Laurino v. BOARD OF PROF. DISCIPLINE

• Decision Date: 16 July 2002
• Docket Number: No. 27131.,27131.
• Citation: 137 Idaho 596,51 P.3d 410
• Parties: James A. LAURINO, M.D., Plaintiff-Respondent, v. BOARD OF PROFESSIONAL DISCIPLINE OF the IDAHO STATE BOARD OF MEDICINE, Defendant-Appellant.
• Court: Idaho Supreme Court

51 P.3d 410

137 Idaho 596

James A. LAURINO, M.D., Plaintiff-Respondent, v. BOARD OF PROFESSIONAL DISCIPLINE OF the IDAHO STATE BOARD OF MEDICINE, Defendant-Appellant.

No. 27131.

Supreme Court of Idaho, Boise, February 2002 Term.

July 16, 2002.

Rehearing Denied July 16, 2002.

Uranga & Uranga, Boise, for appellant. Jean R. Uranga argued.

Quane, Smith, Boise, for respondent. Terrence S. Jones argued.

WALTERS, Justice.

Substitute Opinion the Opinion Issued May 1, 2002 is Hereby Withdrawn.

This is an appeal by the Board of Professional Discipline of the Idaho State Board of Medicine from a decision of the district court that reversed the Board's order revoking James A. Laurino, M.D.'s license to practice medicine. We hold that the Board erred in revoking Dr. Laurino's license in light of the evidence presented at the inquiry concerning Dr. Laurino's treatment of nine patients. However, because we also hold that there is substantial, competent evidence supporting the Board's conclusion that Dr. Laurino failed to provide proper medical care with respect to two of the patients, we remand the case for a new determination by the Board as to an appropriate sanction that should be imposed.

FACTS AND PROCEDURAL BACKGROUND

The Board of Medicine filed a complaint against Dr. Laurino in May of 1998, alleging that Dr. Laurino had provided substandard care in his treatment of nine patients, who were seen in his general practice in Grangeville, Idaho, during a six-month period. A hearing officer appointed by the Board heard evidence on the allegations on October 12, 1998, and subsequently issued an exhaustive decision recapping the testimony and including his findings of fact, conclusions of law and a recommendation.

The hearing officer found only two minor violations of the standard of care with regard to Dr. Laurino's care and treatment of patient M.J. The hearing officer deferred to the Board for a determination of appropriate disciplinary action for the violations but otherwise recommended dismissal of all of the allegations in the remaining counts.

The Board independently reviewed the decision of the hearing officer and his recommended dismissal of the complaint, pursuant to I.C. § 67-5244. On November 5, 1999, the Board issued its findings of fact, conclusions of law and final order. The Board found by clear and convincing evidence on each count that Doctor Laurino's management of his patient's care "did not meet the standard of care taken by other qualified physicians in the Grangeville community, taking into account Doctor Laurino's training, experience and the degree of expertise with which he holds himself out to the public." The Board concluded to take "its experience, technical competence and specialized knowledge in evaluating the evidence, as well as the extensive expert testimony by local physicians in determining that Dr. Laurino's conduct does not meet the standard of care." Finally, the Board determined that revocation of Dr. Laurino's license was the appropriate sanction to administer in the case.

After the Board denied Dr. Laurino's reconsideration request, Dr. Laurino filed a petition with the district court for judicial review. The memorandum decision of the district court reversed the decision of the Board and directed that the disciplinary complaint against Dr. Laurino be dismissed. The district court held that none of the Board's factual findings were supported by any reasonable interpretation of the evidence, that the Board ignored the testimony of witnesses presented by Dr. Laurino, and that the Board concluded that Dr. Laurino had altered or falsified records even though such charges were not a part of the complaint. The Board appealed from the decision of the district court.

STANDARD OF REVIEW

The Idaho Administrative Procedure Act, Idaho Code § 67-5279, sets forth the standard of review for an appeal from a disciplinary proceeding by the Board of Medicine. In an appeal from the district court's decision where the district court was acting in its appellate capacity in a review under the APA, the Court reviews the agency record independently of the district court's decision. Levin v. Idaho State Board of Medicine, 133 Idaho 413, 987 P.2d 1028 (1999); First Interstate Bank of Idaho, N.A. v. West, 107 Idaho 851, 693 P.2d 1053 (1984). The rulings of the district court therefore are not the focus of our review. The Court will defer to the agency's findings of fact unless those findings are clearly erroneous. Paul v. Board of Professional Discipline, 134 Idaho 838, 11 P.3d 34 (2000), citing Ferguson v. Board of County Commissioners for Ada County, 110 Idaho 785, 718 P.2d 1223 (1986). Neither the district court nor this Court on appeal may substitute its judgment for that of the agency as to the weight of the evidence presented in the record. I.C. § 67-5279(1); Levin, supra at 417, 987 P.2d at 1032; Woodfield v. Board of Professional Discipline, 127 Idaho 738, 905 P.2d 1047 (Ct.App.1995). The agency's findings must be affirmed unless the findings are not supported by substantial evidence on the record as a whole, I.C. § 67-5729(3), or the findings are arbitrary, capricious, or an abuse of discretion, I.C. § 67-5729(2)(d). Any findings made by the Board based on matters outside the record must be reversed as unsupported by substantial, competent evidence or as arbitrary and capricious.

I. ESTABLISHING THE STANDARD OF CARE

The Medical Practices Act provides that a physician is subject to discipline by the Board for "the provision of health care which fails to meet the standard of health care provided by other qualified physicians in the same community or similar communities, taking into account his training, experience and the degree of expertise to which he holds himself out to the public." I.C. § 54-1814(7). The language of I.C. § 54-1814(7) has been held to be similar to the well-accepted definition of medical malpractice, contained in I.C. § 6-1012, and sufficient to notify medical practitioners that they could be disciplined for failure to conform to community standards. Krueger v. Board of Professional Discipline, 122 Idaho 577, 836 P.2d 523 (1992); Woodfield v. Board of Professional Discipline, 127 Idaho 738, 748, 905 P.2d 1047, 1057 (Ct.App.1995). The burden of proof in a disciplinary proceeding is the "clear and convincing" standard. Cooper v. Board of Professional Discipline, 134 Idaho 449, n. 3, 4 P.3d 561 n. 3 (2000).

The Board contends that the hearing officer measured the conduct of Dr. Laurino against an incorrect standard of care derived from a misreading of Krueger v. Professional Discipline, 122 Idaho 577, 836 P.2d 523 (1992). Because of the application of the erroneous standard, the Board asserts it was justified in rejecting all of the hearing officer's findings and conclusions. The Board determined the standards of care in this case, relying principally upon the testimony of its experts: Dr. Hollopeter, who had practiced for twenty-five years in Grangeville, and Dr. Gardner, another Grangeville family care practitioner. Both doctors were on staff at the local hospital, Syringa Hospital, and were directly involved in peer review proceedings during which they observed and evaluated Dr. Laurino's performance and ultimately decided not to grant hospital privileges to Dr. Laurino.

In Krueger, the Court held that the district court's reliance on the "consensus of expert opinion" language¹ was misplaced. Krueger, supra at 581, 836 P.2d at 527. The Court reversed the district court's finding that the Board's decision as to patients A though E would be unconstitutionally vague without a finding that the decision was supported by a consensus of expert opinion. Id. at 582, 836 P.2d at 528. As the Court explained in a later case, the Krueger Court upheld "the application of a statutory standard [I.C. § 54-1814(7)] based on expert testimony of other physicians." See Rincover v. State, 124 Idaho 920, 923, 866 P.2d 177, 180 (1993)

.

A determination of a violation of the standard of care must be supported by expert testimony establishing the community's generally accepted standard of care required of the physician under the circumstances of each case under scrutiny. Woodfield v. Board of Professional Discipline, supra.

To the extent that the evidence as to the local standard of care is in conflict, that is a question of the weight, not the admissibility of the evidence. Kozlowski v. Rush, 121 Idaho 825, 828 P.2d 854 (1992) (Bistline, J., specially concurring). The weight to be given such expert opinion testimony depends upon the propriety and reasonableness of the testimony, but the testimony is not binding upon an experienced and professional board. See Snyder v. State, 18 Ohio App.3d 47, 480 N.E.2d 496, 498 (1984). The Board's finding of a breach of the standard of care then may be based on a comparison of the alleged violation against a well-recognized standard, articulated by the Board, based on the expertise and experience of the member physicians. Woodfield, 127 Idaho at 749,

905 P.2d at 1058. See also I.C. § 67-5251(5). The Board, however, may not use its expertise as a substitute for evidence in the record, since the requirement for administrative decisions based on substantial evidence and reasoned findings²— which provide the basis for effective judicial review—would become meaningless if material facts known to or relied upon by the agency did not appear in the record.

II. SUBSTANTIAL AND COMPETENT EVIDENCE

The violations that the Board found against Dr. Laurino must be reviewed to determine whether the evidence in the record as a whole supports the findings, inferences, and conclusions made by the Board. I.C. § 67-5279(3)(d). Substantial evidence is such relevant evidence as a reasonable mind might accept as adequate and reasonable to support a conclusion. Idaho State Ins. Fund v. Hunnicutt, 110 Idaho 257, 260, 715 P.2d 927, 930 (1985).

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