Miulli v. Iowa Board of Medical Examiners, No. 4-100/03-0319 (Iowa App. 4/28/2004), 4-100/03-0319
| Decision Date | 28 April 2004 |
| Docket Number | No. 4-100/03-0319,4-100/03-0319 |
| Parties | DANIEL E. MIULLI, D.O., Petitioner-Appellant, v. IOWA BOARD OF MEDICAL EXAMINERS, Respondent-Appellee. |
| Court | Iowa Court of Appeals |
Appeal from the Iowa District Court for Polk County, Robert D. Wilson, Judge.
Dr. Daniel Miulli appeals the district court's decision affirming the action of the Iowa Board of Medical Examiners to restrict his medical license.
AFFIRMED.
Michael M. Sellers, Sellers Law Office, West Des Moines, for appellant.
Thomas J. Miller, Attorney General, Theresa O'Connell Weeg and Heather L. Adams, Assistant Attorneys General, for appellee.
Heard by Sackett, C.J., and Huitink and Miller, JJ.
Dr. Daniel Miulli is a doctor of osteopathy. He completed a residency in neurosurgery in Pennsylvania and is board certified in neurological surgery by the American Osteopathic Association. He practiced in Minnesota for more than two years. In 1997 Dr. Miulli was issued a medical license in Iowa, and he began to practice neurosurgery at Mercy Hospital in Des Moines.
In February 1999 Dr. John Mawk, chief of neurosurgery at Mercy Hospital, filed a formal complaint against Dr. Miulli with the Iowa Board of Medical Examiners. Dr. Mawk's complaint was based on numerous statements from other physicians that Dr. Miulli had engaged in excessively aggressive surgeries. A board investigator interviewed several physicians in Des Moines who felt Dr. Miulli had performed more extensive surgeries than circumstances warranted.
Eighteen of Dr. Miulli's patient files were sent to a peer review committee comprised of Dr. John Van Gilder, chairman of the Department of Neurosurgery at the University of Iowa; Dr. Chad Abernathy, a neurosurgeon; and Dr. William Pontarelli, an orthopedic surgeon. The peer review committee concluded Dr. Miulli had breached the standard of care in one brain surgery and five spine surgeries. The committee also expressed serious concerns in five additional cases.
On January 18, 2001, the Board filed a statement of charges against Dr. Miulli, alleging he engaged in professional incompetency, practices harmful or detrimental to the public, and making misleading representations in the practice of medicine. The Board entered an emergency adjudicative order, which found Dr. Miulli's "continued practice of surgery on the central nervous system or spine would pose an immediate danger to the public health, safety, or welfare." Dr. Miulli was immediately restricted from performing surgery on the central nervous system or spine until he obtained Board approval of a plan to be monitored by another neurosurgeon. The Board denied Dr. Miulli's application for reconsideration of the emergency adjudicative order.
An administrative hearing was held in August 2001. The State presented the expert testimony of the members of the peer review committee, Dr. Van Gilder, Dr. Abernathy, and Dr. Pontarelli. Dr. Miulli presented the expert testimony of Dr. Fred Geisler, Dr. Keith Kattner, and Dr. Michael Amaral, neurosurgeons, and Dr. Alan Lippitt, an orthopedic surgeon.
The Board determined Dr. Miulli had engaged in professional incompetency in his treatment of four patients and the Board had significant concerns about his treatment of six other patients. The Board stated:
Based on its review of all of these cases, the Board has very serious concerns about the Respondent's clinical judgment, his selection of patients for surgery, his operative judgment in determining the extent of the surgical procedure to be performed, his selection of modalities for surgery, and his assessment of indications for surgery and interpretation of diagnostic studies, such as discograms and MRIs.
The competence issues and concerns raised by this record are extremely serious and justify the conclusion that the Respondent's practice of surgery on the central nervous system and spine was appropriately limited by the Board's Emergency Adjudicative Order.
The Board also found Dr. Miulli was guilty of practices harmful or detrimental to the public. Dr. Miulli admitted he had allowed his nurse to sign prescriptions, in violation of Iowa and federal law. Furthermore, the Board concluded Dr. Miulli knowingly made misleading representations in the practice of medicine. The Board found Dr. Miulli had provided false and misleading answers on his application for licensure in Iowa. The Board determined Dr. Miulli's medical license in Iowa should be restricted until he completed a comprehensive competency evaluation.
Dr. Miulli filed a petition for judicial review, alleging (1) Iowa Code section 17A.18A (2001) did not authorize an emergency adjudicative order in this case; (2) section 17A.18A violated due process; (3) the Board should have employed a clear and convincing evidence standard rather than a preponderance of the evidence standard in issuing the emergency order; and (4) there was not sufficient evidence to justify issuance of the emergency order. The district court rejected Dr. Miulli's claims.
Dr. Miulli then filed a motion to expand, which raised several issues regarding the Board's final ruling. The district court concluded:
The record in this case is extensive, and the factual issues complex and highly technical. The findings made by the Board were specific and detailed, and reflected careful balancing of the facts in each case. The Board relied extensively on its medical expertise to evaluate the patient records and the testimony of the treating physicians and expert witnesses. It is exactly this kind of expertise to which the Iowa Supreme Court repeatedly urges deference. See Iowa Code § 17A.19(11)(c). The Board's decision was supported by substantial evidence on the record, and is therefore affirmed.
Dr. Miulli appeals, claiming (1) section 17A.18A is unconstitutional; (2) he should have received a hearing prior to the restriction of his license; (3) in order to issue an emergency adjudicative order, the Board should use a clear and convincing evidence standard; and (4) there was insufficient evidence to justify the emergency adjudicative order.
We review to determine whether the district court properly applied the law in exercising its judicial review function. Arora v. Iowa Bd. of Med. Exam'rs, 564 N.W.2d 4, 6 (Iowa 1997). We are bound by the agency's factual findings if they are supported by substantial evidence. Dawson v. Iowa Bd. of Med. Exam'rs, 654 N.W.2d 514, 518 (Iowa 2002). In deciding whether a finding is supported by substantial evidence in the record, we consider the evidence that detracts from the challenged finding as well as the evidence that supports it. Iowa Code § 17A.19(10)(f)(3); Dawson, 654 N.W.2d at 518. On constitutional issues, our review is de novo. Glowacki v. Iowa Bd. of Med. Exam'rs, 501 N.W.2d 539, 541 (Iowa 1993).
Dr. Miulli claims the emergency adjudicative proceedings of section 17A.18A are unconstitutional because under this provision the Board restricted his medical license prior to any hearing being held. He states his medical license was a valuable property right, which should not have been taken away without due process of law.
Under the United States and Iowa Constitutions, "no person shall be deprived of life, liberty, or property, without due process of law." U.S. Const. amend. XIV; Iowa Const. art. I, § 9. To determine what process is due in a particular case, we look to the balancing test found in Mathews v. Eldridge, 424 U.S. 319, 332, 96 S. Ct. 893, 901, 47 L. Ed. 2d 18, 33 (1976). We consider: (1) the private interest that will be affected by the State's actions; (2) the State's interest; and (3) the risk that the current procedure will lead to an erroneous deprivation of the interests at stake and the probable value, if any, of additional or different procedural safeguards. Mathews, 424 U.S. at 332, 96 S. Ct. 901, 47 L. Ed. 2d at 33.
With respect to agency adjudications, due process generally requires that a party be informed of the issues and has an opportunity to be heard. See Paulson v. Iowa Bd. of Med. Exam'rs, 592 N.W.2d 677, 680 (Iowa 1999). Our supreme court has recognized four exceptions, where due process does not demand an administrative hearing, in cases involving: (1) no "life, liberty, or property" interests because no entitlement can be established; (2) an absence of relevant disputed facts; (3) emergency agency action; and (4) the use of inspections, examinations and testing to determine relevant facts. Allegre v. Iowa State Bd. of Regents, 349 N.W.2d 112, 115 (Iowa 1984) (citing Arthur Earl Bonfield, The Definition of Formal Agency Adjudication Under the Iowa Administrative Procedure Act, 63 Iowa L. Rev. 285, 325-35 (1977) (emphasis added)); see also Hodel v. Virginia Surface Mining & Reclamation Ass'n, 452 U.S. 264, 299-300, 101 S. Ct. 2352, 2372, 69 L. Ed. 2d 1, 31 (1981) (); Brummer v. Iowa Dep't of Corrs., 661 N.W.2d 167, 173 (Iowa 2003) ().
Section 17A.18A(1) permits an agency to "use emergency...
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