Title: Story v. Wyoming State Bd. of Medical Examiners

State: wyoming

Issuer: Wyoming Supreme Court

Document:

Story v. Wyoming State Bd. of Medical Examiners1986 WY 132721 P.2d 1013Case Number: 85-281Decided: 06/17/1986Supreme Court of Wyoming
J.H. STORY, M.D., 
Appellant (Contestee),

v.

WYOMING STATE BOARD OF MEDICAL 
EXAMINERS, Appellee (Complainant).

Appeal from District 
Court, Big HornCounty, John T. Dixon, 
J.

R. Scott Kath of 
Copenhaver, Kahl & Kath, Powell, for 
appellant (contestee); Van Graham (argued).

A.G. McClintock, 
Atty. Gen., Peter J. Mulvaney, Deputy Atty. Gen., and Richard E. Dixon (argued), 
Asst. Atty. Gen., for appellee 
(complainant).

Before THOMAS, C.J., and BROWN, CARDINE, URBIGKIT 
and MACY, JJ.

CARDINE, 
Justice.

[¶1.]     This appeal is from an 
order revoking appellant's medical license after a hearing before the Wyoming 
State Board of Medical Examiners.

[¶2.]     We affirm. 

[¶3.]     The questions presented 
by appellant for our determination are whether the findings of the Board are 
supported by substantial evidence; whether the Board complied with requirements 
of law; and whether the Board's findings and conclusions are arbitrary, 
capricious, and an abuse of discretion.

[¶4.]     The Wyoming State Board of 
Medical Examiners received written complaints from female patients that 
appellant had inserted his penis into their vaginas during pelvic examinations. 
Following an investigation, there was, pursuant to § 33-26-130, W.S. 1977, 
Cum.Supp. 1985, an interview with appellant. The parties were unable to arrive 
at a satisfactory resolution of the complaints. A contested-case hearing was set 
at which appellant was ordered to show cause why his license to practice 
medicine should not be suspended, revoked, or restricted, or other disciplinary 
action taken. At the conclusion of the hearing, the medical board found that 
appellant was guilty of unethical and unprofessional conduct toward MA, MB, and 
AD, that such conduct was likely to deceive, defraud or harm the public, and 
that as of June 30, 1984, his license to practice medicine in the state of 
Wyoming should 
be revoked.

I.

SUFFICIENCY OF THE 
EVIDENCE

The Board may revoke a 
license for:

"(iii) The performance of 
any dishonest, unethical or unprofessional conduct likely to deceive, defraud or 
harm the public." § 33-26-129(b)(iii), W.S. 1977.

[¶5.]     The authority for the 
Board's revocation of appellant's license is found in § 33-26-136, W.S. 1977, 
which provides:

"(a) After the hearing, 
the board shall enter its order pursuant to the Wyoming Administrative Procedure 
Act [§§ 16-3-101 to 16-3-115]. The board may:

* * * * * 
*

"(iv) Revoke the 
license."

For the board to 
revoke, suspend or restrict a license or take other disciplinary action against 
a licensed physician, the evidence must be clear and convincing that he has 
violated the provisions of § 33-26-129(b), W.S. 1977. Fallon v. WyomingState 
Board of Medical Examiners, Wyo., 441 P.2d 322, 326 (1968). Clear and 
convincing evidence is "`[t]hat kind of proof which would persuade a trier of 
fact that the truth of the contention is highly probable.' MacGuire v. 
Harriscope Broadcasting Co., Wyo., 612 P.2d 830, 839 (1980)." Matter of 
Parental Rights of GP, Wyo., 679 P.2d 976, 982 
(1984); Thomasi v. Koch, 
Wyo., 660 P.2d 806, 812 
(1983).

[¶6.]     At the hearing MA 
testified that during September 1982, she saw appellant for a post-natal 
checkup. The pelvic examination was conducted with her lying on her back on the 
examination table, her feet in the stirrups, and a sheet over her knees which 
obstructed her view of the examiner. Appellant began with a finger examination 
and then informed MA that he would have to dilate her. She could not see what 
was being done, but sensed that something was wrong, associating the experience 
with sexual intercourse. During a second pelvic examination in November 1982, MA 
said, "it happened again" and she concluded that appellant had inserted his 
penis in her vagina to "dilate" her. She informed her sister, her mother, and 
her Bishop of the incidents and did not return to appellant for her medical 
care. In June 1983, MA by letter, informed the president of the Wyoming State 
Medical Board of the incidents.

[¶7.]     MB testified that she 
twice cancelled appointments with appellant because of suspicions that he had 
sexual intercourse with her during prior pelvic examinations. MB was sick with a 
sore throat and appellant's receptionist convinced her to keep a third 
appointment on April 21, 1983. Appellant gave MB a sheet and instructed her to 
prepare for a pelvic examination. With MB lying on the examining table, 
undressed, her feet in the stirrups, and covered with a sheet, appellant began 
the examination with a speculum and his fingers, and then advised MB that he 
would have to "dilate" her. He stood as he dilated her, the pain was intense and 
she felt his pants against her body. Appellant said, "let me pull it out a 
little bit and then I'll try again," and then pushed real hard and said, "well, 
I just can't get it in all the way." Appellant came around to the side of the 
table. MB felt an object touch her hand. She looked - it was appellant's penis. 
Before mailing a letter of complaint to the Medical Board, MB and her husband 
met with appellant at his request. Appellant expressed concern about rumors of 
his misconduct. He then advised MB's husband that he would not have to pay his 
medical bill in the amount of $1613.00.

[¶8.]     AD had prior 
experiences during pelvic examinations about which she was suspicious. Then on 
February 12, 1983, a Saturday afternoon, she went to appellant for treatment of 
a fever and headache. Appellant suggested a pelvic examination because of the 
possibility of a low grade kidney infection. To dilate AD appellant pushed 
something into her vagina, pulled it out and pushed it in further until his hips 
came up against hers and then she knew his penis was penetrating her vagina. AD 
said she didn't know what to do - she was in a panic. Appellant gave her a 
prescription and she left. She informed her husband of what had happened and 
complained, in writing, to the Wyoming State Board of Medical 
Examiners.

[¶9.]     Appellant argues that 
we should not find the evidence substantial because MA, MB, and AD are not 
credible witnesses. His argument is essentially the same as to each of the three 
witnesses. Thus, appellant states,

"why doesn't this adult, 
presumably normal, lady pull the sheet down, if there is one, and see exactly 
what he is doing if she suspects some impropriety. How normal is it to simply 
lay there and allow yourself to be, in effect, raped * * 
*."

[¶10.]  A brief examination of the reported 
testimony demonstrates why they did nothing and why the Board found the evidence 
clear and convincing and the witnesses credible. MA, after stating that 
appellant put his penis in her vagina, said:

"I'm mad because I wasn't 
strong enough to sit up and find out for sure. I'm mad that that strength isn't 
in me. And so as a result of this, I have lost some self-respect, because I 
wasn't strong enough. And I'm scared to death that if another doctor were to do 
it, I don't know what I would do. I just shake.

* * * * * 
*

"Q. I've asked you some 
tough questions and I'm going to ask you one last tough one, Mrs. [MA]. I 
appreciate your bearing with me.

"If you had it to do all 
over again, would you still write the letter to the Board of Medical 
Examiners?

"A. I don't have any 
choice. I can't live with myself if I don't. I've lost enough self-respect, I 
couldn't lose any more. It just wasn't a matter of choice. After I heard that 
people had been offended for five years, I didn't have any choice. It was like 
the choice was then lifted from me and the burden was on my back. I just 
couldn't sit back."

[¶11.]  And AD testified:

"Q. Okay. Then what 
happened next?

"A. Then he got the table 
all ready, you know, and had me scoot down on the end of the table until my rear 
touched his hand. And then he tried with the speculum and he said * * *, `This 
is awfully uncomfortable, isn't it?' And I said, `Yes, but it always 
is.'

"And so he said he would 
dilate me and that would make it easier for me. And I really didn't think 
anything of it, but as soon as he put whatever it was in, I thought, this can't 
be true. This can't be true. He wouldn't do that to me. But I knew it was him * 
* *."

When asked why 
she didn't say something to appellant or object, AD said:

"A. Well, I was alone. I 
did. I thought about it. I thought there is nobody else in here. He could do 
anything to me and nobody would ever know. And caught in a situation like that, 
almost any normal person would panic and maybe do something that would harm 
someone else. And all this went through my mind and I thought I can't say 
anything. So I didn't say anything at all and left."

[¶12.]  With respect to MB's testimony that she 
observed appellant's penis, appellant, in his brief, 
argues:

"Now after this 
ejaculation occurs the witness contends that the doctor simply moved around to 
the side of the table * * *. Next, the witness stated `this object, slips 
between her fingers' and was `laying on the table' * * * at which time she also 
looks down and `sees' the penis.

"[S]ince the doctor had 
his lab coat on, * * * it would appear that the perpetrator of this offense 
would be an individual of remarkable endowment since a portion of it remained in 
his pants, behind his lab coat, crossed her hand, laid on the table and at some 
point was buried in her leg."

[¶13.]  Appellant concludes 
with:

"This testimony is 
greater in degree than simply incredible. It is bizarre, ludicrous and demented. 
The Board, however, finds it not only `credible', but `clear and 
convincing'."

[¶14.]  Appellant's view of the evidence is 
argument pure and simple. He must have made the same argument to the Medical 
Board that heard the case and they rejected it. We look again to the verbatim 
testimony of MB who, after being advised by appellant that he would dilate her, 
states:

"So he pulled it out and 
he turned around and faced the sink again. He walked up over to the side and I 
had my hand down on the side of the table. And he pushed - he leaned up forward. 
And when he leaned up against the table close to put his hand on my stomach to 
push, this object slipped between my fingers again. And this time I didn't pull 
my hand up. I kept it down there. And he had his hands across my arms. It was 
laying on the table and he was pushing my stomach. And every time he would move 
in, the object would move in and rub in between my 
fingers.

"Q. Did you look to see 
what it was?

"A. This time I did. * * 
* And I pulled my hand up and I looked down. And it was a penis. I did not see 
the end, where his pants were and the other end was pushed up against my leg, 
but it was a penis on the table.

"Q. Did you say anything, 
Mrs. [MB]?

"A. I didn't. I laid 
there. And I thought to myself, it couldn't be a penis because he wouldn't do 
this."

[¶15.]  The Board had the advantage of hearing 
the witnesses' testimony firsthand, observing their demeanor, facial 
expressions, reaction to questions, and their openness and fairness in 
testifying. This court on review does not have the same advantage and we, 
therefore, accord considerable deference to the trier of fact in its 
determination of questions of credibility and weight of evidence. The Medical 
Board that presided at this hearing consisted of four practicing doctors, 
appellant's peers, who were educated, experienced, and knowledgeable in the 
procedures appellant performed. We have stated:

"We also start, of 
course, with the presumption that members of the board `are assumed to be men of 
conscience and intellectual discipline, capable of judging a particular 
controversy fairly on the basis of its own circumstances.'" Fallon v. Wyoming 
State Board of Medical Examiners, supra, 441 P.2d  at 329, quoting United States 
v. Morgan, 313 U.S. 409, 61 S. Ct. 999, 1004, 84 L. Ed. 1429 
(1941).

The Board found 
the testimony of MA, MB, and AD,

"credible, consistent, 
clear and convincing. Likewise, with straightforward, candid expression, without 
rancor, [they] testified about [their] experiences with Licensee and his acts of 
ethical and professional misconduct toward [them]."

The burden of 
proving a lack of substantial evidence is upon the party appealing the Board's 
decision. Laramie River Conservation Council v. Industrial Siting Council, 
Wyo., 588 P.2d 1241, 1253 (1978). This court has repeatedly declared a lack of willingness to 
substitute its opinion as to the weight and credibility of the evidence for that 
of the administrative agency which acted as the trier of fact. Gilmore v. Oil 
and Gas Conservation Commission, Wyo., 642 P.2d 773, 776 (1982). We will not 
displace an agency's findings between two fairly conflicting points of view, 
even though the court might have made a different decision had the matter been 
before the court initially. Employment Security Commission of Wyoming v. Young, Wyo., 713 P.2d 198 
(1986).

[¶16.]  Our review of the evidence, testimony, 
and record in this case tells us that there is substantial evidence to support 
the findings, conclusions, and decision of the Board.

II

FAILURE TO REQUIRE 
EXAMINATION

[¶17.]  Appellant next contends that the State 
Medical Board was required by § 33-26-131(a) to arrange for an examination of 
appellant before proceeding with the contested case hearing and that the failure 
to provide such examination necessitates reversal of the Board's order revoking 
appellant's license.

[¶18.]  After receipt of the original complaints 
by patients of Dr. Story, there was an investigation and informal interview with 
Dr. Story, pursuant to § 33-26-130(b) and (d) which 
provide:

"(b) The board on 
complaint to it, or on its own motion, shall investigate any complaint or matter 
which appears to show that an individual licensed in this state may be medically 
incompetent, may be guilty of unprofessional or dishonorable conduct or may be 
mentally or physically unable safely to engage in the practice of 
medicine.

* * * * * 
*

"(d) If it appears to the 
board that the evidence before it pursuant to this section may be true, the 
board shall request an informal interview with the physician or other individual 
licensed by the board. If he refuses an invitation for an informal interview, 
the board may suspend or revoke his license."

[¶19.]  Section 33-26-131(a) 
provides:

"Either before or after 
an informal interview, the board may 
arrange an examination of the physician or other licensee. The board shall 
direct an examination if it has reasonable cause to believe that he cannot 
practice medicine with reasonable skill and safety to patients." (Emphasis 
added.)

[¶20.]  Dr. Story appeared for the interview and 
insisted that all of the complaints by patients were false and without substance 
and that he would defend against them. The Board stated in its written findings 
of fact and conclusions of law:

"20. The materiality of 
the July 22, 1983, minutes is that such an informal interview is a necessary 
part of the procedure for disciplinary action against a medical licensee and 
required by § 33-26-130(d), W.S. No final determination of the validity of the 
complaints against the Licensee was made at that time."

Having made no 
determination with respect to the merits of the controversy, the Board in the 
exercise of its discretion under § 33-26-131(a) did not order an examination. 
The manner in which the Board proceeded with the complaints was eminently fair. 
We note also that neither appellant nor his counsel requested an examination or 
objected to the Board's failure to require one. Thus, the claimed error is not 
preserved for review. McCulloch Gas Transmission Company v. Public Service 
Commission of Wyoming, Wyo., 627 P.2d 173, 180 
(1981). There is no claim of plain error and nothing before us that would 
require reversal.

III

ADMISSION OF 
HEARSAY

[¶21.]  Appellant's final claim of error is that 
the Board's, "actions, findings and conclusions are arbitrary, capricious, an 
abuse of discretion" because, as stated in his brief: 

"[T]he unrestrained 
admittance of hearsay and rumor evidence, so prejudiced the Contestee and 
overwhelmed the Board, that an impartial and fair hearing was 
impossible."

[¶22.]  This court may set aside an action of an 
administrative agency that is arbitrary and capricious or where there is an 
illegal exercise of discretion. Bixby v. Cross, Wyo., 384 P.2d 710, 714 (1963). For an action 
to be considered arbitrary and capricious, such action must be shown to be 
willful and unreasoning action, without consideration and in disregard of facts 
and circumstances. Marathon Oil Company v. Pan American Petroleum Corporation, 
Wyo., 473 P.2d 575, 577 (1970). Recently this court had occasion to state 
that:

"Running through those 
cases we find words of description such as dishonesty, bad faith, illegality, 
and oppressiveness on the part of the agency. The term `abuse of discretion' in 
its application to agency conduct carries with it a connotation of illegal and 
other conduct smacking of censurable behavior, justifying judicial 
intervention." State v. Weisz & Sons, Inc., Wyo., 713 P.2d 176, 185 
(1986).

[¶23.]  And with respect to abuse of discretion 
we have said:

"An abuse of discretion 
is that which shocks the conscience of the court and appears so unfair and 
inequitable that a reasonable person could not abide it. The decision * * * will 
not be reversed unless there is a firm conviction that a clear error of judgment 
was committed." (Citations omitted.) Waldrop v. Weaver, Wyo., 702 P.2d 1291, 1293 
(1985).

[¶24.]  Dr. John Welch testified that he had 
heard rumors concerning Dr. Story molesting patients during pelvic exams, that 
several women had informed him of the molesting, that he had discussed the 
matter with the hospital administrator and with Dr. Story, and that he said to 
Dr. Story in their meeting:

"[T]hat there wasn't any 
way in the world that you can defend yourself unless you have a witness there in 
those situations. And that he ought to have someone with him during his pelvic 
examinations. And he made the statement at that time, I will have to change my 
whole way of, I guess, office practice. I don't remember the exact 
words."

[¶25.]  The proceeding against Dr. Story was 
required to be conducted as a contested case under the Wyoming Administrative 
Procedure Act (APA) § 33-26-135(a), W.S. 1977. With respect to admissible 
evidence, the APA, § 16-3-108(a), W.S. 1977, provides:

"(a) In contested cases 
irrelevant, immaterial or unduly repetitious evidence shall be excluded and no 
sanction shall be imposed or order issued except upon consideration of the whole 
record or such portion thereof as may be cited by any party and unless supported 
by the type of evidence commonly relied upon by reasonably prudent men in the 
conduct of their serious affairs. Agencies shall give effect to the rules of 
privilege recognized by law. Subject to these requirements and agency rule if 
the interests of the parties will not be prejudiced substantially testimony may 
be received in written form subject to the right of cross-examination as 
provided in subsection (c) of this section."

[¶26.]  We begin with the general rule that 
administrative agencies acting in a judicial or quasi judicial capacity are not 
bound by technical rules of evidence that govern trials by courts or juries, and 
it is usually held that evidence will not be excluded merely because it is 
hearsay. Falsone v. United 
States, 205 F.2d 734 (5th Cir. 1953), cert. denied, 346 U.S. 864, 74 S. Ct. 103, 98 L. Ed. 375; 
2 Am.Jur.2d Administrative Law § 378. Where hearsay evidence is by statute 
admissible in administrative proceedings, it is often held that it must be 
probative, trustworthy and credible; and, although it may not be the sole basis 
for establishing an essential fact and is insufficient to support an 
administrative decision, it may be considered as corroborative of facts 
otherwise established. Fisher v. LouisianaState Board of Medical Examiners, La. App., 352 So. 2d 729 
(1977); Annot., 36 A.L.R.3rd 12 (1971).

[¶27.]  The Federal Administrative Procedure Act 
is very similar to the Wyoming Act and is construed to allow the receipt of 
hearsay, it being stated that:

"Not only is there no 
administrative rule of automatic exclusion for hearsay evidence, but the only 
limit to the admissibility of hearsay evidence is that it bear satisfactory 
indicia of reliability * * * that the hearsay be probative and its use 
fundamentally fair." Calhoun v. Bailar, 626 F.2d 145, 148 (9th Cir. 1980), cert. 
denied, 452 U.S. 906, 101 S. Ct. 3033, 69 L. Ed. 2d 407 
(1981).

[¶28.]  Some courts have held that hearsay that 
is reliable, trustworthy, and credible may by itself constitute substantial 
evidence and support an administrative decision. Factors to be considered in 
determining whether hearsay is sufficient are the type of material submitted, 
whether sworn, in writing or oral, whether contradicted by direct testimony, 
whether declarant is available, the credibility of declarant, whether 
corroborated, and the guarantees of trustworthiness. Calhoun v. Bailar, 
supra.

[¶29.]  Our APA provides only for the exclusion 
of "irrelevant, immaterial or unduly repetitious evidence." Section 16-3-108(a), 
W.S. 1977. It does not require that hearsay evidence be excluded. We hold that 
hearsay that is otherwise admissible under § 16-3-108(a), and that is probative, 
trustworthy and credible may be received in evidence at an agency hearing. The 
testimony of Dr. John Welch admitted at this hearing, although hearsay, clearly 
satisfied our requirements and was properly received by the Board. It was "the 
type of evidence commonly relied upon by reasonably prudent men in the conduct 
of their serious affairs," required by § 16-3-108(a), to support the revocation 
of appellant's license.

[¶30.]  We need not decide in this case whether 
the hearsay, by itself, was sufficient to sustain the Board's decision because 
there was direct evidence that was convincing and substantial by each of the 
persons who had complained against appellant in writing.

[¶31.]  Appellant next contends 
that

"it was error for 
Complainant to admit and consider `Minutes of Special Meeting' dated July 22, 
1983."

[¶32.]  The Minutes of Special Meeting to which 
appellant objects were the result of an informal interview with Dr. Story 
pursuant to § 33-26-130(d), W.S. 1977, Cum.Supp. 1985, which provides that upon 
receipt of a complaint, if it appears that the evidence may be true, "the board 
shall request an informal interview with the physician." The informal interview 
was with two physicians appointed by the Board (not members of the hearing 
panel) and with members of the Attorney General's staff representing the Board. 
A written report of the meeting was received in evidence at the 
hearing.

[¶33.]  Section 16-3-108(a), W.S. 1977, provides 
in part:

"Subject to these 
requirements and agency rule if the interests of the parties will not be 
prejudiced substantially testimony may be received in written form subject to 
the right of cross-examination as provided in subsection (c) of this 
section."

After the report 
was received in evidence, the preparer testified and was cross-examined. The 
report was an integral part of the entire process and though hearsay, it was 
admissible as we have previously determined. It was necessary to a complete 
record before the Board. We perceive nothing in it that was extraneous to the 
hearing, inflammatory or prejudicial. Mere exposure to evidence is insufficient 
to demonstrate prejudice. Withrow v. Larkin, 421 U.S. 35, 95 S. Ct. 1456, 43 L. Ed. 2d 712 (1975). A report containing evidence identical to 
evidence received at the hearing is not prejudicial. Fisher v. Louisiana State 
Board of Medical Examiners, supra, 352 So. 2d 729.

[¶34.]  Even if the report of the meeting was 
improperly received (we do not believe it was), it was harmless. The Board was 
meticulous in assuring appellant a fair hearing. Unlike Fallon v. Wyoming State 
Board of Medical Examiners, supra, 441 P.2d 322, the report contained no 
conclusions concerning appellant's guilt and was not submitted to the Board ex 
parte. From the onset of the investigation, the Board separated the 
investigatory and adjudicatory functions. It declined to consider the hearsay to 
which appellant now objects, stating expressly in its Findings of Fact, 
Conclusions of Law, and Order:

"20. The materiality of 
the July 22, 1983, minutes is that such an informal interview is a necessary 
part of the procedure for disciplinary action against a medical licensee and 
required by § 33-26-130(d), W.S. No final determination of the validity of the 
complaints against the Licensee was made at that time. No determination of 
whether Licensee engaged in unethical and unprofessional conduct as a physician 
is based in any part on what was said or done at the July 22, 1983, meeting, but 
is based solely on the testimony and other exhibits received at the March, 1984, 
hearing.

"21. * * * The testimony 
of Dr. Welch that a complaint had been made to him about the daughter of a 
friend having been molested by Licensee is also disregarded as unreliable 
hearsay. Dr. Welch's testimony is only material to the extent he talked to 
Licensee about the latter's pelvic examinations on two occasions and advised 
that he should have someone present when given * * * and to explain the 
procedures involved in the pelvic examination of a woman."

[¶35.]  The Board, in its findings unequivocally 
stated that it did not rely upon the complained of evidence. Thus, the rule of 
harmless error applies. ABC Builders, Inc. v. Phillips, Wyo., 632 P.2d 925, 934-935 (1981); Rule 7.04, 
W.R.A.P. The general rules relating to harmless or prejudicial error apply to 
disciplinary proceedings. Salerno v. Board of 
Dental Examiners, 119 Ga. App. 743, 168 S.E.2d 875 
(1969).

[¶36.]  The Board found the evidence of 
appellant's violation of § 33-26-129(b), W.S. 1977, clear and convincing, and we 
agree. The order of the Board is affirmed.