Expanded Psychology Board Disciplinary Authority

On June 23, 2016 the General assembly approved act 2016–53. This is a new provision in the the Psychology Board Act.  It became effective August 23, 2016.  This an amendment to the Psychology Board’s authority in disciplining it’s licensees. The specific section in bold states:

(b) When the board finds that the license or application for license of any person may be refused, revoked, restricted or suspended under the terms of subsection (a), the board may:

(1) Deny the application for a license.

(2) Administer a public reprimand.

(3) Revoke, suspend, limit or otherwise restrict a license as determined by the board.

(4) Require a licensee to submit to the care, counseling or treatment of a physician or a psychologist designated by the board.

(5) Suspend enforcement of its findings thereof and place a licensee on probation with the right to vacate the probationary order for noncompliance.

(6) Restore a suspended license to practice psychology and impose any disciplinary or corrective measure which it might originally have imposed.

(7) Take other action as the board in the board’s discretion considers proper, including precluding a suspended licensee from engaging in counseling or any other form of mental health practice.

The import of the new (b)(7) provision cannot be under stated. The legislature has given the Board authority to take “other action” within the “Board’s discretion it considers proper”. This is just about anything.  The case law discussing licensing boards authority to discipline their licensees is clear.

Appellate review of a discretionary Board action is limited to determining whether constitutional rights have been violated, an error of law committed, or necessary findings of fact are supported by substantial evidence. 2 Pa.C.S. § 704; Cassella v. Pennsylvania Board of Medicine, Bureau of Professions and Occupations, 119 Pa. Commonwealth Ct. 394, 547 A.2d 506 (1988); DePanfilis v. State Board of Pharmacy, 121 Pa. Commonwealth Ct. 526, 551 A.2d 344 (1988). The State Board of Nursing is the ultimate fact finder and may accept or reject the testimony of any witness in whole or in part.

The proper review of an agency’s action, assuming that it is not defective under the self-explanatory requirements of § 704 of the Administrative Agency Law, 2 Pa. Cons. Stat. § 704, is not whether its order was reasonable, but whether it was made in accordance with law, i.e., whether it was made in bad faith, and whether it was fraudulent or capricious. A reviewing court may interfere in an agency decision only when there has been a manifest and flagrant abuse of discretion or a purely arbitrary execution of the agency’s duties or functions. Slawek v. Commonwealth, State Bd. of Med. Educ. & Licensure, 526 Pa. 316, 318, 586 A.2d 362, 363 (1991).

Where a full and complete record is made of the proceedings before the State Board of Nursing, a reviewing court must affirm the adjudication unless it is in violation of the constitutional rights of the appellant or not in accordance with the law, the procedural provisions of the local agency law are violated, or a finding of fact of the State Board of Nursing necessary to support its adjudication is not supported by substantial evidence. Section 754 of the Administrative Agency Law, 2 Pa. C.S. § 754. The emphasis here is that is a full and complete record is a necessity.

Substantial evidence means that the evidence required to support the finding of an administrative agency must be “such relevant evidence as a reasonable mind might accept as adequate to support the conclusion.”  Civil Service Com. V. Poles, 132 Pa. Commw. 593, 573 A.2d 1169, 1172 (1990); Gallagher v. Philadelphia State Board of Pharmacy, 16 Pa. Commw. 279, 330 A.2d 287, 289 (Pa. Commw. Ct. 1974).

It is imperative that counsel is present at any hearing to insure the trial evidence objections are properly set forth int he record.  In many cases, Board discretionary action can only be limited by insuring the evidence at the hearing is minimized against the licensee.  Or on Appeal, reviewing the record, to insure the Board decision is made in accordance with the facts presented at the hearing. Any decision based on facts outside of the record is not proper. Please call to discuss you psychology license disciplinary issues.

 

 

Pennsylvania’s New Physician Licensing Compact

In November of 2015 I blogged about the proposed version of Pennsylvania’s Interstate Medical Licensure Compact Act.  One year later, effective October 26, 2016, the Act has become Law. What does this mean for Pennsylvania’s physicians?

The Interstate Medical Licensure Compact Act (the “Act”) only applies to “Physician”, a person who:
1. is a graduate of a medical school accredited by the Liaison Committee on Medical Education, the Commission on Osteopathic College Accreditation or a medical school listed in the International Medical Education Directory or its equivalent;
2. passed each component of the United States Medical Licensing Examination or the Comprehensive Osteopathic Medical Licensing Examination within three attempts or any of its predecessor examinations accepted by a state medical board as an equivalent examination for licensure purposes;
3. successfully completed graduate medical education approved by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association;
4. holds specialty certification or a time-unlimited specialty certificate recognized by the American Board of Medical Specialties or the American Osteopathic Association’s Bureau of Osteopathic Specialists;
5. possesses a full and unrestricted license to engage in the practice of medicine issued by a member board;
6. has never been convicted, received adjudication, deferred adjudication, community supervision or deferred disposition for any offense by a court of appropriate jurisdiction;
7. has never held a license authorizing the practice of medicine subjected to discipline by a licensing agency in a state, federal or foreign jurisdiction, excluding an action related to non-payment of fees related to a license;
8. has never had a controlled substance license or permit suspended or revoked by a state or the United States Drug Enforcement Administration; and

9. is not under active investigation by a licensing agency or law enforcement authority in a state, federal or foreign jurisdiction.

Upon receipt of an application for an expedited license, the member board within the state selected as the state of principal license shall evaluate whether the physician is eligible for expedited licensure and issue a letter of qualification, verifying or denying the physician’s eligibility to the interstate commission. The following shall apply:
1. Static qualifications, which include verification of medical education, graduate medical education, results of any medical or licensing examination, and other qualifications as determined by the interstate commission through rule, shall not be subject to additional primary source verification where already primary source verified by the state of principal license.
2. The member board within the state selected as the state of principal license shall, in the course of verifying eligibility, perform a criminal background check of an applicant, including the use of the results of fingerprint or other biometric data checks compliant with the requirements of the Federal Bureau of Investigation, with the exception of federal employees who have suitability determination in accordance with 5 C.F.R. § 731.202 (relating to criteria for making suitability determinations).
3. Appeal on the determination of eligibility shall be made to the member state where the application was filed and shall be subject to the law of that state.

 

An important part of the Act is the joint investigation and disciplinary process. The law as enacted states:

ARTICLE IX JOINT INVESTIGATIONS
A. Licensure and disciplinary records of physicians are deemed investigative.
B. In addition to the authority granted to a member board by its respective Medical Practice Act or other applicable state law, a member board may participate with other member boards in joint investigations of physicians licensed by the member boards.
C. A subpoena issued by a member state shall be enforceable in other member states.
D. Member boards may share any investigative, litigation or compliance materials in furtherance of any joint or individual investigation initiated under the compact.
E. Any member state may investigate actual or alleged violations of the statutes authorizing the practice of medicine in any other member state in which a physician holds a license to practice medicine.
ARTICLE X DISCIPLINARY ACTIONS
A. Any disciplinary action taken by any member board against a physician licensed through the compact shall be deemed unprofessional conduct which may be subject to discipline by other member boards, in addition to any violation of the Medical Practice Act or regulations in that state.
B. If a license granted to a physician by the member board in the state of principal license is revoked, surrendered or relinquished in lieu of discipline, or suspended, then all licenses issued to the physician by member boards shall automatically be placed, without further action necessary by any member board, on the same status. If the member board in the state of principal license subsequently reinstates the physician’s license, a license issued to the physician by any other member board shall remain encumbered until that
respective member board takes action to reinstate the license in a manner consistent with the Medical Practice Act of that state.
C. If disciplinary action is taken against a physician by a member board not in the state of principal license, any other member board may deem the action conclusive as to matter of law and fact decided, and:
1. impose the same or lesser sanction(s) against the physician so long as such sanctions are consistent with the Medical Practice Act of that state; or
2. pursue separate disciplinary action against the physician under its respective Medical Practice Act regardless of the action taken in other member states.
D. If a license granted to a physician by a member board is revoked, surrendered or relinquished in lieu of discipline, or suspended, then any license(s) issued to the physician by any other member board(s) shall be suspended, automatically and immediately without further action necessary by the other member board(s), for ninety (90) days upon entry of the order by the disciplining board, to permit the member board(s) to
investigate the basis for the action under the Medical Practice Act of that state. A member board may terminate the automatic suspension of the license it issued prior to the completion of the ninety (90) day suspension period in a manner consistent with the Medical Practice Act of that state.

Any disciplinary action taken by the physician’s principle licensing board (their home state) shall, under House Bill 1619 of 2015, be deemed unprofessional conduct subject to discipline by other member boards in addition to any violation of the Medical Practices Act or regulations of the principle state. Revocation, suspension, or surrender of a license in lieu of discipline or suspension shall cause the physician’s license to suffer similar status by each and every member board to which that physician is licensed.

Conversely, however, any reinstatement of the physician’s license by his principal state medical board shall not affect the encumbered status of that physician’s license in other member states unless and until each member state takes individual action to reinstate my license. This provision allows each member board to conduct the practice of their medical board license disciplinary action independent of the Act. This process is different the current due process rules that require each state’s discipline of a multiple state licensed professional to be independent of, and not link to, any prior state’s discipline.

Any discipline action taken by the physician by a member board, not the principal license board, may be used by other member boards as a conclusive disciplinary action warranting imposition of the same or less or sanction or a separate disciplinary action by other member boards. As well, any license investigation by a member board that becomes the subject revocation, surrender or relinquishment in lieu of discipline shall cause the physician’s license to suffer the same consequences without any further action in each other member board without the subject to any disciplinary investigation. The physician truly becomes hostage to the initiating state’s disciplinary process and must fight it to the death so as to avoid any automatic domino effect.

The Act seeks to balance the states’ citizens’ need for medical care, a nation’s policy interest in granting access to high quality medical care to all citizens, and a physician’s ability to provide competent medical service regardless of artificial state borders against patient safety and criminally active doctors. The primary concern of the Act is who will become the disciplinary supervisor of doctors practicing throughout the country under the Act. While this is a serious and weighty issue, the Act in its current form fails to safeguard the medical license of Pennsylvania’s many doctors who will choose it as their primary state of licensure.

Pennsylvania’s medical schools have produced thousands of doctors over the years. Many secure initial graduate school training licenses and stay in the Commonwealth after residency to care for Pennsylvania’s residents. Many choose Pennsylvania as a home. The Act as drafted in House 1619 of 2015 will discourage this.

Physicians who seek to practice medicine in multiple states through the Act will sacrifice a significant degree of due process if any disciplinary investigation is commenced or levied against them. While there is significant financial interest to provide internet-based face time oriented medical practice across state borders without driving distances, to save lives, the inevitable due process concerns are significant. Exploding populations are overrunning medical investigatory boards with rampant anonymous complaints that will warrant investigation.

Every day baseless complaints of Medicare Medicaid insurance fraud, pill mills, sexual assaults, or drug theft and diversion are generated from specious reporters who are either aggrieved patients, angry disgruntled business partners, jealous or angry co-employees, or scorned lovers. House Bill 1619 of 2015 exposes Pennsylvania’s principle-based medical practitioners to unilateral concurrent disciplinary process of member states without the ability to respond, investigate, or even defend oneself in a court of law. Member state’s unilateral actions will automatically trickle back to the physician’s primary licensure state, causing potentially automatic disciplinary action there. The Act as written is not in the interest of Pennsylvania medical community.

New Registration Requirement Rules

I write  frequently about the Pennsylvania General Assembly routinely adding criminal and civil consequences to convicted sex offenders ‘s sentences after judicial pronouncement of the sentence. Modifying Megan’s Law registration requirements for convicted sex offenders is the most prominent of these tough-on-crime fighting, constituent-appeasing measures. Megan’s Law V is called the Sex Offender Registration and Notification Act. (SORNA), 42 Pa.C.S. §§ 9799.10-9799.41.
 
The Pennsylvania General Assembly has modified and/or extended Pennsylvania’s Megan’s Law so many times that our Commonwealth now has five different Megan’s Law registration statutes. Parts of Megan’s Law, II-IV were declared unconstitutional. Megan’s Law V’s December 20, 2012 reclassification and extension of registration scheme for sex offenders – whether under supervision or not as of December 20, 2012- is now being attacked.  Defendants who complied with all terms and conditions of their criminal sentences and originally imposed registration requirements object to their reclassification. Successful legal arguments have focused on this provision.

On September 28, 2016 the Pennsylvania Supreme Court finally decided several consolidated cases addressing this issue.  In Commonwealth v. Martinez,  2016 Pa. LEXIS 2183 (Sep. 28, 2016), the Court resolved the legality of the 2012 reclassification scheme against otherwise compliant registrants. Three combined cases present the question of whether the state police can extend or re-enroll in the sexual registry defendants who satisfied all terms and conditions of an original guilty plea agreement and were not under probation or parole supervision as of December 20, 2012. The individuals may still have had to register under Megan’s law I-V.  These cases do not apply to open plea agreements or sentences handed down after a jury or bench trial.

Factually, after December 20, 2012 the state police sent letters out to Megan’s Law registrants compelling re-enrollment or extension of their registration requirements.  Registration requirements were extended from 10 to 25 years and 25 years to life depending on the criminal conviction. If registration had been completed but the convicted offense registration was changed to 25 years instead of 10 years, re-enrollment was demanded.  Martinez and other individuals around the Commonwealth contested reclassification because they complied with all aspects of their criminal plea agreement, may have concluded probation/parole supervision before December 2012, and may have even completed their registration responsibilities.

Some Cases were filed against the state police as injunctions, writs of mandamus, or a petitions to enforce guilty plea agreements. Many of these cases failed for any number of reasons. Case rulings allow reclassification against defendants who violated any term or condition of their guilty plea agreement.  Another basis for allowing reclassification is being charged with violating the registration requirements of their original sentence.  Even being charged for a reporting violation after 2012 became a reason for further reclassification.

The Martinez defendants (as well as several of my clients) satisfied their terms of incarceration with no violations or write ups, honored all probation or parole obligations, and were fully compliant with (or completed) all registration requirements. The state police still contacted them to either re-initiate or extend registration under Megan’s Law V.
 
I, like Martinez’ counsel, filed motions to enforce their guilty plea in various Common Pleas courts around the state.  I sought, like Martinez, to enforce the terms of their pre-2012 plea agreements.  Martinez focuses exclusively on the sanctity pleas agreement as a contract into which the government entered with these defendant.  Focusing defendants’ compliance with their side of the bargain, Martinez, and one other case, Commonwealth v. Hainesworth, 2013 PA Super 318, 82 A.3d 444 (Pa. Super. 2013),  present similar situated defendants.  In those cases the Superior Court of Pennsylvania held that the Contract Clauses of the Pennsylvania, Pa. Const. art. I, § 17, and United States Constitutions, U.S. Const. art. I, § 10, cl. 1, prohibit the Pennsylvania Legislature from enacting laws that retroactively impair contract rights.
The Martinez case question was whether Hainesworth’s ruling, baring reclassification for defendants who complete the terms of the guilty plea contract before December 20, 2012, is proper.  The court said yes and affirms Hainesworth.  The court states “convicted criminals must fulfill the promises they make in connection with plea agreements. See Commonwealth v. Wallace, 582 Pa. 234, 870 A.2d 838, 843 n.6 (Pa. 2005) (“The defendant, on the other hand, accepts this benefit with the implicit promise that he will abide by the terms of the agreement and behave in accordance with the legal punishment imposed by the court.”).  For these defendants, the Court rules, the legislature must  honor the guilty plea agreement/contract its District Attorneys entered and the court approved. 
The issue now is does the guilty plea colloquy adequately set forth with particularity the registration requirements that are part of the guilty plea agreement.  Martinez may not apply to a cases in which the Megan’s Law terms are not stated in the record or were not negotiated.  If there is an open plea, these cases may not apply.  In the late 1990 and early 2000’s in many cases the Commonwealth simply did not negotiate terms of Megan’s Law in the guilty plea agreement or state it was negotiated on the record. 
Some experienced counsel tried to have the record reflect the plea negotiations to lower criminal charges were engaged to reduce the registration time (from a Tier II – 25 year offense to a Tier I – 10 year offense).  In those cases registration terms were reduced in guilty plea agreement by pleas to lower criminal charges.  Martinez find such stipulations in the three consolidated cases.  In Philadelphia and the local counties,  registration notification provisions were always placed in the plea agreement, with a separate signed Megan’s Law Registration form, and in colloquy at a sentencing. 
In the less sophisticated courts sometimes registration terms were not discussed in either the plea or sentencing hearings.  Importantly, counsel must secure both of these transcripts to determine in Martinez applies to the case.  Also, Martinez only applies to guilty pleas (not open pleas) for which a defendant was not under any jail, parole, or probation supervision as of December 2012.   Call me to discuss your case.
 
 t.

Hearsay, The Pharmacy Board, and Due Process

A recent client sought reinstatement of her pharmacy license after a period of suspension for failing out of the SARPH, Pennsylvania pharmacists’ drug monitoring program. The Pharmacy Board rejected her petition. I represented the pharmacist only in her appeal to the Commonwealth Court.

Prior counsel cost her her license and Markowitz did not utilize an attorney during her petition for reinstatement process, including the hearing before the Pharmacy Board.  She represented herself very poorly at that hearing.  As a result, the Commonwealth Court affirmed the Pharmacy Board’s denial of reinstatement. Carol Markowitz should have won her appeal because at the Pharmacy Board hearing the Board accepted inadmissible expert report evidence that tainted the Board’s consideration of the case.  Markowitz v. Bureau of Prof’l & Occupational Affairs, State Bd. of Pharm., 2016 Pa. Commw. Unpub. LEXIS 594, at *16 (Commw. Ct. Aug. 25, 2016).

With every SARPH or PHMP approved monitoring program, following all terms and conditions of the case worker’s demands establishes compliance with a professional board order. Lack of compliance results in prosecutors filing motion to kick licensees out of the monitoring programs and retroactively suspend their license. Thereafter, before reinstatement should be sought and can be approved by the board, licensees must prove compliance with the terms and conditions of the monitoring program as mandated by the disciplinary order suspending the license.

In  Markowitz’ circumstance, she remained drug-free, did not work, and was otherwise compliant with all terms and conditions of the SARPH program. However, during the term of her suspension, she was not enrolled in the SARPH. No SARPH case worker appeared for her at her petition for reinstatement, did not approve of her medications, and did not perform the perfunctory supervised tests to confirm her  drug-free condition.

As part of the reinstatement process, Markowitz contacted SARPH, which sent her to a fitness to return to work evaluation by Drs. Heran and Garbely. These two doctors wrote a report, which the Board utilized against Markowtiz.  Neither appeared nor and testified at the reinstatement hearing.  The prosecutor moved Drs. Heran and Garbely‘s unqualified experts report into evidence.  The Board relied upon these two individuals’ hearsay report to find Markowitz was not eligible for reinstatement.
On appeal Markowitz complained about the Board’s due process violation in considering the expert reports for which Markowitz was unable to cross examine and question the author(s) of the report. Markowitz also complained about Drs. Heran and Garbely’s competence, prior histories of license suspensions, and their own drug addiction issues that ultimately lead to their becoming drug counselors and experts.

“Hearsay is defined as an out-of-court statement, either oral or written, offered in court for the purpose of proving the truth of the matter contained in the statement.” Bailey v. Unemployment Compensation Board of Review, 142 Pa. Commw. 294, 597 A.2d 241, 243 n. 3 (Pa. Cmwlth. 1991). “Hearsay evidence, [p]roperly objected to, is not competent evidence to support a finding[ ],” but “[h]earsay evidence, [a]dmitted without objection, will be given its natural probative effect and may support a finding[ ], [i]f it is corroborated by any competent evidence in the record….” Walker v. Unemployment Compensation Board of Review, 27 Pa. Commw. 522, 367 A.2d 366, 370 (Pa. Cmwlth. 1976). “[A] finding of fact based [s]olely on hearsay will not stand.” Id.

Surprisingly, the Court ruled “It is clear that the joint report is hearsay and not corroborated by other evidence of record. We agree with Markowitz that the report of Drs. Heran and Garbely should not have been considered by the Pharmacy Board.”  Markowitz v. Bureau of Prof’l & Occupational Affairs, State Bd. of Pharm., 2016 Pa. Commw. Unpub. LEXIS 594, at *16 (Commw. Ct. Aug. 25, 2016).

Please call me to discuss your contact with these two doctors, their handling of your licensing case, and any case in which they were involved.

Professional Licensing Board’s Discretion and Appellate Case Review

The discretionary decision making process of Pennsylvania’s twenty six professional boards is a huge appellate issue many cases confront.  In a recent case, board discretion is discussed in the context of non-criminal conduct and the Medical Board’s authority to police its own licensees.  The case is Mosuro v. Bureau of Prof’l & Occupational Affairs, 2016 Pa. Commw. Unpub. LEXIS 717 (Commw. Ct. Oct. 13, 2016).

Dr. Mosuro was disciplined in the state of Texas as a result of a medical relationship with a pain management clinic.  Dr. Mosuro was compensated by the owner of the clinic, an Advanced Practical Nurse (“APN”) licensed under Texas law, with a flat fee for each prescription he wrote for a clinic patient. In turn, the APN referred patients to Dr. Mosuro for other treatment.  Upon being investigated by the Texas Medical Board, but with no criminal charges being filed, the doctor enter into a consent agreement acknowledging violations State of Texas  Medical Board laws, rules, codes, and regulations due to his failure to supervise the APN and allowed her to prescribe medications that were non-therapeutic while acting under his prescriptive delegation. Charts were also not adequately documented and prescriptions were not supported by objective medical findings and data.  In sum, he allow his prescriptions to be used in a pill mill.

The Texas Board of Medicine issue the public reprimand and a $10,000 fine. He was also given a prescription prohibition on ordering, prescribing, or dispensing scheduled medication services.  The licensing authorities of Maryland, Tennessee, Alabama, and Virginia imposed similar discipline on Dr. Mosuro ‘s license.

The Commonwealth of Pennsylvania commenced disciplinary proceedings based upon Texas’ disciplinary action, accusing the doctor under 63 P. S. § 422.41 of improper prescribing of controlled substance through his involvement with the pill mill and his failure to properly supervise a nurse practitioner as required under Texas law. Standard of care violations, documentation of medical record violations, and unprofessional conduct were perceived by the Pennsylvania Medical Board as very serious.

After hearing in Pennsylvania, the hearing examiner proposed an Order and Adjudication of a $500 civil penalty and indefinitely suspended Doctor Mosuro license to practice medicine in the Commonwealth of Pennsylvania. Upon review, the Pennsylvania Medical Board excepted the hearing examiner’s Findings of Fact and Conclusions of Law but rejected the recommended order. Rather, the Medical Board ordered a public reprimand on Dr. Mosuro ‘s permanent licensing record, a $5000 civil penalty, and an indefinite suspension of his license to practice medicine and surgery in the Commonwealth of Pennsylvania. Reinstatement may be sought upon compliance with the Texas Board order and his Texas medical license being reinstated to unrestricted status.  This totaled over $15,000 in fine for a doctor unable to practice medicine.  This Board issued this order even though Dr. Mosuro did not have an active Pennsylvania medical license, was not practicing in the Commonwealth of Pennsylvania, and was disciplined by many other jurisdictions as a result of the same conduct.  PENNSYLVANIA’S DISCIPLINE WAS THE HARSHEST OF ALL JURISDICTIONS.
Dr. Mosuro appealed to the Commonwealth Court.  The scope of the Commonwealth Court appeal is limited to determining whether the findings of fact are supported by substantial evidence and whether the board committed errors of law or constitutional violations.” Blair v. Bureau of Prof’l & Occupational Affairs, State Bd. of Nursing, 72 A.3d 742, 750 (Pa. Cmwlth. 2013).  In review of the record, the appellate court concludes  the Medical Board’s extensive discipline based solely upon the opioid prescription drug abuse crisis is proper. The Board restates with approval the Pennsylvania Medical Board citation to recent Pennsylvania legislative findings regarding human suffering associated with addiction and how its epidemic has reached families throughout the Commonwealth.
The Medical Board and the Commonwealth Court use this case as a example of how to ensure public safety from medical practitioners who use their medical licenses to create “rogue pain management clinics” in Pennsylvania. Citing statistics that Pennsylvania ranks seventh in the nation for drug overdoses from prescription pain killers and the role of pill mills in the overdose epidemic, the Court approves the Medical Board utilizing these facts to “engage in its purpose under the medical practices act of safe guarding the public health and welfare”.

The Court did not address the Board’s role of insuring individual penalties to individual licensees be based upon their case facts. The Court affirms Board citation to broad policy language that the prescription overdose epidemic cannot be ignored. The Commonwealth Court concludes that when as now there is a “current threat to public health and welfare when assessing whether a Board carries out its statutory mandate in a purely arbitrary and capricious manner”, the Medical Board is properly carrying out its broader policy mandate of stopping pill mills during this great opioid epidemic.  Such is sufficient factual and legal reasoning to discipline even an in-active medical licensee.

 The Commonwealth Court limited its inquiry into the “wisdom of the board,” not reviewing the administrative decision of the Medical Board with an eye towards substituting it’s judgment of what is reasonable for that of the agency whose decision is being reviewed. The court let stand the Pennsylvania Medical Board’s perceptions of the seriousness of the doctor’s Texas discipline, how such is also a violation of Pennsylvania’s medical licensing scheme, and the Board’s broad policy reasons for its discipline.
In sum, Commonwealth Court concludes that “the board did not abuse its discretion by taking strong action to protect the safety and welfare of citizens by suspending Dr. Mosuro’s license instead of imposing conditions on his license similar to those of the Texas Board.” Dr. Mosuro’s violation is very serious. In determining that the Board did not abuse its discretion, the Court states “even if we disagreed with the severity of the sanction and thought the Texas Board’s decision was more appropriate, the sanction must be upheld because proper review is not whether it’s order is reasonable, but whether it was made in accordance with law.”  Facilitating and conspiring to engage in operation of a “pill mill”, the Court and the Medical Board conclude, is not in accordance with law and, therefore, the suspension of the medical license is within the confines of the Board’s regulatory authority.

Call me to discuss your out of state disciplinary action and Pennsylvania’s pending disciplinary action.

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