AHMAD E. ABUL-ELA, M.D. v. KENTUCKY BOARD OF MEDICAL LICENSURE
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RENDERED:
DECEMBER 8, 2006; 10:00 A.M.
TO BE PUBLISHED
Commonwealth Of Kentucky
Court of Appeals
NO. 2004-CA-001783-MR
AHMAD E. ABUL-ELA, M.D.
v.
APPELLANT
APPEAL FROM JEFFERSON CIRCUIT COURT
HONORABLE JUDITH E. MCDONALD-BURKMAN, JUDGE
ACTION NO. 03-CI-001395
KENTUCKY BOARD OF MEDICAL
LICENSURE
APPELLEE
OPINION
AFFIRMING
** ** ** ** **
BEFORE:
JOHNSON AND WINE, JUDGES; MILLER,1 SPECIAL JUDGE.
WINE, JUDGE:
Ahmad E. Abul-Ela, M.D. (Dr. Abul-Ela) appeals
from an order of the Jefferson Circuit Court which affirmed a
January 17, 2003 order by the Kentucky Board of Medical
Licensure (the Board) denying his application for licensure by
endorsement.
Dr. Abul-Ela argues that the Board improperly
denied his application without a formal evidentiary hearing, and
that the Board’s procedures violated his procedural due process
1
Retired Judge John D. Miller sitting as Special Judge by assignment of the
Chief Justice pursuant to Section 110(5)(b) of the Kentucky Constitution.
rights.
We conclude that the Board was within its statutory
authority to deny the application without a hearing.
And while
we have concerns about the sufficiency of the Board’s notice to
Dr. Abul-Ela, we conclude that any deficiencies did not affect
his substantial rights.
Hence, we affirm.
On March 27, 2002, Dr. Abul-Ela filed an application
for a license by endorsement to practice medicine in Kentucky.
At the time of the submission, he had been practicing medicine
in Pennsylvania for twenty-five years.
On his application, Dr.
Abul-Ela disclosed that he had had eleven medical liability
claims against him, two of which resulted in jury verdicts
against him, three of which were settled, four of which were
currently pending, and two of which were withdrawn by the
plaintiffs.
After receiving all supporting documentation and
conducting its own inquiry, the Board sent a letter on April 24,
2002, advising Dr. Abul-Ela that his application would be
presented “as a special licensure item due to your malpractice.”
The Board informed Dr. Abul-Ela that the application would be
considered at the next regularly scheduled meeting on June 20,
2002.
That meeting was rescheduled for December 19, 2002.
The Board states that it sent Dr. Abul-Ela notice of the rescheduled meeting by letter dated November 20, 2002.
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No copy of
that letter appears in the record and Dr. Abul-Ela denies that
he received it.
However, Dr. Abul-Ela advised the Board by
letter dated November 26, 2002, that he planned to attend and
address the Board at its December 19 meeting.
The record also
shows that Dr. Abul-Ela did, in fact, attend that meeting.
On January 17, 2003, the Board issued an order denying
the application for licensure.
The Board found that Dr. Abul-
Ela’s malpractice history, along with his dismissal from a
training program in 1969, constituted grounds for denial of his
application under KRS 311.595(21), 311.595(9), and 311.597(3).
The Board’s minutes reflect that one member opposed the motion
to deny the application.
Dr Abul-Ela filed an appeal from the Board’s order
pursuant to KRS 311.593(2).
He argued that the Board’s
procedures violated the requirements of KRS Chapter 13B and his
due process rights.
After considering the record and arguments
of counsel, the circuit court affirmed the Board’s order.
The
court found that the specific procedures set out in KRS Chapter
311 control over the more general provisions of Chapter 13B, and
that the Board afforded Dr. Abul-Ela all the due process to
which he was entitled.
This appeal followed.
Judicial review of actions by the Board is limited.
The courts may only disturb the Board’s actions if they: (1)
constitute a clear abuse of its discretion; (2) are clearly
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beyond its delegated authority; or (3) violate the procedure for
disciplinary action as described in KRS 311.591.
KRS 311.555.
This standard is a codification of the test for review of
administrative actions set forth in American Beauty Homes Corp.
v. Louisville and Jefferson County Planning and Zoning
Commission, 379 S.W.2d 450 (Ky. 1964).
On factual issues, a
court reviewing the agency’s decision is confined to the record
of proceedings held before the administrative body and is bound
by the administrative decision if it is supported by substantial
evidence.
Commonwealth, Transportation Cabinet v. Cornell, 796
S.W.2d 591, 594 (Ky.App. 1990).
On the other hand, this Court
is authorized to review issues of law on a de novo basis.
Aubrey v. Office of Attorney General, 994 S.W.2d 516, 519
(Ky.App. 1998).
Dr. Abul-Ela first argues that the Board’s hearing
procedures are inconsistent with the requirements of KRS Chapter
13B.
KRS 311.571(8) allows the Board to deny an application for
licensure without a prior evidentiary hearing.
Dr. Abul-Ela
points out that the administrative hearing procedures set out in
KRS Chapter 13B apply to all administrative hearings conducted
by an agency except those which are specifically exempted.
13B.020(1).
KRS
Furthermore, an administrative hearing means “any
type of formal adjudicatory process conducted by an agency as
required or permitted by statute or regulation to adjudicate the
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legal rights, duties, privileges, or immunities of a named
person.”
KRS 13B.010(2).
Because proceedings before the Board
are not among those exempted under KRS 13B.020, Dr. Abul-Ela
argues that the hearing procedures set out in KRS Chapter 311
are superseded by the later-enacted hearing procedures set out
in Chapter 13B.
There are three established rules of statutory
construction which are relevant to analyze the apparent conflict
between these statutes.
These rules are:
(1) that it is the
duty of the court to ascertain the purpose of the General
Assembly, and to give effect to the legislative purpose if it
can be ascertained; (2) that conflicting Acts should be
considered together and harmonized, if possible, so as to give
proper effect and meaning to each of them; and (3) that as
between legislation of a broad and general nature on the one
hand, and legislation dealing minutely with a specific matter on
the other hand the specific shall prevail over the general.
City of Bowling Green v. Board of Education of Bowling Green
Independent School District, 443 S.W.2d 243, 247 (Ky. 1969).
With regard to the first prong, KRS 311.555 sets out
the legislature’s declaration of policy.
“It is the declared
policy of the General Assembly of Kentucky that the practice of
medicine and osteopathy should be regulated and controlled as
provided in KRS 311.530 to KRS 311.620 in order to prevent
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empiricism and to protect the health and safety of the public.”
To carry out this intention, the General Assembly has created an
independent Board, “the majority of whose members are licensed
physicians, with the intent that such a peer group is best
qualified to regulate, control and otherwise discipline the
licensees who practice medicine and osteopathy within the
Commonwealth of Kentucky . . . .”
The legislature’s clearly
stated policy, therefore, is that the Board should function
independently of other state regulatory agencies.
With regard to the second prong, we find no inherent
conflict between the procedures set out in Chapter 311 and those
in Chapter 13B.
We agree with Dr. Abul-Ela that the procedures
set out in Chapter 13B broadly apply to all administrative
hearings.
However, KRS 311.571(8) allows the Board to deny a
license application without a hearing.
An evidentiary hearing
is only required when the Board issues an order directing an
applicant for a license to show cause why he should be granted a
license.
KRS 311.572.
Thus, Chapter 13B’s hearing procedures
do not apply to all proceedings before the Board.
And finally,
we agree with the circuit court that the specific medical
licensure provisions prevail over the general statutes
regulating administrative process.
Dr. Abul-Ela next argues that KRS 311.571(8) violates
his procedural due process rights by allowing the Board to deny
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his application without a hearing.
Dr. Abul-Ela has a
constitutionally protected interest in his professional license.
DeSalle v. Wright, 969 F.2d 273, 277 (7th Cir. 1992).
Therefore, he has a right to procedural due process before the
Board may deny his application.
However, procedural due process does not always
require a full-blown trial-type hearing.
Kentucky Central Life
Insurance Co. v. Stephens, 897 S.W.2d 583, 590 (Ky. 1995).
To
determine the sufficiency of due process provided in an
administrative setting, the Kentucky Supreme Court adopted the
three-prong analysis from Mathews v. Eldridge, 424 U.S. 319,
333-35, 96 S. Ct. 893, 902-03, 47 L. Ed. 2d 18 (1976) in
Division of Driver Licensing v. Bergmann, 740 S.W.2d 948, 951
(Ky. 1987).
That test requires consideration of the private
interest that will be affected by the official action; the risk
of an erroneous deprivation of such interest through the
procedures used; the probable value, if any, of additional or
substitute procedural safeguards; and the government’s interest
that any additional procedural requirement would entail.
Mathews, 424 U.S. at 335, 96 S. Ct. at 903.
While the private interest in obtaining a license to
practice medicine is substantial, the state has a compelling
interest in providing its citizens with quality health care.
KRS 311.571(8) satisfies sufficient due process guarantees by
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requiring the Board to provide the applicant with reasonable
notice of its intended action and a reasonable opportunity to be
heard.
The risk, therefore, of erroneous deprivation of a
license under KRS 311.571(8) is unlikely given its notice
provisions.
Finally, a more formal evidentiary hearing would
not give Dr. Abul-Ela any greater protection.
Consequently, we
conclude that KRS 311.571(8) affords a medical licensure
applicant with sufficient due process.
The central issue in this case concerns the adequacy
of the due process which the Board provided in considering Dr.
Abul-Ela’s application.
Due process includes, at a minimum,
reasonable notice of Board’s intended action and a meaningful
opportunity to be heard.
See Goldberg v. Kelly, 397 U.S. 254,
267-68, 90 S. Ct. 1011, 1020, 25 L. Ed. 2d 287 (1970).
As
previously noted, KRS 311.571(8) requires the Board to provide
both before it denies a license application.
We have some concerns about the sufficiency of the
notice which the Board provided to Dr. Abul-Ela.
Unfortunately,
the Board failed to keep a record of all of the notices which it
provided prior to the December 19, 2002, meeting.
While the
earlier notice from April of 2002 is included in the record, the
letter which the Board claims it sent on November 20, 2002, is
not in the record.
Had the Board kept a copy of the letter,
this dispute likely never would have arisen.
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Nevertheless, Dr. Abul-Ela clearly had notice of the
December 19, 2002 meeting, as evidenced by his letter to the
Board on November 26 and by the fact that he actually attended
the meeting.
The Board’s earlier letter of April 24, 2002, was
sufficient to notify Dr. Abul-Ela that his malpractice history
was an area of concern.
Furthermore, Dr. Abul-Ela does not
indicate that he would have presented any additional evidence to
explain or mitigate the previous malpractice claims against him.
Therefore, we agree with the circuit court that Dr. Abul-Ela had
sufficient notice that the Board would address this subject at
its December 19, 2002, meeting.
However, we find no indication that the Board ever
gave Dr. Abul-Ela notice regarding its concerns about his
dismissal from a training program in 1969.
This information was
reported to the Board in the course of its investigation of the
application.
At the December 19 hearing, Dr. Abul-Ela verbally
disputed this evidence and he continues to assert that the
information was reported in error.
However, the Board
apparently rejected his testimony.
We conclude that the Board has failed to establish
that it gave Dr. Abul-Ela adequate notice regarding his
dismissal from the training program.
And since Dr. Abul-Ela did
not have adequate notice regarding this matter, the Board also
failed to afford him with a meaningful opportunity to present
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evidence in rebuttal.
Furthermore, while the dismissal from the
training program does not appear to be determinative of the
Board’s decision, the Board relied on this information, at least
in part, in its conclusion that the dismissal would constitute a
violation of KRS 311.595(21).
However, while we find that the
Board’s notice was insufficient to protect Dr. Abul-Ela’s
procedural due process rights on this issue, we also conclude
that the error was harmless.
Given Dr. Abul-Ela’s more recent history of
malpractice claims, we question whether his dismissal from a
training program more than thirty years ago (and after which he
successfully completed a residency program) was the deciding
factor in the Board’s decision.
Moreover, Dr. Abul-Ela’s
malpractice history, standing alone, would have been a
sufficient basis for the Board’s denial of his application.
Consequently, the Board’s failure to afford Dr. Abul-Ela with
notice of all of the matters to be addressed at the meeting was
not prejudicial and is not a basis to set aside the Board’s
ultimate decision.
Accordingly, the order of the Jefferson Circuit Court
upholding the order of the Kentucky Board of Medical Licensure
is affirmed.
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ALL CONCUR.
BRIEF FOR APPELLANT:
BRIEF FOR APPELLEE:
J. Fox DeMoisey
Louisville, KY
L. Chad Elder
Louisville, KY
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