Young v. Board of Physician Quality Assur.

• Decision Date: 01 September 1995
• Docket Number: No. 1838,1838
• Citation: 684 A.2d 17,111 Md.App. 721
• Parties: Henry A. YOUNG v. BOARD OF PHYSICIAN QUALITY ASSURANCE. ,
• Court: Court of Special Appeals of Maryland

Page 721

111 Md.App. 721

684 A.2d 17

Henry A. YOUNG v. BOARD OF PHYSICIAN QUALITY ASSURANCE.

No. 1838, Sept. Term, 1995.

Court of Special Appeals of Maryland.

Oct. 31, 1996.

John A. Austin and William C.C. Barnes (Hill, Foley, Stone & Miles, on the brief), Towson, for appellant

Cynthia G. Peltzman, Staff Attorney (J. Joseph Curran, Jr., Attorney General and C. Frederick Ryland, Assistant Attorney General, on the brief), Baltimore, for appellee.

Argued before WENNER and CATHELL, JJ., and PAUL E. ALPERT, Judge (Retired), Specially Assigned.

WENNER, Judge.

Henry A. Young (Young) appeals from a judgment of the Circuit Court for Baltimore County affirming the decision of the Board of Physician Quality Assurance (the Board) ¹ to revoke Young's license to practice medicine in Maryland. On appeal, Young has presented us with three questions, which we have rephrased slightly for clarity:

(1) whether the Board's decision to suspend Young's license was based on a peer review process which violated mandatory agency regulations;

(2) whether the trial court erred by refusing to review the entire record when determining whether the Board had sustained its burden of proof; and

(3) whether the decision of the Board established that Young failed to practice within the standard of care.

We shall respond in the affirmative to Young's first question, and reverse the judgment of the circuit court.

FACTS

Young is a neurosurgeon who has been licensed to practice medicine in Maryland since 1986. In November of 1990, the Board received a complaint from one of Young's patients. The patient complained of Young having evaluated her without an appropriate neurological examination. In response to the patient's complaint, the Board selected for review twenty of Young's surgeries at Franklin Square Hospital. ²

On 17 July 1992, the Board referred the Young complaint to the Medical & Chirurgical Faculty of Maryland (Med-Chi), which referred it to the Maryland Neurological Society Peer Rather than individually reviewing each of them, one of the files was assigned to each of the members, with each member presenting a review of the patient's file assigned to that member. During the presentation, pertinent material was circulated among the other members of the Committee. After each presentation, the full Committee discussed that patient's file until coming to a consensus as to whether Young had breached the standard of medical and surgical care with respect to that patient.

Review Committee (the Committee). The Committee spent four hours at a dinner meeting discussing the selected surgeries and reviewing the patients' files and other materials amassed for evaluation.

Only 14 of the 20 files were reviewed at the meeting, with the Committee finding Young had breached the standard of care in nine of them. The Committee issued a report on 4 September 1992, finding Young to have breached the appropriate standard of care by performing unnecessary neurosurgery. Based on these findings, Young was charged with violating H.O. § 14-404(a)(22) in "failing to meet appropriate standards for medical and surgical care."

At a hearing before an administrative law judge (ALJ), several members of the Committee presented expert testimony, including one Dr. Thomas Ducker. Dr. Ducker's testimony was based exclusively on the Committee's findings at its dinner meeting. Young presented no expert testimony, complaining that he had not been given sufficient notice of the hearing adequately to respond to the charges. Nonetheless, the ALJ concluded that Young had failed to meet appropriate standards of care in his neurosurgical practice, and recommended that Young's license be revoked. After denying Young's exceptions, the Board issued a final order revoking Young's license to practice medicine in Maryland.

Young sought judicial review and a stay of the Board's

                order.  The stay was denied.  H.O. § 14-408(c). 3  Young also sought remand of the Board's decision for the taking of additional evidence, which was granted.  The hearing on remand was presided over by the ALJ who had presided at the first hearing.  Although Young presented three expert witnesses, the ALJ again recommended that Young's license be revoked.  Young again sought judicial review, and the Circuit Court for Baltimore County affirmed the Board's decision.  This appeal followed
                

STANDARD OF REVIEW

"Judicial review of administrative agency action is narrow," United Parcel v. People's Counsel, 336 Md. 569, 576, 650 A.2d 226 (1994), and "[t]he court's task on review is not to 'substitute its judgment for the expertise of those persons who constitute the administrative agency.' " Id., quoting Bulluck v. Pelham Wood Apts., 283 Md. 505, 513, 390 A.2d 1119 (1978). The standard for reviewing actions of administrative agencies is set forth in Md.Code Ann. State Gov't § 10-222(h) (Supp.1994), which provides:

Decision--In a proceeding under this section, the court may:

(1) remand the case for further proceedings;

(2) affirm the final decision; or

(3) reverse or modify the decision if any substantial right of the petitioner may have been prejudiced because a finding, conclusion or decision:

(i) is unconstitutional;

(ii) exceeds the statutory authority or jurisdiction of the final decision maker;

(iii) results from an unlawful procedure;

(iv) is unsupported by competent, material, and substantial evidence in light of the entire record as submitted; or (v) is arbitrary and capricious.

(Emphasis added.)

Our task on review is to determine "whether there was substantial evidence before the administrative agency on the record as a whole to support its conclusions." Maryland Comm'n. on Human Relations v. Baltimore, 86 Md.App. 167, 173, 586 A.2d 37 cert. denied, 323 Md. 309, 593 A.2d 668 (1991). In making this determination, we may not substitute our judgment for that of the agency. Maryland State Police v. Lindsey, 318 Md. 325, 333, 568 A.2d 29 (1990). Rather, "the test is a deferential one, requiring 'restrained and disciplined judicial judgment so as not to interfere with the agency's factual conclusions.' " State Admin. Bd. of Election Laws v. Billhimer, 314 Md. 46, 58, 548 A.2d 819 (1988), cert. denied, 490 U.S. 1007, 109 S.Ct. 1644, 104 L.Ed.2d 159 (1989)(quoting Supervisor of Assessments of Montgomery County v. Asbury Methodist Home, Inc., 313 Md. 614, 625, 547 A.2d 190 (1988)).

"When, however, the agency's decision is predicated solely on an error of law, no deference is appropriate and the reviewing court may substitute its judgment for that of the agency." Strother v. Board of Educ., 96 Md.App. 99, 108, 623 A.2d 717 (1993). In ascertaining the propriety of an agency's legal conclusions, our cases have articulated a three-fold analysis:

1. First, the reviewing court must determine whether the agency recognized and applied the correct principles of law governing the case. The reviewing court is not constrained to affirm the agency where its order "is premised solely upon an erroneous conclusion of law."

2. Once it is determined that the agency did not err in its determination or interpretation of the applicable law, the reviewing court next examines the agency's factual findings to determine if they are supported by substantial evidence, i.e., by such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. At this juncture, ... "[i]t is the agency's province to resolve conflicting evidence, and, where inconsistent inferences can be drawn from the same evidence, it is for the agency to draw the inference."

3. Finally the reviewing Court must examine how the agency applied the law to the facts. This of course is a judgmental process involving a mixed question of law and fact, and great deference must be accorded to the agency. The test of appellate review of this function is "whether, ... a reasoning mind could reasonably have reached the conclusion reached by the [agency], consistent with a proper application of the [controlling legal principles]."

Comptroller of the Treasury v. World Book Childcraft Int'l, Inc., 67 Md.App. 424, 508 A.2d 148, cert. denied, 307 Md. 260, 513 A.2d 314 (1986). As we are here presented with an issue of law, our review is expansive, Gray v. Anne Arundel County, 73 Md.App. 301, 307-09, 533 A.2d 1325 (1987). Under such circumstances, deference is not appropriate and we may substitute our judgment for that of the agency. Washington Nat'l. Arena Ltd. Partnership v. Comptroller of Treasury, 308 Md. 370, 378-79, 519 A.2d 1277 (1987).

I.

In order to resolve Young's first question, we must endeavor to divine Med-Chi's intent in promulgating its rules of procedure. That is, we must determine whether they are mandatory, or directory only. Thus, we must begin by ascertaining the intent of the General Assembly in granting authority to Med-Chi to promulgate such rules.

We first note that "the right of the Legislature to delegate powers to administrative agencies has been recognized in this State for more than 125 years." See Department of Natural Resources v. Linchester Sand & Gravel Corp., 274 Md. 211, 218, 334 A.2d 514 (1975). Title 14 of the Health Occupations Article of the Annotated Code of Maryland sets forth the disciplinary actions which may be taken against physicians, and delegates such authority to the Board. HEALTH OCC. § 14-401(c)(2)(i) requires the Board to "refer any allegation involving standards of medical care, as determined by the Board, ... to the faculty ⁴ for further investigation and physician peer review" after performing its preliminary investigation. In deciding to take action against a physician, the Board is required to grant the physician an opportunity for a hearing. HEALTH OCC. § 14-405(a) requires such a hearing to be conducted as prescribed in the Administrative Procedure Act. ⁵ Moreover, COMAR contains the procedures to be used by Med-Chi when conducting such an investigation and physician peer review.

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