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Aleman v. Texas Medical Board

Supreme Court of Texas

May 24, 2019

Ruben Aleman, M.D., Petitioner,
Texas Medical Board, Respondent

          Argued January 22, 2019

          On Petition for Review from the Court of Appeals for the Third District of Texas

          Justice Lehrmann delivered the opinion of the Court, in which Chief Justice Hecht, Justice Green, Justice Guzman, and Justice Devine joined, and in which Justice Busby joined except as to footnote 9.



         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 certificate on the "person in charge of interment or in charge of removal of a body from a registration district for disposition." Tex. Health & Safety Code § 193.002. With certain inapplicable exceptions, that person must "obtain the required medical certification from the decedent's attending physician . . . if the death occurred under the care of the [physician] in connection with the treatment of the condition or disease process that contributed to the death." Id. § 193.005(a).[1] Generally, the Act requires that the medical certification be completed no later than five days after the physician receives the death certificate, id. § 193.005(b), [2] and that the certificate be filed with the appropriate local registrar no later than ten days after the death occurs, id. § 193.003(a).[3]

         In 2007, the Legislature amended chapter 193, adding a provision that requires the person completing the medical certification 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 Tex. Health & Safety Code § 193.005(h)). During the time period at issue in this case, the approved electronic process for preparing and recording death certificates was the Texas Electronic Death Registration system (known as TEDR), administered by the Texas Department of State Health Services' Vital Statistics Unit.[4]

         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 generated and signed J.S.'s death certificate electronically. However, Dr. Aleman was not registered with the TEDR system, so the certificate was dropped to paper and sent to him for manual certification. Dr. Aleman received and hand-certified the paper certificate on July 29. The certificate became "official" on August 8, when it was certified by the local registrar. On August 16, Dr. Aleman submitted an application to register with the TEDR system, and his application was approved and took effect three days later. After registering, Dr. Aleman attempted to certify J.S.'s death certificate electronically. However, the system would not allow him to do so once the certificate became official.

         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 193.002(4) (requiring death certificates to be filed electronically) and 193.005(h) (requiring death certificates to be medically certified electronically). The complaint further alleged that this conduct violated the Medical Practice Act, which authorizes disciplinary action against a licensed physician for "commit[ting] unprofessional or dishonorable conduct that is likely to deceive or defraud the public," including "an act that violates any state or federal law if the act is connected with the physician's practice of medicine." Tex. Occ. Code §§ 164.052(a)(5), .053(a)(1). Finally, the complaint alleged the case involved aggravating factors-increased potential for harm to the public and an intentional, premeditated, knowing, or grossly negligent act-that should be taken into consideration in determining sanctions.

         Dr. Aleman filed a motion to dismiss and plea to the jurisdiction, arguing that the Board lacked subject matter jurisdiction because the complaint did not comply with the Medical Practice Act's requirements. See id. § 164.005. The administrative law judge (ALJ) denied the motion. The ALJ also denied both parties' motions for summary disposition as well as Dr. Aleman's motion for sanctions. After a hearing, the ALJ issued a Proposal for Decision containing findings of fact and conclusions of law. The ALJ found that Dr. Aleman did not violate Health and Safety Code section 193.002(4), which applies only to persons required to file death certificates. However, the ALJ concluded that Dr. Aleman did violate section 193.005(h) by failing to complete the medical certification electronically and that his noncompliance "did not result from circumstances beyond his control." In turn, the ALJ found that, because the violation was related to Dr. Aleman's practice of medicine, he "by definition" violated the Medical Practice Act. The ALJ further found that no aggravating factors were present in the case. Finally, the ALJ concluded that Dr. Aleman was not entitled to, nor was SOAH authorized to award, attorney's fees.

         The Board adopted the ALJ's findings and imposed sanctions. Specifically, the Board ordered Dr. Aleman to: take and pass the Board's Jurisprudence Examination within one year (in no more than three attempts); pay a $3, 000 administrative penalty; complete sixteen hours of continuing medical education within one year, including eight hours of ethics and eight hours of risk management; and give a copy of the Board's order to "all hospitals, nursing homes, treatment facilities, and other health care entities" where Dr. Aleman has privileges or otherwise practices.

         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 164.005 prescribes the procedure for instituting formal administrative proceedings against a physician. Dr. Aleman asserts that the formal complaint against him did not comply with the section's requirements, depriving the Board of jurisdiction over this proceeding. The Board responds that the complaint was statutorily compliant and, alternatively, that any defects are not jurisdictional. See City of DeSoto v. White, 288 S.W.3d 389, 394 (Tex. 2009) (explaining that we presume statutory requirements are not jurisdictional absent clear legislative intent to the contrary). We hold that the complaint met the statutory requirements and thus need not decide whether those requirements are jurisdictional.

         Section 164.005 provides in pertinent part:

(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 each particular act alleged to be a violation of a specific statute or rule.

Tex. Occ. Code § 164.005(a)-(c), (f). Dr. Aleman does not contend that the complaint provided insufficient detail or notice with respect to the particular acts underlying the alleged violations. Rather, he insists that the complaint was not "in the form of a written affidavit" or "made by a credible person under oath" because the Board staff attorney who signed the complaint lacked personal knowledge of the events in question.

         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 administer oaths, and officially certified to by the officer under his seal of office." Tex. Gov't Code § 312.011(1). The complaint at issue meets this definition: it is in writing, states facts, is signed by the party stating them, and is sworn and notarized. We apply this definition in construing civil statutes "unless a different meaning is apparent from the context of the statute in which the word appears." Id. §§ 312.001, .011. But no such different meaning- i.e., one adding a requirement that the complaint be signed by a person with personal knowledge-is apparent from the context of section 164.005.

         To the contrary, section 164.005(b) provides that, "[u]nless 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." Tex. Occ. Code § 164.005(b). This provision would make little sense if personal knowledge were required because board representatives typically will not have such knowledge of the facts underlying an alleged Medical Practice Act violation. Further, the statute contains no indication that a formal complaint is intended to have evidentiary value in the proceedings. By contrast, as the court of appeals recognized, affidavits must affirmatively be "made on personal knowledge" to constitute competent evidence in the summary judgment context. Tex.R.Civ.P. 166a(f). Section 164.005 contains no such express requirement, and we decline to imply one. Accordingly, we hold that the complaint against Dr. Aleman complied with the Medical Practice Act.

         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." Tex. Gov't Code § 2001.174(2)(E), (F). The Board's factual findings are reviewed under a substantial evidence standard, meaning they will be upheld if "more than a mere scintilla" of evidence supports them. City of Dallas v. Stewart, 361 S.W.3d 562, 566 (Tex. 2012) (internal quotation marks omitted). However, the issue here is not whether Dr. Aleman did or did not certify electronically-it is undisputed that he did not. Rather, the parties dispute whether the Medical Practice Act authorized disciplinary action for that conduct, presenting an issue of statutory interpretation.

         Statutory interpretation involves questions of law that we consider de novo, even when reviewing agency decisions. Cadena Comercial USA Corp. v. Tex. Alcoholic Beverage Comm'n, 518 S.W.3d 318, 325 (Tex. 2017). We generally "rely on the plain meaning of a statute's words" to discern legislative intent. Id. In evaluating that language, we construe the words and phrases chosen by the Legislature in context rather than in isolation. Id. at 326. That is, "our objective is not to take definitions and mechanically tack them together," but to "consider the context and framework of the entire statute" and construe it as a whole. Id.

          Under the Medical Practice Act, the Board has "the power to regulate the practice of medicine."[6] Tex. Occ. Code § 152.001(a). As part of its authority to enforce the Act, the Board may take disciplinary action against physicians who engage in certain statutorily prohibited practices. See id. § 164.051(a). Among these prohibited practices, enumerated in section 164.052, is the commission of "unprofessional or dishonorable conduct that is likely to deceive or defraud the public, as provided by Section 164.053, or injure the public." Id. § 164.052(a)(5). In turn, section 164.053 provides a list of acts that, "[f]or purposes of Section 164.052(a)(5), [constitute] unprofessional or dishonorable conduct likely to deceive or defraud the public." Id. § 164.053(a). This list includes "an act that violates any state or federal law if the act is connected with the physician's practice of medicine." Id. § 164.053(a)(1).

         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 193.005(h)-and is connected with the physician's practice of medicine. Thus, the Board concludes, such conduct is subject to disciplinary action. Dr. Aleman responds that, even if he technically violated the electronic certification requirement, section 164.053(a)(1) does not encompass this type of conduct, which does not "actually" qualify as unprofessional or dishonorable conduct that could "actually" deceive or defraud the public. For the reasons discussed below, we hold that the Medical Practice Act did not authorize the Board to take disciplinary action against Dr. Aleman.

         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 an assault while off duty had nevertheless been terminated for misconduct "connected with" her work, rendering her ineligible for unemployment benefits). However, in this case, the Medical Practice Act further delimits the scope of the required connection by grouping the conduct described in section 164.053(a)(1) with a list of behavior that is sanctionable as "unprofessional or dishonorable conduct that is likely to deceive or defraud the public." Tex. Occ. Code §§ 164.052(a)(5), .053(a).

         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 ...

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