Cook v. Workers' Compensation Department

PETERSON, C. J.,

dissenting.

The question is whether the words “doctor” or “physician,” as used in current ORS 656.005(12), include nurse *147practitioners. The answer to this question is “no.” I base my conclusion largely upon an examination of the statutes in effect in 1957, when the legislation that first defined the terms “doctor” and “physician” in ORS chapter 656 was enacted.

The first sentence of current ORS 656.005(12) was enacted in 1957 as ORS 656.002(17). Or Laws 1957, ch 718, § 1(17). It read (and as part of current ORS 656.005(12) still reads): “ ‘Doctor’ or ‘physician’ means a person duly licensed to practice one or more of the healing arts in this state within the limits of the license of the licentiate.” I shall show, by reference to (1) the meaning of “doctor” or “physician,” (2) the meaning of “healing arts,” and (3) the meaning of the phrase “duly licensed to practice * * * in this state within the limits of the license of the licentiate” that the legislature, in passing that legislation, had in mind the class of persons who could diagnose, prescribe and treat persons and who could use the title “doctor” or “physician,” persons such as chiropractic physicians, naturopathic physicians, dentists, osteopathic physicians, chiropodists, and physicians and surgeons.

1. THE 1957 LEGISLATION

Prior to 1957, workers’ compensation benefits were payable to a worker who “sustains a personal injury by accident arising out of and in the course of his employment caused by violent or external means.” ORS 656.202(1) (1955). Labor organizations and others maintained that this definition was too restrictive. See Minutes, House Labor and Industries Committee (March 26,1957; May 6 and 8,1957).

In 1957, legislation was introduced to relax that definition. The legislation was introduced as House Bill 12. Minutes of the Labor and Industries Committee of the House of Representatives for May 6, 1957 contain this explanatory statement as to the measure’s purpose:

“George Brown [George Brown was Political Director of the Oregon AFL/CIO] explained that this bill has as its primary purpose the elimination of the definition of an accident relating it to violent external means. He briefly explained the amendments in the engrossed bill. It was agreed to hold this bill over to the next agenda, to give the Committee members time to study it.”

*148The only specific reference in the legislative history to the language at issue in this case is the following:

“Representative Lent moved to amend HB 12 as follows: * * * (17) ‘Doctor’ or ‘Physician’ means a person duly licensed to practice one or more of the healing arts in this state within the limits of the license of the licentiate. Motion carried.”

Minutes, House Labor and Industries Committee (March 26, 1957). The legislative history does not show why Representative Lent proposed the amendment.

2. “DOCTOR” OR “PHYSICIAN” MEANS A DOCTOR OR PHYSICIAN.

The meaning of ORS 656.002(17), as passed in 1957, becomes clear when other sections of ORS chapter 656 (1957) and other statutes in ORS chapters 676 and 678 (1957) are compared. It is not inappropriate to observe first, however, that the plain meaning of ORS 656.002(17), as passed in 1957, likely was that “doctor” or “physician” meant doctors or physicians practicing one or more of the healing arts.

In 1957, nurses were forbidden from performing “acts of diagnosis or prescription of therapeutic or corrective measures.” The last sentence of former ORS 678.015 (1957) provided: “This section does not authorize a licensed professional nurse to perform acts of diagnosis or prescription of therapeutic or corrective measures.”

Other sections of chapter 656 (1957) referred to the type of work that “doctors” and “physicians” were expected to perform under the Workers’ Compensation Law.

One statute required a physician’s report. Former ORS 656.272(1) in 1957 provided in part: “The physician who attends the workman shall file with the Commission a report on forms furnished by the commission.” This form, now Department of Insurance and Finance Form 827, requires diagnostic information, the type of information that only a doctor could furnish. See OAR 436-10-030.

Another 1957 workers’ compensation statute, ORS 656.806, provided that “[a]s a prerequisite to employment in any case, a prospective employer may, by written direction, require any applicant for such employment to submit to a physical examination by a doctor to be designated by the State *149Industrial Accident Commission * * These statutes suggest that “doctor” or “physician” means a doctor or physician in the traditional sense, such as a medical doctor, osteopathic physician, chiropractic physician, naturopathic physician or podiatric physician.

Other sections of the 1957 Workers’ Compensation Law confirm this analysis.

The 1957 Workmen’s Compensation Occupational Disease Law, ORS 656.802 to 656.824, also contained provisions concerning physicians and doctors. Former ORS 656.810(1) provided for the appointment of “a medical board of review, which board of review shall have jurisdiction to pass upon and decide every issue involved in such [occupational disease] claim.”

Former ORS 656.810(2) (1957) provided:

“The medical board of review shall be appointed in the following manner:
“(a) One doctor from the list provided for by ORS 656.820 shall be named by the commission.
“(b) One doctor from said list shall be named by the claimant.
“(c) The two doctors so named shall, within five days after being notified of their appointment, name a third doctor from said list. If the third doctor cannot be agreed upon, or for any other reason has not been named within such period of time, the commission shall immediately so notify the presiding judge of the circuit court of the county in which the claimant resides, or upon agreement of the claimant and the commission, the circuit judge of the county in which the claim arose. Upon receipt of such notice, such presiding judge shall forthwith name the third member of such board of review from said list.”

The duties of the medical board of review were set forth in former ORS 656.812 (1957). Subsection (2) required findings and “the answers to the following questions”:

“(a) Does claimant suffer from a disease or infection? If so, what?
“(b) When was such disease or infection, if any, contracted, and approximately how long has claimant suffered therefrom?
*150“(c) Is such disease or infection, if any, peculiar to the industrial process, trade or occupation in which claimant has been last employed?
“(d) Has such disease or infection, if any, been caused by and did it arise out of and in the course of claimant’s regular actual employment in such industrial process, trade or occupation?
“(e) Is such disease, if any, disabling to the claimant?
“(f) If so, to what degree is claimant disabled by such occupational disease?”

Nurses were not permitted to perform the type of work that former ORS 656.812(2) (quoted above) required, to diagnose the disease or infection, to decide whether the disease was related to the employment and to determine the extent of disability.

In sum, the statutes in ORS chapter 656 (1957) point to the conclusion that the “doctor” or “physician” referred to in ORS 656.002(17) (1957) were persons authorized to prescribe, diagnose, treat and evaluate injuries, illnesses and disease. Nurses had no such authority. If there is any remaining doubt, that doubt is dispelled by examining other statutes in the context of the “healing arts” language of ORS 656.002(17) (1957).

3. MEANING OF “PRACTICE OF THE HEALING ARTS.”

The only 1957 statutes that speak of the “healing arts” are statutes concerning doctors or physicians — doctors or physicians who are called “doctors” or “physicians.” ORS 676.110 (1957) provided:

“Any person practicing any of the healing arts or the corrective art of optometry who uses the title ‘doctor,’ or any contraction thereof, ‘clinic,’ ‘institute,’ ‘specialist’ or any other assumed or artificial name or title, in connection with his business or profession, on any written or printed matter, or in connection with any advertising, billboards, signs or professional notices, shall add after his name, or after any such assumed or artificial names, one of the following respective designations in letters or print which shall be at least one-fourth the size of the largest letters used in the title or name, and in material, color, type or illumination to give display and legibility of at least one-fourth that of the title or name:
*151“(1) In the case of a person practicing chiropody, the word ‘chiropodist.’
“(2) In the case of a person practicing chiropractic, the word ‘chiropractor’ or the words ‘chiropractic physician.’
“(3) In the case of a person practicing dentistry, the word ‘dentist’ or the words ‘dental surgeon.’
“(4) In the case of a person practicing naturopathy, the word ‘naturopath’ or the words ‘naturopathic physician.’
“(5) In the case of a person practicing the corrective art of optometry, the word ‘optometrist.’
“(6) In the case of a person licensed to practice osteopathy and surgery by the Board of Medical Examiners of the State or Oregon, the word ‘osteopath’ or the words ‘osteopathic physician’ or ‘osteopathic physician and surgeon.’
“(7) In the case of a person licensed to practice medicine and surgery by the Board of Medical Examiners of the State or Oregon, the word ‘physician’ or the word ‘surgeon’ or the words ‘physician and surgeon.’
“(8) In the case of a person practicing veterinary medicine, the word ‘veterinarian.’ ” (Emphasis added.)

From these statutes, I conclude that (1) “doctor” or “physician” meant a person who could call herself or himself a doctor or physician, and (2) that the “practice * * * of the healing arts” reference in ORS 656.002(17) (1957), likely was to the persons “practicing any of the healing arts” referred to in ORS 676.110 (1957) — medical doctors, chiropractic physicians, osteopathic physicians, naturopathic physicians, dentists and chiropodists.

4. MEANING OF “WITHIN THE LICENSE OF THE LICENTIATE.”

Any remaining doubt is dispelled by the third referent — “within the limits of the license of the licentiate.” That very phrase appears in the 1957 ORS chapter concerning nurses, chapter 678, but as a description of what nurses can do while working under the direction and control of a “licentiate. ” ORS 678.031(4) in 1957 provided:

“ORS 678.010 to 678.160 [the statutes governing the nursing profession] shall not be construed to affect or prevent:
4c 4c 4c 4c
*152“(4) Services and acts of technicians, assistants and other persons performed under the direction and control of persons duly licensed to practice medicine or surgery, osteopathy, dentistry, chiropractic, naturopathy or chiropody in this state within the limits of the license of the licentiate under whose direction and control the services and acts are performed; provided, that nothing in this Act shall be construed to permit any person who is not licensed under ORS 678.010 to 678.170 by the Oregon State Board of Nursing to do any act prohibited by subsection (2) of ORS 678.021.”

The phrase “within the limits of the license of the licentiate” clearly refers to the antecedent class of licentiates — “persons duly licensed to practice medicine or surgery, osteopathy, dentistry, chiropractic, naturopathy or chiropody.” I have little doubt that ORS 656.002(17) (1957) derives directly from ORS 678.031(4) (1957).

Supporting this conclusion is a 1949 opinion of the Attorney General which, in 1957, was still fairly recent. See 24 Op Att’y Gen 287 (Or 1949), discussed in the majority opinion at 306 Or at 140-41. See also 33 Op Att’y Gen 294 (Or 1967), mentioned in the majority opinion at 306 Or at 141.

I should add that construing ORS 656.002(17) (1957) as would the majority, made doctors, in 1957, of dental hygienists, licensed practical nurses and masseurs as well as nurses.

5. CONCLUSION

From the foregoing study of the 1957 statutes, there can be no doubt that the source of the “healing arts” language of ORS 656.002(17) (1957) was ORS 676.110 (1957), and that the term “physician,” as used in ORS 656.002(17) (1957) meant medical doctors, chiropractic physicians, osteopathic physicians, naturopathic physicians, dentists and chiropodists. Similarly, there can be no doubt that the “within the license of the licentiate” language in the 1957 statute came from a nursing statute, ORS 678.031(4), a statute that precisely tracked ORS 676.110 (1957) in its specific reference to medical doctors, osteopathic physicians, chiropractic physicians, naturopathic physicians, chiropodists and dentists.

What has happened since 1957 to change or modify that legislative intent? The nurse practitioner statutes were *153enacted in 1975. What was the legislative intent in 1975? ORS 676.110 was still in effect. It still referred to the same class of healing arts-practitioner-podiatrists (formerly chiropodists), chiropractic physicians, dentists, naturopathic physicians, osteopathic physicians, and medical doctors.

The ORS 676.110 reference to “healing arts” was not deleted until 1983, when it was replaced with the term “health care profession.” Or Laws 1983, ch 769, § 1. The changes were made at the request of the Oregon Board of Optometry.1

ORS 678.031(4) (1957) — the statute that concerned the “license of the licentiate” — was amended in 1973, two years before the enactment of the nurse-practitioner legislation, in recognition of the enlarged role of nurses in diagnosing and treating persons with health problems. See ORS 678.010(5) (1973). In 1973 and 1975, however, as now, ORS chapter 678 contained a definition of “physician” as “a person licensed to practice under ORS chapter 677.” ORS 678.010(4) (1973); ORS 678.010(5) (1975); ORS 678.010(5) (1987).

Nothing in the legislative history of Oregon Laws 1975, chapter 205 suggests that the legislature intended that nurse practitioners would be “doctors” or “physicians” under the then or present version of ORS 656.005(12). Rather, as the definition of nurse practitioner provides:

“ ‘Nurse practitioner’ means a registered nurse who has been certified by the [Oregon State Board of Nursing] as qualified to practice in an expanded specialty role within the practice of nursing.”

ORS 678.010(4) (emphasis added).

*154The 1975 nurse practitioner statutes, ORS 678.375 to 678.410, suggest that the “expanded specialty role” consists primarily of the nurse practitioner’s eligibility to apply for drug prescribing authority. These statutes did not make “doctors” or “physicians” out of nurse practitioners in any sense. Rather the 1975 legislation merely “expanded” the power, authority and rights of those in the “practice of nursing” who qualify as “nurse practitioners.” The “practice of nursing” still “includes executing medical orders as prescribed by a physician or dentist.” ORS 678.010(6). The distinction between physicians or doctors and nurses remains clear under the very chapter upon which the majority relies to set nurse practitioners apart from nurses and to class nurse practitioners as physicians. See ORS 678.010(5) (“ ‘Physician’ means a person licensed to practice under ORS chapter 677.”).

Nor did the addition of what is now the second sentence of ORS 656.005(12) (“ ‘Attending physician’ means a doctor or physician who is primarily responsible for the treatment of a worker’s compensable injury”), affect the issue before us. Pure and simple, nurses were not “doctors” or “physicians” under ORS 656.002(17) in 1957, and nothing has happened since then to suggest that the legislature meant to change the meaning of the first sentence of current ORS 656.005(12).

The majority reasons that the legislature intended to give the term “healing arts” its “literal meaning,” 306 Or at 143. Under that reasoning, a host of other persons — physical therapists, radiologic technologists, audiologists, and dental hygienists — are “physicians” under ORS chapter 656.

The legislative intent is apparent and it is clear. The decision of the Court of Appeals should be affirmed.

Jones, J., joins in this dissent.

The 1983 legislature replaced the phrase “any of the healing arts or the corrective art of optometry” with the phrase “a health care profession.” The explanation for the change is in a Senate Exhibit submitted by the Oregon Board of Optometry:

“ ‘Health-care profession’ is a more contemporary and descriptive term than is “Healing art” and the Oregon Board of Optometry is requesting a change in [the] statute to describe all health care professions by the same descriptive term.
“Optometry is a profession which involves diagnosis and treatment of problems relating to human vision. Treatment involves the correction and prevention of problems and the restoration of health function. A dictionary defines ‘heal’ as ‘to make sound or whole’; ‘to restore health’; and to ‘cause (an undesirable condition) to be overcome.’ Optometry is, therefore a healing art.”

Exhibit A, Senate Committee on Human Services and Aging (June 23,1973) (statement of Oregon Board of Optometry).