Case Title: Knight v. Board of Registration in Medicine

Citation: 

Docket Number: SJC-12994

State: massachusetts

Court: Massachusetts Supreme Court

Date: 2021-05-19T00:00:00Z

Document:
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SJC-12994 
 
JOSEPH KNIGHT  vs.  BOARD OF REGISTRATION IN MEDICINE. 
 
 
May 19, 2021. 
 
 
Board of Registration in Medicine.  Doctor, License to practice 
medicine.  Administrative Law, Decision. 
 
 
The petitioner, Joseph Knight, appeals from a judgment of a 
single justice of this court affirming a decision and order of 
the Board of Registration in Medicine (board or Massachusetts 
board) that revoked Knight's inchoate right to renew his medical 
license.  We affirm. 
 
Procedural background.  In March 2016, the board issued a 
statement of allegations and order to show cause why the board 
should not impose discipline on Knight, alleging that (1) Knight 
fraudulently procured his Massachusetts license and renewals of 
that license by concealing the existence of investigations 
against him by the Oklahoma Board of Medical Licensure and 
Supervision (Oklahoma board) and the United States Drug 
Enforcement Administration (DEA), as well as personal medical 
conditions that interfered with his ability to practice 
medicine; (2) Knight was subject to reciprocal discipline in 
Massachusetts based on the Oklahoma board's March 6, 2014, order 
accepting Knight's "Voluntary Submittal to Jurisdiction"; 
(3) Knight practiced medicine in Massachusetts while impaired; 
(4) Knight failed timely to report to the board the complaint 
filed against him by the Oklahoma board, the suspension (and 
subsequent surrender) of his DEA registration, and the summary 
suspension of his license to practice medicine in Illinois; and 
(5) Knight failed to comply with Massachusetts tax laws.  The 
board also stated that discipline could be based on proof that 
Knight "lacks good moral character and has engaged in conduct 
2 
 
 
 
that undermines public confidence in the integrity of the 
medical profession." 
 
The board referred the matter to the Division of 
Administrative Law Appeals for further proceedings.  The board 
filed a motion for a summary decision based on documentary 
evidence.  Acting pro se, Knight submitted a number of documents 
in response to the board's motion and requested that the board 
decide the matter without requiring him to appear in person in 
Massachusetts.1 
 
The magistrate construed Knight's submissions as an 
opposition to the board's motion for a summary decision and 
issued a recommended decision dated May 8, 2019, concluding that 
the board had "met its burden of proving by a preponderance of 
the evidence that [Knight] fraudulently procured a certification 
of registration and its renewal, is subject to reciprocal 
discipline, practiced while impaired, failed to report 
discipline against him and the surrender of his DEA 
registration, and failed to comply with Massachusetts tax laws." 
 
Knight (now acting through counsel) objected to the 
magistrate's recommended decision.  In its final decision and 
order, the board rejected Knight's objections and adopted the 
recommended decision of the magistrate, but it "correct[ed]" the 
magistrate's decision by striking the statement that Knight 
"failed to comply with Massachusetts tax laws." 
 
In a section of its decision entitled "Sanction," the board 
discussed each of Knight's violations as a basis for discipline:  
reciprocal discipline, see 243 Code Mass. Regs. § 1.03(5)(a)(12) 
(2012); "[m]isconduct in the practice," see 243 Code Mass. Regs. 
§ 1.03(5)(a)(18) (2012); fraudulent procurement or renewal of 
medical license, see 243 Code Mass. Regs. § 1.03(5)(a)(1) 
(2012); practicing medicine while impaired, see 243 Code Mass. 
Regs. § 1.03(5)(a)(4) (2012); violation of any rule or 
regulation of the board, see 243 Code Mass. Regs. 
§ 1.03(5)(a)(11) (2012), specifically, the failure timely to 
report changes in registration information pursuant to 243 Code 
Mass. Regs. §§ 2.04(12)(b)2 and 2.07(8) (2012); and lack of good 
 
 
1 By that time, Knight had relocated from Massachusetts to 
Arizona. 
 
 
2 Subsequent to the board's decision, § 2.04(12)(b) was 
renumbered as § 2.04(14)(b).  See 243 Code Mass. Regs. 
§ 2.04(14)(b) (2019). 
3 
 
 
 
moral character, see Levy v. Board of Registration & Discipline 
in Med., 378 Mass. 519, 520 n.2, 528 (1979).  "Taking into 
consideration all of the above," the board revoked Knight's 
inchoate right to renew his medical license. 
 
Knight 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.  Knight now appeals. 
 
Summary of relevant facts.  The following facts are drawn 
from the magistrate's recommended decision, as adopted by the 
board and supplemented by undisputed facts from the record. 
 
Over the course of his decades-long career as a physician, 
Knight has been licensed to practice medicine in multiple 
jurisdictions in the United States and abroad.  In April 2009, 
Knight, who was then licensed to practice in Oklahoma, came to 
the attention of the Oklahoma board when a pharmacist complained 
that Knight "prescribes large amounts of controlled dangerous 
substances to out-of-town patients."  The pharmacist also stated 
that Knight appeared to be "under the influence of controlled 
substances" when he came to the pharmacy to fill a controlled 
substance prescription that he had written for his wife. 
 
In September 2009, after receiving an additional complaint 
about Knight's prescription practices, the Oklahoma board issued 
a "Letter of Concern," identifying several issues regarding 
Knight's pain management practice.  During that time, Knight 
also came under investigation by the DEA regarding his 
prescribing methods with regard to controlled substances. 
 
In August of 2011, while the investigations by the Oklahoma 
board and the DEA were ongoing, Knight accepted a position at 
the Harvard Street Neighborhood Health Center (health center) in 
the Dorchester section of Boston.  Knight submitted his full 
license application to the Massachusetts board on November 28, 
2011.  In response to a question regarding whether he had 
knowledge "of any pending investigation into [his] professional 
competence or conduct by any governmental authority," Knight 
answered "no."  Knight resubmitted certain forms on December 12, 
2011, to clarify an answer on an unrelated issue, again denying 
knowledge of any pending investigation.  On that basis, the 
board then granted Knight an initial license to practice 
medicine in Massachusetts on March 7, 2012. 
 
In or around July 2012, Knight began work at the health 
center in Dorchester.  On August 28, 2012, he applied to the 
4 
 
 
 
board to renew his medical license, again answering "no" to the 
question whether he had "been the subject of an investigation by 
any governmental authority, including . . . any other state 
medical board." 
 
On September 5, 2012, Knight's colleagues at the health 
center observed that he was unwell.  As a result, Knight was 
removed from work with the assistance of a mental health team 
and taken by ambulance to Beth Israel Hospital for care.  Knight 
subsequently took a leave of absence from the health center.  
The health center informed Knight that, in order to return to 
work, he would need medical clearance from his physician.  
Knight submitted a letter of resignation to the health center on 
October 25, 2012, which disclosed that he suffered from certain 
medical issues, including kidney failure, stress, insomnia, and 
chronic headaches.  Knight subsequently relocated to Arizona. 
 
In December 2012, the Oklahoma board commenced disciplinary 
proceedings against Knight, alleging, among other things, that 
he had overprescribed "controlled dangerous drugs," and that 
nine of his patients had died of acute drug toxicity between 
2009 and 2011.  In January 2013, the DEA served Knight with an 
order to show cause as to why his DEA registration should not be 
revoked due to his excessive prescribing of controlled 
substances to patients who exhibited drug-seeking behavior.  The 
DEA also immediately suspended Knight's DEA registration after 
concluding that Knight posed "an imminent danger to the public 
health and safety."  Knight voluntarily surrendered his Federal 
controlled substances privileges in April 2013. 
 
In September 2013, Knight's Oklahoma license expired by its 
own terms; he did not seek to renew it.  In November 2013, 
Knight submitted a lengthy response to the Oklahoma board, 
refuting the allegations in the Oklahoma complaint.  In March of 
the following year, the Oklahoma board held a hearing to address 
the charges pending against Knight.  Following the hearing, the 
Oklahoma board entered an "Order Accepting Voluntary Submission 
to Jurisdiction," to which Knight agreed (Oklahoma order). 
 
The Oklahoma order reiterated the allegations against 
Knight.  It stated that Knight "recognize[d] his right to appear 
before the [Oklahoma board] for an evidentiary hearing on the 
allegations made against him" and "voluntarily waive[d] his 
right to a full hearing."  Knight agreed that, if at any time he 
elected to apply for reinstatement of his Oklahoma license, the 
allegations and charges against him "will be considered by the 
[Oklahoma board] at such time."  Knight further acknowledged 
5 
 
 
 
that "a hearing before the [Oklahoma board] could result in some 
sanction" against him.3 
 
Also in March 2014, the Oklahoma board reported the 
Oklahoma order to the National Practitioner Data Bank as an 
"adverse action" with respect to Knight's Oklahoma license.4  In 
April 2014, upon notice of the action of the Oklahoma board, the 
Massachusetts board moved to summarily suspend Knight's license.  
Later that month, the board ratified a voluntary agreement by 
Knight not to practice in Massachusetts. 
 
In July 2014, Knight applied for a second renewal of his 
Massachusetts license.  On this occasion, he acknowledged that 
he had been investigated by a governmental authority and that he 
had been the subject of a disciplinary action.  However, he 
elaborated on his answer by handwriting the words, "No 
discipline in Oklahoma."  He also answered affirmatively that 
his "privileges to possess, dispense or prescribe controlled 
substances have been suspended, revoked, denied, restricted by, 
or surrendered to any state or federal agency."  However, in 
response to another question, Knight denied that he had "taken a 
leave of absence" from practicing medicine.  Knight also denied 
having a "medical condition that interferes in any way or limits 
[his] ability to practice medicine." 
 
In March 2016, the board issued the statement of 
allegations against Knight that is at issue here, and the 
disciplinary proceedings unfolded as described supra. 
 
Discussion.  "Under G. L. c. 112, § 64, a person whose 
license to practice medicine has been revoked 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. 
 
3 In later correspondence with the Massachusetts board, 
Knight stated that he had "made it clear [to the Oklahoma board] 
that [he] had no intention of ever returning to Oklahoma or 
attempting to reactivate [his] Oklahoma medical license." 
 
4 The Oklahoma board originally characterized the "adverse 
action" it had taken against Knight as a "voluntary surrender of 
license."  Knight contested this characterization, and the 
Oklahoma board thereafter submitted a corrected report, which 
characterized the action as a "voluntary submittal to 
jurisdiction." 
6 
 
 
 
Board of Registration in Med., 443 Mass. 679, 685 (2005).  See 
Fisch v. Board of Registration in Med., 437 Mass. 128, 131 
(2002).  Under the latter statute, the court can modify or set 
aside the decision of the board only if the petitioner 
demonstrates that his or her "substantial rights . . . may have 
been prejudiced" because the agency decision is in violation of 
constitutional provisions, based on an error of law, unsupported 
by substantial evidence, arbitrary and capricious, or an abuse 
of discretion, or contains one or more other enumerated defects 
not at issue here.  G. L. c. 30A, § 14 (7).  See Clark, supra, 
citing Weinberg, supra; Fisch, supra.  This court "reviews the 
Massachusetts board's decision directly, even though the appeal 
is from a decision of a single justice."  Lankheim, v. Board of 
Registration in Nursing, 458 Mass. 1022, 1023 (2011), citing 
Weinberg, supra. 
 
Here, the petitioner raises three arguments in support of 
his contention that the Massachusetts board's decision was 
legally erroneous, arbitrary and capricious, and an abuse of 
discretion:  (1) the board's imposition of reciprocal discipline 
was legally erroneous because there was no "discipline" in 
Oklahoma on which reciprocal discipline could be based; (2) the 
board's imposition of reciprocal discipline violated due process 
because it was based on factual allegations that remain 
unlitigated and as to which the petitioner retains the right to 
be heard in Oklahoma; and (3) the board erred in imposing 
discipline for violations not contained in the board's statement 
of allegations. 
 
"Whether the terms of the [Oklahoma] consent order 
constitute discipline for Massachusetts reciprocal discipline 
purposes is a question of law."  Anusavice v. Board of 
Registration in Dentistry, 451 Mass. 786, 796 (2008).  Here, the 
parties vigorously dispute whether the Oklahoma order 
constitutes "discipline" as a matter of Massachusetts law.  The 
board maintains that the Oklahoma order was the functional 
equivalent of Knight voluntarily resigning his license in 
Oklahoma in lieu of facing the ongoing disciplinary process 
there; Knight, on the other hand, argues that the Oklahoma order 
was nothing more than a promise to return to Oklahoma and to 
submit to its jurisdiction on the disciplinary charge if he ever 
were to seek to reactivate his license there.  In any event, the 
board argues that we need not reach this issue because its 
decision is amply supported by other, independent grounds and 
Knight has therefore failed to demonstrate any substantial 
prejudice even if there were an error in the reciprocal 
discipline aspect of the board's decision. 
7 
 
 
 
 
Under the unique circumstances of the case, we take the 
latter course, concluding that we need not reach Knight's 
arguments regarding reciprocal discipline.  Knight makes much of 
the fact that the Oklahoma order, and the Oklahoma board's 
report of that order to the National Practitioner Data Bank, was 
the triggering event for the board's investigation in 
Massachusetts, suggesting that reciprocal discipline is "the 
scaffolding upon which the [b]oard's disciplinary action against 
[Knight] is based."  This argument misses the mark. 
 
The fact that the report led the Massachusetts board to 
investigate Knight and, subsequently, to uncover multiple, 
independent violations of its own regulations (which had been 
concealed by Knight up to that point) does not diminish the 
significance or the severity of those subsequently discovered 
violations.  Based on the serious nature of the undisputed 
violations shown here, there can be no doubt that the board was 
justified in reaching the result it did, with or without the 
imposition of reciprocal discipline.5  Knight has therefore 
failed to demonstrate prejudice arising from the board's 
treatment of that issue.  We reach this conclusion without 
needing to resolve whether the Oklahoma order constituted 
"discipline" for purposes of the Massachusetts board's 
imposition of reciprocal discipline.  See Anusavice, 451 Mass. 
at 796-798; Ramirez v. Board of Registration in Med., 441 Mass. 
479, 482-484 (2004). 
 
Knight also fails to demonstrate prejudice from the board's 
failure to specify in the statement of allegations that Knight 
was alleged to have violated 243 Code Mass. Regs. 
§ 1.03(5)(a)(11) ("[v]iolation of any rule or regulation of the 
[b]oard") due to his failure to comply with his duty to update 
his registration information.  The statement of allegations 
adequately identified Knight's failure to disclose the 
investigations by the Oklahoma board and the DEA to the 
 
 
5 We are also unpersuaded by Knight's comparison of this 
case to Schware v. Board of Bar Examiners of N.M., 353 U.S. 232 
(1957).  There, the New Mexico Board of Bar Examiners conceded 
that the three factors underlying its decision to exclude the 
petitioner from the New Mexico bar "would not justify exclusion 
. . . if each stood alone."  Id. at 246.  The Massachusetts 
board has made no similar concession here.  There may be 
circumstances in which an unsustainable finding by the board on 
one issue renders the entire result questionable, but this is 
not such a case. 
8 
 
 
 
Massachusetts board in his full license application and renewal 
applications as a basis for discipline, and the board's 
memorandum in support of its motion for summary decision 
specifically set forth its theory that Knight's failure to 
update his registration information with respect to these items 
could subject him to discipline under 243 Code Mass. Regs. 
§ 1.03(5)(a)(11).  In these circumstances, Knight cannot 
demonstrate prejudice from the board's failure to cite the 
particular regulation in its statement of allegations, where he 
had actual notice from the statement of the substantive 
misconduct he was alleged to have committed and an opportunity 
to respond. 
 
The board's final decision and order was amply supported by 
the record evidence, and Knight has failed to demonstrate 
prejudice from any alleged legal or procedural defect.  We 
therefore affirm the judgment of the single justice. 
 
 
 
 
 
 
 
 
So ordered. 
 
 
 
The case was submitted on briefs. 
 
Kenneth R. Kohlberg & Andrew L. Hyams for the petitioner. 
 
Cassandra Bolaños, Assistant Attorney General, for the 
respondent.