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Caribbean Medical School, Students Sue State Medical Board
Claim Disapproval Status a Violation of RightsThe American University of Antigua College of Medicine and four of its students are suing the Arkansas State Medical Board and its board members, claiming board policies unfairly and unconstitutionally exclude graduates of the school from practicing medicine in Arkansas.
The lawsuit was filed in U.S. District Court for the Eastern District of Arkansas April 27 and assigned to Judge Susan Webber Wright. Two of the students, Amber Milward and Justin Harney, are Arkansans who hope to practice medicine in their home state. New York attorney Leonard Sclafani and the Schults Law Firm of Little Rock are the plaintiffs' lawyers.
AUA is one of 53 medical schools not credentialed by the Arkansas State Medical Board. Of those, two are in Africa, one is in Mexico, and the rest are in the Caribbean and Central America.
Unable to monitor the world's 1,800 medical schools, Arkansas, like several other states, relies on the work done by California, which performs costly site visits. Arkansas blacklists schools California has rejected as well as some that have never applied for admission with California. AUA has applied for credentialing in California but has not yet undergone the rigorous certification process and is not listed as approved or disapproved by the California State Medical Board.
That reliance on California is part of the problem, the plaintiffs claim. They contend that Arkansas violates its own rules by failing to perform its own investigations. Moreover, they claim that Arkansas' policies unconstitutionally deprive graduates of practicing their profession, violating their rights guaranteed by the Fourteenth Amendment.
In an interview, the State Medical Board's attorney, Bill Trice, said the board has followed its own regulations in denying credentials to AUA. Trice said AUA has never approached the board with a formal application and has never asked for an interpretation of its rules.
The Arkansas Medical Practices Acts and Regulations lists a number of criteria for the board to base its credentialing decisions. These are to be "based on but not limited to" a number of factors, including its own staff's investigation as well as information compiled by other states' medical boards.
The college was founded in 2004 by American physicians and educators and was later acquired by Manipal University, a school chartered in India. It has been approved by the state of New York for clinical clerkships and residencies and recognized by the World Health Organization. Most students are Americans who plan to practice in the United States.
According to the lawsuit, the policies discriminate against American students because California's rules include a provision that grants approval to schools owned by a foreign government whose students are predominantly citizens of that government's country. That policy discriminates against the predominantly American students of Caribbean schools, the suit claims.
That is no accident, according to the suit and to attorney Sclafani. The suit accuses the Arkansas State Medical Board of colluding with the American Medical Association, the Liaison Committee on Medical Education, and the American Association of Medical Colleges to limit the number of medical schools and the number of medical seats in the United States. It claims those entities have been working for decades "in order to create and maintain an ever growing critical shortage of medical doctors in the United States, thereby driving up the cost of medical care and services so as to enrich the fortunate few doctors who graduate from schools under the LCME's aegis."
In an interview, Sclafani explained, "The graduates of American medical schools are soaking up all of the plum jobs, and who's the real challenge to that? Well, it's Americans that don't get into American medical schools."
Trice scoffed at that notion, saying, "There's not a global conspiracy against these people." Phone calls to the AMA and the AAMC were not returned by deadline.
Sclafani said that Arkansas should accept any student that passes the LCME exam and the Educational Commission for Foreign Medical School Graduates exam.
The lawsuit seeks a declaratory judgment, injunctive relief, compensatory damages and reimbursement for fees and costs. It says that publicizing the list was defamatory and was done with malice. It asks that the school not be listed as disapproved without proper investigation and that plaintiffs and other students not be denied the chance to practice based solely on AUA's listing as a disapproved school.
Sclafani said the school was willing to pay for the board's expenses to come to Antigua to investigate it. He said Arkansas has a shortage of trained personnel in numerous areas of medicine and health care, so it shouldn't be limiting its access to trained medical personnel.
Tags:Amber Milward, American Association of Medical Colleges, American Medical Association, American University of Antigua College of Medicine, Arkansas State Medical Board, Bill Trice, Callifornia State Medical Board, Caribbean medical schools, Foreign Medical School Graduates, Judge Susan Webber Wright, Justin Harney, Leonard Sclafani, Liaison Committee on Medical Education, Schults Law Firm, U.S. District Court for the Eastern District of ArkansasBookmark:
Member Opinions:
By: drbrown1977 on 6/10/09
If you are board certified in your field and completed the ACGME residency program is that qualified? According to the Arkansas Medical Board the answer is "NO". Board certification is the "gold standard" in any given medical profession. By: azskeptic on 6/10/09
I support state medical boards requiring schools to go through inspections, just like US medical schools do. In addition, schools in CARICOM nations should be inspected by the local authority which is http://www.caam-hp.org/ By: drbrown1977 on 6/10/09
There are two standards in which California obtains their list. First, if the medical school is located in the country of origin and trains physicians to practice in their country then the CA accreditation standards are basically waived and the medical school is almost automaticaly on the list. If the medical school is located in the Caribbean, then it is subjected to extreme scrutiny at a cost of at least $25,000 to $50,000 to be examined which is paid for by the medical school - not California. I researched some of the schools on the California list and at least one of them has internet learning - this medical school is located in South Africa. Cuban medical schools are on the CA list and it has been illegal to even visit there for over 50 years. The Saddam Hussein School of Medicine in Iraq is also on the approved list of California medical schools. Most of the students that attend medical school in the Caribbean come back to the US and complete their last two clinical years in US hospitals. Whereas, the medical students/graduates of other medical schools do their clinicals in their home country which has a very different medical model than ours. Many are in very third world countries and have limited technology and facilities and have a hard time with the english language. Many on the California list have to obtain J1 visas to practice. Many will take a postion in a medically underserved area to get the visa and leave as soon as their required time is up only to practice in a large metropolitan area outside of Arkansas. If California wants to examine all schools on the list then they should apply the same rules to other countries as they are the Caribbean. There are people from the Caribbean and other countries that attend Caribbean medical schools, obtain a residency in the US and go back to the Caribbean to practice. Most, if not all, islands are too small to have a medical school dedicated only to their citizens. I know that the school I went to was approved and examined by the Ministry of Health of St. Kitts and Nevis and we contributed to the heathcare system on the island of Nevis. Approval to be on the California list is a violation of many rights and amendments and clearly subjects physicians attempting to obtain a medical license to a double standard. There are several states that have adopted the CA medical school approval list. Several of these will waive any problems with the medical school not being on the list or on the disapproved list if they are Board Certified in their chosen field and completed the approved ACGME residency program. According to AR, it would be a better option to employ physicians assistants or nurse practioners to run rural clinics than a board certifed family or internal medical physician. By: futureboy on 6/12/09
The reliance of Arkansas (and the other states that follow California) on the California list is particularly misplaced because California doesn't actually conduct substantial systematic evaluations of ALL of the Caribbean schools, either. California just PRESUMES that schools are inadequate unless proven otherwise. The schools are classified as either (1) approved (after application and a site visit), (2) disapproved (applied and were rejected), or (3) neither approved nor disapproved (never applied for approval). California does not grant a license to graduates of schools in either of the last two categories. So basically Arkansas will automatically deny a license to graduates of Caribbean schools that were never evaluated by anyone at all, including California. If California actually did systematic site visits at all the Caribbean schools as part of its evaluation and compiled information about the schools that can be shares with other states, the reliance on the California list would make some sense. As it stands now, however, it makes no sense at all. Additionally, I have issues with the criteria California uses to approve/deny schools. I suggest that anyone with an interest in this topic review the California medical board reports approving the SABA medical school and denying approval of the St. Matthews medical school. These reports are posted on the California board's web site (the last time I checked). With St. Matthews, the board seemed to be satisfied with the education provided its students. However, the board focused on things like whether the campus buildings were owned or leased (they were leased), admissions standards, administrative issues (particularly in the clinical rotation program), and the tracking of their graduates (alumni). While these are valid concerns, I wouldn't think they should cause the disapproval of the school if the education and facilities are otherwise adequate. While there are some suspect schools, the majority of Caribbean schools adequately prepare physicians for entrance into residency programs. It is a shame to deny licenses to graduates of decent Caribbean schools because of an irrational fear of being overrun by unqualified Caribbean school graduates. For the record, I am not affiliated in any way with any Caribbean medical school. By: drtim on 1/18/10
I know this might be a very late post but the subject is very real to those of us who jumped through the hoops and continue to find opposition to practacing medicine. First all, anyone who does not recognize that all of this is an issue of politics and attempts to increase medical school slots with each state (my exception to this would be california who is just crazy). Secondly, the legal fight is an uphill battle as nobody like to buck the medical system and certain the way we are credentialed. Is there a legal argument for restriction of trade without a doubt. I have heard some of you argue that a state has the right to make any requirement it likes and you are absolutely right however, the requirements must be uniform and consistent across the board. When CA approves a school out of Bagdad I do not believe for one minute that they went their in person and if they visited the schools out of Cuba than they have broken the law in traveling to the country. Thirdly, I have heard the argument that it protection of public. This is another lie that just gets support. I read on one site the argument that if person failed the USMLE steps 3 times in another state and obtained license than should California have the right to have higher standard. Well of course they do as long as they keep the same standard for everyone. Bottom line: The states are questioning the very essence how one is credentialed and licensed in the US. They wish to gain more seats for their medical schools and it easier to make case for caribbean school than to be politically incorrect and start bashing other countries of more financial or political means. Related:
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