Appellee Donald W. Patrick, M.D. is the Executive Direc tor of the B oard. 1 

### TEXA S C OU R T OF A PPEAL S, THIR D DIST R ICT , AT AU STIN

444 444 444 444 444 444 444 444 444 ON MOTION F OR REHEARING

444 444 444 444 444 444 444 444 444
NO. 03-03-00698- CV

Har old G r ane k, M .D ., App e lla nt

v. Texas State Board of Medical Exam iners and Don ald W. Patr ick, M.D., Appellees

F ROM THE DISTRICT CO URT OF TRAVIS COUNTY , 53RD JUDICIAL DISTRI CT NO. GN201905 , HO NORAB LE SUZ ANNE COVINGTO N, JUDGE PRESIDI NG

O P I N I O N
To addre ss issu es ra ised in the motion for rehe aringof Appe llant Harold Gr anek, M. D. , w e wi thd

ra w o ur op ini on and jud g me nt dat ed May

5, 20 05 , a

nd su bs tit ute the fo llo wi ngin its place. We over

rule the motion for r ehea

ring
. Gra nek appe als the di strict court’s order affirming an order of the Texas State Boa rd of Me dic a l E xami ne rs (B oa rd ) imp os ing dis c ipl ina

ry sa nc tio ns a g a ins t him
. He c omp la ins c hie fl y 1 that th e B oa

rd vio late d d

ue pr oc e ss i n pr os e c uti ng its dis c ipl ina ry c omp la int

a g a ins t hi m w he n s ome2

of its a lleg ations wer e more than a deca de old; that there is not subst antial evidenc e to support the B oa rd ’s dis c ipl ina

ry g ro un ds ; and th at th e B oa rd c omm itt e d e rr or s o f l aw b y inc lud ingc e rt a in
c omm e nta

ry in i ts o rd e r. We w ill a ff

ir m in pa rt and re ve rs e and

re mand in p art
. BACK GR OUND Gra nek holds a lice nse to prac tice med i ci n e i s sued by the B oard. H e is an ophthalmologist who spec ializes in t he tre at m en t o f the vitreo-r etinal par t of the eye and ha s prac ticed in For

t Worth si nce a

pproxi mately

1991. Disciplin ary proce edings

I n J une 2000, t h e Bo ard docketed a formal disciplinary

complaint ag ainst Grane k, which it subsequently

amende d in Dec ember 2000 and aga in in J anuar y 2001. The c omplaint was ref err ed to the State Of

fice of Administrative He aring s, and a he aring wa s held bef ore a n Administrative L aw Judge (AL J ) in J anuar y 2001. The AL J hear d evidenc e and issued a proposal for de cision (PFD) concludingthat the B oard ha d established thre e g rounds for disc ipline.

F ir st, the AL J fo un d that, on Janu ary 8, 19 94 , Gr ane k ha d fa ile d to atte nd a patie nt, L .H ., a ft e r s he ha d p re se nte d he rs e lf a t the e me rg e nc y ro om of the HC A Me dic a l Pla za ho sp ita l in For t Worth (HCA) with sever e pain cause d by building pre ssure within her e y e. The AL J found that Gra nek, who wa s not at the hospital at the time nor “on call,” had re fused to re turn to the hospital to perfor m para cente sis or “tapping ” of L .H.’s eye with a needle to r elieve pressure . Instead, Gr anek had maint ai n ed that tapping wa s at best a short- term mea sure a imed mere ly at sy mptoms and hadPa tie nt a ba nd on me nt is a

fo rm of br e a c h o f d

uty in a me dic a l ma lpr a c tic e a c tio n. El e me nts 2 of an a bandonment cla im are ( 1) the unilater al seve ranc e of the doctor-patient relationship by the doctor; (2) without reasona ble notice or

without providing a dequate alternative medical care ; (3) at a ti me when there is a nec essity of continuing medical attention. King v. Fisher , 918 S.W .2d 108, 112 (Tex. App.—For

t Worth 1996, writ denied). I n Lun sfo rd , this Court affirm ed an order of the B oard of

NursingEx aminers imposing 3 disc ip li n e f

o r “ u np r o f

e s s io n a l o r d is h o n o r a

b le c o n d u c t” in r e f

u s in g to tr e a t a p a ti e n t w h o had prese nted himself at an emer g ency room with chest pains. The patient subsequently died while en route t o an o t h er hospital. I n response to the nurse’ s claim that she owe d no duty to car e for

the patie nt, we fo un d s uc h a

duty ba se d in pa rt on the fo llo wi nga sse rt ion s: When appellant re ceive d the privileg e of being licensed as a nurse in this State, she en t ere d into a covena nt to serve the pe ople of this State with all her profe ssional skills and powers. This suit is not broug ht in contrac t or in tort by one individual who fe els he or she has bee n wrong ed by ap pellant’s ac tions or 3 p r e v i o u s l y

a dv i s e d L. H
. t o s e e a

g l a u c o m a s p e c i a l i s tt o t r e a t h e r u n d e r l yi n g p r o b l e m . T h e A LJ conclude d that by

this conduct, Gra

nek had “ failed to pra ctice me dicine in an a cce ptable prof essional
manner consistent with public health an dwelfa re,” Tex. Occ. Code Ann. § 164.051( a)( 6), and “commit[t ed] unprofessional or dishonora ble conduc t that is li kely to . . . injure the public.” Id
. §§ 164.051(a) (1), 164.052(a) (5) (West 2004)
. Both violations are g rounds for phy sician discipline. Id
. As additional support for thes e u l t i mate conc lusions of law, the AL J relied on two
s e t s o f l e g a l c o n c l u s i o n s r e g ar d i n g G r an e k ’ s d u t i e s t o L. H
. i nt h e s e c i r c u m s t an c e s . F i r s t , t h e A LJ conclude d that Gra

nek brea ched the tort duty not to abandon L .H. See King v. Fishe r , 918 S.W .2d 10 8, 11 2 ( Te x. Ap p. —F or t Wor th 1 99 6, wr it d e nie d) ; Le e v . D e wbr e , 3 6 2 S. W. 2 d 9 0 0 , 9 0 2 ( T e x. Civ. App.—Amarillo 1962, no writ). Second, the AL J derive d a set of phy sician-patient duties from 2 Lun sfo rd v . Boa rd

of N ur seEx am ine rs , 648 S.W .2d 391 (Tex. Civ. App.—Austin 1983, no writ). 3inaction, but this suit i s broug ht by the people of

this S tate for

appellant’ s violation of her c ontrac tual duties to them to alway s act in a p ro fe ssional and honorable manner . Lun sfo rd v . B oa rd of N ur seEx am ’r s , 648 S.W .2d 391, 395 (Tex. Civ. App.—Austin 1983, no writ).

4 C i t i n g Lunsfo r d

, the AL J con c lud e d th a t “ [a] li c e ns e to p ro vid e me dic a l se rv ic e s is a c ov e na nt t o
serve the people of the State of Texas w ith pr ofessional skill and power and a c ontrac t to alway s act in a pr of e ssi on a l and ho no ra

ble mann e r, ” and that Gra ne k bro ke his “ c ov e na

nt t o s e rv e the pe op le of the State of

Te xas w itha ll h is p ro fe ssi on a l sk ill s and po we rs ” and his “ c on tr a c t w iththe pe op le of the State of T exas to act in a prof essional and honor able manne r.” Se e id . at 395. The sec ond g round for

discipline found by

the AL J was ba sed on occ upations code section 164.051(a )(7)
. SeeTex. Occ. C o d e Ann. § 164.051(a)(7) ( West 2004). That provision applies when a licensee “is disciplined by a licensed hospital or medical staf f of a hospital, including
remova l, suspension, limit ation of hospi tal privileg es, or other disciplinary action, if the boa

rd finds that the ac tion: (A) was b as ed o n unprofe ssional conduct or pr ofessional incompe tence that was likely to harm the public; and ( B) was a ppropriate and re asonably supported by

evidenc e submitted to the board.” Id
. The AL J based this conclusion on finding s that Gra nek failed to comply with the reque sts of both the emerg en cy room doctor a

nd the HCA chie f of staf

f to attend L .H. on J anuar y 8, 19 94 ; th a t th e c hie f o f s ta ff ha d s umm ari ly su sp e nd e d Gr ane k’ s hosp ita l pri vil e g e s f or his re fu sa l; t h at an ad hoc p e e r r e v ie w c o mm itte e a t H CA h a d r e s c in d e d th e s u mm ar y s u s p e n s io nbutThe AL J found t hat t he Board had failed to prove similar alleg ations reg ardingtwo other 4 patie nts
. I n ad dit ion , the B oa rd ra ise d thr e e oth e r al le g a tio ns that w e re e ith e r d ism iss e d v olu nta ri ly or fo un d to be un

pr ov e n. No ne of

the se a lle g a tio ns are a t is su e in t his a pp e a l. 5 re c omm e nd e d p la c ingGr ane k o n a tw e lve -m on th p r o b a

t e d s us pe ns ion

wi th m on ito ri ng ; and

that th is
re c omm e nd a tio n h a d b e e n a ff ir me d in a fi na l de c isi on

of the HC A B oa

rd of Tr us te e s. The third g round for

discipline found by

the AL J related to a lleg ations that Grane k had improperly

touched the br easts of f

emale patients during the 1980s. The AL J found that Gra nek had touche d t h e breasts of two patients, J.G. and K.G., althoug h she found that Gr anek ha d acte d int e nti on a lly

on ly wi th r e g ard

to J.G
. B a se d o n h e r f a c t- fi nd ing s that Gr ane k h a d inte nti on a lly 4 tou c he d J.G .’ s b re a sts and tou c he d K .G .’ s b re a sts , th e AL J con c lud e d th a t G ra ne k h a d “ fa ile d to prac tice medicine in a

n acc eptable profe ssional ma nner consistent with public health and we lfare ,” Tex. Occ. Code Ann. § 164.051( a)( 6), and “ commit[ ted] unpro f e s s io n a l o r

d is h onorable conduct that is likely to . . . injure t h e p ublic.” Id . § § 1 64 .0 51 (a )( 1) , . 05 2( a )( 5) . T he AL J als o b a se d th e se ultimate conclusions on her c onclusions of law, de rived fr omL un sf or d , that Gra

nek’s medic al license w as a “ covena

nt to serve the pe ople of the State of Texas with all his professional skills and po we rs ” and

a “ c on tr a c t w ith the pe op le of the State of

Te xas t o a c t in

a pr of e ssi on a l and

ho no ra ble
manner .” Se e Lun sfo rd , 648 S.W .2d at 395.

Havingconclude d that the B oard had established thre e base s for imposing phy sician discipline, see Tex. Oc c. Code Ann. § 164.001(b), the AL J proce eded to make finding s of fa ct and
c o n c l u s i o n s o f

l aw r e g ar d i n g a

r e c o m m e n d e d

p e n a l ty:
20. . . . Respondent is qualified for a probated sanc tion.6

21
. B a se d o n th e fo re g oin g , th e B oa rd may su sp end Re sp on de nt’ s li c e ns e [] to prac tice medicine for t h ree y ear s but probate that suspension for a thre e-year period c onditioned on his successfully completing educational course s desig ned to e nh anc e his kn ow le dg e of pr of e ssi on a l e thi c s and

to i mpr ov e his a

bil ity to c omm un ic a te wi th p a tie nts
. 22
. B a se d o n F ind ing s o f F a c t N os . 7 0- 71 , ther e is ins uf fi c ie nt e vid e nc e to de te rm ine an a

pp ro pr iate a dmi nis tr a tiv e pe na lty a g a ins t Re sp on de nt.
I n her PF D, the AL J ex p resse d conce rn re g ardingthe stalene ss of the B oard’ s improper c ontact alleg ations, which we re ba sed on eve nts that had occ urre d as many as fif t ee n y ea rs b efor e the he ari ng . Sh e a lso inc lud e d a fi nd in g th a t “ Sta ff ’s a lle g a tio ns in t

his c a se we re sta le , th e late st complaint dating from ap p ro x imately 1994,” and f

urther e laborated in her PF D that she view ed staleness a s a mitigating f actor
. The stalene ss of [the Boar d] S taff’ s co m p l ai nts must be considered a mitigating fac tor. I t is sim ply

unfair to a ll persons involved in t h e disciplinary proce ss for complaints to lang uish for y ear s as t hey did in this case. Ove r time memories fa de or be c ome dis tor

te d, re c or ds and

wi tne sse s are los t, r

ule s and statute s a lte r, a ll a dv e rs e ly a ff e c tin g the dis c ipl ina

ry pr oc e ss. I f a

c omp la int

is i mpo rt ant eno ugh to prosec ute, it should be done in a timely fashion. Som e of the i nc ide nts that be c ame c omp la int s in thi s matte r o c c ur

re d in the late 1 980s. The most rec ent complaint was f rom 1994. Staff did not file its complaint a g a ins t Re sp on de nt u

nti l 20 00 . St a ff’s di la

tor ine ss i n p ro se c uti ngthe c omp la int s ultimately

makes the B oard’ s decision that much har der. When the public w elfa re and a pe rs on ’s pr of

e ssi on a l li ve lih oo d a

nd re putatio n a

re a t st ake , ju sti c e de lay e d is justice dim i n i s h ed
. The stalene ss of the complaints in this matter was a n injusti ce bo th t o c omp la ina

nts and Re sp on de nt. The Board’s original order of April 24, 2002

I n an orde r date d April 24, 2002, the B oar d ad o p t ed each of the A L J ’s proposed finding s of fa ct except for three that are not material to this appea l. I t a lso adopted all of the A L J ’s7

conclusions of lawmateria l to this appea l except that it rejecte d conclusions of law20 (that Gra nek “is qualified f

or a pr obated sa

n ction”) a nd 21 (that the B oard c ould suspend Gra nek’s lice nse for three y ear s conditioned on his completion of requir ed educ ation). I n lieu of conc lusions 20 and 21, the Board ordere d that Gra nek’s medical l icense be im mediately revoke d. I t provided the following four- para g raph e x planation (italics in orig inal):
T he Bo ar d o mi tte d th e ALJ ’s pr op os e d c on c lus ion s o f la w No s. 20an d 2 1 in thi s Final Order, and renumbe red the ALJ’s proposed conclusion 22 as 19 in this Final Order. The A L J’ s p roposed conc lusion of l aw No. 20 st ated: “Based on Findings of Fact Nos . 5 7- 58

, R esp on de nt i

s q ua lif ie d fo r a pr ob ate d s an c tio n. ” The ALJ’s proposed conclusion of law No. 21 stated: “Based on the foregoing, the Bo ar d m ay su sp e nd Re sp on de nt’ s li c e ns e [] to prac tic e me dic ine for thr e e ( 3) y e ar s bu t prob ate tha t su sp e ns ion for a thr e e -y e ar pe rio d c on dit ion e d o n h is s uc c essf ull y completing educ ational course s designed to enhanc e his knowledge of professional ethics and to improve his ability to communic ate with pati ents.” The ALJ’s proposed c onclusions of law Nos. 20 and 21 are not really conc lusions of lawat a ll, bu t re c om me nd e d s an c tio ns . W

hile it may be ap

pr op ria te for the ALJ

to recom mend a sanc tion, it i s u l t i mately up to the Board to dete rmine what the ap pr op ria te sa nc tio n s ho uld be

. The ALJ be lie v es the re lat iv e mi no r sa nc tio n o f a three year s uspension of

Respondent’

s license is sufficient, the Board disagreed, and c on c lud e d th at t here v oc ati on of R esp on de nt’ s li c e ns e is the on ly

sa nc tio n th at w ill adequately prote ct the public. Re spondent’s conduc t of fon d l i n g and molesting patients whil e perform i ng ophthalmologic examinations on them is not a problem that wi ll be co r r ec t ed

by additional continuing medical education as suggested by theALJ . R esp on dent ha s eng age d in thi s c on du c t ov e r a pe rio d o f m an yy e ar s. The rewas no e v ide nc e tha t R esp on de nt h as so ug ht a ny tre atm e nt for

his ina bil ity

to control his prurient de s i res, nor in fact was any evide nce adm itted that the Respondent’

s defec ts in character can betreated. The Board fee ls that t he sanction of revoc ation of Respo n d

e n t’s license is the only sanc tion that w ill adequately protect the public. The Board will not condone theRespondent’ s assaulti ng, f

ondling or molesting one other patient by under [sic] the guise of practicing medic ine by allowi ng him to retain his medical license.The c ourt explained that it enjoined the April 24 order beca use “Section 164.001 [ of the 5 occupations code] tells m e that the or der is live and ope rative unle ss it is stay ed.” 8 Gr anek’s app eal and su bsequ ent Board orders

On May 13, 2002, Gra

nek filed a motion for rehe aring of the Boa rd’s April 24 order
. On J une 10, a f

ew da y s after his moti on for r eh ea ri ng expired by operation of law, Gra

nek filed a petition for judicial re view of the Boa rd’s orde r in the Travis County district court. He also soug ht inj un c tiv e re lie f to prev e nt t he B oa rd fr om e nf

or c ingits or de r d

ur ingthe pe nd e nc y

of his administrative appe al. On June 11, the district c ourt g rante d a temporar y restra ining or der e njoining the B oa rd fr om e nf or c ing its or de r “ [p]r ov ide d, ho we ve r, that Pla int if f m us t no t tr e a t f

e ma le patie nts without an assistant prese nt.” At the TRO hear ing, the court evidently expressed concern that the B o ar d ’ s a l l e g a t i o n s a g a i n s tG r an e k w e r e s t a l e an d

t h a tr e v o c a t i o nw a s a

d i s p r o p o rt i o n a t e p e n a l ty. Th e te mpo ra

ry inj un c tio n h e ari ngre g ard ingthe Ap ri l 24 or de r w a s su bs e qu e ntl y

he ld on J une 27, 2002. At the he arin g, counsel for the B oard r ecounte d the eve nts at the TRO hea ring and re prese nted that B oard staf f “took [the district court’s] words to hear t” and ha d reque sted that the B oard r econs i d er the revoc ation sanction it had asse ssed ag ainst Grane k. Howeve r, B oard
c ouns e l e xpla ine d th at, in hi s v ie w, the B oa rd wa s w ith out juri sd ic tio n to mod if y its or de r whil e Gr ane k’ s su it f

or jud ic ia l r e vie w w a s p e nd ing
. B oa rd c ouns e l thus re qu e ste d th a t th e c ourt fo rm a lly “re mand this case back . . . for the limited purpose of them rea ssessing the penalty , not to remand the whole thing back.” Whil e not a ppear ing to oppose this mea sure, Gra nek’s c ounsel insisted that injunctive relief was necessa ry in the i nterim to preve nt the Board from enfor cingits sti ll-live order
. The trial c ourt issued a wr itten order dated August 12, 2002, enjoining t h e B o a r d from enfor cingits April 24 order, stay ing that order, a

nd setting tria l on the m erits. The c ourt furthe r 59

re mand e d th e Ap ri l 24 or de r f or “ fu rt he r p ro c e e din g s . . . lim ite d to a re c on sid e ra

tio n a nd po ssi ble f u rt h e r a c t i o nr e l a t i n g t o t h e p e n a l ty i mp o s e d a g a i n s t
. . . G r an e k ” an d o r d e r e d th a t , “ If
rec onsideration and f

urther a ction is taken,” the Boa rd wa s t o “file any

such cha ng es or de cisions with the Court.”

On re mand, the B oard r econside red its April 24 order duringa mee ting on August 16, 2002. On the same day , it issued a new “Final Order” that was subst antively identical to the B oard’ s April 24 order

except that it chang ed the sanction from immediate license revoc ation to a three -y ear probate d license suspe nsion, subject to six teen ter ms and co n d i t i o n s . The B oard’ s first condition
was “Respondent shall not e x amine or tre at patients.” A nother c ondition required Gr anek to pr ovide a copy of the orde r to all hea lth care fac iliti es whe re h e h ad or soug ht privileg es. The B oard additionally

assessed a

n administrative pena lty of $25,000, notwithstanding its undisturbed conclusion of law

19 that “ther e is insufficient e vidence to deter mine an appr opriate a dminist rative penalty ag ainst Respondent.” F inally , althoug h the Boa rd repla ced its original r evocation sanction with a three -y ear

probate d suspension, it r etained in f ull its explanation for the re vocation sanc tion from the Apr il 24 order.

On Se pte mbe r 23, 20 02 , the B oa rd iss ue d a n “ Am e nd e d F ina l O rd e r” purp or tin g to
corr ect a “ty pog raphic al er

ror” in the conditions stated in the August 16 order a n d o rd er ing that Gr ane k c ou ld n ot t

re a t fe ma le patie nts duri ng his pr ob a tio n pe ri od ; he wa s p e rm itt e d to tr e a t ma le patients. Gra

nek wa s serve d with a copy of the Ame nded Final Orde r under a cove r letter a dvising him of his right to see k rehe aringwith i n t we n t y day s of re ceipt. He did not file a motion for rehe aringspecific ally

addre ssed to this order.SeeTex. Occ. Code Ann. § 164.011( c) ( West 2004). 6 B y thi s junc tur e , un de r the lim ite d sc op e of the re mand , th e B oa

rd ha d a lr e a dy

re pla c e d it s 7 or ig ina l Apr il 2 4 o rd e r w iththe Se pte mbe r 2 3 A me nd e d F ina l O rd e r. Gr ane k a pp are ntl y so ug ht t his relief out of an a

bundance of ca

ution that the orig inal April 24 order might still be eff

ective. 10 On Octobe r 25, 2002, shortly befor e the temporar y injunction was to expi re, Gra nek 6 obtained, in his pending suit fo r judicial re view, a ne w tempora ry injunction enjoining the B oard fr om e nf or c ingits Ap ri l 24 or de r p e nd ingtr ia l on the me ri ts. 7 On Ju ly 1 8 , 2 0 0 3 , th e d is tr ic t c o urt h e ar d G r an e k ’ s a dmi n is tr a ti v e a p p e a l on the merits. On Sep t ember 4, the court r ender ed judg ment reve rsing and re manding “the a ction of the Texas State Boa

rd of M edical Ex aminers,” with appar ent re fer ence to the Boa rd’s Septembe r 23, 20 02 Am e nd e d F ina l O rd e r. Th e dis tr ic t court he ld that the $2 5, 00 0 admin istra tiv e pe na lty

c ou ld
no t be su pp or te d by the fi nd ing s and c on c lus ion s a do pte d by the B oa rd
. Spe c if

ic a lly , the pen a lty
c on tr a dic te d c on c lus ion

of law 1 9, that “th e re is i ns uf fi c ie nt e vid e nc e to d e te rm ine an a pp ro pr iate administrative pena lty

ag ainst Respondent.” The court a ffirme d the B oard’ s order in all other respe cts. On remand, the Board acce pted t he dis trict court’s judgment and opted to “take no further action re g ardingthe impositi on of any administrative pena lty ” ag ainst Grane k. Gra nek now a

ppeals the Boa

rd’s order concluding that g rounds existfor discipline
and imp os ingsanc tio ns a g a ins t hi m.
DI SCU SSIO N

Gra nek bring s five i s s u es , complaining that: (1) the B oard violate d due proc ess by
wa iti ngun til its a lle g a tio ns we re sta le and he ha d s uf fe re d a c tua l pr e

jud ic e be fo re pr os e c uti ngits disciplinary

action ag ainst him; (2) the Boa rd’s finding s of g rounds for disc ipline are not supported11

by substantial evidence ; (3) the B oard c ommitt ed an e rror of law in modifying the AL J ’s P FD to add its four-par ag raph e x planation re g ardingsanctions bec ause it conta ins unproven a s s e r ti o n s r e g a r ding Gra nek’s conduct; (4) the Boa rd commi tted an error of law and exceede d its statutory authority by p r e d i c a t i n g i t s d i s c i p l i n ar y f i n d i n g s u p o n l e g a l d

u t i e s d e r i v e d f

ro m L unsfo rd

v . B oa rd of N ur se Ex am ine rs ; and (5) the Boa rd committed an e rror

of law by

applying a

preponde ranc e of the evidenc e standa

rd, rather than c lear

and convinc ing sta

ndard, to the administrative hea ring seeking to revoke or suspend his license
. See Tex. Gov’t Code Ann. § 2001.174(2) ( West 2000).

As a pre liminary matter, the par ties dispute whether

we must addre ss and af

firm ea ch disciplinary g round found by the Boa rd in or der to a ffirm its order . As previously noted, the B oard made ultimate conc lusions of law that Gra nek’s conduct constituted three g rounds for disc ipline: (1) Gra nek’s f ailure to attend L .H. violated sec tions 164.051(a)(1) and (6) and 164.052(a )(5) of the occupations code; (2) G rane k was disciplined by HCA s o as t o constitute a g round for discipline under se ction 164.051(a) (7); and ( 3) Gra nek’s imprope r conta ct with K.G. and J .G. vi olated sec tions 16 4. 05 1( a )( 1) & (6 ) a

nd 16 4. 05 2( a )( 5) . A ny

on e of the se g ro un ds cou ld have ind e pe nd e ntl y supported the B oard’ s disciplinary action. See Te x. Oc c . Code Ann. § 164 .0 01 (b ). Th e B oa rd po int s out that where its discipli nary sanction is ba sed upon multipl e, independe ntly sufficie nt grounds, we aff irm the order if any one of the g rounds can support the sanction awa rded. Texas State Bd. of Me d. E xa m’rs v. Sc heffey , 9 49 S.W. 2d 43 1, 43 6 ( Te x. Ap p. —Aus tin 19 97 , w ri t de nie d) ; GuerreroRa mi re z v . Te x as Sta te Bd. o

f M e d. Ex am ’r

s , 867 S.W .2d 911, 918 (Tex. App.—Austin 1993, no
wr it) . Re lyingon

thi s p ri nc ipl e , th e B oa

rd c on te nd s that we sh ou ld a ff ir m its or de r if

e ve n a sin g le disciplinary

g round is leg ally

supported.Follo wi n g its ult imate conc lusions of law finding eac h g round for discipline, the order 8 states: “B ased on the fore g oing, the Boa rd should discipline Respondent.” 12 I n our orig in a l o p in io n , w e o v e r r u le d G r an e k ’ s is s u e s w it

hr e g ar d to th e tw o disciplinary g rounds relating to L .H. and pre sumed, in light of Scheffey and Guerrero-Ramirez , that
we did no t ne e d to a dd

re ss h is i ssu e s a s to the thi rd g ro un d r e latin g to imp ro pe r c on ta c t wi th p a tie nts
. On re he ari ng , G ra

ne k a sse rt s th a t, a c c or din g to i ts o rd e r, the B oa rd did no t ba se the sa

nc tio ns it assessed on e ach f

ound violation indepe ndently or alter natively , but relied on the c umulative weig ht of all three violations. He c ontends that by holding that the two grounds re lating to a bandonment 8 of L .H. supported the B oard’ s disciplinary sanctions, we imprope rly s p ec u l ated r eg ardingthe B oa rd ’s re a so nin g and

su bs tit ute d o ur jud g me nt for

that of the B oa rd . G ra ne k a lso ob se rv e s th a t, in assessing sanctions, the B oard appea red to rely primarily on its discipli nary g round that Gra

nek had improper

contac t with patients, y et we did not rev i ew t h e Bo ard’ s findings a nd conclusions supporting that important gr ound.

With out de c idi ngwh e the r w e are ne c e ssa ri ly re qu ir e d to do so , we wi ll p ro c e e d to examine eac h of the thre e disciplinary g rounds found by

the B oard.
Due pr oc e ss I n his first is s u e, Gr an ek urge s that the Boa rd violated his due pr ocess r ights by waiting over thirtee n y ear s to pr osecute its a lleg ations reg arding improper contac t w ith K.G
. and J.G. and over six y ear s to prosecute its alleg ations reg ardingL .H. and the H CA disciplinary action.13

Citi ng sever al ca ses fr o m o ther jurisdictions involving dela y s by medical or

other prof

essional d i s c i p l i n ar

y b o ar d s , G r an e k ar g u e s th a t d u e p r o c e s s b ar

r e d th e B o ar d f

r o m p r o s e c uti ng its disciplinary

action bec ause the delay

has ca used him actua l prejudice
. See A ppeal of Plantier , 494 A.2d 270 (N.H . 1985). As proof of ac tual prejudice , he cites examples f rom the re cord pur

porting to illus trate tha

t “[ e] v ery fa ct wi t n es s at th e a dm i n i s tra t i v e h ea ri n g t es t i fi edt o p ro b l em s re m em b ering the eve n t s at i s s ue” a

nd that “[t] he dela

y also ca used the loss of phy sical evide nce.” The B oard char acte rizes Grane k’s examples of allegedprejudice as out-of- context refer ence s reg arding immaterial details that stem from “D r. Gra nek’s c ounsel’s conf

using c ross examination.” The B oard further contends that e ven if its de lay did cause Gra

nek pre judice, its order

should not be reve rsed beca use the a ppropriate leg al standar d g overning Gra nek’s due-pr ocess complaint is that employ ed by the Texas Court of C ri minal Appeals with re g ard to pre -indictment delay
. Se e Ib arra v . S tate , 11 S.W .3d 189, 193 (Tex. Crim. App. 1999). This test require s a showingof both ac tual prejudice and that the State intentionally delay ed in order t o g ain a tac tical adva ntag e over

the def endant. Id
. at 193. Due proce

ss analysis of agency prosec utori al delay Claims reg ardingdeprivation of constitutional rights prese nt que stions of la w and we
a c c or din g ly

re vie w the m de novo
. State v. Hodge s , 92 S.W
. 3 d 4 8 9 , 494 (Tex. 2002). The due proce ss pr otections of our fede ral and Te x as constitution apply to ag ency proce eding s. Se e Lan gfo rd

v . Emp loy e es R e t. S

y s. , 7 3 S. W.3 d 5 60 , 5 68 (T e x. Ap p. —Aus tin 20 02 , p e t. d e nie d) ; se e als o Texas Health Facilities Comm’n v. Charter Me d.-Dallas, Inc. , 665 S.W .2d 446, 454 (Tex. 1984) (“when a denia l of due proc ess has re sulted in the prejudice of substantial rig hts of a litigant,” a g ency ’sSeeTex. P en. Code Ann. §§ 21.07 ( West 2003) (publ i c l ew d n ess, classifie d as 9 mis de me ano r) , 2 2. 01 (We st Su pp . 2 00 4- 05 ) ( a ssa

ult , c la ssi fi e d a s mi sd e me ano r) ; T e x. Cod e Cr im. Proc. ar t. 12.02 (West 2005) (two- y ear statute of limitations for misdemeanors) ; Tex. C iv. Prac. & Rem. Code §§ 16.003(a) (West 2002) (two-year statute of limitation o n civi l actions), 74.251(a ) (West Supp. 2004-05) (two-y ear statute of limitations for medical malpra ctice c laims).

14 action is arbitra

ry and capr icious even if supported by substantial evidence ); Tex. Gov’t Code Ann. § 2001.174(2)( A) (West 2000). Althoug h statutes of limitations provide the primary assura nce ag ainst prosec ution of unduly stale cl ai m s or cha

rg es, due pr ocess c an provide independe nt and additional protec tions. Se e Ib arra , 1 1 S. W.3 d at 19 3 ( du e pr oc e ss p ro vid e s so me pr ote c tio n a g a ins t undue pre- indictment de lay in mur der prosec ution, whic h has no statute of limit ations i n T exas); State v. Mc Coy , 94 S.W .3d 296, 301-02 (Tex. A pp.—Corpus Christi 2002, no pet.) (addre ssing due pr oc e ss c la im b a se d o n a lle g e d p re -i nd ic tme nt d e la y in p ro se c uti ngc ri me wi thi n a pp lic a ble limit ations period). The fac t that the leg islature has not pre scribed a limit ations period for

the Boa rd’s disciplinary proce eding s does not f orec lose Gra

nek’s due-pr ocess complaint. Se e ge ne ra lly Tex. Occ. Code Ann. §§ 164.051-.204 (West 2004) . At the same time, the f act that the B oard ma

y have d el ay ed beyond the limitations periods for crimes a nd torts compara

ble to Gra

nek’s a lleg ed acts does not in itself compel us to find a due -proc ess violation. 9 To a dd

re ss G ra ne k’ s d ue pr oc e ss c omp la int , w e mus t fir st a sc e rt a in t he a pp ro pr iate standard to a

pply . Neither

party cites any Texas case addre ssing the due-pr ocess implications of pre

pr os e c uti on

de lay s in a g e nc y dis c ipl ina

ry a c tio ns . T he B oa

rd ur g e s that we a

pp ly the te st a

pp lic a ble to d ue -p ro c e ss c om pl ain ts re g ard ingpr e -i nd ic tme nt d e lay in c ri min a l c a se s, wh ic h r e qu ir e s a sh ow ingof

bo th a c tua l pr e

jud ic e and

that th e g ov e rnme nt i nte nti on a lly de lay e d in ord er to obt a in a tac tical adva

ntag e over

the ac cused. See Un i t ed States v. Lovasc o , 431 U.S. 783, 789 (1977);15

Ib arra , 1 1 S. W.3 d at 19 3. Gr ane k r e sp on ds that th is t e st, de ri ve d in the c ri min a l c on te xt, is inappropriate for c ivil adminis trative proc eedings an dthat we should look solely to whether

the delay cause d him actual pre judice. Cf. City of Corpus Christ i v
. Public Util. Comm’n , 51 S.W .3d 231, 262-63 (Te x . 2001) (in addre ssing due proc ess claim re g ardinghear ing pr ocedur e, questioning whether proce dure c aused a ctual injury ). We ag ree with Grane k that he is not require d to show that the B oard intentionally

delay ed its prosec ution ag ainst him to obtain a tac tical adva ntag e but nee d show only

actua l prejudice
. The re quirement that c rimin a l d e f e n d a nts c o mplaining of

due proc ess violations from pre- prosec ution delay

prove intentional de lay

for tac tical adva

ntag e d e r iv e s f

r o m j u d ic ial rec og nition of the unique responsibilities and role of pr osecutors. In Lovasco , the Unit ed S tates Supreme Court
re as o n edt h at d

u e p ro ce s s w o u l d t en d

t o b e s erv ed , ra th er

th an un d erm i n ed , b y

p erm i t t i n g a pr os e c utor

to f ull y inv e sti g a te a

c ri min a l c a se “ un til he is c omp le te ly satis fi e d th a t he sh ou ld prosec ute and will be a

ble promptly

to establish guilt beyond a re asonable doubt” bef ore se eking indictment. Lovasco , 431 U. S. at 795
. Th e c ourt e mph a size d the pr of e ssi on a l dutie s o f p ro se c uto rs , the de mand s o f p ro vin g c ri min a l c ha rg e s be y on d a re a so na

ble do ub t, a

nd the de fe re nc e tr a dit ion a lly af fo rd ed prosec utorial discre tion in determining whether and how to proc eed w ith criminal prosec utions. Id . at 790-95.

These c hara cter istics of criminal prosec utions and prosecutors ar e lac king in B oard disciplinary

proce eding s. Such proce eding s are civil in nature, a nd, as we discuss below, the B oard is not required to prove its case beyond a re asonable doubt. SeeTex. Occ. Code Ann. §§ 165.001- .103 (West. 2004). Moreove r, at lea st in thi s case , there is no sugg estion that the Boa rd’s longdelayFor example, the complainant supporting certain ot her of the B oard’ s alleg ations below, 10 a patie nt n ame d P. G. , d ie d d ur ingthe pe nd ency

of the c omp la int , c ri pp lin g the B oa rd ’s a bil ity to prove those a lleg ations.

We a lso ob se rv e that, u

nd e r t he B oa rd ’s pr op os e d d

ue proces s test, it

is q ue sti on a ble 11 wh e the r d e fe nd ants c ou ld e ve r e sta bli shthat a prejudic ia l de lay by the B oa rd wa s inte nti on a lly soug ht for tac tical adva

ntag e. Te x as law shields virtually all Board investi g ative mater ials from discovery . Tex. Occ. Code Ann. § 164.007( c) & (d) ( West 2004). 16 was the le g itimate product of investig ative ef forts wa rra nted by the B oard’ s need to g ather evidenc e and prepa re sufficie ntly to pr evail. The Boa rd’s claims rested upon straig htforwa rd “s we aring matches” betwee n Gra

nek and othe r witnesses and tended to be weakened, r ather than streng thened, by the passag e of year s, as the proc eeding s befor e the AL J ultimately demonstrated. Whil e we are 10
no t se c on d- g ue ssi ng the B oa rd ’s a dmi nis tr a tiv e de c isi on s re g ard ing re so ur c e a llo c a tio n or the ha ste wi th whic h it ha s pro c e sse d disc ipl ina ry c omp la int s in

the pa st, we no te the se c ir c ums tanc e s b e c a us e they distin gu i s h the B oard’ s delay in this case fr om the prosec utorial investigative delay that underlies the due proce ss standard a rticulated in Lovasco and Ib arra . 11 Acc ording ly , in order to pr evail on his due proce ss de fense , Gra nek need only

prove that the B oard’ s delay

cause d him actual pre

judice. Th i s requires us to consider the de g ree of harmful e ffe ct from de lay that will rise to constituti onally signific ant pre

judice. The AL J expressed g rave conce rn that the B oard’ s alleg ations wer e stale. Howeve r, this doe s not mean that Gr anek’ s due proc ess rig hts were violated. Not all deter ioration in the quality of proof due to delay

constitutes
a c tua l pr e jud ic e . Th e fa c t that wi tne ss me mor ie s fa de ov e r tim e is a n inhe re nt f

e a tur e of e y e wi tne ss te sti m o n y an d m e m o r y , l i k e o t h e r

m a t t e r s b e ar i n go nth e a c c ur a c y o f a w i tn e s s ’ s p e r c e p t i o n s , is traditionally tested throug h cross-e x amination and weig hed by the fac t-finder
. In del i n ea t i n g the17

point at which ac tual prejudice arises, w e must avoid improperly encr oachi n g i n to this t raditional purview of

the fa ct-finde r. We obtain guida

nce r egarding the nature of ac tual prejudice from Te x as cr iminal
case s and administrative disciplinary decisions from other

stat es . T h e Texas Court of Criminal Appea ls has im p l i ed that “proof that exculpatory

evidenc e or w itness became unava ilable to [t he defe ndant] during the de lay ” mig h t es t ab l i sh constitutionally signific ant pre

judice. Ib arra , 11 S.W .3d at 19 3
. I n an al og ous case s from other states involving pre -prose cution delay s in ag ency disciplinary

proce eding s, those courts have applied simil ar due -proc ess standar ds, consideringthe extent to which a g ency delay has cause d witnesses to be come unavailable or the de fenda nt or other witnesses to forg et the re levant eve nts. Com pa reSib le

yv . No rth Caroli na Bd

. of Th e ra py Ex am ’r s , 566 S.E.2d 486, 488 (N.C. App. 2002) (despite over five-y ear delay , “the recor d befor e us does not
reve al that any

of the witnesse s had problems re coll ec t ing the events whic h transpire d, nor has pe tit ion e r s ho wn

tha t any wi tne ss i s n owun avai lab le, no r h a s p e tit ion e r s ho wn dif fi c ult y in
re me mbe ri ngthe e ve nts .” ); Giffone v. De Buono , 26 3 A. 2d 71 3, 71 4- 15 (N .Y
. Ap p. Di v. 19 99 ) ( in 19 9 7 ag ency

disciplinary

proce edingrelating to eve nts in 1970s and 1980s, held that defe ndant fa iled to show actua l prejudice wher e he c ould not demonstrate par ticular lost documents, witnesses, or items of evidenc e which, if available, would c ast doubt upon opposing e vidence ), and Re dd yv . S tate Bd. of Prof’l Med. Conduct , 259 A.2d 847, 848-49 (N.Y . App. Div. 1999) (no due proce ss violation wher e “pr oof of the a lleg ed misconduct wa s primarily based upon the testimony of the complaining witnesses and pe titioner, who rec alled details of the e vents with clarity”), with Appeal of Plant ier ,18

494 A.2d 270, 272-75 (N .H. 1985) (du e p ro ce s s violated by prosec ution of deca de-old a lleg ation wher e sole evidenc e was the patient’s ey ewitness testimony , and doctor and staff had no indepe ndent
rec ollection of patient’s f

ifteen- minute appointments). These courts have also looked to whethe r the rele vant eve nts were contempora neously rec orded a

nd whether the def

endant ha d ear ly

notice of the alleg ations ag ainst him. See Sibley , 566 S.E.2d at 488 (noting that in lawsuit filed t wo y ear s after
a lle g ed inci de nt, a c c us e r h a d a ns we re d inte rr og a tor ie s und e r o a th; “ c on se qu e ntl y , [th e de fe nd ant]
was a war e of the specific s of the alleg ations in the Boa rd’s notice of hear ing” two y ear s therea fter) ; Giffone , 263 A.2d at 714-15 (def endant had reta ined office notes from appointments wher e disputed
e ve nts a lle g e dly

oc c ur re d) ; Appeal of Plantier , 49 4 A. 2d a t 27 4 ( wh ile sta le a lle g a tio ns ba se d s ole ly
on c re dib ili ty

of e y e wi tne ss a c c ounts “ sig nif ic antl y inc re a se the pr ob le ms of pr oo f an d .
. . inc re a se the dang er of

false, f raudule nt, frivolous, s p ec u l at ive or unc erta in claims,” “disciplinar y actions turning on evidenc e that is documenta ry in nature are less likely to be pre judiced by

the passag e of time.”). Havingidentified the a ppropriate standard g overningour an aly sis of Grane k’s due pr oc e ss i ssu e , w e no w a

pp ly it to ea c h of the thr e e dis c ipl ina ry g ro un ds the B oa

rd pr os e c ute d a g a ins t him
. Application Improper c ontact allegations We conclude that the Boa rd vi olated due proce ss by prosec uting its alleg ations that G r an e k i mp r o p e r l y

t o u c h e d K
. G
. a f t e r a th i rt e e n - y e ar

d e l ay . W e f

i n d i ts i g n i f i c an tth a tth e A LJ19

observe d firsthand that the “ staleness of K .G.’s complaint w a s more of a disadvantag e to Respondent tha n Staff. ” Mor e ov e r, the AL J found that, at mo st, Gr ane k h a d ma de ina dv e rt e nt c on ta c t w ith K. G. —a fi nd ing that the B oa rd a do pte d— and

c re dit e d G ra

ne k’ s a sse rt ion s th a t he c ou ld n ot r e c a ll the incidents K.G. a lleg ed. The re was no evidence of any contempora

neous or pr ox imate eve nt that would have put Gr anek on notice of any complaint reg ardingcontac t with K.G. I t was undisputed that K.G. neve r m en t i oned her conce rns to Gra

nek, and the re w as no docume ntary evidenc e memorializing the incide nts she alleg ed.

Fur thermore , Gra

nek estim ated that during his care er he had handle d 250,000 patient vis its inv olv ing25 ,0 00 patie nts . We a g re e wi th th e AL J that G ra ne k “ c ou ld n ot b e e xpe c te d to
reme mber e very

arm position or contac t he maintained dur ing some six office visits [wit h K.G.], the last o f which occurr ed about f ifteen year s ag o.” F or the same rea sons, Grane k was inca pable of defe nding a g ainst a thirteen -y ear old alleg ation that, during a handf ul of these thousands of

patient visits, he un k

no win gly made accide ntal

c on ta c t w itha

patie nt’ s brea st s, e sp e c ia lly wh e re the so le evidenc e wa s the patient’s wor d ag ainst his. See A ppeal of Plantier , 4 9 4 A
. 2 d a t 2 7 2

- 7 5
. We conclude that the B oard violate d due proc ess in prosec uting suc h an alleg ation.

Howeve r, we conclude , as d i d the AL J , that “[b] eca use Respondent ha d
c on te mpo ra

ne ou s n oti c e [of

] J.G. ’s c omp la int , s ta le ne ss w a s n ot a s mu c h o f a c on c e rn a s w ithso me oth e r c omp la ina

nts .” I t is un dis pute d th a t J.G . c on fr on te d G ra ne k f oll ow ing he r fi na l patie nt v isi t in 1987, complained that he ha d touched he r inappropriately during near ly ever y one of he r patient visits, and told hi m that it made her unc omfortable. J .G. either told Gra nek, or G rane k discerne d,20

that the source of J .G.’s conce rns was his touc hing of her brea sts. Both J .G. and Gra nek re counted that Gra nek denie d that any contac t w as intentional. This is the same position that Granek a sserted b ef o re the AL J , and continues to a ssert today
. See Sibley , 5 6 6 S. E
. 2 d at 4 8 8 ( e mp h a s izing importance of ea

rly notice of a lleg ations in alleviating due proc ess conc erns)
. Fur thermor e , it

is a ls o u n d is p ute d th a t, f o ll o w in g th e c o n frontation, J.G. wrote Gra nek a letter reg arding the incident, and that Gra nek responde d by calling J .G., reiter ating that he did not deliberately

touch her , and assur ing he r that he did not wa nt her to fe el uncomfor

table. J .G. and Gra nek likewise a g ree that, within a fewmonths, J .G. filed a written complaint with the Tarrant County Medica l Society . Although J .G.’s letters and complaint are not in the administrative re cord,
we c an disce rn from testimony that the documents continued to e x ist a nd wer e not lost or destroy ed during the interve ning year s. See G iffone , 263 A.2d at 714-15 ( importance of def endant’ s retention of of fi c e no te s f

ro m di sp ute d a

pp ointme nts ); Appeal of Plantier , 494 A.2d at 274 (a cknowledg ing that disciplinary

action s b as ed o n documentar y evidenc e “a

re le ss likely

to be pre judiced by

the passag e of time” ).

Gra nek counte rs that, while he ha d notice in 1987 that J .G. believe d he had touc hed her ina ppropriate ly , she had be en vague re g ardingthe nature of his contac t. Grane k contra sts the nature of her

contempora

neous complaint with J .G.’s testimony befor e the AL J i n 2 0 0 1
. At the hear ing, J.G. testified that she had shie lded her self with mag azines to preve nt Grane k from touching her br easts, y et Gra

nek per sisted in doing so. Gra nek claims that he had neve r hea rd this version of J .G.’s alleg ations until she testified at the hearing
. He urg es t hat t he Board violated due process by21

forc ing him to def

end what he asser

ts were newly

fa b ri ca t ed al leg ations when time had f aded
mem o ri es of va

rious collater al fa cts that he c ould have use d to rebut them—such a s the identities of other hospital staff who may have been present during the alleg ed incidents, the rooms i n which the alleg ed incidents oc curr ed and the ir configuration, and whether J .G. was se ated or

laying down when the a lleg ed incidents oc curr ed.

Suc h in c on sis te nc ie s in

a c c ounts , h ow e ve r, are or din ari ly a su bje c t of c ro ssexamination, not indicia of a due proce ss violation. In fac t, Grane k did cross-e x amine J.G. reg arding inconsistencies be tween he r conte mporane ous acc ounts and her hear ing te stimony , as we ll as the detail s of her

surrounding s when the inc idents occur red. While at times confuse d or inconsistent reg ardingher sur

rounding s when the e vents in question occur red, J.G. testified in detail reg arding how Granek had touched her and r emained une quivocal as to those f acts. See R eddy , 259 A.2d at 848-49 (no due proce ss violation where c omplainant “re called de tails of the eve nts with clarity .”). We a lso e mph a size that th e AL J, the so le jud ic ia l a c tor to h ear J .G. ’s te sti mony and c ro ssexamination firsthand, found her to be a “ cre dible witness.” W e cannot conclude that the B oard’ s pr os e c uti on

of the a lle g a tio ns re latin g to J.G . v iol a te d d ue pr oc e ss. Allegations regarding J.H. We c on c lud e that th e B oa rd ’s pr os e c uti on of its tw o a lle g a tio ns re latin g to J.H . a lso did not violate d u e p ro ce s s . The AL J —the sole judicial ac tor in a position to hear the w itness’s te sti mony fi rs tha nd and a sse ss m e mor

y and oth e r f a c tor s b e ari ng on c re dib ili ty —d id n ot a

pp e ar t o reg ard the Boa

rd’s six-y ear

delay as cr eatingthe ty

pe of stale nes s p ro b l em s prese nt with the22

improper c ontact alleg ations. Grane k cites the followingas proof of ac tual prejudice : (1) two ey ewitnesses, D rs. Gre en and Rosentha l, testified based on the ir notes or medic al re cords rathe r than independe nt rec ollection; (2) Dr . Gre en testified t h a t h e “ a lm o st remember [ed] ” a le tter beingwritten to Gra nek upholdi ng his initial suspension and that Green did not re member the HCA board’ s final decision but only

“the spirit of the f

inal decision”; (3) n o wr i tten rec ord of the H CA board’ s final de c isi on surv ive d; ( 4) Dr . G re e n c ou ld n ot r e c all ce rt a in d e ta ils re g ard inghis c on ve rs a tio ns wi th Gr ane k o r D r. B ru

hl, the e me rg e nc y

ro om p hy sic ian; ( 5) Dr . Br uh l tes tif ie d that he co uld

no t r e c a ll the exact words of

his conversation with Gr anek, but “just the g ist of the conver sation,” explaining “re member, this is six y ear s ag o, and I ’m doing my best to—give a fair repr esentation of what my —I
mean a n acc urate repr esentation of what my rec all is.” We have r eviewe d the re cord a nd conclude that, when viewed in the ir proper context, none of these examples e stablish a ctual prejudi ce that could g ive rise to a due -proc ess violation.

Reg ardingDrs. Gr een a

nd Rosenthal’s relianc e on notes, at least one c ourt has pointed to the exis tence of conte mporane ously rec orded note s as a fac t o r wh ich mitigate s the potential prejudice from a sta le ag ency disciplinary

claim. See G iffone , 263 A.2d at 714. As for Dr. Gr e e n’ s te sti mony

re g ard ing

HC A’ s d isc ipl ina

ry a c tio ns a g a ins t G ra

ne k, Gr ane k h ims e lf acknow ledg ed re ceivinga private letter of r eprimand f rom the hospital reg ardinghis actions toward L .H. Fur thermore , the ref

ere nce to D r. Gre en’s relianc e on the “spirit of the final de cision” is taken somewhat out of c ontext . Gre en testified that he was pre sent when the HCA board or ally announce d its final decision, and that the de cision was to uphold Gre en ’s d i s ci plinary action ag ainst Grane k. G r an e k ’ s o th e r

a tt a c k s a g a in s t t

h e te s ti mo n y

o f D r s . G ree n and B r

uh l a r e c h ie f ly o u t- o f

- c o n te xt23

ref ere nces r eg ardingperiphe ral fa ct s ; b o t h testified re g ardingthe mater ial elements of the alleg ations. Due proc ess was satisfied. Disposition

We sustain Grane k’s first issue as to the B oard’ s al l eg ations reg ardingK.G., but otherwise ove rrule it. We consider the ef fec t of this disposi tion on our consideration of the
rema inder of G rane k’s issues. Reg ardingimproper c ontact with patients , t he B oard ma de the ultimate c onclusion of law that “[b] ased on the Finding s of Fa ct Nos. 45-56 a nd Conclusions of L aw Nos. 1 0

- 1 4 , Re s p o n d e n t v io late d § 1 6 4
. 0 5 1 ( a ) ( 1 ) an d

( 6 ) an d 1 6 4
. 0 5 2 ( a ) ( 5 )
. ” T h e r e f e r ence d finding s and conc lusions concer ned both K.G. a

nd J .G., and include d the findingthat “[o] n m o re tha n o ne oc c a sio n d

ur ingan o ff

ic e vis it, Re sp on de nt i nte nti on a lly tou c he d h is p a tie nt J.G .’ s b re a st wh e n s he tr ie d to avo id h is t ou c hin g by c ov e ri ng he r b re a sts wi th a ma g a zine .” Th is f

ind ing , if otherwise va lid, would alone support the B oard’ s ultim ate leg al conclusion that disciplinary g rounds exis ted under

sections 164.052(a )(5) an d 1 6 4.051(a) (1) a nd (6). Cf. T

exas State Bd. of M

ed. Examn’rs v. Koepsel , 322 S.W .2d 609, 6 1 1 -1 5 (Tex. 1959) (sexual assault of patients c onstitut ed “g rossly unprofe ssional or dishonorable conduct
. . . likely to dece ive or de fra

ud the public” unde r statutory prede cessor

to occupations code sec tion 164.052(a)( 5)). W e ac cording ly sustain Grane k’s first issue as it conce rns K.G.’ s alleg ations, but otherwise ove rrule it, and proce ed to consider Gra nek’s r emainingissues as they conce rn the Boa rd’s disciplinary g rounds reg arding J .G. and J.H.
Stand ard of p roof

I n his fifth i ssue, Granek urge s that the Board committ ed an error of law by utiliz ing
a pr e po nd e ra

nc e of the e vid e nc e sta

nd ard in m akin g its fa c tua l det e rm inatio ns re g ard inge a c h o f i ts24

c l a i m s . Gr an ekar gu es t h at d u e p ro ce s s re qu i re d

th e B o ar d

t o ap p l y a “ cl ea r a n d

co n v i n ci n g” standard of proof

. He r elies on what he cha rac terizes as a “ trend” in other states towa rd holding that due proc ess re quires cle ar a nd convincing ev i d ence in medical disciplinary actions. See , e.g. , Nguyen v . W

ashington , 29 P .3 d 68 9 (Was h. 20 01 ); Painter v. Abe l , 998 P.2d 931 (Wy o. 2000); J oh ns on v . B oa rd

of G ov e rn or

s , 913 P.2d 1339 (Okla. 1996). Th e re is n o T e x as aut hori ty su pp or tin g su c h a

pr op os iti on

and we have re c e ntl y reje cted a simil ar c ontention with reg ard to profe ssional licenses issued by the M otor Vehic le B oard. See Pretzer v. M

otor Vehicle Bd. , 125 S.W .3d 23, 38-39 (Te x . App.—Austin 2003), aff’d in part and

re v ’d in p ar t , 138 S. W
. 3 d 908 (Tex. 2004). We emphasized that ag ency license- revoc ation proce eding s are civil in nature , that in civil case s “[n] o doctrine is more firmly established than that issues of fa ct ar e re solved by a prepondera nce of the evidence, and that Texas applies the c lear and convincingstandard in c ivil cases only in ‘extraordinary

circ umstances,’ ” such as c ivil commit ment hear ings a

nd involuntary

termination of par ental rig hts. Id
. at 38-39 (inter nal quotations omitt ed). Fo l l o wi n g Pretzer , we c ontinue to hold that the prope r standar d of proof in ag ency

fac tual deter minations is prepondera

nce of the evidenc e. We over

rule Gr anek’ s fifth issue.
Sub stantial evidence

I n h is s e c o n d

is s u e , G r an e k

c o n te n d s th a t t

h e B o ar d ’ s f

in d in g s an d

c o n c lu s io ns
e sta bli sh ingg ro un ds fo r d isc ipl ine are no t su pp or te d b y su bs tanti a l e vid e nc e . R e l a

te dly , in his fo ur th iss u e , G r an e k c o mp la in s th a t th e B o ar d c o mm itte d an e r r o r o f la w in r e ly in g o n c oncepts of ph y sic ian d

uti e s d e ri ve d f

ro m Lun sfo rd v . Boa rd

of N ur seEx am ine rs as support for its conclusionsWe also note that there is appare ntly no Texas decision applying the Lun sfo rd dutie s to 12 phy sicians and none that specific ally apply to any other he alth service s profe ssion Lun sfo rd ’s view that a he a lthc are pr of

e ssi on a l li c e ns e is a

c ov e na nt t o s e rv e th e peo pl e of

the State of

Te xas w ith “prof essional skill and power ” or a contra ct “to alway s act in a pr ofessional a nd honorable manner .” Lun sfo rd , 648 S.W .2d at 395. 25 that di sc ipl ina

ry g ro un ds e xiste d . 64 8 S.W.2 d at 395
. Gr ane k ass e rt s th a t Lun sfo rd is i na pp lic a ble and distinguishable beca

use it a ddresse d the duties of a nurse, not phy sicians, and involved a patient appea ring at a hospital and r equesti n g as s i s tance from an on- duty nurse, whe rea s Grane k had indisputably

left the hospital and wa s not o n ca l l . I n response , the B oard doe s not dispute that Lun sfo rd is inapposite, but asserts that its ref ere nces t o the ca se did not prejudice Gra nek’s 12 substantial rig hts beca

use there was other

support for the B oard’ s conclusions of law a uthorizi ng discipline. We ag ree with the Boa rd that substantial evidenc e supports its finding s and conc lusions authorizing disci p line and that its ref ere nces to Lun sfo rd

did not prejudice G rane k’s substantial ri g hts
. When review ing an age n cy decision under

the “substantial evide nce” test, we consider the reliable and probative evidenc e in the re cord a s a whole. T ex. Gov’t Code Ann. § 2001.174(2)( E) (West 2004). We may not substit ute our judgment for that of the a g ency and may only consider the rec ord on which the ag ency based its decision. Stratton v . Au sti n In de p. Sc h. Di st. , 8 S.W .3d 26, 30 (Tex. App.—Austin 1999, no pet.). The issue befor e us is not whether the ag ency
rea ched the corr ect conclusion, but whether there is some basis in the rec ord for its action. Se e City

o f E l Pa s o v . P u b li c U

ti l. Co m m ’n , 8 8 3 S
. W .2d 179, 185 (Tex. 1994); se e als o Te x as He alt h Facilities Comm’n v. Charter Me d.-Dallas, Inc. , 665 S.W .2d 446, 452 (Tex. 1984). The crux of a26

substantial evidence analy sis is whether the a g ency ’s factual findings are rea sonable “ in light of the evidenc e from which they wer e purportedly inferr ed.” John E. Powers, Agenc y Adjudications 163 (1990). “ [S ubstantial evidenc e] does not mean a la rg e or c onsi d er able amount of evidenc e, but
rathe r ‘ su c h r e le va

nt e vid e nc e a s a

re a so na ble min d mi g ht a c c e pt a s a de qu a te to s up po rt a conclusion’ of

fac t.” Lau de rd

ale , 9 2 3 S
. W
. 2 d

at 8 3 6 (q u o t i n g Pierce v. Unde rwood , 487 U.S. 552, 56 4- 65 (1 98 8) ; Consolidat ed Edison Co. v. NLRB , 305 U.S. 197, 229 (1938)). We pre sume that the ag ency ’s finding s, infere nces, c onclusions, and dec isions are supporte d by substantial evidenc e, and t h e b u r d e nt o p r o v e o t h e r w i s e i s o nt h e a

p p e l l an t. C

h a r t er Me d ., 66 5 S. W.2 d at 45 3; Stratton , 8 S.W .3d at 30. Fina lly , the ag ency ’s dec ision should be rever sed only if the par ty challeng ing the decision demonstrates that the absence of substantial evidence has pre judiced that par

ty ’s substantial rig hts. Se e Loc k

le ar v . Te x as De p’ t of In s. , 30 S.W .3d 595, 597 (Tex. App.—Austin 2000, no pet.).
Im proper contact with J.G. We conclu d e that, even apa rt from the B oard’ s relianc e on Lun sfo rd , substantial evidenc e supports the B oard’ s findings a nd conclusions that disciplinary g rounds exis ted in reg ard to Grane k’s improper c ontact with J .G.

Gra nek conte nds that J .G.’s alleg ati ons that he touche d her br easts while she was attempting to shield herse lf with mag azines “is too incre dible to be believed.” Gra nek point s out that the episodes oc curr ed in small examini ng rooms, i n a m an n er in which the B oard’ s own expert
conce ded wa s “just logistica lly ” hard to imag ine. Gra nek adds that his me dical re cords a nd J .G.’s
a c c ount a g re e tha

t th e re wa s a

me dic a l st a ff

me mbe r in th e ro om d

ur ingso me of

the se e pis od e s.27

Finally , Gra

nek empha siz es var ious inconsistencies and c ontradictions in J .G.’s t e stimony reg arding whether and whe n a staff

member w as i n t h e room, the appea ranc e of the room, and the ty pes of examinations or procedur es Gra nek wa s conductingwhen the inc idents occur red. I n a contested case hear ing, the AL J is the sole judge of witness cr edibility and is fre e to a c c e pt o r r e

je c t th e te sti mony

of any wi tne ss o r e ve n a c c e pt “ pa rt of the te sti mony

of on e wi tne ss and disreg ard the rema inder.” Southern Union Gas Co. v

. Railroad Comm’n , 692 S.W .2d 137, 141- 42 (Tex. App.—Austin 1985, writ ref ’d n.r.e .). We are not permitted to substit ute our judg ment for th e A L J’ s r e g ar d in g th e c r e d ib il it y o f w it n e s s e s . Ford Motor Co. v. Texas De p’t of Transp. , 936 S.W .2d 427, 429-30 (Te x . App.–Austin 1996, no writ). We must resolve e videntiary ambig uities in favor of

the administrative orde r with a fi n d i n g of substantial evidenc e to support the AL J ’s decision. Railroad Comm’n of Tx. v. Torch Operating Co. , 912 S.W .2d 790, 792 (Tex. 1995).

Texas courts have rec og nized that “incre dible, perjure d, or unre asonable ” testimony is n o t s u b s ta n ti a l e v id e n ce. Firemen’ s and Policeme n’s Civil Serv. Comm’n v . Brinkmey er , 662 S.W. 2d 95 3, 95 6 ( Te x. 19 84 ). Mi nd fu l of our l imi tatio ns a s an a

pp e lla te c ourt e va luatin g a

c old
re co rdfr o ma b i rd ’s -e y e v i ew , we ca n n o t co n cl u d e th at J
. G. ’s t es t i m o n y ri s es t o th i s l ev el
. Al th o u gh
so me wh a t c on fu se d a

nd inc on sis te nt r e g ard ingthe de ta ils of he r s ur ro un di ngs wh e n th e inc ide nts
oc c ur re d, J.G. te sti fi e d une qu ivo c a lly that G ra ne k to uc he d he r br e a sts de sp ite he r a tte mpt s to sh ie ld herse lf with mag azines. The AL J hear d this testim ony firsthand, wa s able to obser ve J.G. and her demea nor, and c oncluded that “J
. G. m ade a cre dible witness.” We ca nnot second-guess such
c r e d i b i l i t y d e t e r

m i n a t i o n s i nt h e g u i s e o f

a s u b s t an t i a l

- e v i d e n c e i n qu i r

y.28

Fai lure to a tte nd L .H. As pr e vio us ly

dis c us se d, the B oa

rd c on c lud e d that Gra

ne k’ s fa ilure to atte nd

L .H . in the emer g ency

room was a

failure “t o p ra ct ice medic ine in an ac cepta ble profe ssional manner
co n s i stent with public health and we lfare ,” Te x . Occ . Code Ann. § 164.051(a )(6) , and “unprof essional or dishonora

ble conduc t that is likely to .
. . injure the public.” Id . §§ 164.051(a) (1), 164.052(a) (5). The Boa

rd base d these c onclusions upon its fac t-finding s reg ardingthe episode, a s well as other

leg al conc lusions setti ng forth the Lun sfo rd duties, wh i ch the B oard nowag ree s are inapplicable, a

nd the tort of patient a

bandonment. Gra

nek asser ts the re is not substantial evidence supporting a

finding of patient a

bandonment because , at all rele vant t imes, L .H. was under the car e of the e merg ency

room phy sician and staf

f. See King , 9 18 S .W .2 d at 11 2. We n e e d n ot a dd re ss whether Gra nek’s c onduct co n stitut ed the tort of a bandonment bec ause the re is other substantial evidenc e to support the B oard’ s ultim ate c onclusion that Grane k’s fa ilure to attend L
. H. violated sections 164.051(a )(1) & ( 6) and 164.052( a)( 5) of the oc cupations code
.

Our ultimate inquiry

is whether substan

ti a l e v id e n c e s u

p p o r ts th e B o a r d ’ s c o n c lu sions that Gra nek violated the statutory disciplinary

g rounds of “ fail[ i n g] t o prac tice medicine in an
ac ce p t ab l e p ro fe s s i o n al m an n er co n s i s t en twi thp u

b l i c h ea l than d

we l fa re ” a n d

“c o m m i t t [ i n g] unprofe ssional . . . conduct that is likely to . . . injure the public.” SeeTex. Occ. Code Ann. §§ 16 4
. 051(a) (6), .052( a)( 5). When ena cting these statutory provisions, the leg islature did not expli citly ref

ere nce tort duties or other common law conce pts. Berezowski v . Texas State Bd. of Me d. Ex am ’r s , N o. 03 -0 3- 00 73 5- CV , 2 00 4 T e x. Ap p. L EX I S 62 55 , at *2 2- 23 (T e x. Ap p. —Aus tin July 15 , 2 00 4, no pe t.) (m e mor and um o pin ion ). Whil e su c h o pe n- e nd e d s tatut or y language inv ite s it s29

ow n s e t o f p r o b l e m s , u n d e r t h e s e c i r c u m s t an c e s w e ar e r e qu i r e d , a s w i th a l l s t a tu t e s , t o a p p l y its pla in m e anin g to e ff

e c tuate the le g isl a tur e ’s int e nt. See Office of the At torney Gen. of Tex. v. Lee , 92 S.W .3d 526, 528 (Tex. 2002).

Th e re is s ub sta

nti a l e vid e nc e that Gra

ne k co mmi tte d th e se statut or y vio latio ns . F ir st, the B oa rd ’s e xpe rt , D r. Chr ist e n H e ld, te sti fi e d th a t, b a se d o n h e r r e vie w o f r e le va nt m e dic a l r e c or ds , Gra nek’s c are and tre atment of L .H. did not me et the standard of ca re a nd was a profe ssional failure to prac tice medicine consistent with t h e p u b l i c h ealth and w elfa re. SeeTex. Occ. Code Ann. § 164.051(a) (6). This testimony , which is not challeng ed on appe al, is sufficient e vidence that Gr ane k f a ile d “ to p ra c tic e me dic in e in an a c c e pta ble pr of e ssi on a l ma

nn e r c on sis te nt w ithpu

bli c health and welfa

re.” Id . Fur

thermore , beca

use patients ar e conside red me mbers of the public, as noted i n conclusion of law 10, see Koepse l , 322 S.W .2d at 611, Held’ s testimony also supports the Boa rd’s conclusion that Gra

nek committed “ unprofe ssional .
. . conduct that is likely to . . . injure the public.” Te x . Occ . Code Ann. §§ 164.051(a )(1) , .052(a) (5).
HCA di sciplinary action The B o ard’s controlling c onclusion of law that Gr anek violate d occupations code
se c tio n 1 64 .0 51 (a )( 7) is b a se d o n f a c t- fi nd ing s th a t st a te , in

re le va nt p a r t , th a t G ra ne k w a s summa

ri ly suspended by

HCA chief

of staff Dr. L arr y Gre en, Gr anek the n appea led the suspension t o an ad hoc peer revie w committee at HCA, the committee re scinded the summar y suspension but rec ommended a probated twelve- month suspension with m onitoring, a nd the HCA Boa

rd of Trustee s rende red a final dec ision affirmingthe pee r re view committee’ s rec ommendation. Gra nek first contends that30

the re is no t su

bs tanti a l e vid e nc e of the a c tio n take n by the HC A b oa

rd be c a us e the fi na l de c isi on

is missing from the hospital’s r ecor ds. We reje ct t his argument beca use Dr. G ree n testified that he wa s prese nt when the HCA boa rd ora lly announce d its decision t o af fi rm the re commendation of a p ro b at edt we l v e- m o n t hs u s p en s i o nwi thm o n i t o ri n g.

Gra nek next argues that there is not subst antial e v i d en ce o f the other elements of section 164.051(a) (7), namely , that the Boa rd found that the HCA disciplinary action “w as base d on unprofe ssional conduct . . . that wa s likely to harm the p u b l i c. ” T ex . Occ . Code Ann. § 164.051(a) (7)( A). We have alre ady conclude d th at t here is substantial evidence to support the Boa rd’s c onclusion that Grane k’s fa ilure to attend L .H. constituted “unprof essional
. . . conduct that is likely to . .
. i n j u re t h e public. Id . §§ 164.051(a) (1), .052( a)( 5). B eca use the HCA disciplinary
a c tio n w a s d ir e c te d to the same c on du c t, w e lik e wi se c on c lud e the re is s ub st ant ia l e vid e nc e to support discipline under se ction 164.051(a) (7).

We o ve rr ule Gr ane k’ s se c on d a

nd fo ur th i ssu e s.
The Boa r d’ s e xpl ana ti on r e ga r ding sa nc ti ons

Havingconclude d that the B oard’ s determination t h at i t had g rounds to discipline Gra nek pre sents no g rounds for reve rsal, we now turn to whether its a ctions in determining sanctions require reve rsal.

I n his third is s u e, Gr an ek conte nds that the Boa rd improper ly

modified the AL J ’s order by repla cing conclusions of law 20 and 21 w ith its “ridiculous four para g raph inser

t,” which Gran ek co ntends does not identify any of the pe rmissible bases under g overnme nt code se ction31

2001.058(e) and conta ins factua l assertions unsupported by the evidenc e and inc onsistent with the B oa rd ’s ow n a do pte d f

ind ing s. An ag ency may modify an AL J ’s order or chang e an AL J ’s finding of fa ct or conclusion of law

only if the ag ency

deter mines that (1) the AL J improperly applied or inter

prete d the law, a g ency

rules or policies, or prior a dminist rative de cisions; (2) the AL J based he r dec ision on a prior a dminist rative de cision that is incorrec t; or (3) a finding of fac t c ontains a technica l error
re qu ir ingc or

re c tio n. Te x. Go v’ t Cod e Ann. § 20 01 .0 58 (e ) (We st 20 00 ). Th e a g e nc y is r e qu ir e d to explain with particula

rity its specific re ason and le g al basis for e ach c hang e made
. Id. ; Levy v . Texas Sta te Bd . o f M e d. Ex am ’r

s , 966 S.W .2d 813, 815-16 (Te x . App.—Austin 1998, no pet.). Th e B oa rd re sp on ds that sec tio n 200 1. 15 8( e ) is not imp lic ate d for tw o r e a so ns . F ir st, the B oard a

rgues that an AL J ’s rec ommendation reg arding penalties is not the ty pe of finding of fa ct
or conc lusion of law that is presumptively binding on the B oard. S e e B r in k emy er , 6 6 2 S.W .2d at 95 6; Fay-R ay Corp. v. Texas Alc oholic Bev erage Comm’n , 9 5 9 S
. W
. 2 d 3 6 2 , 3 6 8 ( T e x. App.—Austin 1998, no writ). S econd, the Boa rd urge s that Grane k waived his rig ht to complain of the B oard’ s compliance with section 2001.058(e) by failing to file a motion for re hear ing a fter the Boa rd issued its September 23 Amended Final Orde r. F inally , the B oard c ontends that Gra nek wa s
no t pr e jud ic e d b y

the re mov a l of

the tw o c on c lus ion s o f l aw b e c a us e it s ub se qu e ntl y

mod if ie d it s
san c t i o n s t o a

t h r e e - y e ar

p r o b a t e d s u s p e n s i o n , w h i c hi tc h ar a c t e r i z e s a s e s s e n t i a l l y t h e sa me sanctions that the AL J had re commended.

We conclude that section 2001.158(e) is implicated by the Boa rd’s actions. Gra

nek prese rved his ri gh t to complain of the B oard’ s expl anation by filing a motion for rehe aringto theGra nek did not oppose the rema nd prec eding the September 23 Amended F inal Orde r, and 13 the re mand

wa s li mit e d sole ly

to “ a re c on sid e ratio n a

nd po ssi ble fu

rt he r a c tio n r e latin g to t

he pe na lty imposed.” Beca

use Gra nek complains not of the pe nalty imposed in the Amended F inal Orde r, but of the Boa

rd’s inclusion of its ex planation for its orig inal revoc ation sanction, he pr eser ved er ror by raisingthe complaint in his moti on for r ehea ring of the Apr il 24 order. 32 Boa rd’s orig inal April 24 order
. We ag ree with the Boa rd that it is not re q u i re dto give 13 presumptively binding eff ect to a n AL J ’s rec ommendations reg arding sanctions in the same manne r as with other findings of fact a nd conclusions of law . Howeve r, the B oard none theless provided a “spec ific re ason and le g al basis” f or its rejec tion of proposed c onclusions of law 20 and 21 and the sanctions the AL J had re commended. T he B oard e x plained that “[t]he AL J ’s proposed conclusions of law a re not re ally

conclusions of lawat all, but rec ommended sanc tions. W h i le it may be appropr iate for

the AL J to rec ommend a sanction, it is ultimately up to the Boa rd to de termine what the appr opriate sa

nction should be.” The Boa rd we nt on t o “conc lud[ e] that the revoc ation of Re sp on de nt’ s li c e ns e is the on ly sanc tio n that will a de qu a te ly pr ote c t th e pu

bli c ” and , a s p re vio us ly
n o t e d , t o e l a

b o r a t e a ts o m e l e n g t hr e g ar d i n g i t s r e a s o n s f o r i mp o s i n g th a tp e n a l ty. I n its ex planation, the B oard r epre sented that Gr anek ha d eng ag ed in t he “c onduct of fondling and molestin g p at i en ts while perf orming ophthalmologic e x aminations on them,” had “eng ag ed in this conduct over a period of many y ear s,” had “an inability to con t ro l h i s p rurient desires,” and “de fec ts in chara cter ,” and w ould continue “a ssaulting, f ond ling or

molesting . . . patient[s] . . . under the g uise of practicingmedicine” if allowed to re tain his medical license . None
o f t h e s e r e p r e s e n t a t i o n s ar e s u p p o rt e d b y t h e B o ar d ’ s f

i n d i n g s , an d

s e v e r a l ar e f

l a t l y c o n tr a d i c t o r

y. The B oard e stablished that Gra nek int entionally touched the br east of only one patient, J.G.; proved33

only that he had ina dv e rte ntl

ytouched the br east of K .G., a c laim we have found is barr ed by due pr oc e ss; and

fa ile d to pr ov e any

oth e r a lle g a tio ns of

thi s n a tur e re g ardin g o the r p a tie nts
. Fur thermore , t h er e i s n o evidenc e that Gr anek “ eng ag ed in this conduct over a per iod of many y ear s”; J .G. t estified to, at most, a three to four y ear period duringthe 1980s in which the touching episodes occ urre d, the l ast of which was in 1987. The B oard’ s own finding s state that Gra nek had chang ed his behavior since 1994 a nd “wa s not shown to constitute a continuing threat to the public.” The g rava men of the B oard’ s ex p l anation is that it imposed its orig inal revoc ation sanction base d on its own opinions reg ardingimproper c ontact alleg ations that had not been pr oved. Whate ve r i ts o ri g ina l im pli c a tio ns , th e B oa

rd su g g e sts that th e c on tin ue d in c lus ion

of thi s explanation in it s order s does not prejudice Gra nek’s substantial rig hts beca use it ref ers to a sanction that the B oard no long er se eks. We disag ree .

Th e B oa rd ’s or de r n owre qu ir e s G ra ne k to pro vid e a c op y

of the or de r t o a ll h e a lth
c are fa c ili tie s w he re he ha d o r s ou g ht p ri vil e g e s. In o the r w or ds , G ra ne k mu st p ro vid e to t

he se instit utions a document conta inin g u n p roven a ssertions that he had “ fondl[ed] and molest[ed] patients while per f

o r mi n g o p hth a lm o lo g ic e xa

minations on them,” had “e ng ag ed in this conduct over a per iod o f m an y

y ear s,” and w as a c ontinuing thre at due to his “inability to control his prurient desires.” These statements wer e included in a Boa rd orde r, g iv i n g them the imprimatur of a leg itimate adjudicative de termination. We can f athom no leg itimate basis for the B oard to include these a ssertions i n i t s order , espec ially wher e it now no long er se eks to impose the re vocation sanction to which the e x planation was a ddresse d. We hold that t h e Bo ar d ’s explanation violates34

section 2001.058(e) and is arbitra ry and ca pricious. See Te x. Go v’ t Cod e Ann. § 2 00 1. 17 4( 2) (We st 2000). We sustain Grane k’s third issue.
CO NC LU SION

Although w e conc lude that the B oard w as bar red by due proc ess from pr osecuting it s t h i r t e e n ye a r - o l d a l l e g a t i on s r e g ard ingK. G. , it s u lti mate c on c lus ion that di sc ipl ina

ry g ro un ds e xist for Gr anek’ s improper c ontact with p a ti e nts is nonetheless supported by its findings, conc lusions and evidenc e reg arding J .G. We also overr ule Gra nek’s issues c oncer

ning the two disciplinary

g rounds relating to L .H. However, we find arbitrary and ca pricious the B oard’ s four-pa ragraph e x planation g rounding sanctions on unproven asser tions of his “ fondling and molesting patients
. . . over ma ny y ear s” and unc ontrollable “pr urient desire s.” These portions of the B oard’ s order v i o l at e sec tion 2001.058(e)
. SeeTex. Gov’t Code Ann. § 2001.058(e)
.

W e r ev er s e t h e f

o u r- p ar agr ap hex p l an at i o nan d re m an d fo r f urt h er p ro ce ed i n gs consistent with this opi nion. Se e id . We affir m the Boa

rd’s orde r in all other r espec ts.

Bob Pembe rton, J ustice Be fore J ustices Kidd, B . A. Smith and Pemberton; J ustice Kidd Not Participating Affir med in Part; Reverse d and Remande d in Part Filed: August 3, 2005