Case Title: Doane v. Department of Health & Human Services

Citation: 

Docket Number: 2021 ME 28

State: maine

Court: Maine Supreme Court

Date: 2021-05-13T00:00:00Z

Document:
MAINE SUPREME JUDICIAL COURT 
Reporter of Decisions 
Decision: 
2021 ME 28 
Docket: 
Ken-20-163 
Argued: 
February 9, 2021 
Decided: 
May 13, 2021 
 
Panel: 
MEAD, GORMAN, JABAR, HUMPHREY, HORTON, and CONNORS, JJ. 
 
 
STEPHEN DOANE 
 
v. 
 
DEPARTMENT OF HEALTH AND HUMAN SERVICES 
 
 
CONNORS, J. 
[¶1]  Stephen Doane, MD, appeals from a judgment of the Superior Court 
(Kennebec County, Murphy, J.) affirming, pursuant to M.R. Civ. P. 80C and 
5 M.R.S. § 11007(4)(A) (2021), a decision by the Department of Health and 
Human Services excluding him from participation in and reimbursement from 
Maine’s Medicaid program, MaineCare.  We affirm the decision of the Superior 
Court. 
I.  BACKGROUND 
 
[¶2]  The following facts are drawn from the Department’s final decision, 
which adopted the findings of fact made by the presiding hearing officer in his 
recommended decision, and the procedural facts are taken from the court’s 
 
 
2 
record.  See Palian v. Dep’t of Health and Hum. Servs., 2020 ME 131, ¶ 3, 
242 A.3d 164. 
A. 
The Board’s 2015 Censure Decision and 2012 Consent Agreement 
 
[¶3]  On March 10, 2015, Dr. Doane was censured by the Board of 
Licensure in Medicine based on his prescription practices leading up to the 
death, by apparent overdose, of a patient in May 2012.1 
 
[¶4]  Although the Board voted to allow Dr. Doane to retain his medical 
license, it imposed serious restrictions on his ability to practice medicine.  He 
was required to have a “practice monitor” review all of the cases in which he 
prescribed controlled substances and report to the Board every four months. 
[¶5]  These restrictions were in addition to previous restrictions imposed 
by a 2012 consent agreement following the death of a different patient who, in 
2011, had also died of an apparent drug overdose.  In entering that consent 
agreement, Dr. Doane conceded that the conduct at issue, “if proven, could 
                                         
1  By unanimous vote, the Board found that Dr. Doane had failed to conduct all required aspects 
for evaluation of the patient; failed to create a written treatment plan; failed to discuss with the 
patient the risks and benefits of the use of controlled substances; failed to implement a written 
agreement outlining patient responsibilities, including urine/medication serum level screening, pill 
counts, the number and frequency of all prescription refills, and the reasons for which drug therapy 
would be discontinued; and failed to keep accurate and complete medical records.  The Board 
unanimously found that Dr. Doane demonstrated incompetence in his treatment of the patient and, 
by a five-to-one vote, found that he had committed unprofessional conduct by failing to appropriately 
follow up on and respond to information obtained from other doctors and reporters, as well as from 
events that occurred in his own office, regarding his patient’s overdose on the medications that he 
had prescribed. 
 
 
3 
constitute grounds for discipline and the denial of his application to renew his 
Maine medical license for unprofessional conduct pursuant to 32 M.R.S. 
§ 3282-A(2)(F).”2  Pursuant to the consent agreement, among other things, he 
could “no longer prescribe controlled medications for pain, including all opioids 
and benzodiazepines, except for patients in skilled nursing facilities or 
long-term care facilities, patients in hospice care, or patients with metastatic 
cancer.” 
B. 
The Department’s 2015 Decision to Terminate Dr. Doane’s Participation 
in MaineCare 
 
[¶6]  In a letter dated April 9, 2015, approximately one month after 
Dr. Doane’s censure and the imposition of additional restrictions by the Board, 
the Department notified him that it was terminating his participation in medical 
assistance programs, most significantly for this appeal, MaineCare.3  The 
                                         
2  The consent agreement recited that the Board had sufficient evidence from which it could 
conclude that Dr. Doane failed to adhere to the Board’s rules on the use of controlled substances for 
treatment of pain by “failing to obtain patient A’s previous medical records prior to prescribing 
controlled medications to patient A; failing to access and review the [prescription monitoring 
program] prior to prescribing the amount and dosage of controlled medications to patient A; failing 
to recall the telephone message regarding patient A and her recent hospitalization and accompanying 
respiratory distress prior to prescribing medications to patient A; and increasing the dosage 
(doubling), frequency, and total amount (doubling) of narcotics prescribed to patient A only four days 
after initially prescribing fifteen days’ worth of narcotics to patient A, which was done without 
obtaining patient A’s previous medical records or reviewing the [prescription monitoring program].” 
3  Because the basis for termination was grounded in state and federal Medicaid and MaineCare 
regulations, and no other program has been identified by the parties on appeal, we do not discuss 
further any other medical assistance programs. 
 
 
4 
Department stated that it took this action pursuant to the MaineCare Benefits 
Manual, 10-144 C.M.R. ch. 101, ch. I, §§ 1.03-6, 1.19-1, 1.19-3 (effective 
January 1, 2014),4 and the “authority granted [to it] in the Code of Federal 
Regulations.”  The Department relied specifically on section 1.19-1(M), (O), 
and (R) of the Manual, which provides for sanctions based on the violation of 
any law, regulation, or code of ethics governing the conduct of occupations or 
professions of regulated industries; failure to meet standards required by state 
or federal law for participation; and formal reprimand or censure by an 
association of the provider’s peers for unethical practices.  See id. § 1.19-1(M), 
(O), (R).5 
 
[¶7]  Dr. Doane requested an informal review of the termination decision, 
which is the first step of the multi-tiered framework for an administrative 
appeal under the Manual.  See id. § 1.21;6 Palian, 2020 ME 131, ¶ 5, 
242 A.3d 164.  The Department affirmed its decision by a letter dated 
September 11, 2015. 
                                         
4  The locations of various MaineCare Benefits Manual sections have changed during the time 
relevant to this appeal, but no such changes impact this appeal.  The parties do not contend that any 
changes in the Manual affect our analysis.  The relevant sections are currently located at 10-144 
C.M.R. ch. 101, ch. I, §§ 1.03-10, 1.20-1, 1.20-3 (effective Sept. 17, 2018). 
5  Currently located at 10-144 C.M.R. ch. 101, ch. I, § 1.20-1(M), (O), (R) (effective Sept. 17, 2018). 
6  Currently located at 10-144 C.M.R. ch. 101, ch. I, § 1.23 (effective Sept. 17, 2018). 
 
 
5 
C. 
Doane I 
 
[¶8]  On September 23, 2015, Dr. Doane filed a complaint in the Superior 
Court seeking a declaratory judgment that the Department lacked jurisdiction 
to terminate his MaineCare participation and contending that the District 
Court—not the Department—had exclusive jurisdiction over licensing 
decisions pursuant to 4 M.R.S. § 152(9) (2021) and M.R. Civ. P. 80G.  The 
Superior Court agreed with Dr. Doane that the Department lacked jurisdiction, 
and the Department’s administrative proceedings were stayed pending the 
resolution of the Department’s appeal of the Superior Court’s decision.  Doane 
v. Dep’t of Health & Hum. Servs., No. CV-15-168, 2016 Me. Super. LEXIS 125, at *3 
(June 30, 2016). 
[¶9]  On appeal, we ruled that the Department had jurisdiction.  See Doane 
v. Dep’t of Health & Hum. Servs., 2017 ME 193, ¶¶ 31-32, 170 A.3d 269 (Doane I).  
In so concluding, we noted “the functional distinctions between a [Board] 
license revocation and a [Department] termination of participation in a 
program through a provider agreement.”  Id. ¶ 29. 
D. 
Further Administrative and Judicial Review of the Department’s Decision 
 
[¶10]  With the administrative process revived after the issuance of 
Doane I, in 2018, the presiding officer for the Department issued his 
 
 
6 
recommendation following an evidentiary hearing that had been held in 2016 
prior to the stay.  In his findings of fact, the presiding officer acknowledged the 
Board’s previous findings of serious professional deficiencies but nevertheless 
recommended reversal of the Department’s decision to terminate Dr. Doane’s 
participation in MaineCare. 
[¶11]  The acting Commissioner disagreed with the presiding officer’s 
recommendation.  In a decision dated October 10, 2018, the acting 
Commissioner stated: 
I hereby adopt the findings of fact but I do NOT accept the 
Recommendation of the Hearing Officer.  Instead, for the reasons 
set forth below, I find that the Department was correct when it 
terminated Stephen Doane, M.D., from participation in the 
MaineCare program. 
 
Pursuant to the MaineCare Benefits Manual, Chapter I, 
section 1.19-2(A), the Department has independent authority to 
exclude a provider from participation in the MaineCare program 
based 
on 
its 
consideration 
of 
factors 
set 
forth 
in 
section 1.19-3(A)(1).  This authority arises out of the Department’s 
administration of the MaineCare program which provides 
reimbursement for medical services provided to vulnerable 
low-income, disabled, and high-risk populations.  The Department 
properly exercised its authority to exclude Dr. Doane from 
participation in the MaineCare population by basing the exclusion 
on the undisputed serious and multiple incidents of professional 
incompetence by Dr. Doane over an extended period of time as set 
forth in [the Board’s censure decision and preceding consent 
agreement]. 
 
 
7 
 
[¶12]  On November 9, 2018, Dr. Doane filed a Rule 80C petition in the 
Superior Court.  The court affirmed the Department’s decision, and Dr. Doane 
timely appealed.  See 5 M.R.S. § 11008 (2021); M.R. App. P. 2B(c). 
II.  DISCUSSION 
[¶13]  Dr. Doane argues the following: (1) the Legislature did not 
articulate sufficient guidance when it delegated authority to the Department to 
regulate MaineCare pursuant to 22 M.R.S. § 42 (2021) and 22 M.R.S. § 3173 
(2021); (2) the Department’s decision to exclude him is precluded by the 
Board’s decision not to withdraw or suspend his license; (3) there was 
insufficient evidence to support the Department’s final decision; and (4) the 
acting Commissioner provided insufficient reasoning for her decision. 
[¶14]  We disagree. 
A. 
Standard of Review 
 
[¶15]  “When the Superior Court acts in an intermediate appellate 
capacity pursuant to M.R. Civ. P. 80C, we review the administrative agency’s 
decision directly for errors of law, abuse of discretion, or findings not 
supported by substantial evidence in the record.”  Manirakiza v. Dep’t of Health 
& Hum. Servs., 2018 ME 10, ¶ 7, 177 A.3d 1264 (quotation marks omitted).  “We 
review questions of law de novo,” Palian, 2020 ME 131, ¶ 10, 242 A.3d 164, but 
 
 
8 
we will not substitute our judgment for that of the Department, AngleZ Behav. 
Health Servs. v. Dep’t of Health & Hum. Servs., 2020 ME 26, ¶ 12, 226 A.3d 762. 
B. 
Vagueness and Excessive Delegation 
[¶16]  Dr. Doane first argues that the statutes authorizing the 
Department’s action are insufficiently specific.  This argument invokes two 
constitutional doctrines—that a statute is void if it is too vague or if it delegates 
too much authority to the administering body.  While these concepts overlap, 
see Uliano v. Bd. of Env’t Prot., 2009 ME 89, ¶ 15, 977 A.2d 400, they have 
different sources of authority and emphases. 
[¶17]  A goal of both doctrines is to avoid arbitrary decision-making.  See 
Lentine v. Town of St. George, 599 A.2d 76, 78 (Me. 1991); Superintending Sch. 
Comm. v. Bangor Educ. Ass’n., 433 A.2d 383, 387 (Me. 1981).  A “void for 
vagueness” claim is based on the due process protections set forth in the United 
States and Maine Constitutions and focuses on the need for adequate notice.  
See Town of Baldwin v. Carter, 2002 ME 52, ¶ 10, 794 A.2d 62 (“[T]hose subject 
to sanction by law [must] be given fair notice of the standard of conduct to 
which they can be held accountable.” (quotation marks omitted)).  An 
“excessive delegation” claim is based on the separation of powers clause of the 
Maine Constitution, which precludes a statutory delegation to a regulator so 
 
 
9 
broad or amorphous that it amounts to a surrender of legislative authority to 
the executive branch.  See Me. Const. art. III § 2; Lewis v. Dep’t of Hum. Servs., 
433 A.2d 743, 747 (Me. 1981) (“We have consistently endorsed the 
fundamental 
constitutional 
requirement 
that 
legislation 
delegating 
discretionary authority to administrative agencies must contain standards 
sufficient to guide administrative action.”). 
[¶18]  Here, Dr. Doane does not complain that he lacked notice as to the 
type of conduct that would expose him to sanctions, including termination from 
participation in MaineCare.  The Department regulations and Manual are clear.  
Rather, he argues that the authorizing statutes are too broad, so that the 
Department improperly acted in a legislative capacity when it issued its 
regulations.  We therefore analyze his claim as asserting excessive delegation. 
[¶19]  Dr. Doane is correct in noting that the language contained in the 
authorizing statutes is broad.  Title 22 M.R.S. § 42(1) provides: 
The department shall issue rules and regulations considered 
necessary and proper for the protection of life, health and welfare, 
and the successful operation of the health and welfare laws.  The 
rules and regulations shall be adopted pursuant to the 
requirements of the Maine Administrative Procedure Act. 
Title 22 M.R.S. § 3173 provides, in relevant part: 
 
The department is authorized to administer programs of aid, 
medical or remedial care and services for medically indigent 
 
 
10 
persons[,] [and] . . . [t]he department is authorized and empowered 
to make all necessary rules and regulations consistent with the 
laws of the State for the administration of these programs 
including, but not limited to, establishing conditions of eligibility 
and types and amounts of aid to be provided, and defining the term 
“medically indigent,” and the type of medical care to be provided. 
[¶20]  At first blush, these statutes seem to provide few limits on the 
Department’s ability to enact whatever regulations it might choose, triggering 
excessive-delegation concerns.  But a more in-depth review shows that 
sufficient limitations and safeguards are in place for the statutory framework 
to pass constitutional muster. 
[¶21]  We start with the premise that when evaluating the 
constitutionality of a statute we “will, if possible, construe [it] to preserve its 
constitutionality.”  Friends of Me.’s Mountains. v. Bd. of Env’t Prot., 2013 ME 25, 
¶ 21, 61 A.3d 689 (quotation marks omitted). 
 
[¶22]  Greater flexibility is also allowed with respect to delegations of 
authority to state agencies by the acts of the Legislature than to delegations of 
authority to boards and committees by municipalities.  See Uliano, 2009 ME 89, 
¶ 26, 977 A.2d 400.  This is because the “state’s delegation of authority to an 
executive agency . . . is subject to the Maine Administrative Procedure Act [APA] 
and its procedural protections.”  Id.  In Uliano, we noted that because the 
Department of Environmental Protection is required to promulgate rules 
 
 
11 
complying with the APA that are “subject to public notice, modification, and 
judicial review,” these regulatory processes provided significant protection 
against abuse.  Id. ¶ 28; see also Bangor Educ. Ass’n, 433 A.2d at 387 (“Especially 
where it would not be feasible for the Legislature to supply precise standards, 
the presence of adequate procedural safeguards may be properly considered in 
resolving the constitutionality of the delegation of power.”); State v. Boynton, 
379 A.2d 994, 995 (Me. 1977) (“[T]he presence of adequate procedural 
safeguards to protect against an abuse of discretion by those to whom the 
power is delegated compensates substantially for the want of precise 
guidelines and may be properly considered in resolving the constitutionality of 
the delegation of power.”).  The possibility of arbitrary administrative 
decision-making common to both void-for-vagueness and excessive-delegation 
concerns is assuaged by the formal APA rulemaking process. 
 
[¶23]  Also, because the subject matter of the regulation at issue here 
concerns public health and safety, a wide amount of rulemaking latitude may 
be necessary.  See Kovack v. Licensing Bd., 157 Me. 411, 418, 173 A.2d 554, 558 
(1961) (“As compared to a delegation of authority to regulate businesses 
generally, the [L]egislature may be less restricted when it seeks to delegate 
authority of a legislative nature to an administrative body created for a 
 
 
12 
particular purpose, such as the care of public health.” (quotation marks 
omitted)).  This point is driven home by two decisions rejecting an 
excessive-delegation claim involving 22 M.R.S. § 42.  See Lewis, 433 A.2d 743; 
Ne. Occupational Exch., Inc. v. State, 540 A.2d 1115 (Me. 1988). 
 
[¶24]  In Lewis, the plaintiff contended that the absence of specific 
standards within the enabling legislation, section 42, made the Department’s 
adoption of the Maine State Plumbing Code an unconstitutional delegation of 
authority.  433 A.2d at 746.  In rejecting that argument, we considered the 
entire legislative scheme, noting “that the Department of Human Services is 
charged with the general responsibility of supervising the interests of health 
and life of the citizens of the State” and that “[s]uch responsibility quite 
obviously includes the prevention and control of disease and irresponsible 
human waste disposal.”  Id. at 746-47 (quotation marks omitted).  The 
delegation of authority to promulgate plumbing and sewage regulations was 
constitutional because it was contained within a general statutory scheme, was 
confined to a clearly defined area, and resulted in regulations that were limited 
to what was necessary and proper.  Id. at 747-48.  We concluded that a 
legislative delegation is not excessive when “the legislation clearly reveals the 
purpose to be served by the regulations, explicitly defines what can be 
 
 
13 
regulated for that purpose, and suggests the appropriate degree of regulation.”  
Id. at 748. 
 
[¶25]  In Northeast Occupational Exchange, we applied this three-part 
test from Lewis to decide whether the Community Mental Health Services Act, 
34-B M.R.S. §§ 3601-3606 (1988), was an unconstitutional delegation of 
authority.  540 A.2d at 1116-17.  We rejected the claim that the delegation was 
unconstitutional, reasoning that the clear purpose of the Act was “to encourage 
an increased availability of and participation in local community mental health 
services”; the Act clearly defined the services that could be regulated for that 
purpose; and, because the rules promulgated under the Act were subject to the 
APA, there was an appropriate degree of regulation to compensate for the lack 
of precise guidelines.  Id. 
[¶26]  In the instant case, the latitude that the Legislature has bestowed 
upon the Department is further informed by MaineCare’s role within the federal 
Medicaid framework.  As the Manual notes, “The Maine Department of Health 
and Human Services . . . is responsible for administering MaineCare in 
compliance with Federal and State statutes[] and administrative policies.”  
10-144 C.M.R. ch. 101, ch. I, § 1.02-1 (effective Sept. 17, 2018).  The federal 
government appropriates money to Maine to furnish medical, rehabilitation, 
 
 
14 
and other assistance “on behalf of families with dependent children and of aged, 
blind, or disabled individuals, whose income resources are insufficient to meet 
the costs of necessary medical services.”  42 U.S.C.S. § 1396-1 (LEXIS through 
Pub. L. No. 116-344).  Maine must adhere to federal requirements for the use of 
the appropriated funds.  See 42 U.S.C.S. § 1396a (LEXIS through Pub. L. No. 
116-344).  For instance, federal law requires Maine to “comply with provider 
and 
supplier 
screening, 
oversight, 
and 
reporting 
requirements,” 
id. § 1396a(a)(77), (kk), and to notify the Secretary of Health and Human 
Services and the state licensing board “whenever a provider of services or any 
other person is terminated, suspended, or otherwise sanctioned or prohibited 
from participating under the State plan,” id. § 1396a(a)(41).  As we noted in 
Doane I: 
 
Some providers, pursuant to the federal Medicaid 
regulations, must or may be excluded from the Medicaid program 
by the federal Office of Inspector General.  See 42 C.F.R. 
§§ 1001.101, 1001.201–1001.951 (2016).  The Inspector General’s 
office must exclude from participating in the Medicaid program 
providers who have been convicted of certain types of crimes, see 
id. § 1001.101, and may exclude from participation providers who 
have committed other misconduct, including providers who have 
had their state professional licenses revoked or suspended, see id. 
§§ 1001.201-1001.951.  The federal regulations are not to be 
“construed to limit a State’s own authority to exclude an individual 
or entity from Medicaid for any reason or period authorized by 
State law.”  42 C.F.R. § 1002.2(b) (2016) (redesignated as 42 C.F.R. 
§ 1002.3(b) by 82 Fed. Reg. 4100 § 36 (Jan. 12, 2017)). 
 
 
15 
2017 ME 193, ¶ 22, 170 A.3d 269 (emphasis in original).7 
[¶27]  In sum, while the amount of discretion the Legislature can bestow 
upon a state agency is not boundless, latitude must be given in areas where the 
statutory enactment of detailed specific standards is unworkable.  When the 
subject matter is public health, agency regulations are subject to APA review, 
and the scope of the regulatory authority is limited by context, purpose, and a 
comprehensive federal regulatory regime.  Department regulations that call 
for potential exclusion from a medical assistance program based on 
incompetence and failure to comport with professional standards should not 
surprise a physician-participant and fall squarely within the goals articulated 
by the Legislature in the authorizing statutes for the protection of life, health, 
and welfare; the successful operation of the health and welfare laws; and safe 
care for the medically indigent population.  See 22 M.R.S. § 42(1). 
                                         
7  By federal law, generally speaking, individuals eligible for medical assistance under Medicaid 
may choose any “qualified” provider.  42 U.S.C.S. § 1396a(a)(23) (LEXIS through Pub. L. No. 116-344).  
The definition of “qualified” is not included in the federal statute.  Federal regulations provide that 
states may set “reasonable standards relating to the qualifications of providers,” 42 C.F.R. 
§ 431.51(c)(2) (2019), and “qualified” is interpreted to mean capable of performing needed medical 
services in a professionally competent, safe, legal, and ethical manner, Planned Parenthood of Ind. Inc. 
v. Comm’r of the Ind. State Dep’t of Health, 699 F.3d 962, 978 (7th Cir. 2012).  Thus, states have 
“considerable discretion” in establishing qualifications based on professional competency and 
patient care.  Planned Parenthood of Kan. & Mid-Missouri v. Andersen, 882 F.3d 1205, 1230 (10th Cir. 
2018); see also Dube v. Dep’t of Health & Hum. Servs., 97 A.3d 241, 248 (N.H. 2014) (noting that states 
have “considerable authority” to establish qualifications). 
 
 
16 
C. 
Issue Preclusion 
 
[¶28]  Dr. Doane next contends that the Board made a factual 
determination that he was competent and met minimum professional 
standards; that the Department must accept this finding; and that the finding 
requires the Department to continue his participation in MaineCare.  This 
argument misapprehends the distinct roles played by the two agencies. 
 
[¶29]  We review de novo whether issue preclusion, also known as 
collateral estoppel, applies to the Board’s decision.  Portland Water Dist. v. Town 
of Standish, 2008 ME 23, ¶ 7, 940 A.2d 1097.  The doctrine “prevents the 
relitigation of factual issues already decided if the identical issue was 
determined by a prior final judgment, and the party estopped had a fair 
opportunity and incentive to litigate the issue in a prior proceeding.”  Id. ¶ 9 
(quotation marks omitted).  The doctrine can apply to administrative agencies.  
See Fitanides v. Perry, 537 A.2d 1139, 1140 (Me. 1988) (“Absent a specific 
contrary statutory provision, an adjudicative determination of a legal or factual 
issue by an administrative tribunal has the same effect of issue preclusion as a 
court judgment if the administrative proceeding resulting in that determination 
entailed the essential elements of adjudication.” (quotation marks omitted)).  
The Restatement (Second) of Judgments § 36 cmt. f (Am. L. Inst. 1982) notes, 
 
 
17 
however, that “a prior determination that is binding on one agency and its 
officials may not be binding on another agency and its officials . . . [i]f the second 
action involves an agency or official whose functions and responsibilities are so 
distinct from those of the agency or official in the first action that applying 
preclusion would interfere with the proper allocation of authority between [the 
two agencies].” 
 
[¶30]  Applying these principles here, we conclude that the Department 
and the Board serve distinct functions and that the issue decided by the Board 
was not identical to that before the Department. 
 
1. 
Distinct Functions 
[¶31]  We noted the differences between the functions of the Board and 
the Department in Doane I, 2017 ME 193, ¶ 29, 170 A.3d 269.  The Board is a 
licensing authority.  It is composed primarily of physicians, see 32 M.R.S. § 3263 
(2021), sets standards of practice for physicians, and investigates complaints, 
see 32 M.R.S. § 3269 (2021).  Its investigations of complaints can result in 
various restrictions on a physician’s license or in consent agreements, which 
are designed both to protect the general public and to rehabilitate or educate 
the licensee.  See 32 M.R.S. § 3282-A(1) (2021). 
 
 
18 
 
[¶32]  In contrast, the Department is a procurer of services.  It 
administers the Medicaid program, among other activities, and is “authorized 
to administer programs of aid, medical or remedial care and services for 
medically indigent persons.”  22 M.R.S. § 3173.  “To implement the MaineCare 
program, the Department contracts with health care providers, who bill the 
Department for MaineCare-covered services pursuant to the terms of those 
contracts, Department regulations, and federal law.”  AngleZ Behav. Health 
Servs., 2020 ME 26, ¶ 2, 226 A.3d 762; see 42 U.S.C.S. § 1396a (LEXIS through 
Pub. L. No. 116-344). 
 
[¶33]  As we held in Doane I, the Board’s licensing function is not the same 
as the Department’s procurement function.  2017 ME 193, ¶ 16, 170 A.3d 269.  
We noted that “the dispute [in Doane I] focuse[d] not on Doane’s medical license 
but on his capacity to participate in and receive compensation from Maine’s 
Medicaid program, MaineCare.”  Id.  The state exercises its police power to 
regulate the medical profession on behalf of the general public through the 
Board’s professional licensing.  Id. ¶ 29.  The Department’s decision-making 
relates only to those citizens receiving services through MaineCare, and in 
keeping with that goal, making the best use of state funds received from the 
federal government.  Id. ¶¶ 29-30. 
 
 
19 
 
2. 
Different Issues 
 
[¶34]  Dr. Doane next argues that in order to determine that he was fit to 
practice medicine, “the [Board] necessarily had to conclude that in 2015, he was 
a ‘competent and honest practitioner’ who satisfied the ‘minimum standards of 
proficiency in the [medical] profession.’”  To support this proposition, he cites 
10 M.R.S. § 8008 (2021), which provides: 
The sole purpose of an occupational and professional 
regulatory board is to protect the public health and welfare.  A 
board carries out this purpose by ensuring that the public is served 
by competent and honest practitioners and by establishing 
minimum standards of proficiency in the regulated professions by 
examining, licensing, regulating and disciplining practitioners of 
those regulated professions.  Other goals or objectives may not 
supersede this purpose. 
 
[¶35]  As a threshold matter, the Board’s censure decision includes no 
affirmative or express finding that Dr. Doane is fit to serve any population, let 
alone the constituency served under MaineCare.  The Board specifically found 
that Dr. Doane demonstrated incompetence in his opioid prescription practice 
and imposed sanctions, although not the sanction of license revocation.  
Although we can reasonably infer that the Board implicitly concluded that 
Dr. Doane could meet minimum standards of proficiency with monitoring, 
frequent reporting, and a practice limited to certain discrete populations, this 
 
 
20 
implicit finding is not an issue identical to the Department’s determination 
whether to continue a physician’s participation in MaineCare. 
 
[¶36]  The Manual lists the grounds for sanctioning a MaineCare 
provider.  See 10-144 C.M.R. ch. 101, ch. I, §§ 1.19-1(A)–(Y) (effective 
Feb. 13, 2011).8  Most of these grounds for sanction do not involve failure to 
meet minimum standards of proficiency.  See, e.g., id. § 1.19-1(A) (fraudulent 
claims for services); id. § 1.19-1(D) (failing to retain or disclose records of 
services provided to MaineCare members).  This is because, as noted above, the 
Department is concerned with risks to the program as well as risks to the health 
and safety of the specific population it serves.  Grounds for termination cited in 
the Department’s termination decision, section 1.19-1(M), and (R) of the 
Manual, were met: Dr. Doane violated the standards of his profession and 
suffered formal censure.  The sanctions available to the Department are listed 
in its regulations, and in determining which sanctions to impose, the 
Department may consider factors such as the seriousness of the offense, the 
extent of violations, the history of prior violations, and consideration of 
whether a lesser sanction would be sufficient to remedy the problem, among 
                                         
8  This provision is currently located at 10-144 C.M.R. ch. 101, ch. I, § 1.20-1 (effective 
Sept. 17, 2018). 
 
 
21 
other factors.  10-144 C.M.R. ch. 101, ch. I, § 1.19-3 (A)(1)(a)–(c), (g) (effective 
Feb. 13, 2011).9  Irrespective of any implicit Board finding that, with practice 
limitations, Dr. Doane met minimum standards for serving certain populations, 
from the perspective of the interests and regulations, both state and federal, 
governing the Department’s administration of MaineCare, Dr. Doane fell below 
the Department’s standards such that it could choose to terminate him.  
Although ensuring professional competency is an important consideration in 
the decision-making of both the Board and the Department, the agencies may 
make different determinations in accordance with their own standards.  See 
Grant’s Farm Assocs., Inc. v. Town of Kittery, 554 A.2d 799, 803 (Me. 1989) (“It is 
therefore often the case that an applicant . . . must simultaneously persuade 
different agencies that the same or similar standards are met.” (citing Larrivee 
v. Timmons, 549 A.2d 744, 747-48 (Me. 1988))). 
D. 
Substantial Evidence 
 
[¶37]  The Department terminated Dr. Doane’s participation in 
MaineCare based on “undisputed serious and multiple incidents of professional 
incompetence by Dr. Doane over an extended period of time.”  Dr. Doane 
                                         
9  This provision is currently located at 10-144 C.M.R. ch. 101, ch. I, § 1.20-3 (effective 
Sept. 17, 2018). 
 
 
22 
contends that this determination was not supported by substantial evidence 
and constituted an abuse of the Department’s discretion because the evidence 
presented at the Department’s hearing did not show that he currently poses 
any risk to MaineCare patients. 
 
[¶38]  We review an “administrative agency’s decision directly for legal 
errors, abuse of discretion, or unsupported factual findings.”  Forest Ecology 
Network v. Land Use Regul. Comm’n, 2012 ME 36, ¶ 28, 39 A.3d 74 (quotation 
marks omitted).  In conducting such a review, we “do[] not substitute [our] 
judgment for that of an agency and must affirm findings of fact if they are 
supported by substantial evidence in the record.”  Int’l Paper Co. v. Bd. of Env’t 
Prot., 1999 ME 135, ¶ 29, 737 A.2d 1047.  “Substantial evidence exists when a 
reasonable mind would rely on that evidence as sufficient support for a 
conclusion.”  Richard v. Sec’y of State, 2018 ME 122, ¶ 21, 192 A.3d 611 
(quotation marks omitted).  “Upon review of an agency’s findings of fact we 
must examine the entire record to determine whether, on the basis of all the 
testimony and exhibits before it, the agency could fairly and reasonably find the 
facts as it did.”  Friends of Lincoln Lakes v. Bd. of Env’t Prot., 2010 ME 18, ¶ 13, 
989 A.2d 1128 (quotation marks omitted). 
 
 
23 
 
[¶39]  The Department based its decision to exclude Dr. Doane from the 
MaineCare program on its determination that serious incidents of professional 
incompetence occurred over an extended period of time.  This conduct related 
to Dr. Doane’s treatment of a patient between 2003-2012, with particular focus 
on events in 2012 leading up to his patient’s overdose.  The presiding officer 
found, as the Board had previously, that Dr. Doane had “committed 
unprofessional conduct,” “demonstrated incompetence in his treatment” of a 
patient who “died of oxycodone and cyclobenzaprine intoxication,” and 
“violated Board Rule Chapter 21, Section III, governing the use of controlled 
substances for the treatment of pain” with regard to the same patient who died 
of an overdose.  The presiding officer’s findings of fact, which the Department 
adopted in its final decision, were supported by the testimony of the 
Department’s audit program manager, who issued the initial April 2015 
decision excluding Dr. Doane from MaineCare. 
 
[¶40]  The Department’s audit program manager testified about the 
Board’s investigation into Dr. Doane’s prescription practices leading up to the 
death of his patient.  He testified that Dr. Doane’s patient had been to the 
emergency room twice as a result of opiate overdoses and that an emergency 
room doctor treating the patient had informed one of Dr. Doane’s partners that 
 
 
24 
the patient was overmedicated and was taking opiates at dangerous levels.  
Instead of reducing the patient’s medication as the emergency room doctor had 
recommended, Dr. Doane increased the number of pills he was prescribing to 
his patient.  The Department’s witness testified that Dr. Doane’s patient died on 
May 19, 2012, in an accidental death relating to “[o]xy and [cyclobenzaprine] 
intoxication.”  He further testified that the Board found that the opiate 
treatment Dr. Doane provided for his patient demonstrated poor judgment and 
“decision-making regarding prescriptions that were well outside the standard 
of care.” 
 
[¶41]  Based on this evidence, the Department was not compelled to find 
that it could not terminate Dr. Doane.  See Friends of Lincoln Lakes, 2010 ME 18, 
¶ 14, 989 A.2d 1128 (“The ‘substantial evidence’ standard does not involve any 
weighing of the merits of evidence.  Instead it requires us to determine whether 
there is any competent evidence in the record to support a finding.”). 
 
[¶42]  In the end, Dr. Doane is not contesting the Department’s findings—
he acknowledges that his conduct fell below professional standards and does 
not dispute that the Board censured him—a basis for the Department’s 
sanction in its own right.  Instead, as he argued with respect to issue preclusion, 
he asserts that because the Board did not revoke his license based on his 
 
 
25 
conduct, the Department cannot terminate his participation in MaineCare 
based on the same conduct.  But not only do these two agencies have different 
functions, just as we do not substitute our judgment for an administrative 
decision-maker, one agency is entitled to reach a different conclusion based on 
the same or similar evidence presented to another agency, as long as both 
conclusions are supported by the record evidence.  The Board determined that 
the appropriate action to take as to Dr. Doane’s license based on his conduct 
was to assign him a practice monitor and impose limitations on his practice.  
The Department determined that the appropriate action regarding his 
participation in MaineCare was termination.  Each agency acted within the 
bounds of its discretion. 
E. 
Sufficient Findings and Conclusions 
 
[¶43]  Finally, Dr. Doane contends that the decision issued by the 
Department violates the APA because it does not include sufficient findings of 
fact.  See 5 M.R.S. § 9061 (2021) (“Every agency decision made at the conclusion 
of an adjudicatory proceeding shall be in writing or stated in the record, and 
shall include findings of fact sufficient to apprise the parties and any interested 
member of the public of the basis for the decision.”).  The presiding officer’s 
factual findings were comprehensive, and the acting Commissioner adopted 
 
 
26 
them in toto.  Dr. Doane argues that the acting Commissioner’s explanation as 
to why she imposed the sanction of termination based on those findings was 
too terse. 
 
[¶44]  The acting Commissioner’s explanation was concise, not deficient.  
She noted that she accepted the presiding officer’s fact-finding, which was 
based in turn on much of the Board’s fact-finding, and stated that her decision 
was due to “the undisputed serious and multiple incidents of professional 
incompetence by Dr. Doane over an extended period of time as set forth in” the 
Board’s censure decision and consent agreement.  The gravity, number, and 
length of time over which the violations occurred are relevant factors in 
determining appropriate sanctions pursuant to the Manual.  10-144 C.M.R. 
ch. 101, ch. I, § 1.19-3 (A)(1)(a)–(c) (effective Feb. 13, 2011).10  That the Board 
did not revoke Dr. Doane’s license based on this conduct did not require the 
Department to provide a lengthy elaboration of its conclusion that the conduct 
warranted termination under its regulations. 
The entry is: 
Judgment affirmed. 
 
 
 
 
 
 
 
 
 
                                         
10  Currently located at 10-144 C.M.R. ch. 101, ch. I, § 1.20-3(A)(1)(a)–(c) (effective Sept. 17, 2018). 
 
 
27 
Christopher C. Taintor, Esq. (orally), Norman, Hanson & DeTroy, LLC, Portland, 
for appellant Stephen Doane 
 
Aaron M. Frey, Attorney General, and Thomas C. Bradley, Asst. Atty. Gen. 
(orally), Office of the Attorney General, Augusta, for appellee Maine Department 
of Health and Human Services 
 
 
Kennebec County Superior Court docket number AP-2018-74 
FOR CLERK REFERENCE ONLY