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Order for licensee to relate lessons learned, and warn board if he intended to return to practice, not a sanction

An Iowa court, in a March 6 decision, upheld the dismissal of an attempted appeal by a doctor who had been ordered to submit a report to the state medical board informing them in advance if he ever intended to return the practice. The court ruled that, although the letter seemingly imposed certain requirements on the physician licensee, it was, in fact, only advising the licensee to take the listed actions.

(Irland v. Iowa Board of Medicine).

The case began when the Iowa Board of Medicine issued physician Mark Irland a “Confidential Letter of Warning” regarding a questionable incident of treatment, as well as the revocation of his clinical privileges at a hospital, which resulted from that incident. In the letter, the board directed Irland to submit a report within 60 days stating what he had learned from the incident.

Additionally, although the board declined to actually sanction Irland’s license because he was currently not practicing, it required him to provide it 60 days’ notice before ever resuming practice and it notified him that he would likely have to undertake a comprehensive clinical examination before any return.

Irland filed for a court review of the letter, but a state district court concluded that the document was not subject to judicial review, as the issuance of a letter was not a disciplinary sanction and did not constitute a formal order of the board that would be subject to review. Irland appealed that decision, and the case went up to the Court of Appeals of Iowa.

Irland contended that the letter was, in fact, a disciplinary action because it imposed real requirements on his license in the form of the report to the board and the need to provide early notice to the board if he decided to return to practice. Thus, the letter, Irland argued, imposed disciplinary sanctions while not allowing him to contest any formal charges.

Unfortunately for Irland, the court agreed with the board that the letter was not a disciplinary sanction. The letter, Judge David Danilson explained, was actually the closing of Irland’s case without sanction, an action that cannot be reviewed by a court. “There is no dispute the Board may issue ‘an informal letter of warning’ when there has been no disciplinary action taken and, if no such action is taken, the physician may not seek judicial review,” wrote Judge Danilson.

Although appearing to impose a requirement that Irland to submit a report on his actions and provide it notice before returning to practice, the board had couched its language by using the word “advise,” a seemingly sufficient vocabulary trick to avoid the formal appearance of an order in the eyes of the court.

“We acknowledge the letter of warning is colored with advisories that have the appearance of sanctions,” wrote Judge Danilson. “The identification of specific dates when the Board expects action to be completed, as well as identifying a specific sanction—a comprehensive clinical competency evaluation that will occur if Irland returns to the practice of medicine—have the markings of sanctions. However, the paper and the sixty-day notice before practicing medicine are not mandatory; rather the action is simply advised. Further, there is no identifiable repercussion if Irland does not comply with the actions that are ‘advised.’”

Last, although the board stated that it would subject Irland to a clinical competency evaluation should he return to practice, the appropriate time for an appeal to the court system would be when he would actually challenge such an order.

The court affirmed the decision of the lower court to dismiss the case.