Title: Langan v. Board of Registration in Medicine

State: massachusetts

Issuer: Massachusetts Supreme Court

Document:

NOTICE:  All slip opinions and orders are subject to formal 
revision and are superseded by the advance sheets and bound 
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error or other formal error, please notify the Reporter of 
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SJC-12242 
 
MICHAEL L. LANGAN  vs.  BOARD OF REGISTRATION IN MEDICINE. 
 
 
June 13, 2017. 
 
 
Board of Registration in Medicine.  Doctor, License to practice 
medicine.  Practice, Civil, Action in nature of certiorari. 
 
 
 
Michael L. Langan appeals from a judgment of the county 
court denying his petition for relief in the nature of 
certiorari from a decision of the Board of Registration in 
Medicine (board).  We affirm. 
 
 
Background.  Langan is a board-certified physician in 
geriatrics and internal medicine.  In 2008, after he had tested 
positive for various controlled substances, he and the board 
entered into a letter of agreement, under which he agreed to 
certain conditions in order to continue practicing medicine, 
including refraining from the use of alcohol and controlled 
substances without a prescription and submitting to substance 
use monitoring by Massachusetts Physician Health Services (PHS).  
The letter of agreement provided that violating its terms would 
"constitute sufficient grounds for the immediate suspension of 
[Langan's] license," and that Langan had a right to an 
adjudicatory hearing as to any violation found by the board.   
 
 
After Langan entered into the letter of agreement, PHS 
reported three positive tests, at low levels, for ethyl 
glucuronide (EtG) and ethyl sulfate (EtS), two alcohol 
biomarkers.  The board took no action at that time.  In June and 
July, 2011, however, Langan tested positive for the same 
biomarkers, at higher levels.1  As a result of these positive 
                     
 
1 In addition, in July, 2011, a test for a different 
biomarker, phosphatidylethanol, came back positive.  This test, 
2 
 
 
tests, PHS requested that Langan undergo an inpatient 
evaluation, and the board asked him to enter into a voluntary 
agreement not to practice pending completion of such an 
evaluation.  Langan refused at first, causing the board to find 
him in violation of the letter of agreement.  Langan then 
underwent the inpatient evaluation in September, 2011. 
 
 
On February 1, 2012, Langan, represented by counsel, signed 
an addendum to his letter of agreement requiring, in particular, 
that he "participate in a minimum of three (3) 12-step meetings 
per week" and "submit proof of said participation to PHS."  In 
October, 2012, PHS reported that Langan had misrepresented 
attending meetings.  In November, 2012, Langan again tested 
positive for EtS and EtG.  Langan entered into a voluntary 
agreement not to practice and was asked to produce documentation 
that he had attended all required meetings.  He did not do so, 
and in February, 2013, the board determined, based on all the 
documentation before it, that Langan was in violation of his 
letter of agreement for the second time.  The board therefore 
suspended his license.  The 2013 order of suspension provided 
that any stay of the suspension would be contingent on an 
independent psychiatric examination, a worksite monitoring plan, 
and a substance abuse monitoring plan.  Langan did not exercise 
his right to obtain review of the 2013 order. 
 
 
In 2014, Langan petitioned the board for a stay of his 
suspension.  By that time, he had undergone a psychiatric 
examination by a board-approved evaluator, who provided a 
favorable evaluation.  However, he failed to submit the 
necessary worksite and substance use monitoring plans.  The 
board denied Langan's petition, reaffirmed his suspension, and 
stated that he could file a new petition "upon submission of 
proof of abstinence from alcohol and controlled substances for 
twelve consecutive months."  Langan filed a petition in the 
county court seeking relief in the nature of certiorari under 
G. L. c. 249, § 4.2  See Hoffer v. Board of Registration in Med., 
                                                                  
however, was tainted by a chain of custody issue and played no 
part in the board's decisions. 
 
 
2 Langan also requested relief under G. L. c. 211, § 3.  
Such relief was denied on the ground that Langan had an adequate 
remedy under G. L. c. 249, § 4.  In addition, our 
superintendence power under G. L. c. 211, § 3, extends only to 
the lower courts of the Commonwealth, and not to executive 
branch bodies such as the board. 
 
3 
 
 
461 Mass. 451, 458 (2012) (G. L. c. 249, § 4, provides avenue of 
relief from board decision not to reinstate license).  That 
petition was dismissed as untimely, having been filed more than 
sixty days after the board's decision.  Langan did not appeal 
from the judgment of dismissal.  
 
 
Finally, on January 15, 2015, Langan again petitioned the 
board for a stay of his suspension.  He did not include any 
records, such as test results, demonstrating that he had 
abstained from alcohol and controlled substances.  He also did 
not include worksite and substance use monitoring plans, as 
required by the 2013 order as a condition of reinstatement.  The 
board again denied Langan's petition and reaffirmed the 
suspension of his medical license.  Langan timely filed his 
petition for relief under G. L. c. 249, § 4, which was denied by 
a single justice of this court.3  Langan now appeals from that 
judgment. 
 
 
Discussion.  The board's decision denying Langan's 
reinstatement to his chosen profession is reviewable under G. L. 
c. 249, § 4, the certiorari statute.  Hoffer, 461 Mass. at 458.  
Certiorari is a "limited procedure reserved for correction of 
substantial errors of law apparent on the record created before 
a judicial or quasi judicial tribunal."  Indeck v. Clients' Sec. 
Bd., 450 Mass. 379, 385 (2008), quoting School Comm. of Hudson 
v. Board of Educ., 448 Mass. 565, 575-576 (2007).  "[T]he proper 
standard of review under the certiorari statute is flexible and 
case specific, but . . . as with review under G. L. c. 30A, 
§ 14, the disposition must ultimately turn on whether the 
agency's decision was arbitrary and capricious, unsupported by 
substantial evidence, or otherwise an error of law."  Hoffer, 
supra at 458 n.9.  Moreover, "[t]he board has broad authority to 
regulate the conduct of the medical profession, . . . which 
authority includes its ability to sanction physicians for 
conduct which undermines public confidence in the integrity of 
the medical profession."  Sugarman v. Board of Registration in 
Med., 422 Mass. 338, 342 (1996), citing Kvitka v. Board of 
Registration in Med., 407 Mass. 140, cert. denied, 498 U.S. 823 
                     
 
3 In connection with the proceedings before her, the single 
justice encouraged the parties to settle on terms of 
reinstatement and gave them a sixty-day period to attempt to do 
so.  Contrary to Langan's suggestion, the single justice did not 
and could not "order" the parties to settle.  When the parties 
were unable to reach an agreement, she quite properly proceeded 
to rule on Langan's petition. 
4 
 
 
(1990).  In reviewing the board's decision, we defer to its 
expertise.  Sugarman, supra at 347. 
 
 
As Langan made no timely challenge to the 2013 order 
suspending his license or to the 2014 order denying a stay of 
the suspension, the sole issue before the single justice was the 
propriety of the board's 2015 order.  In that order, the board 
found that Langan failed to fulfil the conditions of 
reinstatement expressly set forth in the 2013 and 2014 orders:  
submission of a worksite monitoring plan, submission of a 
substance use monitoring plan, and proof of abstinence from 
alcohol and controlled substances for twelve consecutive months.  
As a result, the board concluded that Langan had not 
demonstrated his sobriety and fitness to practice medicine.  The 
board's findings are amply supported by the evidence, and its 
2015 order denying a stay and reaffirming the suspension is well 
within its broad discretion to regulate the conduct of the 
medical profession. 
 
 
Langan's arguments on appeal are unavailing.  Langan 
alleges that the chain of custody error in a July, 2011, 
phosphatidylethanol (PEth) test was the result of deliberate 
fraud.4  See note 1, supra.  That is a serious and disturbing 
charge, but one that is not substantiated in the record.  
Moreover, the PEth test results formed no part of the basis for 
any of the board's decisions in this matter.  Langan was 
suspended for misrepresenting his attendance at twelve-step 
support group meetings, not for failing the PEth or any other 
test, and he was denied reinstatement for failing to fulfil the 
conditions thereof.   
 
 
Langan also argues that his rights under the establishment 
clause of the First Amendment to the United States Constitution 
were violated by the requirement that he attend twelve-step 
support group meetings.  Even assuming that such support groups 
are religiously based, his argument fails for several reasons.  
Langan voluntarily agreed to attend meetings when he signed the 
2012 addendum to the letter of agreement; the requirement was 
not unilaterally imposed by the board.  Langan did not timely 
challenge the suspension.  Moreover, the board's 2015 decision 
makes it clear that Langan would have been permitted to attend a 
                     
 
4 On a related point, Langan argues that the board violated 
G. L. c. 112, § 5, by failing to investigate his charges of 
fraud at PHS.  He did not raise this issue before the single 
justice, and in any event, the board's action or inaction on any 
other complaint provides him with no defense. 
5 
 
 
secular support group if he had so requested.  Finally, and most 
importantly, the 2015 decision, which is the only one properly 
before us, was not based on Langan's failure to attend meetings, 
but on his failure to fulfil the conditions of reinstatement. 
 
 
Because the board committed no error in denying Langan's 
petition to stay his suspension, the single justice properly 
denied relief in the nature of certiorari.5 
 
 
 
 
 
 
 
 
Judgment affirmed. 
 
 
Michael L. Langan, pro se. 
 
Bryan F. Bertram, Assistant Attorney General, for the Board 
of Registration of Medicine. 
                     
 
5 We recommend that the board provide Langan with model 
worksite and substance use monitoring plans if it has not 
already done so.