Opinion ID: 1356666
Heading Depth: 1
Heading Rank: 2

Heading: The use of unprofessional conduct in ORS 679.140.

Text: On review in this court, petitioner changes emphasis to the question whether the board misapplied the statutory term unprofessional conduct. He contends that the legislature did not mean unprofessional conduct to extend to a dentist's dealings with an insurance company, or at least not without prior rulemaking. The argument combines two claims against the board's application of this phrase in the statute, one substantive and the other procedural. In theory, the statutory standard unprofessional conduct could be intended in one of three ways. The intended meaning will not be found in cases decided under different laws in this or another state. Occupational licensing is not common law but statutory administration. The meaning to be found is what the statute's drafters, if aware of the problem, could readily have made explicit, and what they can change if they so choose. First, an occupational licensing law might use unprofessional conduct to refer to norms of conduct that are uniformly or widely recognized in the particular profession or occupation, apart from the views of the agency itself and in this sense external to the law. If this were the intended meaning of the phrase, its application would depend not on interpreting the law or making rules but on finding what the existing standards in fact are. Second, such a phrase might be intended to express the legislature's own licensing standard, though in very general terms. While its contours might have to be derived from the context and legislative history, its meaning would nevertheless be a question of statutory interpretation, not of external sources, and agency interpretive rulemaking would be confined to providing notice of the agency's view of its proper application. Such an agency interpretation of a broadly stated standard entrusted to it is often entitled to judicial respect, see e.g. McPherson v. Employment Division, 285 Or. 541, 591 P.2d 1381 (1979). But it remains an interpretation rather than an execution of a legislative assignment to make new rules. Finally, such a legislative assignment to the agency to make new rules is the third possible role intended for unprofessional conduct in the statute. If so, the term itself cannot be applied without prior rule-making, and the issue on review is whether a given rule remains within the scope of the delegated authority. An example is the rule against advertising that was sustained in Angelos v. Bd. of Dental Examiners, 244 Or. 1, 414 P.2d 335 (1966), and compare Ore. Newspaper Pub. v. Peterson, 244 Or. 116, 415 P.2d 21 (1966). Board of Medical Examiners v. Mintz, supra , proceeded on the premise that the legislature, in enacting the statute involved there, meant the general standard of unprofessional or dishonorable conduct in the first of the three ways mentioned above, as a reference to standards recognized in the profession external to the board itself. The question seems not to have been made a central issue in the case. The statute defined unprofessional or dishonorable conduct as conduct unbecoming a person licensed to practice medicine or detrimental to the best interest of the public, and the dispute centered on the vagueness of this standard rather than on the proper source from which to give it substance. With its focus on the vagueness issue, the court followed a New York decision which treated unprofessional conduct as referring to the standards of conduct generally accepted by practitioners in the State of New York and held that these standards were not so indefinite that they cannot be determined by qualified persons. Matter of Bell v. Board of Regents, 295 N.Y. 101, 110, 65 N.E.2d 184, 189 (1946), quoted in 233 Or. at 446-447, 378 P.2d 945. Accordingly, the court in Mintz continued: The board's discretion is not without controls. As was noted above, the standards are those which are accepted by the practitioners in the community. The standard must be ascertained through expert opinion; except where the standard is clear as it is in the present case. [The charge against Mintz was that he administered drugs for the purpose of performing an abortion, which fell short of an express proscription of the statute.] . . Conceding that the charge is so limited, we are of the opinion that the conduct described is of such a nature that the board was warranted in regarding it as a violation of medical ethics and that it was not necessary to elicit expert opinion outside of the board to support the conclusion. 233 Or. at 448-449, 378 P.2d at 948-949. The court later followed the same approach in holding that expert testimony was not needed to establish that a nurse who aided another in violating an express proscription of the licensing statute was herself guilty of conduct derogatory to the standards of professional nursing. Ward v. Ore. State Bd. of Nursing, supra . We hold to the view that expert testimony is not the proper source for determining the governing standards of unprofessional conduct, but we do so for somewhat different reasons. Mintz and Ward started from the assumption that the board's task was to determine what the standards of the profession in fact were. Taking this assumption to its logical conclusion, such determinations would presumably have the character of findings, required by ORS 183.470, which would have to be supported by substantial evidence in the record unless the conduct was deemed so clearly unprofessional, as in Mintz and Ward, as to be a matter of official notice under ORS 183.450(4). But upon further reflection, we think that when the legislative assembly delegated authority over professional standards to the Board of Dental Examiners, it intended the board to exercise responsibility for those standards itself rather than to look to private practitioners or associations in order to determine what their standards are. To view the statute as incorporating external professional standards by reference creates needless difficulties. It poses a question whether authority to impose rules, enforced by governmental power to grant or revoke licenses, has been delegated to private associations. See Hillman v. North. Wasco Co. PUD, 213 Or. 264, 323 P.2d 664 (1958). Licensing statutes are a form of public regulation, not organized self-regulation. Although generally members of the regulated occupations are appointed to licensing boards, they are agencies of the government, not representatives of a guild. [12] Their responsibilities are not to their own occupational groups but to the public. Cf. Marbet v. Portland Gen. Elect., 277 Or. 447, 469-470, 561 P.2d 154 (1977). Nor may a board proceed on the assumption today, if it ever could, that all members of the profession should be expected to share unarticulated understandings about professional manners and mores because they were drawn from a few homogeneous ethnic, religious and social origins. And to view the profession's attitude toward particular conduct as a factual issue for decision in disciplinary proceedings might well lead to contradictory results depending on the evidence put in the record on that issue. A decision that Dr. A's conduct was shown to be contrary to prevailing professional standards would not mean that Dr. B's identical conduct might not be shown, on different evidence, to be consistent with prevailing professional standards. We doubt that this is the legislative intent. Indeed, the statute is not wholly silent on the question. Along with unprofessional conduct, ORS 679.140(1)(c) lists gross ignorance, incompetence or inefficiency as grounds for disciplinary action. Subsection (4) of the same section states that in determining what constitutes gross ignorance, incompetence or inefficiency the board may take into account such sources as the practices generally followed and accepted by practitioners, current teaching at dental schools, and technical reports. [13] In this subsection the legislature has itself stated that substandard levels of skill and performance may result in disqualification and that these may be measured against the stated sources among others. If rules are promulgated only to indicate that particular skills or practices are considered essential for competence or efficiency, they are interpretive rules. Cf. McPherson v. Employment Division, supra, 285 Or. at 551, 591 P.2d 1381. However, this subsection makes no such reference for determining what constitutes unprofessional conduct. While current standards of scientific knowledge and of safe and effective technique in a profession or craft may be determinable from such sources, disputed ethical standards often are more an issue of policy and values than of the state of the art. So, at least, the legislature may have thought. No doubt the views of members of the profession itself on standards of professional conduct nevertheless are entitled to weight when the board adopts rules to give content to a general standard under the statute. Cf. Morra v. State Board of Examiners of Psychologists, 212 Kan. 103, 510 P.2d 614 (1973) (professional association's code of ethics not applied before adoption by board rule). So, for that matter, are the views of others potentially affected by the conduct in question. But responsibility for the statutory standard and its application rests with the board. Petitioner claims that the meaning of unprofessional conduct by dentists was narrowed by amendments of ORS 679.140 adopted after the 1963 decision in Board of Medical Examiners v. Mintz, supra . Like his constitutional claim, this claim is not explained. The history of ORS 679.140 appears to the contrary. Before 1963, the statute provided, apart from other grounds for suspending or revoking a license, that [u]nprofessional conduct means any of a list of 12 specified practices, mostly though not exclusively concerned with solicitation and advertising. ORS 679.140(2) (1961). The use of the word means clearly was designed to limit unprofessional conduct to the specified acts. In 1963, after the decision in Mintz, the legislature amended the section to read: Unprofessional conduct as used in this chapter includes but is not limited to essentially the same list of practices. [14] The term remains not limited to the listed practices, which now have added a contemporary concern with narcotics to the old preoccupation with advertising. [15] Plainly the significant change made after Mintz was to authorize the board to expand the reach of unprofessional conduct rather than to confine it. But how was the board to do this? Since 1939 the statute has authorized the board to make and enforce rules . . . for regulating the practice of dentistry. ORS 679.250(7). [16] The statute does not expressly state that the expanded grounds for disciplinary action under the rubric unprofessional conduct were to be created by board rules. But there are reasons to believe that this is the legislative policy. One is that the legislature should not be assumed to be insensitive to the importance of fair notice of grounds that may lead to loss of one's profession or occupation, whether or not this is a constitutional requirement. More concretely, the legislature made this policy explicit in many similar licensing statutes even if not in this one. Chapter 679 is one of more than 30 such statutes brought together in ORS chapters 670-703. Repeatedly the legislature has specified that the several boards are to exercise their control over professional standards by adopting codes or rules. Thus the State Board of Architect Examiners is authorized to promulgate reasonable rules prescribing standards of professional conduct for architects. ORS 671.125(2). Accountants may be disciplined for violations of the Code of Professional Conduct adopted by the board. ORS 673.170(4). [17] Similar provisions are made for professional engineers, ORS 672.255(1)(c), geologists, ORS 672.655, psychologists, 675.110(10), occupational therapists, ORS 675.300(1)(a), audiologists, ORS 681.420(5), and tax consultants, ORS 673.730(6). Other licensing statutes simply give the licensing board general rulemaking authority. [18] The drafters' usage has not been consistent. The Board of Dental Examiners, respondents in the present case, itself is directed to specify by rule or regulation . . . what constitutes unprofessional conduct, gross ignorance, incompetence or inefficiency for dental hygienists or other dental assistants, ORS 680.100(1)(d), while its rulemaking authority for dentists is phrased in general terms. ORS 679.250(7). Sometimes such differences in statutory drafting represent deliberate differences in policy. We see no reason to believe that this was the case here. [19] The difference of the potential impact, when one occupation is given fair notice of obligatory standards of propriety by prior rulemaking and another occupation is given no such prior notice, is too pronounced to be attributed to the legislature without some showing that it was intended. Thus we doubt that the stylistic differences among 30-odd statutes separately enacted over many years mean that some of the boards are to develop professional standards by rulemaking and others by ad hoc determinations, insofar as they are authorized to add to the express statutory grounds for discipline at all. Rather, we infer from statutes such as those cited above that when a licensing statute contains both a broad standard of unprofessional conduct that is not fully defined in the statute itself and also authority to make rules for the conduct of the regulated occupation, the legislative purpose is to provide for the further specification of the standard by rules, unless a different understanding is shown. When such a rule purports to be an interpretation of one of the more specific proscriptions or requirements stated in the statute itself, it is reviewable as an interpretation. See McPherson v. Employment Division, supra ; Angelos v. Bd. of Dental Examiners, supra, 244 Or. at 5-6, 414 P.2d 335. When a board lays down a new rule of proscribed or required conduct under delegated authority to do so, this is reviewable to determine whether the rule remains within the intended scope and purpose of the delegated authority. See Ore. Newspaper Pub. v. Peterson, supra , and cf. Neuhaus v. Federico, 12 Or. App. 314, 505 P.2d 939 (1973). The administrative procedure act makes compliance with rulemaking procedure reviewable in either case. ORS 183.310(7), 183.335, 183.400. Doubts are sometimes expressed whether rules can encompass the variety of acts that should be recognized as unprofessional, or unethical, or unbecoming, or otherwise improper. An attempt to catalogue all the types of professional misconduct might well seem infeasible, as the court said in Board of Medical Examiners v. Mintz, supra, 233 Or. at 448, 378 P.2d at 948. But rules need not imitate a detailed criminal code to serve the two purposes of giving notice of censurable conduct and confining disciplinary administration to the announced standards. [20] Nor is the only alternative to include some form of catchall clause that is as general as the standard it purports to elucidate. The resources of rulemaking are not so limited. For instance, as this case illustrates, an important question is what relationships are covered by the term unprofessional conduct and thus within the range of professional discipline. It might be agreed that the term covers conduct in the course of rendering the professional service on the one hand, and on the other that it excludes the licensee's purely private affairs unrelated to any relevant professional qualification or performance. But between these two poles, there may be questions how far unprofessional conduct extends to financial arrangements or to mixing professional with other relationships. There may be disagreement whether the term should extend beyond conduct toward the patient or other recipient of the regulated service so as to cover relationships with employees or suppliers, with other professionals, or perhaps with the regulating agency itself. As stated above, in many licensing statutes the legislature does not itself provide explicit or implicit answers to these and similar questions; it delegates this task, within the limits of each statute's objectives, to the licensing agencies. The answers might well differ in one occupational setting from another. They may change within the same occupation over time, as has occurred in the very issue in Mintz, the issue of abortions. Thus, when the statute itself offers no further definition, the legislative delegation to the agency calls for such questions to be resolved in principle by rules rather than being confronted and disputed for the first time in charging a particular respondent directly under a conclusory term such as unprofessional conduct. Petitioner contends that his dealings with the insurance company in this case could not in any event be brought within the range of the legislative standard unprofessional conduct because it is too unlike the other types of unprofessional conduct proscribed in ORS 679.140(2)(a)-(q), for which he invokes the Latin phrase ejusdem generis. The argument is that the listed practices all relate directly to the dentist-patient relationship or to the dentist's physical or mental qualifications. If this were so, or if the statute authorized only interpretive rulemaking under the term unprofessional conduct, the conclusion might follow. But we do not find all the specific proscriptions to be so limited. As stated above, more of them dealt with advertising than with any other subject, and while advertising is indeed addressed to potential patients, the restrictions do not seem designed exclusively to protect their interests. [21] Nor is it evident that the rules on obtaining drugs are limited to the dentist-patient relationship. [22] We do not mean that unprofessional conduct necessarily extends further. But we are not prepared to hold that the board's power to make rules for ethical conduct in the practice of the profession is narrowly limited to the dentist's relationship with a patient. Besides, it would not be farfetched to recognize a concern of patients in a dentist's fraudulent application for malpractice insurance which, in case of need, might not be available without litigation.