Pons v. Ohio State Med. Bd.

Decision Date07 July 1993
Docket NumberNo. 92-115,92-115
Citation614 N.E.2d 748,66 Ohio St.3d 619
PartiesPONS, Appellee, v. OHIO STATE MEDICAL BOARD, Appellant.
CourtOhio Supreme Court

SYLLABUS BY THE COURT

When reviewing a medical board's order, courts must accord due deference to the board's interpretation of the technical and ethical requirements of its profession.

In 1970, appellee, Pablo A. Pons, M.D., became licensed to practice medicine in Ohio. Since then, he has specialized in obstetrics and gynecology. On November 9, 1989, appellant, Ohio State Medical Board ("board"), notified Dr. Pons that it proposed to take disciplinary action against him for violations of R.C. 4731.22(B)(6) (a departure from, or failure to conform, to minimal standards of care) and former R.C. 4731.22(B)(15) and its successor former R.C. 4731.22(B)(14) 1 (violations of medical ethics) in his treatment of a woman referred to as "Patient 1."

On January 30, 1990, a hearing was held before a hearing officer with regard to the board's allegations. The testimony and exhibits received at this proceeding and, as noted in the findings of fact, revealed that Dr. Pons was the treating physician of Patient 1 from around 1973 to March 26, 1984. Sometime in 1976, Dr. Pons began a sexual and emotional relationship with her. This relationship lasted until 1983.

Dr. Pons first saw Patient 1 in 1973, when he had been called as a consult by her family physician to perform a therapeutic abortion for her. In large part, the medical indication for the abortion was Patient 1's severe anxiety, anxiety which arose from the birth of a previous child with Down's Syndrome. Dr. Pons was aware of this previous history of psychiatric problems, including Patient 1's treatment and subsequent hospitalization for these problems.

Prior to the beginning of their sexual relationship, Dr. Pons continued to treat Patient 1 for periods of depression and anxiety. At one point, in 1975 Dr. Pons counseled Patient 1 and her husband regarding their marital difficulties.

From 1974 to March 1984, Dr. Pons served as Patient 1's exclusive physician. He treated her for all her gynecological problems. He also provided non-gynecological medical care, such as treatment for back pain (severe enough to warrant hospitalization), and the removal of a mole or cyst from Patient 1's shoulder because Patient 1 refused to see other physicians.

When Patient 1 became pregnant with his child in 1983, Dr. Pons ended his sexual relationship with her, yet continued to professionally treat her throughout the pregnancy, serving as her attending obstetrician at the birth. Dr. Pons terminated his professional relationship with Patient 1 in March 1984. At this time, Patient 1 was exhibiting severe depression and Dr. Pons recommended psychiatric treatment.

Expert medical testimony was also provided. The expert witness, Dr. George P. Leicht, opined that Dr. Pons' overall care departed from the minimum standards of care of similar practitioners under the same or similar circumstances because the sexual relationship placed Dr. Pons in a very compromising position in which, as an objective individual, he would have difficulty in rendering appropriate guidance and care.

In addition, Dr. Leicht believed Dr. Pons violated several provisions of the American Medical Association Principles of Medical Ethics for his failure to deal objectively and honestly with the patient and exhibiting a lack of respect for her dignity. Also, Dr. Pons failed to adhere to ethical principles when he neglected to seek a consultation regarding Patient 1's apparent psychiatric problems.

After hearing this evidence, the hearing examiner concluded that Dr. Pons had violated R.C. 4731.22(B)(6), (14) and (15). She filed her report and recommendations to that effect. After considerable discussion, the board approved and confirmed the findings of fact and conclusions of law, yet adopted an amended order. The board's order revoked Dr. Pons' certificate to practice medicine and surgery, stayed the revocation, and indefinitely suspended his certificate for not less than one year, subject to conditions. 2

Pursuant to R.C. 119.12, Dr. Pons filed an administrative appeal to the Franklin County Common Pleas Court. The common pleas court affirmed, finding that the board's order was supported by reliable, probative and substantial evidence, and was in accordance with law. Upon further appeal, the court of appeals vacated the judgment of the common pleas court and remanded the cause to the board with instructions that the finding as to violations of R.C. 4731.22(B) be reversed and the disciplinary action dismissed.

The cause is now before this court pursuant to the allowance of a motion to certify the record.

Porter, Wright, Morris & Arthur, William M. Todd and Terri-Lynne B. Smiles, Columbus, for appellee.

Lee I. Fisher, Atty. Gen., Susan C. Walker and Diane M. Weaver, Asst. Attys. Gen., for appellant.

Katrina Miller English, Odessa, TX, urging reversal for amicus curiae, Ohio State Medical Ass'n.

David Orentlicher, Chicago, IL, urging reversal for amicus curiae, American Medical Ass'n.

David Goldberger, Columbus, and Robin Thomas, urging reversal for amici curiae, Ohio National Organization for Women, Citizen Action, Committee Against Sexual Harassment, Ohio Coalition on Sexual Assault, Project Woman, Senator Linda Furney, and Representative Raymond Miller.

FRANCIS E. SWEENEY, Justice.

In an appeal from a medical board's order, a reviewing trial court is bound to uphold the order if it is supported by reliable, probative, and substantial evidence, and is in accordance with law. R.C. 119.12; In re Williams (1991), 60 Ohio St.3d 85, 86, 573 N.E.2d 638, 639. The appellate court's review is even more limited than that of the trial court. While it is incumbent on the trial court to examine the evidence, this is not a function of the appellate court. The appellate court is to determine only if the trial court has abused its discretion, i.e., being not merely an error of judgment, but perversity of will, passion, prejudice, partiality, or moral delinquency. Absent an abuse of discretion on the part of the trial court, a court of appeals may not substitute its judgment for those of the medical board or a trial court. Instead, the appellate court must affirm the trial court's judgment. Lorain City School Dist. Bd. of Edn. v. State Emp. Relations Bd. (1988), 40 Ohio St.3d 257, 260-261, 533 N.E.2d 264, 266. See, also, Rossford Exempted Village School Dist. Bd. of Edn. v. State Bd. of Edn. (1992), 63 Ohio St.3d 705, 707, 590 N.E.2d 1240, 1241.

Moreover, when reviewing a medical board's order, courts must accord due deference to the board's interpretation of the technical and ethical requirements of its profession. The policy reason for this was noted in Arlen v. State (1980), 61 Ohio St.2d 168, 173, 15 O.O.3d 190, 194, 399 N.E.2d 1251, 1254-1255: " ' * * * The purpose of the General Assembly in providing for administrative hearings in particular fields was to facilitate such matters by placing the decision on facts with boards or commissions composed of [people] equipped with the necessary knowledge and experience pertaining to a particular field. * * * ' " (Quoting Farrand v. State Med. Bd. [1949], 151 Ohio St. 222, 224, 39 O.O. 41, 42, 85 N.E.2d 113, 114.)

Thus, the narrow issue before us today is to determine whether the appellate court correctly determined that the trial court abused its discretion in affirming the board's decision. For the following reasons, we hold that it did not. Accordingly, we reverse its decision.

I

The board concluded that the acts, conduct, and/or omissions of Dr. Pons fell below the minimum standards of care in violation of R.C. 4731.22(B)(6): "A departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established." The board never alleged that Dr. Pons' surgical skills were remiss or that he lacked basic medical knowledge. However, the board felt that the care a doctor renders to a patient includes more than just procedures performed or medications prescribed. The overall care consists of the entire treatment relationship between the physician and patient.

In finding that Dr. Pons' overall care of Patient 1 was deficient, the board specifically found that Dr. Pons exhibited extremely poor medical judgment by entering into an emotional and sexual relationship with Patient 1 when he had reason to believe she was in a vulnerable, unstable, emotional state. The basis of this belief was that the sexual relationship began after Dr. Pons had received over one year's worth of complaints from Patient 1 of depression, anxiety, and marital discord. Additionally, he knew of her previous psychiatric hospitalization, he had prescribed anti-depressants for her, and he had counseled Patient 1 and her husband for their marital difficulties. Dr. Pons knew, or should have known, that Patient 1 placed a great deal of trust in him, and that by entering into an emotional relationship with her this was likely to be detrimental to Patient 1's already unstable condition. In doing so, Dr. Pons was not acting in Patient 1's best interest.

Also, the board determined that Dr. Pons failed to maintain the level of objectivity that minimal standards of care dictate by advising Patient 1 on various forms of birth control while engaging in a sexual relationship with her, thus serving his own personal desire that she not become pregnant with his child. In addition, he lacked objectivity when he failed to insist she see specialists for her back pain and psychiatric care or counseling for her marital problems. Indeed, the board felt Dr. Pons took personal advantage of the fact that Patient 1 and her husband were having marital difficulties, an intimate fact learned through the professional relationship.

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