Connecticut State Medical Soc. v. Connecticut Bd. of Examiners in Podiatry

Decision Date23 August 1988
Docket NumberNos. 13334,13335,s. 13334
Citation546 A.2d 830,208 Conn. 709
CourtConnecticut Supreme Court

William J. McCullough, Asst. Atty. Gen., with whom, on the brief, were Joseph I. Lieberman, Atty. Gen., and Robert E. Walsh and Richard J. Lynch, Asst. Attys. Gen., for appellant (named defendant).

William H. Narwold, with whom were Eric Watt Wiechmann and, on the brief, Karen L. Goldthwaite, Hartford, for appellants (defendant Steven Perlmutter et al.).

Linda L. Randell, with whom were Jeanette C. Schreiber, New Haven, and Andrew W. Roraback, Litchfield, for appellees (plaintiffs).


HULL, Associate Justice.

The dispositive issue in this appeal is whether the trial court erred in sustaining the appeal of the plaintiffs, the Connecticut State Medical Society and Enzo Sella, M.D., from a declaratory ruling of the defendant Connecticut Board of Examiners in Podiatry (board). In proceedings to determine whether the scope of podiatry practice, as defined in General Statutes § 20-50, 1 includes treatment of the ankle in certain respects, 2 the board had declared that "the ankle is part of the foot and the foot is part of the ankle." We conclude that the court applied the correct standard of review of the board's ruling in determining that as a matter of law the board had erroneously construed the applicable statute. Accordingly, we find no error.

This case has its genesis in the following ruling by a Medicare intermediary in January, 1984: "Podiatrists meet the Medicare definition of physician to the extent that state law permits their practice. In Connecticut that practice is limited to the diagnosis, prevention and treatment of foot ailments; therefore, services involving the ankle are not covered by Medicare." This ruling caused great concern to doctors of podiatric medicine. In a letter dated March 18, 1984, the board sought an opinion from the attorney general on the following question: "Is the diagnosis and treatment of sprains, strains and positional abnormalities of the ankle ... within the scope of podiatry practice in Connecticut?" In its request, the board noted that "[p]odiatrists in Connecticut have conservatively treated minor sprains, strains and fractures of the foot and ankle for many years without any regulatory or reimbursement questions being raised."

The attorney general responded by letter dated May 30, 1984, and stated that the "question posed in the request for advice is one which calls for a factual determination. In order to respond, analysis must first be conducted of the human anatomy to ascertain whether the ankle is, in fact, part of the foot, or vice-versa. Once accomplished, the analysis would have to continue with the determination of whether a sprain or strain of the ankle is, in fact, an 'ailment of the foot.' Conn.Gen.Stat. § 20-50." 62 Op.Conn.Atty.Gen. 229, 231 (1984). The attorney general concluded that "[these] factual issues identified above are best addressed After issuance of the attorney general's opinion, three doctors of podiatric medicine, the defendants Steven Perlmutter, Kove J. Schwartz and Harvey D. Lederman, wrote separately to the board requesting clarification of the opinion. In September, 1984, the board issued a notice of hearing, pursuant to § 4-176, 3 stating that a hearing would be held "for the purpose of issuing a declaratory ruling as requested on the issue of: Whether the diagnosis and treatment of sprains, strains and positional abnormalities of the ankle [are] within the scope of podiatry practice in Connecticut." The commissioner of health services and the three named doctors of podiatric medicine were designated as parties to the proceedings.

                by the Board of Examiners in Podiatry directly."   Id.  The attorney general's opinion then set forth three mechanisms that the board could utilize to resolve these factual issues:  (1) a declaratory ruling pursuant to General Statutes § 4-176;  (2) regulations pursuant to General Statutes § 19a-14(a)(4);  or (3) adjudication of a disciplinary complaint concerning a podiatrist claimed to [208 Conn. 713] be acting beyond the scope of his licensure, pursuant to General Statutes § 20-59.   Id

The board conducted the hearing on November 7, 1984, and received fifteen exhibits and heard testimony from eleven witnesses, both podiatrists and medical doctors, concerning the anatomical relationship between the foot and the ankle. 4 It subsequently issued a declaratory ruling that the ankle is part of the foot and that podiatrists could, therefore, treat ankle ailments. The plaintiffs appealed from the board's ruling, pursuant to General Statutes § 4-183(a). 5 The defendants moved to dismiss the appeals on the ground that the plaintiffs failed to allege sufficient facts from which aggrievement could be found. The trial court granted the motion to dismiss. On the plaintiffs' appeal from the judgment of dismissal, we reversed and remanded, holding that the allegations of the plaintiffs' complaint satisfied the pleading requirements for aggrievement. Connecticut State Medical Society v. Board of Examiners in Podiatry, 203 Conn. 295, 303-304, 524 A.2d 636 (1987).

On remand, the trial court found that the plaintiffs were aggrieved and sustained their administrative appeal. The court characterized the issue as whether the board's actions represented a valid interpretation of the statute or an impermissible attempt to expand the scope of podiatry practice. It acknowledged that the board, as an agency within the meaning of General Statutes § 4-166(1), may properly issue declaratory rulings, pursuant to § 4-176, predicated on its interpretation of statutes made for its guidance and which it is charged with administering. It noted, however, that such an agency must act strictly The court then considered § 20-50, noting that it concerned "foot ailments" and, in four separate areas, referred to "feet." It reasoned that words and phrases are to be construed according to the commonly approved usage of the language. It further concluded that where language is clear and unambiguous, there is no room for construction, and that a statute does not become ambiguous merely because the parties argue for or would prefer different meanings. The court finally concluded that the statute clearly and specifically limits the practice of podiatry to diagnosis of foot ailments and surgery on the feet. In doing so it relied on common understanding and the definition of "foot" contained in Webster's Third New International Dictionary. The court decided that "foot" has a well accepted and common meaning that does not include the ankle, and therefore, the board's ruling clearly expanded the ambit of podiatry practice as defined in § 20-50 because it is contrary to the plain meaning of the statutes.

                within its statutory authority and cannot modify, abridge or otherwise change the statutory provisions under which it acquires authority.   The court stated that its review was not limited to a determination of whether the board's declaratory ruling interpreting a statute was clearly [208 Conn. 715] erroneous in view of the reliable, probative and substantial evidence on the whole record, but that while the court should not substitute its judgment for that of the agency on factual issues, it may disturb the agency's ruling if it is in violation of statutory provisions or affected by other error of law.   The court concluded that, since General Statutes § 20-50 has not previously been subjected to judicial scrutiny, its construction was a question of law on which an administrative ruling is not entitled to special deference and that the court may review the ruling to determine whether it was correct as a matter of law

The board and the podiatrists filed separate appeals to the Appellate Court. Pursuant to Practice Book § 4023, we transferred these appeals to this court.

On appeal, the podiatrists claim that: (1) the trial court erred in reviewing the board's declaratory ruling under a de novo standard of review, rather than under the statutory review criteria contained in § 4-183(g); and (2) the board correctly concluded, on the basis of the facts found at the evidentiary hearing held on November 7, 1984, that the diagnosis and treatment of sprains, strains and positional abnormalities of the ankle are within the scope of podiatry practice in Connecticut.

The board assigns as error: (1) the trial court's ruling that the proper interpretation of the term "foot" as used in § 20-50 is purely a question of law rather than a mixed question of law and fact; (2) the trial court's conclusion that the board's declaratory ruling served to expand the ambit of podiatry practice as set forth in § 20-50; and (3) the trial court's ruling that the term "foot" as used in § 20-50 is to be accorded its commonly understood meaning as reflected in Webster's Dictionary.

For clarification, we construe these various claims of error as two issues: (1) whether the trial court applied the appropriate standard of review to the board's rulings; and (2) whether the trial court correctly interpreted § 20-50.


The podiatrists argue that the trial court conducted a de novo review of the board's declaratory ruling and disregarded entirely the opinion of the attorney general and the board's factual findings and conclusions of law. They claim that the court substituted its judgment for that of the agency as to the weight of the evidence on questions of fact in violation of General Statutes § 4-183(g). They further claim that the court erred in failing to afford "special deference" to the board's factual findings, and to time-tested agency interpretations.

The standard of judicial review of administrative agency rulings is well established. Section 4-183(g) permits...

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