Case Title: Schwartz v. Board of Registration in Medicine

Citation: 

Docket Number: SJC-13292

State: massachusetts

Court: Massachusetts Supreme Court

Date: 2022-10-27T00:00:00Z

Document:
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SJC-13292 
 
SHELDON SCHWARTZ  vs.  BOARD OF REGISTRATION IN MEDICINE. 
 
 
October 27, 2022. 
 
 
Board of Registration in Medicine.  Doctor, License to practice 
medicine.  Jurisdiction, Administrative matter.  
Administrative Law, Evidence.  Constitutional Law, Trial by 
jury. 
 
 
 
The petitioner, Sheldon Schwartz, appeals from a judgment 
of a single justice of this court affirming a final decision and 
order of the Board of Registration in Medicine (board) 
suspending indefinitely his license to practice medicine.  We 
affirm. 
 
 
Procedural background.  In December 2015, the board issued 
a statement of allegations and order to show cause why the board 
should not discipline Schwartz.  The board alleged that Schwartz 
committed misconduct in the practice of medicine; that he lacked 
good moral character and engaged in conduct that undermines 
public confidence in the integrity of the medical profession; 
and that, by his actions, he violated Board of Registration in 
Medicine Policy No. 01-01 (disruptive physician behavior 
policy).  The board referred the matter to the Division of 
Administrative Law Appeals (DALA), and an administrative 
magistrate held a hearing over eight days in 2016.  The 
magistrate subsequently issued a recommended decision finding 
that Schwartz's disruptive behavior on two separate occasions 
amounted to misconduct and demonstrated that he engaged in 
conduct that undermines the public confidence in the integrity 
 
2 
of the medical profession.  On this basis, the magistrate 
concluded that Schwartz is subject to discipline by the board.1 
 
 
The board adopted the findings and conclusions of the 
magistrate, over various objections from Schwartz, and, after 
further briefing by the parties on the issue of sanctions, 
concluded that Schwartz's actions warranted an indefinite 
suspension of his license to practice medicine.  In issuing the 
sanction, the board also provided that any petition to stay the 
suspension would be conditioned on Schwartz's completion of (1) 
a new evaluation by Physician Health Services and following any 
recommendations resulting from the evaluation; (2) a board-
approved course in anger management; and (3) a board-approved 
course in conflict management. 
 
 
Schwartz thereafter filed a petition for judicial review in 
the county court pursuant to G. L. c. 112, § 64, and a single 
justice of this court affirmed the board's decision.  Schwartz 
appeals. 
 
 
Relevant factual background.  The magistrate's 
recommendation that Schwartz be subject to discipline stems, 
principally, from incidents that occurred on two different 
dates, while Schwartz was employed as an internist at Arbour-HRI 
Hospital (Arbour), a psychiatric hospital in Brookline.  On 
February 28, 2013, at the end of a daily meeting, at which 
Arbour's senior management met to review and discuss admissions, 
discharges, clinical issues, and other matters, Schwartz, who 
did not regularly attend the daily meetings, knocked and entered 
the meeting room.  He was specifically concerned about access to 
certain patient records while the hospital's computerized 
medical records system was offline for maintenance.  He was 
upset, agitated, and loud.  A nurse executive, Michelle 
McIntosh, led him away from the meeting room, which was located 
in the executive suite at the hospital, to take him to meet with 
Arbour's chief financial officer, James Rollins.  Rollins had 
not been at the meeting.  While McIntosh and Schwartz were 
looking for Rollins, Schwartz called McIntosh a "bitch" while 
they were in a hallway outside the executive suite.  After 
McIntosh and Schwartz found Rollins, McIntosh told him what had 
happened at the meeting.  Cheryl Grau, a social worker and the 
clinical services director at Arbour, was also present for part 
of the meeting with Rollins, but she left after Schwartz told 
 
1 The magistrate issued the recommended decision in December 
2020, more than four years after the 2016 hearing. 
 
3 
her that she was "corporate now" and that he could "buy and sell 
[her] a billion times." 
 
 
On the other date relevant to the magistrate's decision, 
May 30, 2013, two different incidents occurred involving 
Schwartz and various coworkers.  While Schwartz was finishing 
assessment notes on a patient in a treatment room, which also 
served as his office, a nurse asked him if Allison Ippolito, a 
social worker, and Jen Moran, a mental health worker, could use 
the room to examine a new patient.  Schwartz responded "no" 
without explanation.  Ippolito and Moran examined the patient in 
a bathroom instead.2  When they returned with the patient to the 
treatment room, Schwartz and Dr. Krishnaswamy Gajaraj were 
outside the room arguing loudly, apparently about the necessity 
of medication for a particular patient.  When Ippolito and Moran 
told the doctors that there was a patient in the treatment room 
who could hear them, Schwartz responded, "I don't care." 
 
On the following day, Schwartz met with Patrick Moallemian, 
then Arbour's chief executive officer, to discuss the previous 
day's incidents.  Schwartz admitted that he had been disruptive, 
and he apologized to at least some of the staff who had been 
present at the time.  Moallemian gave Schwartz a letter of 
suspension, which had been prepared in advance, summarily 
suspending Schwartz based on his behavior.  On the day that 
Schwartz's suspension ended, June 19, 2013, Schwartz resigned 
from Arbour. 
 
In her recommended decision, the magistrate also noted the 
following, among other things:  that Schwartz was good with 
patients; that some medical staff agreed with Schwartz's view 
about patient care at Arbour and appreciated his efforts to 
improve patient safety; that Schwartz and Moallemian had a tense 
relationship; that Schwartz had a positive relationship with, 
and was respected by, two of Arbour's former medical directors; 
and that following an incident in September 2013, Moallemian was 
dismissed from Arbour and that McIntosh was asked to resign. 
 
Additionally, of note, this was not Schwartz's first 
violation of the disruptive physician behavior policy.  In 2012, 
he entered into a consent order with the board in which he 
admitted to violating the policy and pursuant to which the board 
issued a reprimand against him. 
 
2 Although this was not the first time a patient had been 
examined in the bathroom rather than in a treatment room, it was 
technically against hospital policy. 
 
4 
 
Discussion.  "Under G. L. c. 112, § 64, a person whose 
license to practice medicine has been [suspended, revoked, or 
canceled] may petition the court to 'enter a decree revising or 
reversing the decision . . . in accordance with the standards 
for review provided' in G. L. c. 30A, § 14 (7)."  Clark v. Board 
of Registration of Social Workers, 464 Mass. 1008, 1009 (2013), 
quoting Weinberg v. Board of Registration in Med., 443 Mass. 
679, 685 (2005).  "The court may modify or set aside the board's 
final decision only if the petitioner demonstrates that the 
decision was legally erroneous, procedurally defective, 
unsupported by substantial evidence, arbitrary or capricious, or 
contained one or more of three other enumerated defects not at 
issue here."  Weinberg, supra, citing Fisch v. Board of 
Registration in Med., 437 Mass. 128, 131 (2002).  "This court 
reviews the Massachusetts board's decision directly, even though 
the appeal is from a decision of a single justice" (quotation 
and citation omitted).  Knight v. Board of Registration in Med., 
487 Mass. 1019, 1022 (2021), and cases cited. 
 
Schwartz's arguments can be loosely grouped into four 
categories:  (1) that the board did not have the authority to 
issue a statement of allegations against him, and that DALA, in 
turn, did not have jurisdiction to consider those allegations; 
(2) that the magistrate improperly considered certain evidence 
at the hearing, and that the evidence was insufficient to 
support her recommended decision; (3) that he is entitled to a 
jury trial on the issue of the indefinite suspension of his 
license to practice medicine; and (4) that the board's decision 
to indefinitely suspend was legally erroneous or arbitrary and 
capricious.  We address each of these in turn. 
 
1.  Authority and jurisdiction of the board and DALA. In 
its statement of allegations against him, the board alleged that 
Schwartz had violated the board's disruptive physician behavior 
policy, the relevant portions of which are set forth in the 
margin.3  In Schwartz's view, the board did not have the 
 
3 Board of Registration in Medicine Policy No. 01-01 
provides in relevant part: 
 
"The American Medical Association (AMA) has defined 
disruptive behavior as a style of interaction with 
physicians, hospital personnel, patients, family members, 
or others that interferes with patient care.  The recent 
Institute of Medicine study concluded that health care 
systems must promote teamwork, the free exchange of ideas, 
 
5 
authority to issue an allegation against him because the board 
did not establish both that his behavior was disruptive and that 
the behavior had an impact on patient care, which Schwartz 
argues is required by the policy.  The policy, however, does not 
provide the sole basis upon which the board sought to discipline 
him.  As the board noted in its statement of allegations, it 
may, pursuant to its regulations, discipline a physician upon 
proof that the physician has committed "[m]isconduct in the 
practice of medicine."  243 Code Mass. Regs. § 1.03(5)(a)(18) 
(2012).  In other words, Schwartz need not necessarily have 
violated the disruptive physician behavior policy to be subject 
to discipline. 
 
That said, we do not agree with Schwartz that his behavior 
did not have an impact on patient care.4  When a patient 
overhears doctors arguing with each other, and hears a doctor 
state that he does not care that patients can hear the argument, 
there is an impact on patient care.  Furthermore, even if much 
of Schwartz's disruptive behavior occurred outside of patients' 
hearing, that behavior clearly affected Schwartz's relationship 
with his colleagues, and it is not hard to imagine that this, in 
turn, can have an impact on patient care.  There is, in short, 
no basis for Schwartz's argument that the board had no authority 
to issue the statement of allegations against him.  Schwartz's 
argument that DALA lacked authority, or jurisdiction, is equally 
 
and a collaborative approach to problem solving if medical 
errors are to be reduced.  Disruptive behavior by a 
physician has a deleterious effect upon the health care 
system and increases the risk of patient harm.   
 
"The Board strongly urges physicians to fulfill their 
obligations to maximize the safety of patient care by 
behaving in a manner that promotes both professional 
practice and a work environment that ensures high standards 
of care.  Behavior by a physician that is disruptive, and 
compromises the quality of medical care or patient safety, 
could be grounds for Board discipline. . . . 
 
"Behaviors such as foul language; rude, loud or offensive 
comments; and intimidation of staff, patients and family 
members are now recognized as detrimental to patient care."  
(Footnotes omitted.) 
 
4 There is no question that Schwartz's behavior was 
disruptive, and he himself does not genuinely argue otherwise. 
 
6 
unavailing, stemming, as it does, from his argument regarding 
the board's purported lack of authority. 
 
2.  Magistrate's consideration of the evidence.  Schwartz 
next raises a number of arguments related to the evidence 
presented at the DALA hearing, ranging from the magistrate's 
consideration of the evidence to the sufficiency of that 
evidence.  He argues, for example, that the magistrate ignored 
certain testimony; that she improperly relied on unsworn 
testimony; and that she improperly relied on certain character 
evidence.  To the contrary, the magistrate's recommended 
decision, which was adopted by the board, indicates careful and 
thoughtful consideration of the evidence.  She specifically 
indicated which witnesses she found credible and reliable, and 
how those determinations affected her consideration of 
conflicting testimony.  She also noted that she gave little or 
no weight to written statements from individuals who did not 
testify. 
 
As to the latter point, Schwartz argues that the magistrate 
did, in fact, rely on a statement from an individual who did not 
testify, Ippolito.  Furthermore, according to Schwartz, 
Ippolito's statement was the only evidence that a patient heard 
Schwartz and Gajaraj arguing outside a treatment room.  That is 
incorrect.  Among the exhibits admitted in evidence at the DALA 
hearing was an e-mail message from Schwartz to Moallemian, dated 
May 31, 2013, in which Schwartz admitted that he had been 
disruptive, that he was sorry that a patient had become upset by 
their behavior, and that he had apologized to the staff. 
 
Schwartz also argues that individual members of the board 
defied State law or ignored certain unethical conduct on the 
part of the attorney representing the board in the proceedings 
against Schwartz.  The arguments, at least some of which are 
being raised here for the first time, do not amount to adequate 
appellate argument.  See Mass. R. A. P. 16 (a) (9), as appearing 
in 481 Mass. 1628 (2019).  Schwartz's argument that he was 
prejudiced by the approximately four-year delay between the DALA 
hearing and the magistrate's recommended decision suffers from 
the same problem –- that is, it does not amount to adequate 
appellate argument.  We note as well that, during that period, 
Schwartz had not yet been subject to any discipline and his 
license to practice medicine, therefore, had not yet been 
suspended. 
 
3.  Jury trial.  We next consider Schwartz's argument that 
the indefinite suspension of his license without a jury trial 
 
7 
"offends" the Massachusetts Declaration of Rights.  There is no 
merit to this argument.  To the extent that Schwartz suggests 
that his license to practice medicine is a property right, he is 
correct, but that alone does not entitle him to a jury trial.  
See Matter of Gargano, 460 Mass. 1022, 1025 (2011), cert. 
denied, 566 U.S. 921 (2012) (no right to jury trial in matter 
involving suspension of license to practice law), and cases 
cited. 
 
4.  Sanction.  Finally, we turn to the issue of the 
sanction –- the indefinite suspension of Schwartz's license to 
practice medicine.  As noted above, although we review the 
board's decision directly, we will only modify or set aside the 
decision if Schwartz demonstrates that the decision was "legally 
erroneous, procedurally defective, unsupported by substantial 
evidence, arbitrary or capricious."  Weinberg, 443 Mass. at 685.  
Schwartz does not specifically contest the sanction.  His 
dissatisfaction, at least so far as set forth in this court, 
lies largely with the DALA and board proceedings, but he says 
little about the sanction itself.  We have nevertheless reviewed 
the record and agree with the single justice that it supports 
the board's conclusions that Schwartz engaged in misconduct in 
the practice of medicine and violated the board's disruptive 
physician behavior policy and 243 Code Mass. Regs. 
§ 1.03(5)(a)(18). 
 
In reaching its decision, the board noted that it has 
imposed sanctions ranging from admonishment to license 
suspension for disruptive conduct and that a reprimand was the 
sanction most often imposed.  Indeed, that is the sanction that 
the board imposed the first time that it found that Schwartz 
violated the disruptive physician behavior policy, in 2012.  As 
the board also noted, in imposing sanctions it considers, among 
other things, patterns in a physician's misconduct.  Where the 
board had already previously reprimanded Schwartz, a harsher 
sanction, in the circumstances, is neither legally erroneous nor 
arbitrary and capricious. 
 
Conclusion.  The board's decision, which adopted the 
magistrate's recommended decision, was supported by the 
evidence, and Schwartz has not demonstrated that the decision 
was legally erroneous, procedurally defective, or arbitrary or 
capricious.  We therefore affirm the judgment of the single 
justice. 
 
 
 
 
 
 
 
 
So ordered. 
 
 
8 
 
 
The case was submitted on briefs. 
 
Sheldon Schwartz, pro se. 
 
Timothy R. McGuire, Assistant Attorney General, for the 
respondent.