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Added factual findings not required to deny license to doctor out of practice for 15 years

On July 3, an appeals court in Tennessee upheld a decision by the state's medical board to deny the licensure application of a doctor who had maintained licensure in other states but had not actively seen patients during a recently-ended 15-year period. The court held that the board was not required to make an extensive factual finding for purposes of appellate review where the facts of the case were not in dispute.

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(Perez v. Tennessee Board of Medical Examiners)

The physician in the case, Andres Perez, practiced emergency medicine for more than a decade, but in 1999, he began working for private companies in an administrative and advisory capacity, becoming board-certified in preventative medicine but ceasing any direct patient care.

In 2015, Perez filed for licensure in Tennessee, asking to be certified in emergency medicine and general practice. In an attempt to mitigate his 15 years away from patient care, Perez began participating, under supervision, as an emergency doctor in Michigan and Kentucky, eventually submitting letters of recommendation from supervising physicians at those locations.

However, the state’s Board of Medical Examiners, concerned about his lack of practice in emergency medicine and noting that his short program of reintegration into emergency medicine was simply not enough to remedy his long absence from the field, denied the application. The board did not completely rule out licensing Perez, stating that he could meet the state’s requirements if he successfully completed a formal assessment within the next year.

Perez appealed, arguing that the board had improperly failed to create a formal report of its findings sufficient for appellate review, that its decision was not supported by the evidence, and that it had improperly presumed Perez’s incompetence for practice due to his long period of inactivity.

After a state trial court held in favor of the board, Perez appealed to a state Court of Appeals in Nashville, which issued a decision affirming the denial.

Regarding his claim that the board maintained an inadequate record of his case for appeal, Perez argued that the board had failed to cite the specific grounds it had based its rejection on. However, the judges of the Court of Appeals disagreed, noting that “the Board clearly explained” that Perez had not seen a patient since 1999, then referred back to that fact when stating that was denying his licensure application.

That citation was simple, but no more was needed because the facts of the case were not in question, Judge Steven Stafford wrote in his opinion. “The contested case hearing at issue here was simply not the kind ‘wherein issues of fact are sharply contested and the proof is conflicting,'” wrote Judge Stafford, citing a prior case.

“Rather, here, the facts underlying Appellant’s application for licensure were never in dispute, nor were the facts regarding the approximately 15-year gap in his emergency medicine practice. The only dispute was whether based upon those facts the Appellant was qualified, in the Board’s discretion, for medical licensure in Tennessee.”

Regarding Perez’s argument that the board erred in finding that he had spent an extensive time outside of the active practice of medicine, since he had engaged in preventative medicine in an advisory capacity during the 15 years he ceased seeing patients, the court again disagreed.

“Appellant has cited no law to undermine the Board’s apparent conclusion that Appellant was required to engage in actual patient care to meet this definition,” wrote Judge Stafford. “Affording the Board the proper deference, we cannot conclude that it lacked substantial and material evidence to make this finding.”

“The record is undisputed that Appellant was not solely and directly responsible for any patient’s care for more than one and one-half decades . . . Appellant cites no law that persuades us that this decision was outside the bounds of the Board’s discretion or was not based on any sound course of reasoning or exercise of judgment, and we thus conclude that the Board’s ruling was not arbitrary and capricious.”