Universal Licensing: Arizona Opened The Doors To Less Qualified Workers

Malin was in pain and needed surgery. 

But the surgery went bad. Fecal matter spilled from the kitten's colon, contaminating his innards. He died later that night. 

The veterinarian performing the surgery, Karen Smolen, failed to use proper surgical techniques, according to an investigation by state regulators. Dr. Smolen was fired but denied any wrongdoing.  

At the time of the surgery, Dr. Smolen had applied for a universal license in Arizona and was working on a temporary license. Universal licensing is a relatively new pathway that allows professionals with out-of-state licenses––from doctors and dentists to barbers and massage therapists––to get licensed quickly. Arizona was the first state in the country to speed up licensing in this way.   

But in adopting universal licensing more than two years ago, Arizona opened the door to applicants from states with lower licensing requirements, some of whom wouldn't be eligible for an old-fashioned Arizona license. Others, like Dr. Smolen, are able to also use temporary licenses to start work while their universal applications are processed. She is accused of performing poorly, and licensing gaps make it hard to hold her accountable. 

Jennifer Kottwitz, the foster mom of the dead kitten, didn't want another animal to be harmed. So she made the licensing boards in Arizona and California aware of what happened and how she felt. But boards in Arizona and California both said they had no jurisdiction to intervene. 

Arizona said Dr. Smolen's temporary license had expired when they got the complaint and her universal license had not been finalized; California said the allegations happened outside their state boundary. 

Kottwitz is left feeling frustrated that nothing can be done. 

"Arizona needs to figure it out and get on the ball and hold people responsible for their actions," she said. 

Dr. Smolen, meanwhile, is free to keep working as a vet in California. 

"There's nothing nefarious about what I was doing. I was trying to help and was treated like garbage over it," she told The Arizona Republic. 

Reporters from The Arizona Republic, assisted by two journalism students from the University of Texas at Austin, spent four months reviewing universal license documents from a wide variety of professions, including medical fields. Reporters listened to hundreds of hours of board meetings, read thousands of pages of documents and talked with license applicants. They spoke to policy makers who wrote the law, researchers who study professional licensing, lawmakers who opposed and supported the legislation and licensing board members.

Among the findings:

• Only a tiny fraction of universal applications are denied in Arizona, and people with histories of disciplinary actions or malpractice have been allowed to work, including a dentist accused of pulling out two of the wrong teeth from a 12-year-old girl.

• The Governor's Office takes a heavy hand in ensuring licensing boards approve universal licenses, in one case ordering a board to grant a license to a counselor who graduated from a school that didn't have the required accreditation at the time.

• Universal licensing creates an uneven playing field for people seeking in-state licenses in professions where Arizona requires more education, training or testing. For example, funeral directors are being licensed who haven't passed national exams required by the majority of states. Under universal licensure, it's considered good enough that they met the requirements in their home states. 

• The Governor's Office requires licensing boards to track all applications received under universal licensure. But boards aren't required to report health and safety metrics to the public––such as how many professionals have faced discipline in their home states. The Republic found examples of people who have been disciplined, including a chiropractor convicted of felony fraud and licensees named in malpractice claims. Because their discipline requirements had been completed, their licenses were considered to be in good standing. They were given Arizona licenses. 

C.J. Karamargin, spokesman for Arizona Gov. Doug Ducey, calls universal licensing a "tremendous success," and says other states have contacted the Governor's Office to find out how to replicate the law. Public health and safety is a top priority, he said, with licensing boards required to do due diligence in examining an applicant's background.

"There is always the possibility that a bad actor may become licensed through any path of license, not just universal recognition. But our expectation is that bad actors will be held accountable," he said. 

To be sure, universal licensing has helped thousands of new Arizona residents get to work quickly. It makes it easier for people to get a job if they have a professional license in another state for at least a year. The option has been especially useful getting doctors licensed quickly during the COVID-19 pandemic, state officials said. 

Big businesses are proponents of the law. It allows them to recruit workers and expand much faster because they're able to find labor in tight markets. When Ducey announced his support for the legislation in early 2019, he was backed by several chambers of commerce, the Home Builders Association of Central Arizona and the National Federation of Independent Business.

But in the rush to fill open positions and satisfy the needs of business, critics say Arizona and its governor are placing Arizonans at risk. 

Michael Armstrong, vice president of the Federation of Associations of Regulatory Boards, calls Arizona's universal licensing law an overcorrection that will create more problems than it solves. The law is based on the misimpression that most states have the same minimum qualifications for licensure, he said. They don't. 

"You could risk having people doing harm to the public because they're not qualified or competent to practice," he said. "Just because another state says you're competent or qualified, what's their criteria? Does that criteria comport with what you think should be appropriate in Arizona?"

Two years into the law, few denials

Universal licensing applies to more than 65 occupations and professions under one state law, many of them health-related. It doesn't apply to teachers and lawyers, who are licensed differently and have their own agreements with states. 

As of August, 4,041 universal licenses had been approved with only 29 denials, according to a survey by the Goldwater Institute. Another 528 applications were pending or had been withdrawn. Common reasons for withdrawing include people change their minds about moving, get job offers in other states or are unable to prove Arizona residency.

The Governor's Office didn't have numbers on how universal licensing compares to traditional licensing pathways. It's still a small amount in comparison. The law has been in place just over two years. For example, out of about 10,600 licensed massage therapists in Arizona, only 51 have been universal applicants. 

The law leaves little room for denial. 

Under universal licensing, if you are licensed in another state for at least a year and your license is in good standing, you can establish Arizona residency and apply––and almost certainly receive––Arizona's equivalent of the same professional license. 

The Arizona State Board of Dental Examiners had approved 234 universal licenses as of August and had no denials. Another 40 were pending or withdrawn. 

The dental board earlier this year approved a dentist who was the subject of a malpractice settlement for removing the wrong teeth from a 12-year-old girl. 

Ryan B. Gibson was working as a dentist in a Dallas suburb when an orthodontist referred a patient to him for teeth extraction in 2017, according to a malpractice disclosure he was required to submit as part of his application. 

Gibson said the referral had marked two of the girl's top teeth for removal. Within an hour, the girl's mother called, saying he had taken out the wrong teeth. A closer inspection revealed conflicting information: further down on the referral form, the orthodontist said the teeth that were to be extracted were the "lower first premolars." 

In an explanation to the Arizona licensing board, Gibson said the orthodontist apologized, "telling me he had made a mistake and marked the wrong teeth and would let the patient's parents know of his error." 

The parents filed a claim, which was settled for $82,500. The case was not investigated by the state licensing board in Texas, he said. 

When Gibson's license application went before the Arizona Dental Board for discussion this year, a board member expressed concern about granting the license. He suggested the burden was on Gibson to make sure the right teeth were extracted, even if the patient had been referred to him. 

​Two other board members defended Gibson, saying healthy teeth are sometimes removed based on the position of other teeth. Gibson also had no previous disciplinary actions in the states where he was licensed. 

"We've all made mistakes," said board member and dentist Russell Jeffrey Morrow. "I don't think it's going to endanger the body of the public going forward," he said.

The board voted to grant him a license, unanimously.

​Gibson did not respond to The Republic's requests for comment. 

​The Governor's Office declined comment on applicants being approved for licenses who had malpractice settlementst because the allegations weren't part of state disciplinary actions.

Governor Ducey is known for his business-friendly policies. One of his 2014 campaign slogans was "Opportunity for All," and a belief that opportunity comes through employment. Under this philosophy, everyone who is qualified to do the job should have the ability to do the job without undue delay or government interference. 

The Republican governor declared during his 2016 State of the State address that too many jobs required licenses. This resulted in what he called a "maze of bureaucracy for small business people looking to earn an honest living." 

Ducey pushed for and passed the Right to Earn a Living Act in 2017, legislation developed by the Goldwater Institute that enabled people to challenge unfair licensing requirements in court. Ducey issued an executive order that year, requiring state licensing boards to justify licensing requirements that exceeded national averages.​

He called on lawmakers to pass a universal recognition licensing law in his 2019 State of the State address, saying, "If people want to work, let's let them work." 

​The Republican-backed legislation was an expansion of an Arizona law in place since 2011 that made it easier for spouses of military service members stationed in Arizona to transfer their licenses. 

Two libertarian, conservative-leaning groups, the Goldwater Institute and the Institute for Justice, backed the expanded legislation, known as House Bill 2569. When the legislation was introduced in early 2019, Ducey sent a representative from his office to House and Senate hearings to reiterate his support. 

During hearings, there was one central message:​

"If you have a licensed occupation, your skills don't end when you cross the border, when you come into Arizona. You still have those skill sets, and we want to put you to work right away," said Warren Petersen, the Republican lawmaker who sponsored universal licensing legislation. ​

Democrats had supported the previous legislation for military spouses, but some felt the expanded version went too far. ​

"We have shortages in teaching, medicine and nursing. But we don't have shortages across the board," said Rep. Pamela Powers Hannley, D-Tucson, during a House hearing. "So why should we dumb down our standards when it's really not necessary to build up the work force?"

Another Democrat, Rep. Dr. Amish Shah of Phoenix, liked the concept but said he couldn't vote for the legislation because there was no assurance other states would accept Arizona 's professional licenses. That would create an unfair trade practice, he said.

Despite some Democratic opposition, the bill passed easily. 

​Ducey signed the legislation on a blustery April day. He rolled up to the Arizona Capitol in a U-Haul van, a rental company that is synonymous with Arizona. he greeted supporters in front of a sign that proclaimed the state to be "OPEN FOR OPPORTUNITY."

Stepping to a podium emblazoned with the state seal, the governor reminded the crowd that he, too, was a transplant, from Toledo, Ohio. He had never been to Arizona, didn't know anyone here when he came west to attend Arizona State University. He met his wife, raised his family and built a business, becoming CEO of the Cold Stone Creamery ice cream parlor chain. 

Ducey told that crowd that 100,000 people would move to Arizona that year. People were looking for opportunities, through good-paying jobs and meaningful work. But too often, the government acts as an adversary for people who want to work, he said. 

"You don't lose your skills simply because you pack up a U-Haul truck and make the decision to move," he said. 

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