree (referred to as the Supplemental Decree, hereafter) for as long as the Supplemental Decree is in effect under Oregon law.
2. In addition to enforcement of this Supplemental Decree by a motion for contempt and other procedures allowed by law, Defendant is subject to ongoing monitoring by the BME, to be conducted at the sole discretion of the BME. The BME may conduct such monitoring through its Investigating Committee (IC) or otherwise, in order to ensure compliance with the te~s of this Supplemental Decree. The BME will conduct its monitoring so that it does not notify Defendant's employer of the monitoring, except that it may notify the employer if Defendant's employment is in a health-care or clinical setting.
3. Except as may be necessary to enforce her legal rights under a contract of sale, Defendant shall have no ownership or management interest in Cascade Health Group if it is open to treat patients or otherwise transact business.
4. Defendant will not manage, nor shall she maintain or acquire any ownership interest in, a facility, clinic, or other business at which persons engage in the practice of medicine. But this Paragraph 4 does not prohibit the Defendant from owning shares of stock in such a business that is publicly traded on a regulated stock exchange such as NASDAQ or the New York Stock Exchange, so long as Defendant's ownership interest consists of less than one-half of one percent of the outstanding stock. This Paragraph 4 also does not prohibit Defendant from being employed to do solely administrative work at such a business in which persons engage in the practice of medicine.
5. Within the State of Oregon, Defendant may not: Make entries upon a medical patient's chart; Diagnose, treat, or have hands-on contact with a client for the purpose of making a diagnosis or providing treatment; Draw blood; Administer IV treatment; Perform injections on humans or; Otherwise engage in the practice of medicine. Such practice is prohibited, whether it is in person, via the internet or via other forms of communication, including telecommunications. The "practice of medicine" is defined in Paragraph 3 of the Decree and may be otherwise defined under Oregon law. This Paragraph 5 does not prohibit the defendant from providing dietary advice, nutrition education, and information on weight-loss. It also does not prohibit the Defendant from doing work in accordance with any licensing she may have as a dental hygienist, so long as such work is d9ne in compliance with the terms of such license.
6. Respecting the requirements of Paragraph 8 of the Decree, Defendant's notification shall also include the complete name, address, and telephone number of Defendant's employer or place of business.
7. Defendant shall immediately inform the IC in writing of any research programs or research projects in which she participates, including those in the field of human nutrition. All research protocols involving human subjects shall be provided to the B:ME prior to the beginning of any such program or project, or if such notice is impossible, then within 7 days thereafter.
8. Defendant shall inform the B:ME of any internet web sites of which she is aware relating to nutrition or heavy metal toxicity that she operates or in which she participates, immediately upon commencing such operation or participation.
9. Defendant shall immediately report to the IC any party, including name, telephone number and address, to whom she provides any consultation in the field of heavy metal toxicity. Notwithstanding the preceding sentence, Defendant need not report any consultation consisting solely of referral to a physician. She also need not report a consultation with a physician. And she also need not report conversations of a general nature in which she is neither given information about the condition of a particular person, nor does she make a diagnosis or any recommendation for treatment for any medical or health condition.
10. Paragraph 13 of the Decree is amended to provide that its terms shall apply for as long as this Supplemental Decree is effective under Oregon law. But the requirements in Paragraphs 4, 6, 8 and 9 of this Supplemental Decree expire 66 months from the date of entry of this Supplemental Decree unless the B1.1E or its representatives discover the violation of any provision in either decree and give notice of such violation to the Defendant prior to the expiration of such 66 months.
11. Defendant shall pay all future costs of complying with this Supplemental Decree, including all reasonable costs of the BME associated with the audits provided for herein. But Defendant is not liable for costs of the BME associated with audits of employment in settings where persons do not engage in the practice of medicine.
12. The activities set forth in this Paragraph 12 do not per se, constitute any violation of the Decree or Supplemental Decree. But such activities are violations if done in conjunction with activities prohibited in the Decree or elsewhere in the Supplemental Decree:
a) Assessing the nutritional needs of clients and advising them on appropriate nutritional intake.
b) Engaging in business development.
c) Conducting research as a research investigator.
d) Practicing as a dental hygienist.
e) Writing books or articles.
f) Conducting seminars or presenting classes, either in person or via audio or video presentation, telecommunications, including the internet.
g) Consulting with a physician.
h) Dental compatibility studies done at the request of a licensed dentist, where the results of the study are transmitted only to the dentist.
i) Being employed by a physician or health care facility, provided that Defendant presents a copy of this Supplemental Decree to her employer no later than her first day on the job.
13. All communications to the Board of Medical Examiners required by this Supplemental Decree shall be made, unless alternative means are given by Plaintiff to Defendant in writing, and all communications to the Defendant, unless alternative means are given by Defendant to Plaintiff in writing, to the following addresses, faxes or telephone numbers: .
To the BME --
Board of Medical Examiners
1500 SW 1st Street, Suite 620
Portland, Oregon 97201-5826
Phone (503) 229-5770
To the Defendant
17840 Wolf Drive
Sandy, OR 97005
Phone (503) 668-8325
14. All references herein to the BME or IC apply equally to any successor entity.
15. Judgment is granted to Plaintiff and against Defendant in the amount of$5,000 as a fine and $2500 in costs. This provision supersedes Paragraph 16 of the Decree.