2023 IL App (1st) 220657
Ill. App. Ct.2023Background:
- Dr. Shahid Masood, an Illinois physician with a controlled-substance registration, was investigated by the DEA and entered a 2018 agreement limiting Schedule II prescribing; the Illinois Department of Financial and Professional Regulation filed administrative charges alleging excessive prescribing to multiple patients, focusing on S.W. (a nurse with a prior substance-abuse probation) and M.S. (an Ohio resident who traveled to see Masood).
- At an administrative hearing the Department’s expert (Dr. Buvanendran) testified that Masood prescribed very high opioid dosages (well above CDC MME guidance), combined dangerous drug regimens, failed to check the prescription monitoring program (PMP), and failed to perform urine toxicology or adequate risk assessments for red-flag patients.
- The ALJ found, by clear and convincing evidence, that Masood violated the Controlled Substances Act and sections of the Medical Practice Act in his treatment of S.W. and M.S., and recommended indefinite suspension of Masood’s physician and controlled-substance licenses for a minimum of two years.
- The Medical Disciplinary Board adopted the ALJ’s findings; the Director issued an order suspending both licenses indefinitely (minimum two years). Masood sought administrative and judicial review, raising factual, evidentiary, procedural, and sanction challenges.
- The appellate court affirmed: it deferred to the Director on credibility and factual findings (manifest-weight review), rejected Masood’s mens rea challenge as forfeited (and in any event not clearly erroneous), found no prejudicial evidentiary or due-process error, and held the sanction within the Director’s discretion.
Issues:
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether findings that Masood violated the Controlled Substances Act / Medical Practice Act were against the manifest weight of the evidence | Masood: evidence does not show his subjective intent to maintain patients' addictions; ALJ applied an objective/negligence standard (Ruan requires subjective mens rea). | Department: record shows red flags, circumstantial evidence supports inference of intent; agency credibility findings entitled to deference. | Forfeited in part; even if considered, factual finding sustained — not against manifest weight; intent may be inferred from circumstances. |
| Whether ALJ improperly limited cross-examination of Department expert or allowed undisclosed expert opinions | Masood: prevented from probing expert's personal practice and bias; expert offered undisclosed opinions in violation of discovery and due process. | Department: rulings discretionary; excluded questions irrelevant; Masood had adequate opportunity to cross-examine and was not prejudiced. | No abuse of discretion; exclusion not materially prejudicial; discovery rule as applied did not render hearing fundamentally unfair. |
| Whether Board procedure (no member attended live hearing; only chair signed recommendation) violated due process | Masood: Board members must hear live testimony and recommendation must bear majority signatures. | Department: Abrahamson allows members to review the record instead of attending; emergency remote procedures justified single signature; Board reviewed record. | No due-process violation: agency members may act after reviewing record; presumption Board reviewed the transcript; signature issue not shown to cause unfairness. |
| Whether the discipline (indefinite suspension min. 2 years; suspension of both licenses) was unlawful or an abuse of discretion | Masood: statute does not permit indefinite suspension; only controlled-substance license should be suspended; sanction overly harsh and punitive. | Department: indefinite suspension with a minimum term is permitted and permits later restoration; Medical Practice Act authorizes suspension of medical license for CS violations; discipline tailored to public-protection purpose. | Sanction upheld: within Director’s discretion, not arbitrary or unrelated to statutory purpose; minimum two-year term and restoration process lawful. |
Key Cases Cited
- Ruan v. United States, 142 S. Ct. 2370 (2022) (Supreme Court discussion of mens rea required for criminal prescription convictions; subjective intent and role of circumstantial evidence)
- Abrahamson v. Illinois Dept. of Professional Regulation, 153 Ill. 2d 76 (1992) (agency decisionmakers need not attend hearings if they review the record)
- Cinkus v. Village of Stickney Municipal Officers Electoral Board, 228 Ill. 2d 200 (2008) (standard for clearly erroneous review of administrative findings)
- Carter-Shields v. Alton Health Institute, 201 Ill. 2d 441 (2002) (Medical Practice Act regulates physicians to protect public welfare)
- Siddiqui v. Department of Professional Regulation, 307 Ill. App. 3d 753 (1999) (deference to agency on appropriate sanction and review for abuse of discretion)