Berlow v. WV Board of Medicine
Annotate this Case
January 1995 Term
_____________
No. 22588
_____________
ABRAHAM J. BERLOW, M.D.,
Petitioner Below, Appellee
v.
WEST VIRGINIA BOARD OF MEDICINE,
Respondent Below, Appellant
___________________________________________________________
Appeal from the Circuit Court of Ohio County
Honorable George L. Spillers, Judge
Civil Action No. 93-CAP-28
REVERSED
___________________________________________________________
Submitted: May 3, 1995
Filed: May 19, 1995
Deborah Lewis Rodecker, Esq.
Charleston, West Virginia
Attorney for the Appellant
Jolyon W. McCamic, Esq.
Wheeling, West Virginia
Attorney for the Appellee
The Opinion of the Court was delivered PER CURIAM.
JUSTICE BROTHERTON did not participate.
RETIRED JUSTICE MILLER and JUDGE FOX sitting
by temporary assignment.
SYLLABUS
"Upon judicial review of a contested case under the West
Virginia Administrative Procedure Act, Chapter 29A, Article 5,
Section 4(g), the circuit court may affirm the order or decision of
the agency or remand the case for further proceedings. The circuit
court shall reverse, vacate or modify the order or decision of the
agency if the substantial rights of the petitioner or petitioners
have been prejudiced because the administrative findings,
inferences, conclusions, decisions or order are: '(1) In violation
of constitutional or statutory provisions; or (2) In excess of the
statutory authority or jurisdiction of the agency; or (3) Made upon
unlawful procedures; or (4) Affected by other error of law, or
(5) Clearly wrong in view of the reliable, probative and
substantial evidence on the whole record; or (6) Arbitrary or
capricious or characterized by abuse of discretion or clearly
unwarranted exercise of discretion.'" Syllabus point 2,
Shepherdstown Volunteer Fire Department v. West Virginia Human
Rights Commission, 172 W. Va. 627, 309 S.E.2d 342 (1983).
Per Curiam:
The West Virginia Board of Medicine appeals the order of
the Circuit Court of Ohio County restricting Abraham J. Berlow,
M.D.'s license to practice medicine for two months. On appeal, the
Board argues that its more restrictive order, requiring Dr. Berlow
to perform only a limited number of tonsillectomies and then only
with an assistant capable of performing the tonsillectomy and a
supervising physician, is necessary to protect the public interest.
Because we agree that the circuit court lacked justification to
modify the Board's order, we reverse the circuit court and
reinstate the Board's order.
Dr. Berlow, who is currently 86 years old, received his
medical degree from the Royal Colleges of Physicians and Surgeons,
Glasgow, Scotland in 1952. Dr. Berlow, an eye, ear, nose and
throat surgeon who is not board certified, is licensed to practice
medicine and surgery in West Virginia. Dr. Berlow has a private
practice in Wheeling and since 1962, has performed over 2,000
tonsillectomies.
By letter dated January 31, 1992, R. V. Pangilianan,
M.D., the Chair of the Department of Ophthalmology and
Otolaryngology at Ohio Valley Medical Center, advised Dr. Berlow
that based on a review of forty-two of his tonsillectomy and
adenoidectomy (T & A) cases, the Department determined that his
patients had excessive blood loss. The Department recommended that
Dr. Berlow be trained in newer surgical techniques for T & A cases. By letter dated May 21, 1992, Ohio Valley Medical Center
reappointed Dr. Berlow to its Medical/Dental Staff but withheld
privileges to perform T & A surgery, pending additional training.
Dr. Berlow received additional training in the dissection
hyfercation technique from Phillip Mathias, M.D. and in Cincinnati,
Ohio.See footnote 1 However, Dr. Berlow was unsuccessful in his two attempts to
use the new procedure. According to Dr. Mathias, both cases
resulted in excessive blood loss requiring Dr. Mathias to complete
the procedures. Dr. Mathias testified that during the procedures,
Dr. Berlow had difficulty with his vision, did not follow any
standard technique, had difficulty remembering things, had shaking
and trembling hands and was unable to use his right arm
effectively. Dr. Berlow testified that Dr. Mathias had required
him to set up the table during these two procedures, which Dr.
Mathias had not done when Dr. Berlow observed. Dr. Berlow said
that Dr. Mathias' criticism had the effect of making him shaky. By
letter dated July 27, 1992, Dr. Mathias said "that Dr. Berlow
should not be doing T and A's without an assistant. . . able to do
a T and A and proceed with a T and A if he [Dr. Berlow] gets into
trouble."
Harry S. Weeks, Jr., M. D., an anesthesiologist at Ohio
Valley Medical Center, testified that other physicians at the facility had a higher incidence of T & A post operative bleeding
than Dr. Berlow. Dr. Weeks, who over the last 10 years was the
anesthesiologist in about 25% of Dr. Berlow's T & A procedures,
noticed that Dr. Berlow was starting to show the aging process and
was slower in the operating room than six years ago. Dr. Weeks
concluded that although Dr. Berlow should not perform T & A
procedures any longer, Dr. Berlow was able to maintain an office
practice in his specialty.
After the Acting Chair of the Department of Ophthalmology
and Otolaryngology received Dr. Mathais' letter, the Department
notified the President and Chief Executive Officer of Ohio Valley
Medical Center. Dr. Berlow, at the suggestion of Dr. Weeks,
requested that his staff privileges be moved to emeritus status and
Dr. Berlow's request was granted. Emeritus status at Ohio Valley
Medical Center means a physician has no clinical privileges and may
not care for patients at the Center. Dr. Berlow has staff
privileges at another hospital.
Ohio Valley Medical Center notified the Board of
Medicine, which contacted Dr. Berlow to see if he wanted his
license to be placed on inactive status. Because Dr. Berlow
refused to request inactive status, the Board required Dr. Berlow
to submit to a physical and mental examination. By letter dated
December 29, 1992, George R. Hanna, M.D., a Professor of Neurology
at the University of Virginia, concluded that "our evaluation
reveals no medical reason why Dr. Berlow should not be able to practice medicine." However, Jeffery T. Berth, Ph.D., Chief of
Psychology, Director, Neuropsychology, suggested "a supervisory
relationship where his [Dr. Berlow's] work quality can be monitored
on a very regular basis."
Based on the evidence, the Board determined that probable
cause existed to substantiate the charges of disqualification from
the practice of medicine and surgery. Dr. Berlow rejected the
Board's offer to delay the complaint's filing for two months in
order for a physician selected by the Board to review Dr. Berlow's
medical records and to observe his practice.
The matter was heard by a Hearing Examiner who
questioned whether Dr. Berlow's treatment by his colleagues had
been totally objective and professional. However, the Hearing
Examiner found sufficient evidence for "a temporary limitation or
restriction" on Dr. Berlow's performing T & A procedures to allow
the Board "to conduct an objective and impartial investigation of
the issues." The Hearing Examiner recommended "a temporary
restriction for a period of time not to exceed two months,
prohibiting him [Dr. Berlow] from performing T and A procedures
without an assistant who can perform T and A procedures. During
the time period, the Board may select a physician to review the
respondent's files. . . and submit a report to the Board . . .[to]
determine if additional action should be taken against the
respondent."
By order dated September 16, 1993, the Board adopted the
Hearing Examiner's Findings of Fact and Conclusions of Law except
for the two-month restriction. Citing public safety, the Board
determined that, rather than a time based restriction during which
no procedures might be performed, the temporary restriction should
be imposed "until such time as Dr. Berlow performs a number of T &
A procedures under certain restrictions." The Board also ordered
that an assistant capable of performing a tonsillectomy be present
during Dr. Berlow's up to fifteen T & A procedures along with a
supervising physician approved by the Board. The supervising
physician, who was not to be affiliated with Ohio Valley Medical
Center, was to report to the Board at the completion of the fifteen
T & A procedures or sooner, if necessary.
Dr. Berlow appealed the Board's order to the circuit
court. The circuit court found the Board's order "arbitrary" and
reinstated the Hearing Examiner's recommended order imposing a two-
month restriction on Dr. Berlow's license to perform T & A
procedures. The Board, alleging that the circuit court's order
fails to protect adequately the public interest and was without
justification, appealed to this Court. On appeal the Board argues
that it is not required to adopt automatically the Hearing
Examiner's recommended sanction and that its decision to impose
supervision during a limited number of procedures was not arbitrary
and did not violate the requirement that the agency decision be
"reasoned" and "articulate." See Citizens Bank of Weirton v. W. V. Bd. of Banking and Financial Insts., 160 W. Va. 220, 230, 233 S.E.2d 719, 726 (1977).
I
W. Va. Code 30-3-14(i) [1989] gives the Board of Medicine
authority to impose sanctions when a person is found "unqualified
because of any of the grounds set forth in subsection (c) of this
section. . . ."See footnote 2 See 11 CRS 1A 12.3 [1994] for the sanctions the Board can impose under its legislative rules. W. Va. Code 30-3-
14(c) [1989], allows the Board to determine a person to be
unqualified for numerous reasons including "[p]rofessional
incompetence . . . [; or,] [t]he inability to practice medicine or
surgery or podiatry with reasonable skill and safety due to
physical or mental disability, including deterioration through the
aging process. . . ." See 11 CRS 1A 12.1 [1994].
In order to carry out its functions, W. Va. Code 30-3-
7(a)(4) [1980] authorizes the Board to "[e]mploy investigators,
attorneys, hearing examiners, consultants and such other employees
as may be necessary. [Emphasis added.]" Although hearing examiners
may be appointed to conduct hearings (11 CRS 3 10.5(h) [1989]),
they "are not authorized or empowered to suspend or revoke any
license or to place any licensee on probation." 11 CRS 3 10.5(p)
[1989]. The Board's procedural rule, 11 CRS 3 10.5(p) [1989]
states, in pertinent part:
The function of a hearing examiner is to
preside at the hearing and to cause to be
prepared a record of the hearing, as described above, so that the Board is able to discharge
its functions. The hearing examiner shall
prepare recommended findings of fact and
conclusion [sic] of law for submission to the
Board.
Procedural rule, 11 CRS 3 13.2 [1989], states, in pertinent part:
The hearing examiner shall submit written
findings of fact and conclusions of law to the
Board pursuant to West Virginia Code section
three, article five, chapter twenty-nine-a,
and the Board may adopt, modify or reject such
findings of fact and conclusions of law.
Neither the West Virginia Medical Practice Act, W. Va.
Code 30-3-1 [1980] et seq., nor the Board's rules contains any
reference to a hearing examiner making recommendations for
sanctions. The Board's authority to impose sanctions under W. Va.
Code 30-3-14 [1989] is not delegated to a hearing examiner and the
Board is not required to follow the "recommendations" of a hearing
examiner. We note that the Board consists of fifteen members,
eight of whom are medical doctors and in this case the Hearing
Examiner was a lawyer. The Board, not the hearing examiner, "shall
be a regulatory and disciplinary body for the practice of medicine
and surgery. . . ." W. Va. Code 30-3-5 [1982].
Other jurisdictions have also refused to require a board
appointed because of expertise to follow blindly the
recommendations of a hearing examiner regarding sanctions. In
Matter of Haugen, 278 N.W.2d 75, 80 n.10 (Minn. 1979) (concerning
corporate and individual real estate brokers' licenses), the
Minnesota Supreme Court said that "the assessment of penalties and sanctions by an administrative agency is not a factual finding but
the exercise of a discretionary grant of power."
Boards and commissions like the Board of
Medical Examiners are appointed because of
their special expertise regarding the
standards of their own professions. When a
professional person must be disciplined for
breaching these standards, the nature and
duration of the discipline is best determined
by his or her fellow professionals, who are in
a superior position to evaluate the breaches
of trust and unprofessional conduct.
Padilla v. Minnesota State Bd. of Medical Examiners, 382 N.W.2d 876, 886-87 (Minn. App. 1986). In Criminal Justice Standards and
Training Commission v. Bradley, 596 So. 2d 661, 663 (Fla. 1992), the
Florida Supreme Court said that a "primary function of professional
disciplinary boards [is] to determine the appropriate punishment
for the misconduct of the professionals it regulates." The Florida
Supreme Court also noted that "hearing officers . . . are judicial
generalists . . .[and t]he various administrative boards have far
greater expertise in their designated specialties and should be
permitted to develop policy concerning penalties within their
professions." Criminal Justice Standards, 596 S.2d at 664. See
also Pence v. Idaho State Horse Racing Commission , 109 Idaho 112,
705 P.2d 1067 (1985); Cherry v. Board of Regents of University of
State of New York, 289 N.Y. 148, 158, 44 N.E.2d 405, 412 (1942);
Beall Construction Co. v. Occupations Safety and Health Review
Commission, 507 F.2d, 1041 (8 Cir. 1974); Tempo Trucking and
Transfer Corp. v. Dickson, 405 F. Supp. 506, 514 (E.D.N.Y. 1975).
II
Although the Board is not required to accept
automatically the recommendations of a hearing examiner, the Board
must present "a reasoned, articulate decision." Citizens Bank of
Weirton, supra, 160 W. Va. at 230, 233 S.E.2d at 726. Citizens
Bank of Weirton noted that in order for judicial review of an
administrative decision to be meaningful, an agency must provide
more than "a mere statement of a general conclusion in the
statutory language." 160 W. Va. at 231-32 n.7, 233 S.E.2d at 727-
28 n.7. See Consumer Advocate Division of Public Service Commission
v. Public Service Commission, 182 W. Va. 152, 386 S.E.2d 650
(1989).
In this case, the circuit court found the Board's
decision to be arbitrary because it failed to adopt the sanction
recommended by the Hearing Examiner. However, the Board explained
that the restriction recommended by the Hearing Examiner might not
provide the Board with information because during the two-month
restriction Dr. Berlow might not perform any procedures. The
Board's order explained:
Rather than impose a temporary restriction for
a period of time, during which time Dr. Berlow
may or may not perform any T & A procedures,
the Board concludes that the imposition of the
temporary restriction until such time as Dr.
Berlow performs a number of T & A procedures
under certain restrictions is safer for the
public and more appropriate.
In this case, we find that the Board provided an
understandable justification for modifying the Hearing Examiner's
recommended sanction. The Board's sanction, crafted for
circumstances of this case, allows Dr. Berlow to practice and
protects the public interest. Dr. Berlow's characterization of the
Board's sanction, which was adopted by the circuit court, as "so
onerous and demanding that it amounts to removing . . . [Dr.
Berlow] from the practice of medicine," is without merit.See footnote 3
Dr. Berlow also argues that the Board's order fails to
provide a process for him to appeal if the supervising physician
recommends terminating his license to perform T & A procedures.
During oral arguments, the Board acknowledged that its order did
not specify any appeal process. However, the Board did note that
under W. Va. Code 30-3-14(j) [1989], it could take action against
a physician when it finds "an immediate danger to the public."
When the Board undertakes such action, W. Va. Code 30-3-14(j)
[1989] requires the Board to institute proceedings for a hearing to
begin within fifteen days of such action and to render a decision within five days of the hearing's conclusion.See footnote 4 See 11 CSR 1A 14.16
[1994]. According to the Board, an adverse action by Dr. Berlow's
supervising doctor would be under this code subsection and the
Board would follow the subsection's hearing procedures. If the
hearing resulted in a disciplinary action against Dr. Berlow, under
W. Va. Code 30-3-14(k) [1989], he would have the right to appeal to
the circuit court. Although the Board's order does not outline the
process to appeal if the supervising physician finds that Dr.
Berlow's performance falls below a reasonable standard of care, the
appeal process specified in W. Va. Code 30-3-14 [1989] is
applicable and, therefore, we find that the Board's order does not
deprive Dr. Berlow of due process.
III
The Medical Practice Act states that persons affected by
a disciplinary action by the Board can seek review in the circuit court in accordance the Administrative Procedures Act, W. Va. Code
29A-5-1 [1964] et seq.See footnote 5 W. Va. Code 29A-5-4(g) [1964], allows a
circuit court to reverse a decision of the Board if a party's
substantial rights:
[H]ave been prejudiced because the
administrative findings, inferences,
conclusions, decision or order are:
(1) In violation of constitutional or
statutory provisions; or
(2) In excess of the statutory authority or
jurisdiction of the agency; or
(3) Made upon unlawful procedures; or
(4) Affected by other error of law; or
(5) Clearly wrong in view of the reliable,
probative and substantial evidence on the
whole record; or
(6) Arbitrary or capricious or
characterized by abuse of discretion or
clearly unwarranted exercise of discretion.
The standard of judicial review that must be followed by
a circuit court in contested cases was stated by this Court in Syl.
pt. 2, Shepherdstown Volunteer Fire Department v. West Virginia
Human Rights Commission, 172 W. Va. 627, 309 S.E.2d 342 (1983):
Upon judicial review of a contested case
under the West Virginia Administrative
Procedure Act, Chapter 29A, Article 5, Section
4(g), the circuit court may affirm the order
or decision of the agency or remand the case
for further proceedings. The circuit court
shall reverse, vacate or modify the order or
decision of the agency if the substantial
rights of the petitioner or petitioners have
been prejudiced because the administrative
findings, inferences, conclusions, decisions
or order are: "(1) In violation of
constitutional or statutory provisions; or
(2) In excess of the statutory authority or
jurisdiction of the agency; or (3) Made upon
unlawful procedures; or (4) Affected by other
error of law, or (5) Clearly wrong in view of
the reliable, probative and substantial
evidence on the whole record; or (6) Arbitrary
or capricious or characterized by abuse of
discretion or clearly unwarranted exercise of
discretion."
In accord Syl. pt. 1, Smith v. Bechtold, 190 W. Va. 315, 438 S.E.2d 347 (1993); Syl. pt. 1, FMC Corp. v. W.Va. Human Rights Commission,
184 W. Va. 712, 403 S.E.2d 729 (1991); Frank's Shoe Store v. W.Va.
Human Right Commission, 179 W. Va. 53, 56, 365 S.E.2d 251, 254
(1986).
Frank's Shoe Store, supra, 179 W. Va. at 56, 365 S.E.2d
at 254, explained that "a reviewing court must evaluate the record
of the agency's proceeding to determine whether there is evidence
on the record as a whole to support the agency's decision."
In this case, the Board's decision to apply a procedure
based limitation rather than a time based restriction and to
require the presence of a supervising physician are supported by the record.See footnote 6 The Board's determination of the sanction is not
arbitrary and the Board's order explained why a procedure based
restriction was preferred to a time based restriction. The circuit
court should not have reversed the Board "simply because it is
convinced that it would have decided the case differently. . . ."
Frank's Shoe Store, supra, 179 W. Va. at 56, 365 S.E.2d at 254,
quoting Anderson v. City of Bessemer City, N.C., 470 U.S. 564, 573,
105 S. Ct. 1504, 1511, 84 L. Ed. 2d 518, 528 (1985).
For the above stated reasons, the order of the Circuit
Court of Ohio County is reversed and the September 16, 1993 order
of the West Virginia Board of Medicine is reinstated.
Reversed.
Footnote: 1
Several physicians testified that surgeons should use the
technique most comfortable to them and that data suggests minimal
differences in blood loss among the different T & A techniques.Footnote: 2
W. Va. Code 30-3-14(i) [1989] provides:
Whenever it finds any person unqualified
because of any of the grounds set forth in
subsection (c) of this section, the board may
enter an order imposing one or more of the
following:
(1) Deny his application for a license or
other authorization to practice medicine and
surgery or podiatry;
(2) Administer a public reprimand;
(3) Suspend, limit or restrict his license
or other authorization to practice medicine
and surgery or podiatry for not more than five
years, including limiting the practice of such
person to, or by the exclusion of, one or more
areas of practice, including limitations on
practice privileges;
(4) Revoke his license or other
authorization to practice medicine and surgery
or podiatry or to prescribe or dispense
controlled substances;
(5) Require him to submit to care,
counseling or treatment designated by the
board as a condition for initial or continued
licensure or renewal of licensure or other
authorization to practice medicine and surgery
or podiatry;
(6) Require him to participate in a program
of education prescribed by the board;
(7) Require him to practice under the
direction of a physician or podiatrist
designated by the board for a specified period
of time; and
(8) Assess a civil fine of not less than
one thousand dollars nor more than ten
thousand dollars.Footnote: 3
In his brief, Dr. Berlow objects to the Board's order because
it allows him to select the supervising physician rather than
having the Board select. The Board maintains that Dr. Berlow was
given the selection to avoid perceptions of conflict. The Board
alleges that, if requested, it would assist Dr. Berlow in the
selection.
Dr. Berlow also questions the payment of the supervising
physician. The Board submitted an affidavit from Ronald D. Walton,
the Board's Executive Director, noting that payment by the
supervised physician would not be appropriate and that supervising
physicians donate their time to the program.Footnote: 4
W. Va. Code 30-3-14(j) [1989] states:
Notwithstanding the provisions of section
eight [§ 30-1-8], article one, chapter thirty
of this code, if the board determines the
evidence in its possession indicates that a
physician's or podiatrist's continuation in
practice or unrestricted practice constitutes
an immediate danger to the public, the board
may take any of the actions provided for in
subsection (i) of this section on a temporary
basis and without a hearing, if institution of
proceedings for a hearing before the board are
initiated simultaneously with the temporary
action and begin within fifteen days of such
action. The board shall render its decision
within five days of the conclusion of a
hearing under this subsection.Footnote: 5
W. Va. Code 30-3-14(k) [1989] states, in pertinent part:
Any person against whom disciplinary action is taken pursuant to the provisions of this article has the right to judicial review as provided in articles five and six [§§ 29A-5-1 et seq. and 29A-6-1 et seq.], chapter twenty- nine-a of this code.Footnote: 6 The presence during Dr. Berlow's T & A procedures of a fully trained assistant was required by both the Board and the circuit court.
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