When then-state Rep. Tricia Derges was indicted in 2021 for selling fake stem cell treatments at her southwest Missouri clinics, it put a spotlight on the licensing process that allowed her to set up shop as a medical doctor with a degree from an unaccredited offshore medical school.
In February, Derges began serving a six-year federal sentence for seven counts of fraud related to the fake treatments, as well as three counts of fraud in COVID-19 programs, 10 counts of illegally prescribing Oxycodone and Adderall, and two counts of lying to the FBI.
Three bills on Gov. Mike Parson's desk, each with identical language, would tighten the path Derges used to obtain a license as an "assistant physician." The change to licensing rules was never introduced as a bill, but found its way onto bills addressing professional licensing or health care as they moved through the Senate.
Under current law, anyone who graduates from a medical school and can pass a national test but is unable to find a residency for final training can apply to become an "assistant physician." They must have a collaborative practice agreement with a fully licensed physician.
The legislation before Parson would make two significant changes that would make it harder to become an assistant physician. The bills would require applicants to be graduates of a U.S.-based school recognized by the national medical and osteopathic school accreditation agencies or, when graduates of non-U.S. schools, be accredited by the Educational Commission for Foreign Medical Graduates.
Derges received her degree from Caribbean Medical University in the Netherland Antilles. It is not accredited by any recognized accrediting body and is not listed in the World Directory of Medical Schools.
She called her practice "Ozark Valley Medical Clinic" and set up offices in Springfield, Ozark and Branson. She purchased sterile amniotic fluid from the University of Utah and told patients it contained stem cells, charging four to six times her cost for injections or nebulizer treatments.
The fluid contained no stem cells and had no therapeutic value. She advertised it as a cure for COVID-19 in April 2020.
The new provisions for assistant physician licensing first appeared in an amendment from state Sen. Curtis Trent, R-Springfield, during debate on a House bill to make it easier for physical therapists to offer treatments without a physician referral.
He didn't intend to target Derges, Trent said.
"I do recall some commentary at the time, around the Senate, as we tried to get the language right, that it would probably have affected her case as well," Trent said. "That really wasn't the prime reason."
The Missouri State Medical Association wasn't particularly happy with the legislation, but didn't work against it, said Jeff Howell, the organization's executive vice president.
"I didn't raise a fuss about it," Howell said. "It wasn't worth the political capital it would take to do that."
The assistant physician program is intended to be a way for medical or osteopathic school graduates who cannot obtain a slot in a residency program to use their knowledge, often obtained at great expense, Howell said.
"There is definitely an issue with not enough residency slots," Howell said. "Every medical school graduate that doesn't get a slot, they are not incompetent."
During discussions of the provision, Derges became the example for what it was intended to stop, he said.
"They are not all Tricia Derges," Howell said of assistant physicians. "That is how it is framed in the (Capitol) building, but that is not how it is in real life. She's an easy target in the building."
One in four physicians working in the United States obtained their degrees from international schools and access to care would be more difficult if they did not have the opportunity to practice, he said.
The purpose of the language is not to cut down on the number of assistant physicians but to make sure those that are licensed have a quality medical education, Trent said.
"We want to make sure that these physicians are gatekept for quality, and that we know the kinds of institutions and kind of rigor they have," Trent said. "These are important positions, dealing with health and people's lives."
The Missouri Independent, www.missouriindependent.com, is a nonprofit, nonpartisan news organization covering state government and its impact on Missourians.