THEBAUT v. GEORGIA BOARD OF DENTISTRY; and vice versa.
A98A1130, A98A1131
Court of Appeals of Georgia
DECIDED NOVEMBER 10, 1998
235 Ga. App. 194 | 509 SE2d 125
BEASLEY, Judge.
Gannam & Gnann, Michael J. Gannam, for appellants.
Duffy, Feemster & Lewis, George L. Lewis, for appellees.
BEASLEY, Judge.
The Georgia Board of Dentistry commenced an administrative proceeding to sanction Dr. Thebaut, a pediatric dentist, based upon his proposed treatment of two children. Following a lengthy hearing, the administrative law judge issued an initial decision against the Board, holding the evidence did not support a finding that Dr. Thebaut‘s actions fell below minimal standards of acceptable and prevailing dental practice. The Board, on its own motion, elected to consider the case itself. After a hearing in which only Dr. Thebaut testified, the Board in the final decision adopted all but one of the ALJ‘s findings of fact and all of his conclusions of law. Substituted was its finding that with regard to one patient Dr. Thebaut‘s recommendations fell below the requisite standards. The Board ordered that Dr. Thebaut be sent a letter of concern and that the matter be closed.
Citing among other things lack of evidence, Dr. Thebaut sought judicial review by the superior court, which affirmed. Dr. Thebaut‘s discretionary appeal is Case No. A98A1130. The Board‘s cross-appeal, Case No. A98A1131, contests the trial court‘s jurisdiction.
1. Of first order, raised by Dr. Thebaut (Case No. A98A1130), is whether the Board had lost the power to act for failure to comply with
The statute does not state that review is foreclosed if such is not done, nor, unlike
Safety Fire Commr. v. U.S.A. Gas2 held that the 30-day requirement in
This rationale arises out of
We similarly hold that because no harm is shown nor authority withdrawn, the Board‘s written decision on Dr. Thebaut beyond the time prescribed in
Case No. A98A1131
2. Next addressed is whether judicial review was available. The Board argues that its final decision did not aggrieve Dr. Thebaut and thus was not subject to judicial review.13 The Board reasons that a letter of concern is not a form of disciplinary action and is not disclosed to anyone but Dr. Thebaut.14
Ga. Power Co. v. Campaign for a Prosperous Ga.16 defines “aggrieved” as used in this statute more broadly than does Black‘s Law Dictionary. “In the context of the Administrative Practice Act, the word ‘aggrieved’ has been interpreted to mean that the person seeking to appeal must show that he has an interest in the agency decision that has been specially and adversely affected thereby. [Cit.]”17
Dr. Thebaut had a professional interest in the Board‘s decision that criticized his actions and ordered he be sent a formal letter of concern. Detrimental official action condemning professional judgment offends professional pride and self-confidence, has a chilling effect on the recipient‘s approach to his practice, and constitutes a negative entry in the records of the professional‘s governing agency, regardless of the alleged non-public nature of the letter‘s contents. The court did not err in exercising jurisdiction over his petition for judicial review.
The Board‘s argument that
If the Board decides the possibility for more severe action exists, it then engages in a “contested case,” which is a proceeding in which the rights, duties, or privileges of a party must be determined by the agency after an opportunity for the hearing described in
Thus, the statement in
Other jurisdictions agree with this analysis. Murphy v. Bd. of Med. Examiners &c.24 held that under Arizona law a letter of concern normally is nondisciplinary, is issued only as a result of an investigation finding insufficient evidence to support disciplinary action, and does not come after an adjudicatory hearing. Accordingly, “issuance of a letter of concern is not a final decision subject to review before the agency or superior court. [Cits.]”25 An appellate court in Colorado agrees.26
The Georgia Board conducted an adjudicatory hearing, made findings of fact justifying discipline, and issued a final decision ordering the letter as a result. The absence of these factors precluded judicial review in Arizona and Colorado; their presence in this case makes judicial review available.27
The court did not err in exercising jurisdiction over the case.
Case No. A98A1130
3. Dr. Thebaut claims the evidence did not support the Board‘s amended finding that his actions fell below the minimal standards of acceptable and prevailing dental practice. He argues the Board relied solely on its own review of the physical evidence to judge his actions and had no expert testimony to support a finding of inappropriate care.
The Board as a party presented only the deposition testimony of Dr. Stewart (an orthodontist) and the patient x-rays and dental molds he examined to support its substituted finding that Dr. Thebaut‘s recommendation of the use of certain devices to correct some mild crowding of one child‘s lower teeth fell below minimal standards. But Dr. Stewart did not so testify. He testified only that in his opinion the “treatment was not indicated.” He conceded that his opinion was nothing more than a philosophical difference with Dr. Thebaut (a pediatric dentist), and that the decision whether to recommend these devices in this child was purely a clinical judgment. He further admitted that he reached his conclusion that “treatment was not indicated” without referring to any textbooks, and that the learned treatises in the area recommended the use of such devices as
On the other hand, Dr. Thebaut called four well-credentialed dentists, all of whom testified without equivocation that Dr. Thebaut‘s recommendation was clearly above minimal dentistry standards. These included Dr. Adair, Chairman of the Department of Pediatric Dentistry at the Dental School of the Medical College of Georgia; Dr. Bench, a Diplomate in the American Board of Orthodontics since 1970 and well-known lecturer on dentistry with 33 years of experience; Dr. Samson, dual-trained in pediatric dentistry and orthodontics and a professor at the University of Tennessee and the University of Alabama; and Dr. Lugus, Board Certified in Pediatric Dentistry.
In light of this strong evidence, the ALJ found Dr. Thebaut acted appropriately. On review, the Board rejected this portion of the ALJ‘s decision and found that based on its own review of the “physical evidence” (presumably the x-rays and the dental molds), the preponderance of evidence supported a finding that Dr. Thebaut‘s actions fell below minimal standards. Curiously, it nevertheless adopted the ALJ‘s conclusion of law that Dr. Thebaut had conformed with appropriate standards.
The Board found Dr. Thebaut had acted below the minimal standards despite the absence of any expert testimony to this effect. It relied on its own expertise (most but not all Board members are dentists) and reached its decision based on its own review of the physical evidence. The superior court affirmed.
The Board argues that
The concluding sentence does not authorize the Board to use its expertise to compensate for the absence of key evidence not presented or noticed.
Hicks v. Harden,31 a claim for disability, exemplifies these principles. Even though the only expert to appear testified that involutional depression was totally and permanently disabling, the agency itself found that involutional depression was ” ‘not a permanent disability since it begins around the time of menopause and should improve when menopause is completed. Also, this depression does not appear to be psychotic but simply neurotic and, therefore, is not totally disabling.’ ”32 Citing
Based on administrative procedure acts similar to Georgia‘s, a majority of courts in other jurisdictions that have addressed this issue have required expert testimony to establish the standard of care to which the professional is held and to test whether that professional‘s conduct fell below that standard.33
The South Dakota Supreme Court synthesized the law in this area in another dentistry case.34 It stated: “These jurisdictions have advanced several reasons for requiring expert testimony in administrative hearings. Some have held that the due process protections of the Constitution require that the professional in danger of losing his license has the right to confront, cross-examine and rebut the witnesses’ testimony and evidence sought to be placed in the record to
“A second rationale which also applies to this case is that the boards in many states are not totally comprised of professionals. Many of them contain lay members who are not trained in that particular profession. It has been held that it is improper for the Board to rely on its own expertise in determining competency rather than expert testimony on the record as some of the members do not hold this type of expertise. . . .
“The rationale most often relied upon by these jurisdictions is that expert testimony is required to be placed in the record to allow proper judicial review by appellate courts. When the administrative body applies its own expertise outside the hearing record to set the standard of care and a determination whether a professional violated it, the appellate courts, who are lawyers by training, lack the expertise to review findings of a board concerning medical, dental or any multitude of professions and occupations.
“This startling theory that the Board could use its own expertise without the evidentiary basis of that expertise appearing in the record, if recognized, would not only render absolute a finding opposed to uncontradicted testimony but would render the right of appeal completely inefficacious as well. A board of experts, sitting in a quasi-judicial capacity, cannot be silent witnesses as well as judges. The board may put its expertise to use in evaluating the complexities of technical evidence. However, the board may not use its expertise as a substitute for evidence in the record.”35
Rejecting this analysis, a substantial minority of jurisdictions have allowed agency findings of negligence, without expert testimony, based solely on the expertise of the board members.36 These jurisdictions find that the boards are best qualified by training and expertise to make determinations of competence and therefore expert testimony is unnecessary. But as the South Dakota Supreme Court stated: “The problem with this rationale is that it does not offer any explanation as to how an appellate court is to review the record which is absent of any expert testimony on the standards of the particular professions involved or their violation.”37
The majority rationale being the sounder, we hold that “where the issues of competence and negligence are of a complicated nature, expert testimony is required to establish the proper competency stan-
At least two cases have reversed agency decisions for lack of evidence where the agency‘s expert was equivocal as to the standard of care or as to whether the accused professional complied with that standard.40 We similarly hold that no evidence supports the Board‘s finding that Dr. Thebaut acted below the requisite standards. Thus there is no basis for sanctions or issuance of a letter of concern. The judgment is reversed and the case remanded to the trial court to reinstate the ALJ‘s initial decision.
4. This resolution moots the other enumerations of error raised by Dr. Thebaut.
Judgment affirmed in Case No. A98A1131. Judgment reversed and remanded with direction in Case No. A98A1130. Pope, P. J., and Ruffin, J., concur and concur specially.
RUFFIN, Judge, concurring specially.
I fully concur with the majority opinion. I write separately regarding Division 1 to address what I perceive to be a weakening of the mandatory nature of the word “shall.”
Thebaut correctly notes that
Notwithstanding the generally accepted meaning of “shall,” however, the Supreme Court of Georgia has carved out an exception for cases in which the word “shall” specifies a time period for the accomplishment of some action. “[W]hen not accompanied by any negative words restraining the doing of the thing afterward, [the word ‘shall‘] will generally be construed as merely directory and not as a limitation of authority, and this is especially so where no injury appeared to have resulted from the fact that the thing was done after the time limited by the plain wording of the Act.” Barton v. Atkinson, 228 Ga. 733, 739 (1) (187 SE2d 835) (1972).
“Probably the most firmly established rule of statutory construction is the ‘plain meaning rule.‘” Pittman v. State, 133 Ga. App. 902, 905 (1) (212 SE2d 505) (1975). Since I believe the plain meaning of “shall” is “must,” I am inclined to agree with Thebaut. Nevertheless, I am constrained by the precedent set forth in Barton, and, therefore, I specially concur.
I am authorized to state that Presiding Judge Pope joins in this special concurrence.
DECIDED NOVEMBER 10, 1998.
Chilivis, Cochran, Larkins & Bever, Anthony L. Cochran, John K. Larkins, Jr., for appellant.
Thurbert E. Baker, Attorney General, Brenda H. Cole, Deputy Attorney General, Alan Gantzhorn, Senior Assistant Attorney General, Kristin R. Loecke, Assistant Attorney General, for appellee.
