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The report of the State Medical Board to the OSMA by James Dickson, M.D, a member of the new board, addressed these changes. Dickson told the OSMA that the phrasing of the original bill was flawed and the board’s lawyers were concerned that if the law was challenged, it most likely would be scrapped by the courts.<ref>James Dickson, M.D. “Report of the State Medical Board,” <i>Proceedings of the Eighteenth Annual Meeting of the Oregon State Medical Society 18</i> (1891): 176-177.</ref> The 1891 amendment eliminated this problem by augmenting the power of the medical board to set its own standards for medical schools. The board was no longer obligated to admit any physician who had graduated from a university if it had a proper charter. Instead, the board was allowed to set certain rules, as had been originally intended, to determine what the board considered to be a school in good standing. The board immediately decided to require that medical schools mandate three sessions of six months each of school and no two of those sessions could be in one year. The board, in essence, adopted the recommendations of the Illinois State Board of Health. Unlike Illinois, Oregon did not have the resources to conduct any meaningful investigations on its own.<ref><i>Proceedings Eighteenth Annual Meeting</i> (1891): 177-180.</ref>
Under the promulgated standards, Dickson postulated that graduates of forty of the existing one-hundred-and-thirty-five American medical institutions would be forced to take an exam under Oregon law. The 1891 revision also placed physicians who registered with the county clerks under the control of the medical board. Under the 1889 Act, the board lacked jurisdiction over these physicians and could not discipline them for dishonorable conduct. <ref><i>Proceedings Eighteenth Annual Meeting</i> (1891): 177-180.</ref> The 1891 act remedied the problem and compelled all practitioners to submit themselves to the board for a license. Not only did the medical board draft standards; it immediately exercised its statutory authority and began rejecting applicants.
====Imposing New and Licensing Exam and new Ethical Standards====In 1895, Oregon again altered its medical licensing law by requiring all applicants to pass a licensing exam. The 1895 amendment also expanded the power of the Oregon Medical Board to revoke the license of a physician for unprofessional or dishonorable conduct including any physician who was originally exempted in the first law. Soon thereafter, the Oregon board immediately targeted physicians in the state. The 1895 statute specified the grounds for unprofessional or dishonorable conduct: Taking part in a criminal abortion, employing “cappers” and “steerers,” obtaining a fee and claiming the ability to cure an incurable disease or condition, betraying a professional secret, using untruthful or improbable statements in advertisements, conviction of any offense involving moral turpitude and habitual intemperance, and advertising medicines claiming to regulate the monthly periods of women. <ref><i>Oregon Laws</i>, 1895, 61-65, sec. 6.</ref>
State medical boards throughout the country were adopting similar licensing criteria. Before 1890, only nine states adopted codes of ethics, but during the 1890s, twenty-four more states developed codes of conduct for physicians. These codes governed what grounds could be used by the board either to deny a license or revoke one after issuance. These ethics rules often included laws that barred physicians from performing abortions. Typically, “the exercise of the same wide discretion cannot be extended to a case where, when one has been regularly admitted, the revocation of his license is sought under another independent provision of the statute.” Like Oregon’s, these codes typically barred unprofessional or dishonorable conduct, procuring abortions, gross immorality, false statements and promises, false advertising, distributing indecent and obscene material, and the fraudulent use of diplomas. <ref>Hugh Emmett Culbertson, <i>Medical Men and the Law: A Modern Treatise on the Legal Rights, Duties and Liabilities of Physicians and Surgeons</i>, (Philadephia and New York, 1913), p. 47-51. Culbertson was citing <i>Czarra v. Board of Medical Supervisors of District of Columbia</i>, 25 App. D.C. 443.</ref>
In one case, the Oregon Medical Board enforced its ethics code and revoked the license of an Astoria physician, Otis Burnett Estes, for providing an abortion. Estes was a Regular physician and a graduate of College of Physicians and Surgeons at St. Joseph, Missouri. Estes had been described in the community as “Daddy Estes” because he had delivered more than two-thousand-five-hundred babies around Astoria, Oregon. <ref>Larsell, <i>The Doctor in Oregon</i>, 285.</ref> Estes’s was convicted in the Oregon criminal court of performing an illegal abortion. After his conviction, a local Astoria physician, Dr. Oswald Beckman, filed a complaint against Estes with the state medical board. At the hearing, the full board heard the case against Estes. The prosecution questioned three witnesses at the hearing: Sophia Schultz and two other Astorian physicians. Schultz was Estes’s patient and she recanted her earlier testimony and stated that Estes had not performed an abortion. Estes’s counsel introduced sixty-four affidavits from Astorian citizens in support of the physician. Despite Estes’s support and Schultz’s testimony, the full board revoked Estes’s license.<ref><i>State v. Estes</i>, 1897 Ore. LEXIS1. Citing LEXIS because it is not clear if this portion of the decision is cited in the other reproductions of this decision; “Dr. O.B. Estes, of Astoria, Found Guilty by State Medical Board,” <i>Daily Capitol Journal</i>, October, 21, 1896.</ref>
Estes challenged the board’s decision to revoke his license, and the trial court reversed the revocation. <ref><i>Estes</i>, 14-15.</ref>While Estes was convicted of performing an illegal abortion, his patient recanted her testimony during the license revocation hearing and claimed that she was confused and sick with a fever during the criminal trial. <ref><i>Estes</i>, 20-21.</ref> His patient’s inability to speak English also hampered the efforts of the prosecutor to cross-examine her. The prosecution failed to provide any other admissible evidence to support the charges. The board also failed to file an appeal of the circuit court’s decision in a timely fashion. <ref><i>Estes</i>, 24.</ref> The board was forced to reinstate Estes as practicing physician and surgeon. The Estes cases demonstrated the difficulty in enforcing ethics laws. Even though Estes was convicted of performing an abortion, the court was not willing to use that conviction as evidence against Estes. Medical boards had to prove their cases in their own administrative hearings.
The Estes case showed that courts were not going to bar doctors from practicing based solely on a criminal convictions. To suspend or expel physicians from the practice of medicine, medical boards were going to have to prove cases in their own administrative hearings. They simply could not rely on outside hearings. Additionally, the court made that they were willing to scrutinize medical board decision, they were going to just rubber stamp their decisions.
