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 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.
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