Jorge R. Guevara, M.D. v. Texas Medical Board
15-25-00036-CV
| Tex. App. | Jun 30, 2025Background
- Dr. Jorge R. Guevara is a Texas family physician and long‑time owner of Medical Associates of Brownsville, PA (MAB); he practiced in the family‑medicine department but also served as the radiology department’s Radiation Safety Officer (RSO).
- In January 2019 DSHS inspected MAB’s radiology operations and identified mammography‑specific deficiencies (quality assurance, technician qualifications); DSHS assessed an administrative penalty against MAB and its interpreting physician (Dr. Kapilivsky), which MAB paid; Guevara was not individually disciplined by DSHS.
- The Texas Medical Board (TMB) later filed an administrative complaint against Dr. Guevara based on largely the same factual findings; an ALJ adopted many DSHS findings and recommended discipline of Guevara on grounds including unprofessional conduct, inadequate supervision, improper delegation, and failure to use proper diligence.
- The TMB adopted the ALJ’s recommendations and issued a final order barring Guevara from owning/operating/being associated with any imaging program (not only mammography) and from supervising/delegating imaging personnel; the TMB summarily denied rehearing.
- Guevara sued in district court; the trial court affirmed the TMB’s final agency decision. Guevara appealed to the Fifteenth Court of Appeals.
- Appellant’s (Guevara’s) principal arguments: TMB exceeded its statutory authority by disciplining conduct not connected to practicing medicine (applying Aleman), the TMB’s finding of lack of diligence is conclusory and unsupported by substantial evidence, and the disciplinary sanctions are arbitrary, capricious, and unreasonably overbroad (sweeping beyond mammography and into all imaging).
Issues
| Issue | Plaintiff's Argument (Guevara) | Defendant's Argument (TMB) | Held |
|---|---|---|---|
| 1) Whether TMB exceeded statutory disciplinary authority by disciplining conduct not connected to the practice of medicine | TMB punished Guevara for acts as RSO and owner unrelated to the practice of medicine; under Aleman the Board may discipline only conduct connected to medical practice in a manner likely to deceive or defraud the public | TMB treats ownership, RSO duties, supervision, and delegation as sufficiently connected to a physician’s practice to support discipline | Trial court affirmed TMB’s order; Guevara appeals and argues reversal is required because discipline exceeded statutory authority |
| 2) Whether the TMB’s finding that Guevara “failed to use proper diligence” is supported by substantial evidence | ALJ/TMB made only conclusory findings; the record lacks clear, specific factual findings tying diligence failures to Guevara’s medical practice (he did not practice in radiology) | TMB relies on DSHS findings and on the ALJ’s conclusions that ownership/RSO/referring‑physician roles connected Guevara to the deficiencies | Trial court upheld the agency; Guevara contends the findings are legally insufficient and unsupported, so should be set aside on judicial review |
| 3) Whether the penalties are arbitrary, capricious, or unreasonable (scope of sanctions) | The sanctions sweep far beyond the mammography issues adjudicated by DSHS and the Board, barring association with all imaging modalities and interfering with property rights and DSHS jurisdiction over RSOs | TMB defends sanctions as necessary to protect public health and tied to the Board’s findings about systemic failures | Trial court affirmed the sanctions; Guevara argues they are untethered to the adjudicated conduct and therefore arbitrary and must be vacated |
| 4) Whether the TMB could rely on DSHS findings/adopt them against Guevara (preclusive effect / imputing non‑party findings) | DSHS disciplined MAB and Dr. Kapilivsky; Guevara was not a party and was not individually disciplined by DSHS—TMB improperly imputed those findings to him | TMB/ALJ treated DSHS findings as preclusive or persuasive and incorporated them into the TMB proceeding | Trial court accepted TMB’s adoption of ALJ/DSHS findings; Guevara argues reliance on non‑party findings against a physician who was not personally found responsible is legally improper |
Key Cases Cited
- Aleman v. Tex. Med. Bd., 573 S.W.3d 796 (Tex. 2019) (limits TMB authority: Board may discipline only for acts connected with the practice of medicine in a manner likely to deceive or defraud the public)
- Baptist Mem'l Hosp. Sys. v. Sampson, 969 S.W.2d 945 (Tex. 1998) (ownership of a practice does not automatically impute individual physician liability for other physicians’ malpractice or operational failures)
- Charter Med.-Dall., Inc. v. Tex. Health Facilities Comm'n, 665 S.W.2d 446 (Tex. 1984) (administrative findings must be clear, specific, nonconclusory, and support ultimate statutory findings)
- Park Haven, Inc. v. Tex. Dep't of Hum. Servs., 80 S.W.3d 211 (Tex. App.—Austin 2002) (APA governs judicial review of agency actions)
- Tex. Dep't of Ins. v. State Farm Lloyds, 260 S.W.3d 233 (Tex. App.—Austin 2008) (agency actions may be set aside as arbitrary and capricious where they are unreasonable or inadequately supported)
- Motor Vehicle Mfrs. Ass'n v. State Farm Mut. Auto. Ins. Co., 463 U.S. 29 (U.S. 1983) (administrative actions are arbitrary and capricious if agency fails to offer reasoned explanation for action)
- McDonnell Douglas Corp. v. U.S. Dep't of the Air Force, 375 F.3d 1182 (D.C. Cir. 2004) (courts should not defer to agency conclusory, unsupported suppositions)