Singha v. State Bd. of Medical Examiners

• Decision Date: 29 June 2000
• Docket Number: No. 990393.,990393.
• Citation: 2000 ND 134,613 N.W.2d 34
• Parties: Ebenezer M. SINGHA, Plaintiff, Appellant and CrossAppellee, v. NORTH DAKOTA STATE BOARD OF MEDICAL EXAMINERS, and Rolf Sletten, Executive Secretary and Treasurer of the North Dakota Board of Medical Examiners, Defendants, Appellees and Cross-Appellants.
• Court: North Dakota Supreme Court

613 N.W.2d 34

2000 ND 134

Ebenezer M. SINGHA, Plaintiff, Appellant and CrossAppellee, v. NORTH DAKOTA STATE BOARD OF MEDICAL EXAMINERS, and Rolf Sletten, Executive Secretary and Treasurer of the North Dakota Board of Medical Examiners, Defendants, Appellees and Cross-Appellants.

No. 990393.

Supreme Court of North Dakota.

June 29, 2000.

Rehearing Denied August 18, 2000.

Roger R. Sundling and Alvin O. Boucher, Robert Vogel Law Office, Grand Forks, N.D., for plaintiff, appellant and cross-appellee.

John M. Olson, Special Assistant Attorney General, Bismarck, N.D., for defendants, appellees and cross-appellants.

KAPSNER, Justice.

[¶ 1] Ebenezer M. Singha appealed a judgment affirming in part and reversing in part a State Board of Medical Examiners' decision finding he did not meet the educational requirements for a license to practice medicine in North Dakota and denying his application. The Board cross-appealed from the part of the judgment reversing its decision that Singha's deceit and misrepresentations rendered him unfit for licensure. We affirm the Board's decision that Singha did not meet the educational requirements for licensure.

I

[¶ 2] In Singha v. North Dakota State Bd. of Med. Exam'rs, 1998 ND 42, ¶¶ 2-3, 574 N.W.2d 838, we described some of the factual background for Singha's application for a license to practice medicine in North Dakota:

Singha, a 1990 graduate with a "diploma in osteopathy" from the British School of Osteopathy (B.S.O.), applied to the Board in April 1995 for a license to practice medicine. As relevant to Singha's application, N.D.C.C. § 43-17-18(3) outlines certain requirements for licensure "[i]f the applicant is a graduate of a medical or osteopathic college that has not been approved by the board or accredited by an accrediting body approved by the board at the time the degree or its equivalent was conferred." The B.S.O. was not approved by the Board and was not accredited by an accrediting body approved by the Board when Singha received his diploma in osteopathy, and the essence of this case is whether Singha qualified for licensure under the educational requirements of N.D.C.C. § 43-17-18(3).

While attending the B.S.O., Singha received additional clinical training at hospitals in Pennsylvania, and he self-studied pharmacology and biochemistry. In 1991, Singha was accepted in a family practice residency program at the University of North Dakota Medical School. In 1991 and 1993, the Board assisted Singha in sitting as a courtesy candidate for a Federal Licensing Examination (F.L.E.X.) administered in Ohio. Singha successfully completed the F.L.E.X. in 1993, and in September 1995, he successfully completed the three-year family practice residency program at UND.

[¶ 3] In Singha, 1998 ND 42, ¶ 1,574 N.W.2d 838, we held N.D.C.C. § 43-17-18(3) requires a foreign-educated applicant for a North Dakota medical license to demonstrate the kinds of courses taken at a foreign educational institution, when combined with the successful completion of three years of Board-approved postgraduate training, are substantially equivalent to the kinds of courses required at a reputable medical or osteopathic college in the United States, and the successful completion of one year of Board-approved postgraduate training.¹ We rejected Singha's argument the Board was estopped from denying him a license because it had a duty to properly advise him about the requirements for licensure and led him to believe he would be granted a license after completing the three-year family practice residency program at UND. Singha, at ¶¶ 33-34. We also held the Administrative Agencies Practices Act, N.D.C.C. ch. 28-32, applied to the Board's consideration of an application for a license. Singha, at ¶ 1. Because the Board failed to comply with the procedural requirements of N.D.C.C. ch. 28-32 in deciding Singha's application, we remanded for proceedings consistent with those requirements and our interpretation of N.D.C.C. § 43-17-18(3). Singha, at ¶¶ 32, 39.

[¶ 4] On remand, an administrative law judge ("ALJ") was appointed to make a recommendation on Singha's application. After an administrative hearing, the ALJ recommended granting Singha a license. The ALJ recommended finding Singha's B.S.O. education, including his self-study of pharmacology and biochemistry and his clinical externships in Pennsylvania, was substantially equivalent to the training a majority of osteopathic students receive in the United States. The ALJ recommended finding if there were any deficiencies in Singha's B.S.O. education, they were more than compensated for by his three years in the UND family practice residency program. The ALJ commented that he "gave great weight to the testimony of those doctors from the UND family practice residency program who testified for Singha" and were all satisfied he was "competent to practice medicine in North Dakota." The ALJ also recommended finding Singha did not intentionally deceive the Board, the UND residency program, or anyone else about his educational credentials or B.S.O. degree.

[¶ 5] The Board rejected the ALJ's recommendation, finding Singha did not meet the educational requirements for licensure. The Board decided Singha's self-study and clinical externships could not be considered under N.D.C.C. § 43-17-18(3). The Board found Singha's B.S.O. education and successful completion of three years of Board-approved postgraduate training at the UND family practice residency program were not substantially equivalent to the kinds of courses taken at a reputable osteopathic college in the United States and the successful completion of one year of Board-approved postgraduate training. The Board also concluded Singha's deceit and misrepresentations in the application process rendered him unfit for licensure. The district court affirmed the Board's decision Singha did not meet the educational requirements for licensure and reversed the Board's decision Singha's deceit and misrepresentations rendered him unfit for licensure. Singha appealed, and the Board cross-appealed.

II

[¶ 6] Under N.D.C.C. § 28-32-19, we affirm the Board's decision unless it is not in accordance with the law; it violates Singha's constitutional rights; the Board failed to comply with the provisions of N.D.C.C. ch. 28-32; the Board's rules or procedures have not afforded Singha a fair hearing; the Board's findings of fact are not supported by a preponderance of the evidence; or the Board's conclusions of law and decision are not supported by its findings of fact.

[¶ 7] In Singha, 1998 ND 42, ¶ 14, 574 N.W.2d 838, we outlined our deferential standard of review of the factual basis of a decision by the Board:

Our review of the factual basis for the Board's decision involves a three-step process to decide whether its findings of fact are supported by a preponderance of the evidence, its conclusions of law are supported by its findings of fact, and its decision is in accordance with the law and is supported by its conclusions of law. In applying the preponderance-of-evidence standard, we do not make independent findings of fact or substitute our judgment for that of the Board; rather, we decide only whether a reasoning mind reasonably could have decided the Board's factual conclusions were proved by the weight of the evidence from the entire record. It is not our function to act as a super board when reviewing decisions by an administrative agency. In technical matters involving agency expertise, we have acknowledged the agency decision is entitled to appreciable deference.

III

[¶ 8] Singha argues the Board's decision is not in accordance with the law, its findings of fact are not supported by a preponderance of the evidence, and its conclusions of law are not supported by its findings of fact, because the Board interpreted N.D.C.C. § 43-17-18(3) too narrowly and did not consider his clinical externships in Pennsylvania and his self-study of pharmacology and biochemistry. He argues the Board erred in requiring his B.S.O. education to be the mirror image of the education at an osteopathic college in the United States.

A

[¶ 9] In Singha, 1998 ND 42, ¶ 20, 574 N.W.2d 838, we recognized the Board has discretion to assess the substantive merits of an applicant's qualifications for a medical license, and we rejected an interpretation of N.D.C.C. § 43-17-18(3) which would require the Board to give carte blanche approval to any foreign educational institution that used a form of the word osteopath in its title, or offered some level of osteopathic education. We declined to construe N.D.C.C. § 43-17-18(3) to permit an entity other than the Board to decide a foreign-educated applicant's qualifications for licensure. Singha, at ¶ 22. We construed N.D.C.C. § 43-17-18 as a whole to establish a minimum educational threshold requiring the Board to compare the kinds of courses taken at a foreign institution with the kinds of courses required at a reputable osteopathic college in the United States. Singha, at ¶ 22. We interpreted N.D.C.C. § 43-17-18(3) to require a foreign-educated applicant to demonstrate the kinds of courses taken at a foreign institution, when combined with the successful completion of three years of Board-approved postgraduate training, were substantially equivalent to the kinds of courses required at a reputable medical or osteopathic college in the United States and the successful completion of one year of Board-approved postgraduate training. Singha, at ¶ 22.

[¶ 10] Our decision in Singha recognizes the Board's statutory authority to assess the substantive merits of a foreign-educated applicant's educational qualifications and to decide whether the kinds of courses taken at a foreign institution and three years of postgraduate training are substantially equivalent to the kinds of courses required at an osteopathic college in the United States and one year of postgraduate training. Here, although Singha's...