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Rural Community Left In quandary As Qualifications of UND Trained Physician Not Recognized



Minutes after arriving at work, James Opdahl picks up the phone on his desk, dials one of his staff down the hall and asks a question that says it all: "Who's the doc today?" Even though he runs the place, Opdahl has to ask. For more than a year, Community Hospital in Nelson County has been without a full-time physician and is using substitutes.

"It's frustrating," Opdahl said, because for all that time, he's had the perfect candidate lined up, all ready, but unable, to take on the job.

The hospital's choice, Ebenezer Singha of Grand Forks, is having problems receiving his license from the State Board of Medical Examiners, which is in charge of licensing physicians in North Dakota. The State Board refuses to license Singha, even though he has successfully completed a three-year residency program in family medicine at UND's medical school. After losing several appeals to the State Board over the past two years, Singha sued in District Court in Bismarck in December, asking a judge to reverse the State Board's denial of his license. A decision could be handed down late this month.

Meanwhile, McVille hospital officials are frustrated. Like all rural hospitals, McVille has a difficult time attracting doctors. Opdahl calls the board's denial an outrage and ticks off Singha's qualifications:

"He knows United Hospital in Grand Forks, which is our main referral. UND highly recommends him. He has a rare commitment to care for patients. He has almost an old-fashioned desire to practice medicine in a rural community."

More than 140 people from the McVille area wrote letters to the State Medical Board on Singha's behalf; about 30 of them attended a board meeting to press their case. But now Opdahl and his hospital only can wait and hope.

Question of Training

The legal dispute centers on Singha's training. Singha's attorneys argue Singha has complied with all rules for licensing by passing a federal exam and completing his training at UND's medical school.

But the State Board goes back to Singha's earlier foreign training as a reason to deny him a license. Singha, who was born in Pakistan, was trained in Britain as an osteopath. About one-quarter of North Dakota's 2,400 licensed physicians are foreign-educated. But they have gone to medical school, not osteopathy school.

Osteopathy is an alternative form of traditional Western medicine, based on theories about the relationship of the body's organs, muscles and bones. Osteopaths are recognized as full-fledged physicians in the United States, although they have the title D.O., doctor of osteopathy, instead of M.D. It seems clear from court documents that Singha's use of the title D.O. in his first letter to the State Board led to his being considered a doctor by all parties concerned. But he used it in the British sense, meaning "diploma of osteopathy," his attorneys say.

The U.S. osteopathic establishment approves of only U.S. osteopathic schools. The State Board, led by its chairman, Fargo osteopathic physician Terry Wolff, decided the British school Singha attended does not meet the definition of a foreign medical school under North Dakota state law. Wolff would not talk to the Herald about the matter.

UND has accepted only one other osteopath into its family medicine residency program, and Singha likely is the only person with a foreign medical education to be admitted in the program, according to Dr. William Mann, chairman of family medicine at UND's medical school.

"The question is, how did this guy get into a residency program at UND?" said Rolf Sletten, executive director of the State Board.

Well, largely because the State Board wrote letters saying Singha would be eligible for a license if he completed a residency, said Mann, who supervised Singha's residency.

Sletten acknowledges that "I would have worded some of those earlier letters differently if I had known then what I know now" about Singha's training, he said. In any case, UND should not be relying on State Board letters for its admissions, he said.

But the larger point, according to Mann and Singha's attorneys, is that Singha is qualified based on all his training and his compliance with requirements as they were explained to him. He never tried to misrepresent himself.

Singha's test scores are as good or better than any family physician coming out of UND's medical school, and he is "capable of giving compassionate, competent" medical care, Mann said.

Besides, Singha's attorneys say, state taxpayers already have paid $125,000 for his UND residency.

Singha A Perfect Fit

Neither Sletten nor Mann can remember a case in which UND's medical school and the state's medical board have been in such a conflict. And while the conflict goes to court, the McVille hospital is losing business because it lacks its own physician, Opdahl said. It can't afford to lose much more, he said.  "The bottom line is, a physician makes the place," Opdahl said. The hospital is almost at the point of starting to look elsewhere. But finding someone such as Singha would not be easy, Opdahl said.

Despite salary packages averaging about $125,000 a year, rural hospitals have a hard time attracting U.S.-trained family doctors.

Standing in his office, Opdahl lifts a foot-high pile of papers.

"This stack is all applications from internal medicine doctors, all educated in other countries," Opdahl said. "They can become U.S. citizens if they get a job. So of course they are very interested in working here. But we are looking for someone in family practice." Singha is the perfect fit, Opdahl said. "It's very frustrating and disappointing that he would be denied that opportunity. I think it is an outrage, in capital letters."

James Opdahl, administrator of the Community Hospital of Nelson (N.D.) County in McVille thought he had found a full-time doctor for the hospital in Ebenezer Singha. The State Board of Medical Examiners, which is in charge of licensing physicians in North Dakota, refuses to license Singha because of his earlier training in Britain.
Julie Polasky, a registered nurse at Community Hospital, prepares patient medication. Although it doesn't have a full-time doctor, the hospital staffs one RN at all times.Dr. Erling Martinson is one of two physicians who rotate service at the McVille Medical Clinic and Community Hospital of Nelson (N.D.) County.

Source: Grand Forks Herald, February 2, 1997