Watkins v. NORTH CAROLINA DENTAL BD.

• Decision Date: 02 April 2004
• Docket Number: No. 301A03.,301A03.
• Citation: 358 N.C. 190,593 S.E.2d 764
• Court: North Carolina Supreme Court
• Parties: Paul E. WATKINS, D.D.S., Petitioner, v. NORTH CAROLINA STATE BOARD OF DENTAL EXAMINERS, Respondent.

593 S.E.2d 764

358 N.C. 190

Paul E. WATKINS, D.D.S., Petitioner, v. NORTH CAROLINA STATE BOARD OF DENTAL EXAMINERS, Respondent.

No. 301A03.

Supreme Court of North Carolina.

April 2, 2004.

The Charleston Group, by Freddie Lane, Jr., Fayetteville, for petitioner-appellee.

Ellis & Winters, L.L.P., by Paul K. Sun, Jr.; and Bailey & Dixon, L.L.P., by M. Denise Stanford, Raleigh, for respondent-appellant.

Allen & Pinnix, P.A., by Noel L. Allen and Angela Long Carter, Raleigh, on behalf of North Carolina State Board of Certified Public Accountant Examiners and North Carolina Board of Architecture, amici curiae.

North Carolina Medical Board, by Amy Yonowitz and Marcus Jimison, Raleigh, amicus curiae.

Howard A. Kramer, Raleigh, on behalf of North Carolina Board of Nursing, amicus curiae.

Womble, Carlyle, Sandridge & Rice, P.L.L.C., by Johnny M. Loper, Raleigh, on

behalf of North Carolina State Board of Examiners in Optometry, amicus curiae.

Young, Moore & Henderson, P.A., by John N. Fountain, Raleigh, on behalf of North Carolina State Board of Examiners of Electrical Contractors and North Carolina State Board of Examiners of Plumbing, Heating, and Fire Sprinkler Contractors, amici curiae.

North Carolina State Board of Examiners for Engineers and Surveyors, by David S. Tuttle, Raleigh, amicus curiae.

MARTIN, Justice.

Petitioner, Paul E. Watkins, is a dentist licensed to practice dentistry in North Carolina who limits his practice in this state¹ to the specialty area of orthodontics. Based on formal complaints initiated by three of petitioner's patients—John Casto, Conrad Naico, and Sabrina Wolfe—the North Carolina Board of Dental Examiners (Dental Board or the Board) held an administrative hearing to determine if petitioner had violated applicable provisions of the Dental Practice Act, N.C.G.S. § 90-22 to 90-48.3 (2003). The evidence presented at the hearing included documentary evidence as well as lay and expert testimony. On 18 July 2001, the Board issued its final agency decision, concluding that petitioner's failure to comply with the applicable standards of care in his treatment of all three patients constituted negligence in the practice of dentistry within the meaning of N.C.G.S. § 90-41(a)(12) (2003). Accordingly, the Board ordered that petitioner's license be suspended for a period of six months, with conditional restoration subject to petitioner's adherence to probationary terms.

Petitioner sought judicial review of the Board's order in Wake County Superior Court. By judgment signed 5 April 2002, the trial court reversed and remanded to the Board for reinstatement of petitioner's license. The trial court concluded that the Board's determination that petitioner was negligent in the practice of dentistry was unsupported by substantial, material, and competent evidence in view of the entire record and, therefore, that the suspension of petitioner's license was arbitrary and capricious. A divided panel of the Court of Appeals affirmed, and respondent appealed to this Court as a matter of right. We reverse.

I.

The first issue presented is whether the Board was authorized, under Leahy v. North Carolina Bd. of Nursing, 346 N.C. 775, 488 S.E.2d 245 (1997), to determine the appropriate standard of care for petitioner's treatment of patient John Casto (Casto) without expert testimony from an orthodontist.

At the outset, we note that this issue does not encompass the Board's consideration of petitioner's treatment of Sabrina Wolfe (Wolfe) and Conrad Naico (Naico). With respect to Wolfe and Naico, Board experts testified as to the requisite standards of care in addition to offering their expert opinions that petitioner had breached those standards. With regard to Casto, on the other hand, the Board's expert witness, Dr. Christopher Trentini, testified that Casto's progress "was behind schedule, clearly" given the nature of Casto's orthodontic problems and the length of time he had been in treatment. Dr. Trentini did not testify that the standard of care for orthodontists practicing in North Carolina required a more timely resolution of Casto's orthodontic problems. Nevertheless, after reviewing the dental records and the expert and lay testimony presented, the Board found that the standard of care for dentists licensed to practice in North Carolina "required an orthodontist to establish and follow a treatment plan which would address the patient's orthodontic needs in a timely manner." The Board also found that petitioner "violated the standard of care ... by failing to establish and follow a treatment plan that would address the patient's orthodontic needs in a timely manner." The Board concluded that petitioner's failure to comply with the applicable standard of care in his treatment of Casto was a "dereliction from professional duty constituting negligence in the practice of dentistry within the meaning of N.C.G.S. § 90-41(a)(12)." Petitioner argues that given the absence of expert testimony as to the appropriate standard of care and breach thereof, the Board lacked substantial evidence to support its conclusion that petitioner's treatment of Casto constituted negligence in the practice of dentistry. This argument, however, is foreclosed by our holding in Leahy, which we now reaffirm.

Leahy involved a disciplinary action by the North Carolina Board of Nursing (Nursing Board) against a registered nurse (the petitioner or Leahy) concerning her treatment of two patients. Leahy, 346 N.C. 775, 488 S.E.2d 245. At that hearing before the Nursing Board, four nurses presented eyewitness testimony as to the factual details of the conduct at issue. Id. at 776-77, 488 S.E.2d at 245-46. They did not, however, testify as to the requisite standard of care for registered nurses. Id. The Nursing Board found facts consistent with the eyewitnesses' testimony and concluded that Leahy's treatment of the two patients breached the requisite standard of care in violation of the Nursing Practice Act. Id. at 778, 488 S.E.2d at 247. Relying on our holding in Dailey v. North Carolina State Bd. of Dental Exam'rs, 309 N.C. 710, 309 S.E.2d 219 (1983), the Court of Appeals reversed, holding that the Board's suspension of the petitioner's license was improper because of the absence of expert testimony defining the standard of care for registered nurses in the practice of their profession. Leahy, 346 N.C. at 780, 488 S.E.2d at 248.

We reversed the Court of Appeals, rejecting the argument that expert testimony was required to establish the applicable standard of care. Leahy, 346 N.C. at 780-81, 488 S.E.2d at 248. In reaching this decision, we turned to North Carolina's Administrative Procedure Act (APA), which expressly provides that "[a]n agency may use its experience, technical competence, and specialized knowledge in the evaluation of evidence presented to it." Id. (quoting N.C.G.S. § 150B-41(d) (1995)). We concluded that the specialized knowledge of the Nursing Board "includes knowledge of the standard of care for nurses," and thus that the Nursing Board was entitled to use this knowledge in evaluating the evidence before it. Id. at 781, 488 S.E.2d at 248. In support of this conclusion, we looked to the composition and statutorily prescribed functions of the Nursing Board, noting that it (1) consisted of nine registered nurses, four licensed practical nurses, one retired doctor, and one layperson; (2) was authorized by statute to develop rules and regulations to govern medical acts by registered nurses; (3) was empowered to administer, interpret, and enforce the Nursing Practice Act; and (4) was required by statute to establish the qualifications and criteria for licensure of nurses. Id. Reasoning that "[t]o meet these requirements, the [Nursing] Board must know the standard of care for registered nurses in this state," we held that the Court of Appeals had erred in requiring expert testimony to establish that standard. Id.

Leahy illustrates the deference that courts accord to administrative bodies in the exercise of their factfinding functions. See, e.g., In re Berman, 245 N.C. 612, 616-17, 97 S.E.2d 232, 236 (1957)

. We acknowledge that, in a medical malpractice action, the standard of care is normally established by the testimony of a qualified expert. Jackson v. Mountain Sanitarium & Asheville Agric. Sch., 234 N.C. 222, 226-27, 67 S.E.2d 57, 61 (1951). This general rule is based on the recognition that in the majority of cases the standard of care for health providers concerns technical matters of "highly specialized knowledge," and a lay factfinder is "dependent on expert testimony" to fairly determine that standard. Id. This rationale is not necessarily controlling within the context of disciplinary proceedings conducted by professional licensing boards where, as here, the factfinding body is composed entirely or predominantly of experts charged with the regulation of the profession. See Arlen v. State Med. Bd., 61 Ohio St.2d 168, 174, 399 N.E.2d 1251, 1255 (1980). Thus, we decline to impose a per se rule that expert testimony is required to establish the standard of care in disciplinary hearings conducted by professional licensing boards.

Petitioner contends that Leahy is distinguishable in light of the relative compositions of the Dental and Nursing Boards. In Leahy, petitioner argues, the Nursing Board was competent to establish the standard of care for registered nurses without the benefit of expert testimony because, by statute, at least eight of its fifteen members must be registered nurses. N.C.G.S. § 90-171.21(a) (2003). In the present case, by contrast, the Dental Practice Act does not mandate that any orthodontists serve on the Board, see N.C.G.S. § 90-22(b) (2003), and at the time petitioner's case came on for hearing, none did. Thus, petitioner argues, the Board lacked the requisite expertise, technical training, and specialized knowledge to determine the standard of care for orthodontists. For the...