RUBEN ALEMAN, M.D., PETITIONER, v. TEXAS MEDICAL BOARD, RESPONDENT
No. 17-0385
IN THE SUPREME COURT OF TEXAS
May 24, 2019
Argued January 22, 2019
ON PETITION FOR REVIEW FROM THE COURT OF APPEALS FOR THE THIRD DISTRICT OF TEXAS
JUSTICE
JUSTICE BLACKLOCK filed a concurring opinion, in which JUSTICE BROWN joined.
JUSTICE BOYD filed a dissenting opinion.
In this administrative appeal, we review the Texas Medical Board‘s order imposing disciplinary sanctions under the Medical Practice Act against a physician for violating a state law that requires medical certifications for death certificates to be completed electronically. On the physician‘s petition for judicial review, the trial court affirmed the Board‘s order, and the court of appeals likewise affirmed. The physician argues that the Board lacked jurisdiction over the proceedings, that the Medical Practice Act does not authorize disciplinary action for the conduct at issue, that compliance with the electronic certification requirement was impossible, that the Board‘s sanction was so severe as to be an abuse of discretion, and that the physician is entitled to recover attorney‘s fees. We agree with the physician that disciplinary action was not authorized and thus reverse the court of appeals’ judgment in part.
I. Background
A. Death Certificates: Statutory Framework
The Texas Health and Safety Code places the responsibility of filing a death
In 2007, the Legislature amended chapter 193, adding a provision that requires the person completing the medical сertification to “submit the information and attest to its validity using an electronic process approved by the state registrar.” Act of May 17, 2007, 80th Leg., R.S., ch. 302, § 2, 2007 Tex. Gen. Laws 577, 577 (codified at
To use the TEDR system, a physician would submit an application to the Department and receive a password from the registrar. When the person required to file a death certificate (often a funeral director) prepared his portion of the certificate electronically and entered the medical certifier‘s information, the system automatically notified the certifier via email that certification was necessary. The certifying physician would then log into the system to complete the certification. If the certifier was not registered to use the system, the certificate could be “dropped to paper” by the funeral director, meaning it was removed from the system, and sent to the physician for completion on paper. In either event, the completed certificate was filed with the local registrar.
B. Factual and Procedural Background
J.S., a patient of Dr. Ruben Aleman‘s, died on July 16, 2011. The funeral director
Almost two years later, on May 3, 2013, the Texas Medical Board filed a complaint with the State Office of Administrative Hearings (SOAH) seeking disciplinary action against Dr. Aleman.5 The complaint, signed and sworn to by a Board staff attorney, alleged that “[r]ather than certifying the patient‘s death certificate through TEDR as required, [Dr. Aleman] required the mortuary to provide him with a paper death certificate,” which he “ultimately signed.” The complaint alleged that, in doing so, Dr. Aleman violated Health and Safety Code sections
Dr. Aleman filed a motion to dismiss and plea to the jurisdiction, arguing that the Board lacked subject matter jurisdiction becausе the complaint did not comply with the Medical Practice Act‘s requirements. See
The Board adopted the ALJ‘s findings and imposed sanctions. Specifically, the Board ordered Dr. Aleman to: take and
On Dr. Aleman‘s petition for judicial review of the Board‘s order, the trial court affirmed the order in all relevant respects, and the court of appeals affirmed the trial court‘s judgment. 565 S.W.3d 26 (Tex. App.—Austin 2017). The court of appeals held in pertinent part: (1) the Board‘s complaint complied with all statutory requirements, id. at 31; (2) substantial evidence supported the Board‘s conclusion that Dr. Aleman violated the Medical Practice Act, id. at 35; (3) no legal impossibility excused Dr. Aleman‘s failure to comply because “the impediment to Aleman‘s submitting the medical certification electronically was of his own making—his failure to register with the TEDR until August 2011,” id.; (4) the discipline imposed by the Board was neither in excess of its statutory authority nor arbitrary or capricious, id. at 36; and (5) the Board did not abuse its discretion in declining to award Dr. Aleman attorney‘s fees as sanctions for frivolous pleadings, id. at 37. We granted Dr. Aleman‘s petition for review.
II. Discussion
A. Sufficiency of Complaint
Texas Occupations Code section
Section
(a) In this section, “formal complaint” means a written statement made by a credible person under oath that is filed and presented by a board representative charging a person with having committed an act that, if proven, could affect the legal rights or privileges of a license holder or other person under the board‘s jurisdiction.
(b) Unless otherwise specified, a proceeding under this subtitle or other applicable law and a charge against a license holder may be instituted by an authorized representative of the board.
(c) A charge must be in the form of a written affidavit that:
- (1) is filed with the board‘s records custodian or assistant records custodian; and
- (2) details the nature of the charge as required by this subtitle or other applicable law.
. . . .
(f) A formal complaint must allege with reasonable certainty each specific act relied on by the board to constitute a violation of a specific statute or rule. The formal complaint must be specific enough to:
(1) enable a person of common understanding to know what is meant by the formal complaint; and - (2) give the person who is the subject of the formal complaint notice of eаch particular act alleged to be a violation of a specific statute or rule.
As the court of appeals noted, the Texas Government Code defines “affidavit” as “a statement in writing of a fact or facts signed by the party making it, sworn to before an officer authorized to administеr oaths, and officially certified to by the officer under his seal of office.”
To the contrary, section
B. Authorization for Disciplinary Action Under the Medical Practice Act
Dr. Aleman next argues that the Board erred in taking disciplinary action against him for failing to complete the medical certification for J.S.‘s death certificate electronically. Under the Administrative Procedure Act, the Board‘s order may be reversed if its findings and conclusions are “not reasonably supported by substantial evidence” or are “arbitrary or capricious or characterized by abuse of discretion.”
Under the Medical Practice Act, the Board has “the power to regulate the practice of medicine.”6
The Board argues that a physician‘s certifying a death certificate using pen and paper rather than electronically is a violation of state law—specifically, Health and Safety Code section
The Board is correct that, in light of the Health and Safety Code‘s electronic certification requirement, Dr. Aleman necessarily violated state law by certifying J.S.‘s death certificate manually, regardless of his knowledge of the law‘s existence. But such conduct was subject to disciplinary action under the Act only if “connected with” the practice of medicine. The question thus arises: what kind of connection is required between the conduct at issue and the practice of medicine?
Typically, when applying statutes requiring a connection between two things, our analysis hinges on how direct that connection must be. See ExxonMobil Pipeline Co. v. Coleman, 512 S.W.3d 895, 900 (Tex. 2017) (analyzing whether communications were made “in connection with” a matter of public concern under the Texas Citizens Participation Act, and rejecting the court of appeals’ determination that more than a “tangential relationship” is required to trigger the Act); Collingsworth Gen. Hosp. v. Hunnicutt, 988 S.W.2d 706, 709 (Tex. 1998) (examining whether a hospital employee who was fired for committing
By classifying the prohibited conduct in this way,7 the Legislature demonstrated its intent to authorize discipline for certain acts that fall within that category. Examining the list of qualifying conduct in its entirety furthers this conclusion:
(a) For purposes of Section 164.052(a)(5), unprofessional or dishonorable conduct likely to deceive or defraud the public includes conduct in which a physician:
- (1) commits an act that violates any state or federal law if the act is connected with the physician‘s practice of medicine;
- (2) fails to keep complete and accurate records of purchases and disposals of:
- (A) drugs listed in Chapter 481, Health and Safety Code [controlled substances]; or
- (B) controlled substances scheduled in the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.);
- (3) writes prescriptions for or dispenses to a person who:
- (A) is known to be an abuser of narcotic drugs, controlled substances, or dangerous drugs; or
- (B) the physician should have known was an abuser of narcotic drugs, controlled substances, or dangerous drugs;
- (4) writes false or fictitious prescriptions for:
- (A) dangerous drugs as defined by Chapter 483, Health and Safety Code [i.e., drugs that are unsafe for self-medication but are not included on the list of controlled substances]; or
- (B) controlled substances scheduled in Chapter 481, Health and Safety Code, or the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.);
(5) prescribes or administers a drug or treatment that is nontherapeutic in nature or nontherapeutic in the manner the drug or treatment is administered or prescribed;
(6) prescribes, administers, or dispenses in a manner inconsistent with public health and welfare:
- (A) dangerous drugs as defined by Chapter 483, Health and Safety Code; or
- (B) controlled substances scheduled in Chapter 481, Health and Safety Code, or the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.);
(7) violates Section 311.0025, Health and Safety Code [which prohibits billing for a treatment that thе provider
knows was not provided or was improper, unreasonable, or medically or clinically unnecessary]; (8) fails to supervise adequately the activities of those acting under the supervision of the physician; or
(9) delegates professional medical responsibility or acts to a person if the delegating physician knows or has reason to know that the person is not qualified by training, experience, or licensure to perform the responsibility or acts.
It is easy to see how the specific conduct described in subsections (a)(2) through (a)(9)—keeping inadequate records of controlled substances, prescribing drugs to those known to be drug abusers, writing false or fictitious prescriptions for certain drugs, prescribing or administering controlled substances and dangerous drugs in a manner inconsistent with public health and welfare, billing for unperformed or medically unnecessary treatments, failing to adequately supervise, and delegating medical responsibilities to unqualified persons—falls under the umbrella of “unprofessional or dishonorable conduct likely to deceive or defraud the public.”8 The conduct referenced in subsection (a)(1) is less precise, but it is nevertheless intended to fall within the same classification; otherwise, categorizing the conduct at all serves no purpose.
We therefore hold that an act that violates state or federal law is subject to disciplinary action by the Board under the Medical Practice Act only if the act is connected with the practice of medicine in a manner that makes it likely to deceive or defraud the public. In turn, we reject the Board‘s contention that a sufficient connection exists solely by virtue of the fact that Dr. Aleman certified the death certificate in his capacity as J.S.‘s physician. See
Indeed, by providing a finite list of acts in section
Applying sections
The Board insists that the electronic certification requirement serves an important public purpose by promoting the prompt issuance of death certificates, thereby reducing delays in various postmortem legal proceedings. That may very well be, but if anything it proves the point. Requiring electronic certification may address inefficiencies in the process, but it in no way addresses fraud or deception.11 And we fail to see how disciplining a physician for failing to comply with that requirement comports with the express policy behind the Act: “to protect the public interest” by “regulat[ing] the granting of [the] privilege [of practicing medicine] and its subsequent use and control.”
Further, potential fact patterns readily come to mind that only heighten the concerns associated with the Board‘s overly broad interpretation. For example, suppose
Accordingly, we hold that a physician‘s act of completing the medical certification for a death certificate manually rather than by using the approved electronic process does not constitute a “prohibited practice” under section
C. Attorney‘s Fees
Finally, Dr. Aleman argues that the ALJ abused its discretion in failing to award him attorney‘s fees as sanctions under Texas Civil Practice and Remedies Code chapter 10 and Texas Rule of Civil Procedure 13. Dr. Aleman contends that some of the allegations against him in the formal complaint—specificаlly, that he violated Health and Safety Code section
As a state agency, SOAH has those powers the Legislature expressly confers, along with “whatever powers are reasonably necessary to fulfill its express functions or duties.” Pub. Util. Comm‘n of Tex. v. City Pub. Serv. Bd. of San Antonio, 53 S.W.3d 310, 316 (Tex. 2001). Section
(b) A sanction imposed under Subsection (a) may include, as appropriate and justified, issuance of an order:
- (1) disallowing further discovery of any kind or of a particular kind by the offending party;
- (2) charging all or any part of the expenses of discovery against the offending party or its representatives;
- (3) holding that designated facts be considered admitted for purposes of the proceeding;
- (4) refusing to allow the offending party to support or oppose a designated claim or defense or prohibiting the party from introducing designated matters in evidence;
- (5) disallowing in whole or in part requests for rеlief by the offending party and excluding evidence in support of those requests; and
- (6) striking pleadings or testimony, or both, in whole or in part.
By contrast, a similar provision of the Administrative Procedure Act authorizing SOAH to impose sanctions in contested cases involving the Public Utility Commission expressly includes as a permissible sanction “an order . . . requiring the offending party or its representative to pay . . . the reasonable expenses, including attorney‘s fees, incurred by other parties because of the sanctionable behavior.”
Dr. Aleman thus relies on Civil Practice and Remedies Code chapter 10 and Texas Rule of Civil Procedure 13, which “allow a trial court to sanction an attorney or a party for filing motions or pleadings that lack a reasonable basis in fact or law.” Low v. Henry, 221 S.W.3d 609, 614 (Tex. 2007). Sanctions imposed under these provisions may include attorney‘s fees.
III. Conclusion
We hold that (1) the Board had jurisdiction over this proceeding, (2) the Board abused its discretion in finding that Dr. Aleman violated the Medical Practice Act, and (3) Dr. Aleman is not entitled to attorney‘s fees. Accordingly, we affirm the court of appeals’ judgment in part, reverse it in part, and render judgment vacating the sanctions imposed against Dr. Aleman.
OPINION DELIVERED: May 24, 2019
Debra H. Lehrmann
Justice
