Establishment of the Louisiana State Board of Medical Examiners
Public health in Louisiana has a very colorful past. Its progressive and innovative nature stems from the urgency created by outbreaks of diseases, such as yellow fever and malaria. Early attempts at containment of those epidemics are not well documented. However, from the time of the Louisiana Purchase in 1803, there is documentation of the establishment of "ad hoc" boards of health, designed to create measures to control such outbreaks. Louisiana then established a Board of Health, the first ever in the United States. On March 15, 1855, a bill was introduced in the Louisiana Legislature to create a permanent State Board of Health. With the passing of this bill the first permanent public health agency at the state level in the United States was born.
The physicians in Louisiana were very few outside of New Orleans, and the ones mentioned were appointees. Many of these were here only for a few years at military posts. Laws or edicts governing licensure in accordance with the times were issued by the Governor who advised monthly meetings.
Medical Society
It was reported in the Louisiana Gazette in 1804 that a Medical Society would be formed in New Orleans. When Louisiana became a state in 1812, the population grew. Due to recurrent epidemics and lack of training of many so-called physicians, an “Act Concerning Physicians, Surgeons and Apothecaries” was passed in 1808. This provided for an Examining Board of four (4) of the oldest physicians in New Orleans to be appointed by the Mayor of New Orleans.
Anyone who wished to practice medicine had to present to the Board a diploma from the college where he had studied medicine and be examined by the Board. The provisions of the law did not apply to anyone already in practice, including many quacks and unqualified persons. It also included no penalty for failure to comply with the law.
A Better Law
In 1816, a new and better law was passed (amended in 1817) including the penalties so necessary for successful enforcement. Two medical districts were set up, an Eastern Board known as Comité Médical de la Nouvelle Orléans, and a Western Board. The five (5) members from each board and one (1) apothecary were appointed by the Governor.
During the antebellum period the laws for the regulations of medicine and pharmacy were generally superior to those found in other sections of the state. Unfortunately, this is not true of the second half of the nineteenth century.
With the elimination of medical examining boards by the act of 1852, Louisiana was left virtually without control over medical practice. The Civil War put an end to the medical societies and medical education in the south. Little attention seems to have been given to regulation of medicine in the immediate postwar years. The physicians in Louisiana were too preoccupied with attempts to establish unity within its own ranks than to worry about raising standards through legal enactments.
Affidavit Law
In 1872, a slight effort was made to increase penalties for falsifying an affidavit in the process of acquiring a medical license. Anyone who claimed to have a medical degree which he was not entitled was to be barred forever from practicing in Louisiana and was subject to imprisonment from six (6) months to five (5) years. Most physicians didn’t even bother to make an affidavit which made increasing the punishment meaningless.
In 1877, the medical profession was successful in securing the passage of a law which permitted doctors to submit a sworn affidavit instead of attending court as a witness. This applied only to doctors who lived more than 10 miles from the seat of justice, provided such attendance would endanger the life of a patient.
Later in 1877, Dr. Chaillé wrote and published A History of Medical Regulation in Louisiana. He was one of the first to realize that only an enlightened public could bring about effective reform. He felt that a law without public support had little value, and that the same public which happily contributed to quacks and charlatans were hardly likely to prosecute them for violations of the medical licensing laws. With the organization of the Louisiana State Medical Society in 1878, with a measure of unity, Louisiana State Medical Society was able to put pressure on both the public and legislature for reform.
Dr. Chaillé was appointed chairman of the society’s committee and this committee was able to secure passage of a revised medical act in 1882. While it was an improvement, it still did nothing about the all-important enforcement. The law stated that any and all fines collected were to be given to Charity Hospital of New Orleans. The doctor was subject to a $100 fine for each offense.
Unfortunately, the administration of Charity Hospital refused to enforce the law. The Board of Health and the Louisiana State Medical Society finally secured an amendment to the law in 1886 which made it a crime for any person to practice medicine or surgery without first complying with the provisions of the law of 1882. Anyone violating the law would be indicted by the grand jury of the parish in which he committed the offense. The offenders would be fined not less than fifty ($50.00) dollars or be imprisoned for not more than three (3) months.
Defeat of Medical Bill
In 1888, the state medical society took a big step asking the legislature to authorize the creation of the medical licensing board to operate under the jurisdiction of the state board of health. In 1890, the State Medical Society held its annual meeting in Baton Rouge in hopes of influencing the legislature toward the proposed medical legislation. This bill would create the board of examiners. The bill passed the lower house by a large majority but was defeated in the senate. It failed because of a petition by ten (10) homeopaths and a division in the ranks of regular physicians. The decisive factor of its failure was a letter from a prominent physician, Dr. Bruns. He opposed the bill because it had been prepared by a special committee and had not been examined or approved by the society as a whole.
Boards Established…A Time Capsule
v 1894
The society called a meeting with the homeopathic physicians and promised to insert a provision stipulating a separate homeopathic board in return for their support. The bill was modified and the bill to regulate medical practice was enacted into law in July of 1894.
Two medical boards were established to examine all future practitioners. The Governor appointed the board of examiners on the recommendation of the State Medical Society. The Homeopathic Board was also appointed by the Governor on the recommendation of the Hahnemann State Medical Society. The candidates from then on appearing before either of the boards were to present a diploma and submit to an examination. The Governor, Murphy J. Foster, acted promptly in complying with the law, and by September of 1894 appointed both boards.
The medical board of examiners held an organized meeting on August 31, 1894 and examined the first group of candidates on December 3, 1894. They examined sixteen (16): two were refused licenses – one because of his abysmal ignorance and the other for presenting a diploma from a fraudulent institution.
In a report to the Board of Health, the Board of Medical Examiners stated that because of financial reasons that it had been unable to publish an official list of registered physicians. As a result of a court writ, the state printer was forced to print the list. They also reported they had an inability to prosecute offenders and that they could only recommend that the grand juries and district attorneys take action.
v 1896
An amending act was passed which authorized the presidents of the examining boards to issue injunctions through any competent court against anyone failing to comply with the registration procedure. Also, another provision in the amendment enabled the examining boards to obligate the state for the cost of publishing the list of registered physicians.
The board of examiners was criticized for not enforcing the laws against unlicensed practitioners. These criticisms caused the board of examiners to raise their standards. The Board of Medical Examiners and the State Medical Society worked with each other to raise the general level of medical practice throughout the state.
v 1908
The legislature revised the law of 1894. It required each candidate for a medical license to hold a diploma from a medical college in good standing and to pass a satisfactory examination in 10 fields of medicine, including such subjects as anatomy, physiology, chemistry, obstetrics, and so forth. No change was made in the penalties for noncompliance. It did provide for summary trial before a judge in medical licensing cases.
v 1908
The Louisiana State Board of Medical Examiners was given the right to make its own by-laws and on September 29, 1908 proceeded to draw up a new series of regulations.
v 1912
A series of amendments were added to the Medical Practice Act. One was that midwives were required to register within ninety (90) days with the state board of health or with the clerks of court of the district courts. A second amendment provided that it was to be the duty of district attorneys to prosecute all violators of the medical licensing laws. A third was significant, it increased the examining fee from ten (10) to twenty-five (25) dollars.
v 1914
The medical practice act was replaced by a new measure. There was no basic change in the law. It provided for a six (6) year term for the members of the board. It also required that all future examinations would be in writing.
v 1916
The Louisiana State Board of Medical Examiners required all candidates for Licensure, beginning the study of medicine after January 1, 1918, to have a minimum of two years of college education before starting medical school. It also required all physicians to register with the Louisiana State Board of Medical Examiners before January 1 of each year. It empowered the board to revoke the licenses of physicians guilty of such offenses as incompetence, crime, drunkenness, abortion and so forth.
Throughout the years, the Medical Practice Act has been revised as to the changing medical profession.
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Abstracted from: The Rudolph Matas History of Medicine in Louisiana, Volume II, Louisiana State University Press, 1962
Rudolph Matas History of the Louisiana State Medical Society, Volume I, Rudolph Matas History of Medicine Trust Fund, 1957
Rudolph Matas History of the Louisiana State Medical Society, Volume I, Rudolph Matas History of Medicine Trust Fund, 1957