History of the Merger
Pioneering Osteopathy (1890s to 1920s)
- 1892: American School of Osteopathy founded by Andrew Taylor Still, M.D. in Kirksville, Missouri.
- 1895: Aubrey C. Moore, D.O. (Diplomat of Osteopathy) graduated from the ASO and moved to California.
- 1896: Dr. Moore and Dr. Scheurer (an M.D.) started the first osteopathic college outside of Missouri, the Pacific Sanitarium and School of Osteopathy in Anaheim.
- 1898: San Francisco College of Osteopathy opened. The Pacific Sanitarium and School of Osteopathy, now called the Pacific School of Osteopathy (PSO), was the first school to grant the D.O. (Doctor of Osteopathy) degree to two M.D. students.
- 1899: The first graduates of PSO without advanced standing were granted a Doctor of Osteopathy degree.
- 1900: The Pacific School of Osteopathy moved to Los Angeles and established the first osteopathic clinic in California for teaching and training. The Osteopathic Association of the State of California (OASC) was formed (became the California Osteopathic Association (COA) 1917-1962).
- 1901: Dain Tasker was elected president of OASC. AB 230 became law by the statutes of limitations, establishing the Board of Osteopathic Examiners. It allowed for D.O.s, who graduated from a state osteopathic licensing board accredited college, to practice osteopathy, which at that time was limited to a drugless and non surgical scope of practice. There were separate licensing boards for M.D.s, Homeopaths, and Eclectic practitioners as well.
- 1903: South Pasadena Osteopathic Sanitarium opened, with Dain Tasker, D.O., as Director. The Pacific School moved to South Pasadena too but kept the free clinic in LA.
- 1904: The PSO declared bankruptcy and a new non-profit school was established, the Pacific College of Osteopathy (PCO), which returned to Los Angeles. It was chartered to offer both the D.O. and the M.D. degrees.
- 1905: The Los Angeles College of Osteopathy (LACO) was established by faculty from the Des Moines S. S. Still College of Osteopathy as a for-profit institution.
- 1906: The Los Angeles County Osteopathic Medical Society, sponsored by Dr. Dain Tasker, was formed to “consolidate those who were opposed to the Los Angeles College of Osteopathy group”. The San Francisco earthquake badly damaged the San Francisco College of Osteopathy.
- 1907: Dr. Tasker was elected President of OASC. The osteopathic state licensing board did not accredit the LACO and refused to let its graduates sit for its examination. The LACO faculty filed a law suit and won. The osteopathic practice act was declared unconstitutional and repealed. The legislature enacted a new Medical Practice Act to regulate all of the health professionals in the state under one composite licensing board consisting of 5 allopaths (regular M.D.), 2 osteopaths, 2 homeopaths and 2 eclectic practitioners. The Medical Practice Act of 1907 repealed the previous Medical Practice Acts of 1876 and 1901. This act provided for the issuance of three different forms of certificates by the Board of Medical Examiners of the state of California: First, a certificate authorizing the holder to practice medicine and surgery; second, a certificate authorizing the holder to practice osteopathy; and third, a certificate authorizing the holder to practice any other system or mode of treating the sick and afflicted, not otherwise referred to. The 1907 Medical Practice Act allowed D.O.s to have an unlimited physician and surgeon license if he or she took the required curriculum and passed the requisite examinations. Only M.D.s or D.O.s were allowed to sit for that examination, however, since the other professions were not complete schools of medicine and surgery.
- 1910: Dain Tasker, D.O. became the only D.O. to be president of the composite state licensing board. The AOA threatened the PCO it would remove accreditation unless the school dropped granting the M.D. degree; PCO acquiesced and only provided the D.O. degree thereafter. Clement Whiting, D.O., dean of PCO, enabled the first D.O.s to care for patients at the L.A. County outpatient maternity clinics.
- 1912: The D.O. school in San Francisco closed.
- 1913: The Medical Practice act of 1913 was enacted under which medicine and surgery is still practiced in California today. The Medical Practice Act of 1907 was repealed. A ten-person board was appointed by the governor and three types of licenses were issued: Physician and Surgeon, Drugless Practitioner, and License by Reciprocity. Clement Whiting, D.O., dean of PCO and intermediary between the two osteopathic colleges in Los Angeles, was killed upon being struck by a car on his way to a meeting between each of the two osteopathic college’s Board of Trustees to discuss merging.
- 1914: The two osteopathic schools in Los Angeles, the PCO and the LACO, merged to form a non-profit institution, The College of Osteopathic Physicians & Surgeons (COP&S).
- 1916: Four COP&S graduates were appointed as interns to the Los Angeles County Hospital.
- 1917: An amendment to the 1913 Medical Practice Act enabled D.O.s licensed under the previous acts to take an oral examination to raise the license from that of drugless to that of physician and surgeon. The OASC was renamed as COA.
- 1918: University of Southern California (USC) closed (until 1928) leaving COP&S and the College of Medical Evangelists as the only medical schools remaining open in Southern California. The American College of Surgeons (ACS) began on-site inspections and accreditation of hospitals.
- 1919: One third of the interns (10/31) at L.A. County Hospital were D.O.s. The Council on Medical Education of the American Medical Association (AMA) threatened the L.A. County Hospital with removal of accreditation unless any association with osteopaths was discontinued, i.e., not allowing D.O.s to be interns. The state composite licensing board also declared that COP&S was no longer accredited and graduates could not sit for licensure exams. COP&S filed suit against the state licensing board and prevailed, forcing the licensing board to allow D.O.s to sit for the exam.
- 1922: Proposition 20 was passed as an initiative by the people of the state of CA, creating a separate osteopathic licensing board. (A separate chiropractic licensing board was also created on the same ballot by the same process). D.O.s applied for the right to admit and attend patients at the L.A. County Hospital, and have post graduate training, i.e., internships and residencies. In order for the M.D.s to maintain accreditation from the AMA, however, the D.O.s had to be in a segregated building and attend patients separately from the M.D.s
- 1923: Agreement signed between the osteopathic profession and the L.A. Board of Supervisors granting D.O.s the right to care for patients at a segregated Unit II and instituted post-graduate training at the L.A. County Hospital. This was the only County Hospital in the world that allowed D.O.s on staff until the 1950s.
Osteopathic Medicine as segregated medical profession (1928 to 1960)
- 1928: The communicable diseases building at the L.A. County Hospital was renovated to accommodate the D.O. physicians in a segregated unit, called Unit II, and the M.D. unit was called Unit I. There was a tunnel adjoining the two units for housekeeping and food services. USC re-opened its medical school.
- 1929: The ACS removed its accreditation of Unit I until a newer Unit I was built and the M.D.s were physically and administratively separated from the D.O.s. The American Osteopathic Association mandated that all osteopathic colleges implemented into their curricula education about materia medica and pharmacology. The name of the profession changed from “Osteopathy” to “Osteopathic Medicine.”
- 1930: The L.A. Board of Supervisors allocated funds for a new and much larger, more modern Unit I facility, physically separated from Unit II.
- 1931: Forest Grunigen graduated from COP&S.
- 1932: Louis Chandler, D.O. noticed that between 1928 and 1932, the morbidity and mortality statistics for Unit II were less than Unit I, implying superior care, not inferior care, as the M.D.s consistently insinuated.
- 1933: Construction of the new Unit I was completed. Dr. Chandler had his data analysis of the M.D. vs D.O. care of L.A. County patients published in an article in the Journal of the American Osteopathic Association. Nevertheless, the segregation policy persisted.
- 1934: Unit II was renamed to Los Angeles County Osteopathic Hospital (LACOH), though the nickname of “Unit II” remained. L.A. County Hospital 20 story acute facility was built with 2,500 beds.
- 1935: The ACS re-approved accreditation for Unit I of the L. A. County Hospital.
- 1938: President Carle Phinney, D.O. of COP&S died in office, throwing the institution into turmoil as to its direction.
- 1939: A merger between USC and COP&S was proposed by COP&S alumni. A member of the USC Presidential cabinet, Ballentine Henley, JD, was selected as the new President of COP&S, the first non-D.O. to fill this position.
- 1940: A merger between the California Osteopathic Association (COA) and California Medical Association (CMA) was promoted by COP&S alumni, including Forest Grunigen, D.O..
- 1943: Forest Grunigen, D.O. elected president of COA on the platform of unifying the osteopathic and allopathic professions in California. Grunigen appointed a Fact Finding Committee to lead merger talks with CMA’s Committee on Other Professions. Merger agreement made between CMA and COA, but not accepted as valid by the AMA, medical specialty societies or the AOA. Grunigen and his colleagues (Vincent Carroll, D.O., Glen Cayler, D.O., and Dorothy Marsh, D.O.) move into national professional politics to promote merger of the AOA and AMA, or at least to obtain permission from the national organizations to enable the state associations to handle the negotiations between the two professions according to their own discretion.
- 1944: Alumni of COP&S engaged in obtaining an M.D. degree from Metropolitan University in Los Angeles, a diploma mill (not accredited by licensing boards) set up in Los Angeles to provide M.D. degrees to D.O.s upon taking some courses and an examination.
- 1947: John Cline, M.D. was elected as CMA President.
- 1948: COA delegates went to the AOA to request that graduates of Metropolitan University have their AOA membership revoked; the AOA created a policy to revoke membership if D.O.s took an M.D. degree from an institution not accredited by a state licensing board. Forest Grunigen, D.O. served on the AOA Board of Trustees along with Vincent Carroll, D.O..
- 1950: Mark Twain Hospital built in San Andreas, California. Senator Stephen Teale, D.O. wrote into the bond measure for that hospital in 1948 that there will be no discrimination of D.O.s who wanted to admit and care for patients there. It was the first such hospital built anywhere by a state bond measure mandating non-discrimination against D.O.s.
- 1951: Vincent Carroll, D.O., from Laguna Hills, CA, elected President of the AOA at the 54th AOA Annual Convention in Chicago. John Cline, MD, from San Francisco, CA, became AMA President. The two Californians, along with Forest Grunigen, formally began a national campaign to merge the AMA and AOA. Formal talks began between AMA and AOA representatives. The American College of Physicians, the American Hospital Association, the American Medical Association, and the Canadian Medical Association joined with the American College of Surgeons (ACS) to create the Joint Commission on Accreditation of Hospitals (JCAH), an independent, not-for-profit organization whose primary purpose was to provide voluntary accreditation of hospitals. The AOA or osteopathic hospitals were not included.
- 1952: Past AMA President Cline created an AMA Committee for the Study of Relations Between Osteopathy and Medicine to seek information about osteopathy. The AOA appointed a Conference Committee to correspond with like committee at AMA. L.A. County Board of Supervisors voted to build a new L.A. County Osteopathic Hospital.
- 1953: College of Osteopathic Physicians and Surgeons received a contract of $120,000 per year for 14, 358 hours of service in the Los Angeles County Osteopathic Hospital.
- 1952-1955: Meetings of AOA-AMA conference committees, visitations to five osteopathic colleges by the Cline Committee, including COP&S.
- 1954: $9,000,000 bond measure passed by the Los Angeles voters for the building of a new Los Angeles County Osteopathic Hospital.
- 1955: Report of Cline Committee was given to AMA House of Delegates at Atlantic City meeting. Majority report reflected visits of educators and requested acceptance of osteopathic physicians and their institutions, and removal of the “cult” label; this was rejected by the AMA House in favor of the minority report by Milford Rouse, M.D. Unless the AOA and its institutions remove statements in their brochures and catalogs related to the “osteopathic concept” and “A.T. Still”, the AMA voted to maintain the “cult” label and considered it unethical for M.D.s to interact professionally with D.O.s. Informal, unofficial, but regular meetings between the COA Fact Finding Committee (Seth Hufstedler as Counsel) and the CMA Committee on Other Professions (Howard Hassard as attorney) began.
- 1956: The cornerstone, with a time capsule embedded, of the new L.A. County Osteopathic Hospital was laid. Grace Bell, D.O. was appointed as the first Dean of COP&S, the first woman as dean of an American osteopathic medical school and of a U.S. co-ed medical institution.
- 1958: The AOA and its institutions removed reference to the “osteopathic concept” and “A.T. Still” from their brochures and catalogs in order to comply with the AMA demands. The L.A. County Osteopathic Hospital was dedicated.
- 1959: The new L.A. County Osteopathic Hospital was opened; a ten story structure with 500 beds. The AMA received a report from its judicial council. Council recommendations were amended in Reference Committee and on the floor of the House of Delegates. Action called for appointment of liaison committee to talk with AOA committee. Judicial council recommended to accept D.O.s and allow M.D.s to associate with them in their schools and institutions, and remove the “cult” label. California’s MDs told AMA House and committee that overall action was unnecessary because California D.O.s wanted to become MDs and that discussions were underway between the professions. Warren Bostick, M.D., delegate from the CMA, proposed an amendment to only accept interaction with D.O.s who were in the process of changing their school to an accredited M.D. institution and who practiced only scientific medicine. This was approved. AOA House of Delegates at their annual meeting reaffirmed the “separate and distinct” status of osteopathic profession. California delegates opposed. AMA appointed committee to meet with AOA committee.
- 1960: AOA House of Delegates resolved that any state society entering negotiations with another profession concerning unification or merger is subject to possible revocation of charter by AOA. COA House of Delegates voted to continue negotiations with the CMA. Official, formal negotiations between the Fact Finding Committee of the COA and the CMA Committee on Other Professions began. Osteopathic Physicians and Surgeons of California (OPSC) formed in opposition to the merger and COA. Richard Eby, D.O. was elected founding president. AMA-AOA committees met twice with no resolution.
The COA/CMA Merger and its aftermath (1961-1974)
- 1961: COA charter was revoked by the AOA. OPSC was accepted as the new state association representing the AOA in California. COA/CMA merger was completed. The Board of Trustees of COP&S changed the name of its school to the California College of Medicine (CCM).
- 1962: CCM was accredited by the AMA on Feb. 15. The faculty of CCM, led by Grace Bell, the Founding Dean of the College, were the first to receive the M.D. degree on March 7. (Grace Bell, M.D. became the first female Dean of an American M.D. granting Medical School). CCM took over the Los Angeles County Osteopathic Hospital, whose name reverted to “Unit II” once again. CCM graduated its first class of M.D.s in June, and granted M.D. degrees to approximately 2,000 D.O.s in July. The COA became the 41st Medical Society which became part of the CMA in August. Proposition 22 was passed by the voters in November, which limited the power of the osteopathic licensing board so that it could no longer grant new licenses to D.O.s, and would transfer its duties to the medical licensing board when the number of D.O.s re-certifying annually decreased to less than 40.
- 1964: The 41st Medical Society established the 41st Medical Trust to direct funds from the sale of osteopathic property and COA membership dues and donations to integration of D.O.s with M.D.s and to research osteopathic (musculoskeletal) manipulation. Thanks to political efforts of Senator Stephen Teale, now M.D., the State legislators voted to accept CCM as part of the University of California, effective January 1, 1964.
- 1964: Warren Bostick, M.D., dean of CCM, became the Founding Dean of the University of California at Irvine College of Medicine. Dr. Grunigen and Dr. Bostick unsuccessfully campaigned through the AMA nationwide to effect mergers of state medical and osteopathic associations and eliminate U.S. osteopathic medicine completely.
- 1966: First D.O. promoted to Medical Officer in U.S. Armed Forces. Former D.O. specialists still had difficulty in getting accepted into M.D. specialty societies unless they were trained in M.D. residency programs.
- 1967: First D.O. civilian commissioned as Medical Officer in U.S. Armed Forces. Forest Grunigen, M.D. became the first, and only, former D.O. president of the M.D. licensing board of California.
- 1968: CCM relocated to UC Irvine campus; USC leased the 2 buildings adjacent to the L.A. County Hospital from UC Regents. USC took over the patient load and faculty of the old osteopathic hospital and renamed it Women’s Hospital of the Los Angeles County Hospital. D’Amico et al (osteopathic physicians from out of state and commissioned Medical Officers in the military), with the support of OPSC, filed a law suit against the Attorney General of the State of California, and the Medical and Osteopathic Licensing Boards, for civil rights infraction, restricting trade of osteopathic practice. AMA allowed D.O.s to become members of state and county M.D. societies.
- 1969: AMA allowed D.O.s to become members of the AMA. D.O.s were accepted as residents in allopathic post graduate training programs. The AOA began to rebuild and grow: the first of many new osteopathic colleges in about 50 years was established at Michigan State University, which became the first state supported osteopathic college.
- 1970: American Hospital Association accepted hospitals with D.O.s on staff and Joint Commission on Accreditation of Hospitals recognized D.O.s as qualified members of hospital medical staffs. The American Academy of Family Physicians (AAFP) accepted its first former D.O., Richard Ryder, M.D., as member.
- 1974: California Supreme Court rules in favor of D’Amico et al and restored licensing power of the osteopathic licensing board. The first new osteopathic physician and surgeon licenses were granted to over 340 qualified out of state D.O.s since 1962. Efforts to build a hospital on the campus of CCM at UC Irvine, subsidized in part by the sale of the buildings across from L.A. County Hospital to USC and assets of the 41st Medical Society Trust, were unsuccessful. CCM continued to use Orange County Medical Center in Orange, CA as its main training hospital.
- 1975: CMA opened its membership to qualified D.O.s
D.O.s return to California (1978-1982)
- 1978: College of Osteopathic Medicine of the Pacific (COMP) is opened in Pomona, CA. President Philip Pumerantz, Ph.D.
- 1979: AOA allowed its members to join the AMA and specialty societies outside the osteopathic profession. CMA proposed legislation enabling DOs to be licensed by either the Board of Medical Quality Assurance (BMQA) or the Board of Osteopathic Examiners failed to pass.
- 1980: BMQA attempted to change its regulations enabling it to license D.O.s, but Attorney General stated it would be illegal to do so as BMQA could not accredit osteopathic schools.
- 1981: The Journal of the American Medical Association published the first American randomized clinical trial on an osteopathic manipulation procedure for patients with low back pain, carried out at UC Irvine CCM, with funding from the 41st Medical Trust, under the direction of Jerome Tobis, M.D.
- 1982: COMP graduates its first class. The first osteopathic internships and residencies open since 1962.
M.D.s and D.O.s work side by side in California (1982-2007):
- 1983: 41st Medical Trust funds transferred to the California College of Medicine Support Foundation. OPSC begins string of anti-discrimination legislation to protect the rights of osteopathic students and physicians in obtaining clerkships, training and employment throughout the state. It was settled in court that an osteopathic physician must use the D.O. designation unless he or she applied to the Board of Medical Examiners in 1962 for permission to use the M.D. degree.
- 1986: UC Irvine Family Medicine Residency began to accept D.O.s into its post-graduate training program. UC Irvine Physical Medicine & Rehabilitation Residency had accepted D.O.s into its Residency program already earlier.
- 1989: Anti-D.O. discrimination laws in California were finally in place.
- 1991: M.D.s and D.O.s began to associate in combined business ventures and medical groups as Health Maintenance Organizations put economic pressures on both groups.
- 1992: The American Academy of Family Physicians began to accept D.O.s who trained in AOA approved family practice residency programs as members.
- 1995-1996: Josiah Macy Foundation sponsored a two year symposium looking at the current and future status of the relations between M.D.s and D.O.s in America.
- 1996: The College of Osteopathic Medicine of the Pacific (COMP) became part of Western University of Health Sciences in Pomona, CA.
- 1997: Touro University College of Osteopathic Medicine, in the San Francisco Bay Area, became the second osteopathic college in the state of CA. The 41st Medical Society was dissolved on 7-31-1997.
- 1999: CMA resolved to work with OPSC on issues of common concern of physicians in California.
- 2004: Cynthia Stotts, D.O., a COMP graduate (1988), became the first female and the first D.O. President (Chief) of Medical Staff (which includes approximately 2,000 M.D.s, 40 D.O.s, about 900 interns and residents, and 200-400 medical students, as well as allied health professionals) at the Los Angeles County/USC Hospital in its 158 year history.
- 2005: CMA resolved to oppose consolidation [efforts led by the Governor] of the Medical Board of California with the Osteopathic Medical Board of California. 41st Medical Trust funds narrative history project on D.O.-M.D. relations in California.
- 2006: Cynthia Stotts, D.O. became the first physician to be elected for a second two-year term as Chief of Staff at LA County/USC Hospital.
- 2007: All hospitals in the state allow mixed M.D.-D.O. staff and allopathic post-graduate training programs accept both D.O.s and M.D.s. However, osteopathic post-graduate training programs only accept D.O.s. University of California Irvine School of Medicine, Western University of Health Sciences College of Osteopathic Medicine and Touro University College of Osteopathic Medicine continue to thrive in California, and CMA and OPSC interact on a regular basis on common issues. D.O.s can become voting members of CMA, but M.D.s cannot become voting members of OPSC. There are still two separate licensing boards, one for D.O.s and one for M.D.s.