T hi s ca s e w as tr an s ferred from the T hi rd C ou rt o f A pp ea l s to t he T hi rt ee nth C ou rt of A pp ea l s as pa rt 1 o f th e T e x a s S u p re m e C o u rt's d o c k e t e q u a l i za ti o n p ro g ra m . See T EX
. G OV ' T C OD E A NN
. § 73. 001 ( Ver non 2005)

. W e m ust deci de t he ca se i n acco r dance wi t h t he p r eceden t of t he t r ansf er or cour t und er pr i nci pl es ofst ar e deci si s i fourdeci si on o t her wi se woul d ha v e be en i nconsi st ent wi t h t he p r eceden t of t he t r ansf er or c o u rt. See T EX
. R. A PP
. P. 41. 3. W e ar e not , howev er , awar e ofanyconf l i ct bet ween t he p r eceden t of t he A u s ti n c o u rt a n d th e p re c e d e n t o f th i s C o u rt o n a n y i s s u e re l e v a n t i n th i s a p p e a l

. S e e id

. 

### NUM BER 13-06- 0054 7-CV 

## COURT OF A PP EA LS T H I R T E E N T H D I S T R I C T O F T E X AS C O R P U S C H R IS T I - 

## EDI NBURG
TE XAS STA

TE B OA RD OF D ENTA L EXA M INER S, A pp ellan t,
v . M ISTY J. BR OWN , D .D.S., A pp ellee.

On ap pe al f rom th e 1 26t h Dist rict C ou rt of T rav is C ou nty , T exas . 

## O P I N I O N Be fo re C hie f J us tice Vald ez an d Ju stice s R od rigu ez an d Be na v ide s

Op inio n by

Ju stice R od rigu ez This is a n appea l from a di str ict c our t' s rev ersal of a s anct ion s o rd er i n a c ontes ted case h earing und er the T exas Adm inistrative Procedu re Act (APA). See gen erally T EX . 1M i st y J. Br own, D

. D

. S. , was pr ev i ou s l y m ar r i ed a nd known as D r . St aff el

. Bot h na m es ar e use d 2 t hr ougho ut t he r ecor d. For ease of r ef er ence we wi l l r ef er t o ap pel l ant as D r . Br own.

2 G OV ' T C OD E A NN . §§ 2001 .001- .902 (V er non 200 8) ; see als o id. § 2 0 0 1

. 0 0 3 ( d e fi n ing

" c o n t e s t e d c a s e " a s " a p ro c e e d i n g . . . in w h i c h t h e l e g a l r i g h t s , d u t i e s , o r p r i v i l e g e s o f a party are to be de term ined by a state agency af ter an oppo rtunity for adjud icative hearing"). By ei g ht i ss ues, appel lan t, the Tex as Stat e Board of Dent al Ex aminers ( Board) , c ontends that it , notthe Admin is trati v e Law Ju dg e ( AL J), has the a uthor ity to deter mine w hether sanct ions s h o u ld be imp osed against app ellee, Misty J. Brow n, D.D.S.; thatthere is 2 subs tanti al ev ide nce to s uppor t the Board' s f ind ing s and the rest it uti on ordered; and, t hat the B oard proper ly

del eted cer

tai n of the ALJ' s fin din g s o f factand conc lus ion s o f law and
articu la te d i ts re asons for d oin g so . By one is sue on c ro ss appeal , D r. Brow n c ontends tha t the doctrine of

res judicata app lies. W e reverse and rend er.

I. Bac kg ro und On A pr il 29, 2003, Dr . Brow n's dent al li cens e w as temporar il y su spend ed by

order of the Boa rd 's Ex ecut iv e C ommitt ee. On J une 20, 2003, the Board and Dr . Brow n ent ered int o an ag re ed s ettl ement order ( ASO) to re sol v e iss ues in di sput e at that ti me. The ASO impos ed a ten- y ear

su spens ion per iod , probated ex ceptfor tw o s e p a ra te four-mont h per iod s dur ing w hic h ti me Dr

. Brow n w as not t o pract ic e dent is tr y , and as ses sed $10,000 in fines. I t req uired, a mong othe r thi ng s, tha t Br o w n par ti ci pate in a mentor ing and monit or ing prog ra m w it h a d enti st approv ed by the Board Secretar

y and that she p a rt ic ip a t e in t h e T e xa s De n t a l P e e r A s s is t a n c e P ro gr a m . Ita ls o p r o vid e d t h a tif B ro wn v iol ated any

of the t er ms of the ASO, the Board w oul d ini ti ate p ro ceedi ng s t o rev oke her li cens e.3

On O cto ber

16, 2003, the B oard filed a compl ain t ag ain st Dr . Brow n w it h the Sta te Off ic e of Admini strati v e H ear ing s ( SOAH ). See T EX . G OV ' T C OD E A NN . § 2003. 021 ( Ver non 2008)

. On M a y 18, 200 4, t he Boa rd fil ed an amended c omplai nt as ser ti ng that , among other thi ng s, Dr . Brow n v iol ated the ASO by (1 ) per forming dent al act s o n pat ien t C .R . on or aboutJu ne 3, 2003, w hil e her li cens e w as sus pended; ( 2) recei v ing remunerati on from denti str y w hil e her li cens e w as sus pended; ( 3) fail ing to par ti ci pate in a mentor ing prog ra m w it h an approv ed l ic ensed dent is t; and ( 4 ) f a ili n g to par ti ci pate in the B oard's peer ass is tanc e prog ra m p ro to col s, inc lud ing the si g nin g of a par ti ci pati on and monit or ing agreem ent . Th e Boa rd also compla ined tha t Dr. Brow n (1) condu cted herself dishon orab ly tow ard E. B., a mi nor

de n tal pati ent, and A. B., the mi nor pati ent' s mot her ; ( 2) fail ed to
ma ke, kee p, an d ma intain den tal records on E .B.; a nd (3) a llow ed her assista nts to perform non -delegab le den tal w ork on T .M. After a three- day cont est ed tr ial , conv ened by the SOAH w it h an ALJ presi din g , see id. § 200 3.0 42 (Ve rnon 200 8), the ALJ recom me nde d, in her Propo sal for Decision (PFD), that Dr . Brow n not be subj ect ed to anyaddi ti onal sa nct ion s. See id . § 2003.04 2( 6)

. The ALJ based her

recommendat ion on t he foll ow ing rele v ant c oncl usi ons that w ere, in tur n, based on h er

findi ng s o f factnot re ci ted h ere: 4. Base d on the f indings of fact, while her license w as s u s p e n d ed, Dr. Brow n di d notpract ic e dent is tr y nor recei v e remunera ti o n f ro m the pract ic e of denti str

y , as the p ra cti ce of denti str y i s d efined i n T EX . O CC
. C ODE ch . 259 et s eq . 5

. Ba s e d o n t h e fi n d i n g s o f fa c t , D r . B ro w n d i d n o t v i o l a t e t h e ter ms of her Agreed Se ttlem entOrder. 6

. B a s e d o n t h e f in d in gs o f fa c t , [ t h e B o a rd ] S t a f

f p re ve n t e d Dr

. B ro wn from co mply ing w it h the ter ms of her Ag re ed Settl ement O rd er . . . .4

7. Base d on the f ind ing s o f fact , D r. Brow n fail ed to ke ep adeq uate d e n tal records on one pati ent i n v iol ati on of 22 T EX . A D M IN . C OD E § 108.8. 8. Base d on the findi ng s of fact , Dr

. Brow n did not v iol ate the mi nimum sta ndard of care w it h r e sp e ct to t he treatment of T.M.' s t eeth under T EX . O CC
. C OD E ch. 258, and 22 T EX . A D M IN . C OD E § 108. 7. 9. Base d on the fin din g s o f fact , D r. Brow n i mpermi ss ibl y del eg ated d e n t a l w o r kt o a n o n - d e n t i s ti n o n e i n s t a n c e , i n v i o l a t i o n o f T EX . O CC
. C OD E §§ 259.001 , 259 .008( 3) , 22 T EX . A D M IN . C OD E §§ 108 .1(3), 114.1.

. . . 11. Base d on the f indings of fact, Dr. Brow n did no t com mit dish ono rable condu ct under

22 T EX . A D M IN . C OD E §108.9.

. . . 13. Base d on the fin din g s o f factand conc lus ion s o f law , t he ALJ finds that no s anct ion s s houl d be impos ed ag a ins t D r. Brow n for the v iol ati ons in thi s c ase. At a publ icmeeti ng , after co nsi der ing the PFD , t he Boa rd dec li ned t o ac ceptthe ALJ's recom me nda tion

. T h e B o ard de leted some ALJ f indings and disregarded ot hers. It als o deleted ALJ concl usi ons of law 4, 5, 6, 10, and 13. And, in it s fin al order si g ned M ay 9, 20 05, t he Boa rd i mposed addi ti onal sa nct ion s. By i ts order , t he Board sus pended the dental l ic ense of Dr . Brow n for fifteen y ears, probated for th e ent ire per iod , a ss e ssed a $20,000 admi nis trati v e f ine , and ordered rest it uti on to one pati ent i n the amount of $1,805. The Board ag ain ordered Dr . Brow n to par ti ci pate in a desig nated peer assi sta nce prog ra m for the d uratio n of

the Bo ard's orde r. Dr . Brow n s oug ht j udi ci al re v iew i n di str ict c our

t. See T EX . G OV ' T C OD E A NN . § 2001.17 1; T EX . O CC
. C OD E A NN . § 2 6 3

. 0 0 9 (V e r n o n 2 0 0 4 ) ( " Ap e rs o n a ggr ie ve d b y a deci si on of the board under thi s c hapter

i s e nti tl ed to appeal a s p ro v ide d by C hapter 2001,5

Gov er nment C ode.")

. Uph old ing the ALJ' s PFD , the dist ri ct cour t rev ersed and remanded the B oard's order

. The Board appea ls fro m the final j udg ment of the dis tr ict c our t. See T EX . G OV ' T C OD E A NN . § 2001. 145. II. Au thor ity

to Sanc ti on By its f irst an d secon d issues, the B oard gen erallyco nte nds tha t it, not th e ALJ, is the ulti m a t e d ecision m aker con cerning sanctio ns, even w hen the AL J's disciplinary
recom me nda tion is set ou t as a con clusion o f law rathe r tha n as a recom me nda tion. It also argues tha t section 2 001 .05 8(e) is n ot imp licated in t his case, b ut if it is, the Bo ard ap pea rs to arg ue th at i t c ompli ed w it h t h e r e quirement s t o prov ide a "s peci fic reason and leg al basi s" for

the chang e. See i

d. § 20 01. 058 (e). A. Ag ency

or ALJ "[T]he c hoi ce of penalty i s v est ed i n the ag ency , noti n the co urts. " S e a rsv. Tex. Sta te Bd . of Dental Exam'r s , 759 S.W .2d 7 48, 7 51 ( Tex

. App.–A ust in 1988, no pet ). "The ag ency i s c harg ed by

l aw w it h di sc re ti on to fix

the penal ty w hen i t det er mines thatthe sta tute has been v iol ated. " Id. (cit in g Firem en's & Po licem en's Civil Serv. Com m 'n v. Br ink m eyer , 6 6 2 S

. W

. 2 d 9 5 3 , 9 5 6 ( T e x. 1 9 8 4 ))

. T h u s , t h e B o a rd " is n o tr e qu ir e d t o gi ve pres um pt i v el y

b i nd i ng e ffec t t o an ALJ ' s re c om me nd at i on re g ardi ng sa nc ti on s i n th e s am e ma n n e r a s w i t h o t h e r

fi n d i n g s o f fa c ta n d c o n c l u s i o ns of law ." Gr anek v. Tex. St

ate B d. of Med. Exam 'rs , 172 S .W .3d 7 61, 7 81 (Te x . App .–A ustin 200 5, pet

. den ied). Th e me re lab eli ng of a recommended sancti on as a c oncl usi on of l aw or as a find ing of fact does not chang e the effectof the A LJ' s recommendat ion

. See i d. Therefore, w e a g re e tha t t he Board, no t t he ALJ , i s t he dec is ion maker co ncer nin g sa nct ion s i n thi s c ase.6

The Board al so note s that al thoug h s ect ion 2001. 058( f) prov ide s t hat a st ate ag ency , by

r ule , may

g ra nt au thor ity

to the ALJ to render

a fina l deci si on, see T EX . G OV ' T . C OD E A NN . § 2001.05 8( f), the Board has promulg ated no s uch ru le. Therefore, itco ntends that secti on 2001.05 8( f) prov ide s n o bas is for t he ALJ to hav e been g iv en final -d eci si onma k i n g a u t h o r i t y

re g a rd i n g s a n cti ons i n t h i s c a s e . W e a g re e t h a ts e c t i o n 2 0 0 1

. 0 5 8 ( f) prov ide s n o s uch basi s i n thi s c ase. B. Sect ion 2001. 058( e) Impl ic ated The Board al so ass erts, i n i ts firs t tw o i ss ues, thati t w as not req uired to jus ti fy w hy itdi sreg arded t he ALJ 's penal ty reco m m e n d a ti on. It arg ues that becau se the
re c o mm e n d a t i o n w a s n o t a c o n c l u s i o n o f l a w , t h e a g e n c y s h o u l d n o t h a v e t o j ust ifyi ts alt erati on of the ALJ' s recommendat ion under se cti o n 2 0 0 1 .058(e) , es peci all y w hen t he ag ency has not promulg ated a ru le under se cti on 2001 .058( f). See T EX . G OV ' T C OD E A NN . § 2001. 058( e) , ( f). Und er the facts of this ca se, w e di sag re e. Sect ion 20 01. 058 (e) permits a sta te agen cy to chan ge a n ALJ's f inding of fact or a conc lus ion of

law or v acat e or

modi fy an ALJ 's order

w hen t he ag ency

dete rmi nes that (1 ) the A LJ improper ly

appl ied or

i nter preted appl ic abl e l aw , ag ency ru les or pol ic ies , a w ri tten sta tement of appli cabl e r u le s o r pol ic ies , or pr ior admi nis trati v e dec is ion s; (2 ) the A LJ based her

dec is ion on a pri or

admi nis trati v e dec is ion thati s i ncor re ct or sh oul d be chang ed; o r (3 ) a findi ng of fact contai ns a techni cal error that s houl d be chang ed. Id. § 2001.05 8( e) ; s ee 22 T EX . A D M IN . C OD E A NN . § 107. 51( a) ( 2008) ( Stat e Bd. of Den tal Exam'rs, Findings of

Fact and Conclusion s of Law) . W hen doing so, "[t ]he agency shall sta te i n w ri ti ng the spec ificreason and leg al basi s for a c hang e under

thi s s ubsecti on."7

T EX . G OV ' T C OD E A NN . § 2001.05 8( e) ; see 22 T EX . A D M IN . C OD E A NN . § 107. 51( b) ( 2008) (State Bd. of

Denta l Ex am 'rs, Findings of Fact and Conclusion s of Law)

. In Grane k v. Te xas Sta te Boa rd of Medical Exa m iners , the Board rejected the AL J's
re commended penal ty

thatw as setout as tw o s eparate c oncl usi ons of l aw . 172 S.W .3d at 78 1. Beca use the B oard r eje cte d the recommendat ion , t he Aus ti n c our t c oncl uded
secti on 2001 .058( e) w as impl ic ated . Id.; see Pierce v. Tex. RacingCom m 'n , 212 S.W .3d 745, 752 ( Tex . Ap p.–Aus ti n 2006, pet. deni ed) (h old ing that w hen the c ommis si on modi fied the ALJ's pen alty recom me nda tion it com plied wi th sect ion 20 01 .05 8(e) by expressly set ti ng forth i n i ts final order the re asons and leg al basi s for i ts modific ati on; e x pla ini ng "that the A LJ had f a ile d to proper ly appl y or i nter pret ap pli cabl e l aw , ag ency r ule s, and
w ritten po licie s b e cause her recom me nda tion was inconsisten t w ith the comm ission's precede nt reg ardin g the enforc ement pol icy and g uid eli nes") ; see als o Gr otti v. T ex. Sta te Bd. of Medical Exa m 'rs , No

. 0 3 -0 4 -0 0 6 1 2 -C V , 2 0 0 5 T e x. A p p . L E XI S 8 2 7 9 , *2 6 -3 1 (T e x. App.–A ust in Oct . 6, 2 0 0 5 , n o pet.) ( mem. op.) ( conc lud ing thatthe Board c ompli ed w it h
secti on 2001 .058( e) by st ati ng the spec ific re ason and l eg al basi s for el imi nati ng a find ing of factch aract er iz ed as a s anct ion recommendat ion ; ex pla ini ng thatthe re commendat ion
w as too l eni ent t o effect iv ely puni sh the d oct or

for s uffocat ing a p a ti e nt ev en th oug h the pat ient was in the proce ss of dy ing). In t h e p re s e n t case, the AL J chose to set ou t her san ction reco mm end ation as a c o n c l u s i o n o f

l a w . S h e i d e n t i f i e d i ta s s u c h

. T h e B o a rd r ej e c t e d t h e c o n c l u s i o n o f l a w . W e conc lud e, therefore, as did the cour t i n Gr anek , that by

the Board's ac ti ons in dis re g ardin g the A LJ' s c oncl usi on of law thatse t outher

penal ty recommendat ion , s ect ion 2001. 058( e)W e do not det er m i ne, und er t he f act s oft hi s case, w het her2001. 058( e) i s i m pl i cat ed when t he Boar d 3 r ej ec t s an AL J' s di sc i pl i na r y r ec om m en da t i on t ha t i s no t s et o ut a s a co nc l us i on o fl aw .

W e no t e t hat , i n i t s br i ef , t he Boar d st at es t hat " D r . Br own cor r ect l y poi nt s out t hat t he Boar d di d no t 4

' di s c us s ' i n i t s F i na l O rde r wh y i t di s ag ree d w i t h t h e A LJ ' s pe na l t y rec om m en da t i on . " H ow eve r, t he B oa rd pr ov i ded wr i t t en r easons and a l eg al basi s f or i t s deci si on t o de l et e t he ALJ' s concl usi on o fl aw r egar di ng s a n c tio n s a n d e x te n s iv e ly a r g u e s , o n a p p e a l, th a t it h a d s u p p o r t f o r its d e c is io n to d is r e g a r d th e A L J 's r ecom m endat i on. W e, t her ef or e, do not consi dert hi s st at em ent as a con cessi on o n t he p ar t of t he Boar d. 8 is i mpli cat ed. See T EX . G OV ' T C OD E A NN . § 2001.05 8( e)

. And, w e are notpersuade d by

3 the Bo a rd 's arg ument t hat o nly w hen a ru le has been promulg ated under se cti on 200 1 .058( f) s houl d the Board be re q uired to j ust ify w hy i t di sag re ed w it h the
re comme n d a ti on. The Board prov ide s u s w it h no author ity , and w e find none, that suppo rt s t his as ser

ti on. C. C ompli ance w it h Secti on 2001 .058( e) Hav ing co ncl uded t hat 2 0 01.058( e) i s i mpli cat ed i n thi s c ase, w e must , t herefore, deter mine w hether

the Board compli ed byprov idi ng a spec ificreaso n and leg al basi s for
re jecti ng the A LJ' s s anct ion recommendat ion

. See i d. The B oard as ser

ts, throug hout it s firs t and second is sues , that becaus e the ALJ found thatD r. Brow n had tw o v iol ati ons of law and the B oard adopt ed th ose v iol ati ons in it s fin al order , t he B o a rd h a d a u thori ty to chan ge the AL J's recomm end ation o f n o pen alties. Dr. Brow n respo nds th at th e Boa rd
canno t c hang e the ALJ 's co ncl usi on of l aw reg ardin g sa nct ion s w it hout re ferenc ing the findi ng s o n w hic h i t is base d. From these arg uments , Dr . Brow n is apparentl y arg uin g that the Board did notcom p ly with section 200 1.0 58(e ), w hile the Board is conten ding it did
c o m p ly. 4 In Gr anek , al thoug h the co urt ul ti matel y co n cluded that a por ti on of the medic al board's ex pla nati on v iol ated secti on 2001 .058( e ) b e caus e i t w as based on u nprov en allegation s and w as arbitrary and capriciou s, the court conclude d tha t the med ical boa rdT he Boar d' s di sci pl i nar y det er m i nat i on was based on t he f ol l owi ng f i ndi ngs o ff act and concl usi ons 5 ofl aw m ade by t he Boar d:

BD [ FO F] 3 ALJ Fi ndi ng of Fact N o. 11 l acks a m i ni m al basi s of r at i onal i t y i n l i ght oft he

ev i dent i ar y r ecor d. [ D r . Br own] i s t he so l e sha r ehol de r o f t he st ock i n he r de ntal co rpo rat i on . D uri ng he r su s pe ns i on , [ D r. B row n] hi red t em po rary dent i st s t o pr act i ce de nt i st r y and r ecei v ed t he pr oceeds ofi nsur ance f unds f r om t he t em por ar y den t i st ' s pr act i ce of den t i st r y . [ D r . B r own] v i ol at ed t he t er m s of her ( AS O ) by pr act i ci ng d ent i st r y whi l e he r l i cense was suspen ded.

. . . B D [F O F ] 6 D r . B r o w n 's e m p lo ym e n t o f te m p o r a r y d e n tis ts to w o r k in h e r p r a c tic e w h ile

herl i cense was act i v el y suspended was an at t em pt t o ci r cum v ent an or der o f th e [B o a rd ]. B D [F O F ] 7 D r . B r o w n 's e m p lo ym e n t o f te m p o r a r y d e n tis ts to w o r k in h e r p r a c tic e w h ile

h e r lic e n s e w a s a c tiv e ly s u s p e n d e d w a s a f a ilu r e to e x e r c is e r e a s o n a b le d ilig e n c e to p r e v e n t p a r tn e r s , a s s o c ia te s o r e m p lo ye e s f r o m e n g a g in g in conduct t hat supp or t ed t he p r act i ce of den t i st r y wi t hout a l i cense. 9 did prov ide a "' spec ificreason and leg al basi s' for i ts re jecti on of .

. . the sancti ons the A LJ had recommended. " Id. at 781- 82. The medic al board i n Gr anek explained tha t the ALJ's prop osed conclusio ns of law w ere no t conclu sions bu t recom me nde d san ctions a nd while the A LJ mayrecommend a s anct ion , it is up to the medic al board to deter mine appropr iat e sancti ons. Id. at 781

. T he med ical boa rd conclu ded tha t rev ocat ion of Grane k's license
w as the o nly

sa nct ion thatw oul d protec t t he publ icand ela borated re g ardin g i ts re asons for i mposi ng thatpenal ty

. Id. In this case, the ALJ' s conc lus ion of law 13 prov ide d the foll ow ing : "[b]as ed on the findi ng s of fact and conc lus ion s o f law , t he ALJ finds thatno s anct ion s s houl d be impos ed agai n s tD r. B row n for the violations in th is case." The Board disagreed w ith the ALJ's
sancti on reco mmendati on and re jected i t. In it s w ri tten re asons and leg al bases for d e le ti n g th e AL J' s co n clu sio n of la w 1 3 , t h e Bo a rd st a te d th e fo llo wing: The Board bel iev es that dis ci pli nar y ac ti on i s w ar ra nted in thi s matter bas ed s o le ly u p o n t h e fo ll o win g F in d in gs o f Fa c ta n d Co n c lu s io n s o f L a w: 1

. [Bo a rd ] F i n d i n g o f F a c t N o s . 3 , 6 , 7 a n d 9 , a n d C o n c l u si on of Law Nos . 1, 2, 3, 4, 5 an d 6[ ] .

. . . [and ] 5. . . B D [ F O F ] 9 D r . B ro w n ' s o ffe r t o s h o w E

. B

. , a s e ve n t e e n -y e a r o l d g i rl , a n d A

. B

. , E .B .'s

m ot her , t he sca r s on herbr east s f r om sur ger y w as no t app r opr i at e an d c o n s ti tu te s d i s h o n o ra b l e a n d u n p ro fe s s i o n a l c o n d u c t.

. . . B D [ C 0L ] 1 B as ed up on fi nd i ng of fac t N o. 3 an d A LJ fi nd i ng s of fac t N os . 9 an d 10 , D r.

Br own pr act i ced d ent i st r y dur i ng h er per i od o fsuspe nsi on, as t he p r act i ce of d en t i s t ry i s de fi ne d b y T E X

. O C C

. C O D E § 2 51

. 00 3 (a)(4). B D [C O L ] 2 B a s e d u p o n fin d i n g o f fa c t N o s . 3 , 6 a n d 7 , a n d A L J fin d i n g s o f fa c t N o s . 9

a n d 1 0 , D r . B r o w n a t te m p te d to c ir c u m v e n t a n o r d e r o fth e [B o a r d ] in vi ol ati on of 22 T ex . A dm i n. C od e § §1 08

. 1(1 ), 10 8.1(2) an d 1 08

. 1(3 ). B D [C O L ] 3 B a s e d u p o n fin d i n g o f fa c t N o s . 3 , 6 a n d 7 , a n d A L J fin d i n g s o f fa c t N o s . 9

and 10, D r . Br own f ai l ed t o exer ci se r easona bl e di l i gence t o p r ev ent associ at es orem pl oy ees f r om eng agi ng i n con duct t hat supp or t ed t he pr act i ce of

den t i st r y wi t hout a l i cense i n vi ol at i on of22 T ex. Adm i n. C ode §§ 10 8.1(4) an d 1 08

. 1(5 ). B D [C O L ] 4 B a s e d u p o n fin d i n g o f fa c t N o s . 3 , 6 a n d 7 , a n d A L J fin d i n g s o f fa c t N o s . 9

a n d 1 0 , D r . B r o w n v i o l a t e d t h e t e r m s o fh e r A S O. BD[ CO L ] 5 Base d u p o n f i n d i n g o ff a c t No

. 9 , Dr

. B r o wn c o m m i t t e d unpr of essi onal

conduct und er T EX

. O C C

. C O D E § 259

. 008. B D [C O L ] 6 B a s e d u p o n f i n d i n g o ff a c t N o . 9 , D r . B r o w n c o m m itt e d d is h o n o r a b le

conduct und er 22 T EX

. AD M I N

. C O D E § 108

. 9. (C i t ati on s t o t he rec ord om i t t ed

. ).

T he Boar d' s di sci pl i nar y act i on was al so based on t he f ol l owi ng ALJ' s f i ndi ngs o ff act and concl usi ons 6 of l aw : A L J [F O F ] 9 D r . B r o w n h i re d a n d p a i d te m p o ra ry d e n ti s ts to w o rk i n h e r p ra c ti c e w h ile herl i cense was act i v el y suspe nded. ALJ[ FO F] 10 T he t em por ar y den t i st s r ecei v ed t he m oneyf r om t hei r pr act i ce, m i nus t he

c o s t o fo v e r h e a d a n d l a b w o r k.

. . . A L J [F O F ] 4 0 D r . B r o w n a ll o w e d h e r n o n - d e n tis t e m p lo ye e s to a d ju s t o c c lu s io n o n T .M .'s

t eet h.

. . . ALJ[ C O L] 7 Based on t he f i ndi ngs o ff ac t , D r. B row n fai l ed t o keep ad equat e dent al 10 2. ALJ Findi ng of Fact N os. 9, 10 and 40, a nd ALJ C oncl usi on of Law Nos . 7 and 9

. . . .[ ] 6r ecor ds on one pat i ent i n v i ol at i on o f22 T EX

. AD M I N

. C O D E § 108

. 8.

. . . ALJ[ C O L] 9 Based on t he f i ndi ngs o ffac t , D r. B row n i m per m i ssi bl y del egat ed dent al

w o r k t o a n o n - d e n t i s t i n on e i ns t a n c e , i n v i o l a t i o n o fTE X. OCC. CODE §§ 25 8.00 1, 25 8.00 2, 25 9.00 8(3 ), 22 T E X

. A D M I N

. C O D E §§ 10 8.1(3), 114. 1. 11 The Board ex pla ine d, i n w ri ti ng , t hat t he di sc iplina ry a cti on w as w ar ra nted and ide nti fied th e findi ng s o f factand conc lus ion s o f law th a t it dete rmi ned s uppor ted t hat action . It is appare nt th at th e B o a rd ' s w ritten explana tion for chan ging the AL J's dis ci pli nar

y recommendat ion i mpli cat es the A LJ' s i mprop e r appl ic ati on of l aw —th at t he imp osition of

add itiona l sanction s w as sup porte d a n d t h at th e Boa rd, notthe AL J, deter mines the penal ty

. See T EX . G OV ' T C OD E A NN . § 2001.05 8( e) (1 ); Sea rs , 759 S.W .2d at 75 1. W e conclu de, t here fore, th at th e Boa rd provi ded a specif ic reason a nd legal basis for the Bo ard's actio ns an d, th us, com pli e d wi th sect ion 20 01. 058 (e). Se e T EX . G OV ' T C OD E A NN . § 200 1.0 58(e ). Ag re ein g w it h the Board that it , not the ALJ, has the author ity to deter mine sancti ons in this case , we sustain the Bo ard's f irst and seco nd issue s on tha t basis. Moreover, hav ing co ncl uded t hat s ect ion 2001. 058( e) i s i mpli cat ed i n thi s cas e, w e al so sus tai n the first and s econd i ss ues to t he extent the B oard i s a ss erti ng i t c ompli ed w it h s ect ion 2001.05 8( e) after

reje cti ng the ALJ' s sancti on re commendat ion thathad been s et ou t as
a co n c lu s io n o f

la w. III. Dishon orab le Cond uct By i ts thi rd iss ue, the Board contends that there is su bst anti al ev ide nce— more than
a s ci nti ll a of ev ide nce—to s uppor t t he Boa rd 's findi ng thatD r. Brow n's offer to s how E.B .,T he Boar d al so concl uded t hat D r . B r own' s conduct w as unpr of essi onal and appear s t o con t end on 7 a p p e a l th a t t h e re i s s u b s ta n ti a l e v i d e n c e to s u p p o rt th is c o n c lu s io n . See T EX
. O CC
. C OD E A NN
. § 25 9. 008 ( Ver no n 20 04 )

. Howe v er , b ec au se o ft he d i sp os i t i on o ft hi s i ss ue o n t he b as i s of d i sh on or ab l e co nd uc t , we n e e d n o t a d d re s s th i s c o n te n ti o n . See T EX
. R. A PP
. P. 47. 4. 12 a min or patie nt, sca rs on her brea sts w as disho nora ble. It a sserts tha t the re is a 7
reaso nab le basis i n the record fo r its conclu sion that D r. Brown com mitt e d dishon orab le cond uct—co ndu ct tha t the Board claims w ould supp ort its sanctio n orde r. A. Standa rd of Rev iew This C our

t rev iews the Board 's f ina l order under the s ubst anti al ev ide nce ru le. See T EX . G OV ' T C OD E A NN . § 200 1.1 74. "Sub stan tial e vid e nce m ean s more than a me re scinti ll a ; t h u s, the ev iden ce ma y prepo nde rate againstthe agen cy 's decision, y et still amount t o s ubst anti al ev ide nce. " Ma tth e w s v . Sc ott , 2 6 8 S

. W

. 3 d 1 6 2 , 1 7 2 (T e x. Ap p .– Co rp u s Ch ris ti 20 0 8 , n o pe t. ) (qu o ti n g Mi ller v. Houston In dep. Sch. D is t. , 51 S.W .3d 6 7 6 , 6 8 0 (T e x. Ap p .– Ho u st o n [1 stDist .] 20 0 1 , p e t. de n ie d ) (ci ti n g Mi re les v. T ex. D ep't of Pub. Safet

y , 9 S.W .3d 128 , 131 (Te x . 199 9) (per curiam ))) . W het her the Board 's order is suppo rt ed by

su bst anti al ev ide nce is a q uest ion of law w hic h we re view de nov o. Montg om ery Inde p. Sch . Dist. v. Davis , 34 S.W .3d 5 59, 5 62 ( Tex . 200 0) ; San chez v. Tex. Sta te Bd . of Med. Exam 'rs , 229 S.W .3d 498 , 511 (Tex. App. –Au stin 20 07, no pe t.). Unde r the sub stan tial evi den ce rule, w e giv e significan t def eren ce to th e agency in it s fie ld of ex per

ti se. Tex. Heal th Facilities Com m 'n v. Charter Med. -Dallas, Inc. , 665 S.W .2d 4 46, 4 52 ( Tex . 198 4) . W e presume that the a g ency 's order i s v ali d and that it s findi ng s, inferences , c onclusion s, and dec is ion s a re su ppor ted b y su bst anti al ev ide nce, and t he burden t o prov e oth er w is e i s o n the par

ty ch all eng ing the deci si on. Id. at 45 3; see Str atton v. Aus ti

n Indep. S ch. D is t. , 8 S.W .3d 26, 30 (T ex. App.–Aust in 199 9, no pet. ). "[ W ]e w i l l s us ta i n an a g en c y ' s fi nd i ng i f rea s on ab l e mi nd s c ou l d ha v e rea c he d th e s am e13

conc lus ion ," Hinkley v. Tex. Bd. of Med. Exa m 'rs , 140 S .W .3d 7 37, 7 43 (T ex. App.–Aust in 2004, pet. deni ed) ( ci ti ng Te x. Sta te Bd. o f Denta l Exa m 'rs v. Sizem ore , 759 S.W .2d 1 14, 116 ( Tex . 1988)) , ev en i f the ev ide nce act ual ly preponderates ag ain st it

. Sw. Pub. Serv. Co./P UC v. PUC , 962 S.W .2d 207 , 215 (Tex. App. –Au stin 19 98, pet. de n ie d ). W e are ultim ate ly

conce rned w ith the reason able ness of the agen cy 's order, no t its correctness. See S anche z , 229 S.W .3d a t 511

. B. Appl ic abl e Law Ad e n t is tis ca ll e d u p o n t o co n d u c th e r p ra c t ic e o n t h e h ig h e s tp la n e o f h o n e s t y, int e grity , and fair

deal ing

. See 22 T EX . A D M IN . C OD E A NN . § 108. 1 ( 2008) ( Stat e Bd. of Den ta l Ex am'rs, Prof'l Res ponsi bil ity ). A denti st is i n v iol ati on of the Board's r ule s w hen she e ngages in dish ono rable con ductw hich includ es, am ong oth er things, engaging "in condu ct thatha s b e co m e es ta b lis h e d th ro u gh p ro fe ss io n a l e xpe rie n ce as like ly to di sgrac e, deg ra de or br ing dis credi t upon him or her or the dental professi on." Id. §10 8.9 (6) (2008). C. Analysi s Att h e h e a ri n g b e fo re t h e A L J , E

. B

. wa s a s k e d i f t h e re we re a n y b e h a vio rs t h a tga ve h e r p a rt ic u la r c a u s e fo r c o n c e rn . E. B

. re s p o n d e d , p ro vid in g t h e fo ll o win g t e s t im o n y: One o f the i nst ances thatI can re cal l extremely clear is on the thi rd att empt to do my v eneer I had a temporar

y put on. And I w as v er

y ups et w it h w hat it looke d l i k e. It w as v er y di s c ol ored

. It w as brow n. An d I w as v ery dis appoi nted w it h i t. I w as cr y ing

. And Mi sty

- Dr . Brow n sat me o n her l ap as if I w ere a child and proce ede d to tell me abo ut he r breast can cer, w hich w as a w ell -k now n fact throug hout the off ic e becau se w it h the breastca ncer post er thatsh e had on the w all

. It w asn' t a sec re t that she ha d breastca ncer and s he procee d e d t o t e ll me abou t t hat a nd adj ust ed her w ig , as i f to com pare our stories. And I h a d t h is d iscolored toot h an d she had breast cance r, just try ing to, I gue ss, conso le me , butI 'v e never h ad anyone to sit me on t hei r lap and tel l me thi s. She als o offered to show my mother and I h e r b re a s t , j u s ta s i f

t o co m p a re , lo o k , I h a ve ca n c e r; yo u h a ve a b ro wn tooth

. I c an feel y our pai n, I g uess . And I nev er had any one offer to sh ow me their breastand I thou ght thatw as just ridiculou s.14

At the sa me h earing, E.B. 's m oth er t estif ied abo ut Dr. Brown's condu ct as follows: T he th ird treatm entthatmy dau ghter had , she w as v eryu psetb ecau se Dr. Brown g ave her a brown too th, w hich w as v eryupse tting w ith he r. And Dr. Brow n tr ied to cons ole her , w hic h i s fin e, bu t th e n she sa id, y ou th ink y ou h a ve go tso m e t h in g t o cry a b o u t ? Le tm e s h o w yo u m y b re a s t s . An d we both sai d, oh no, no, i t i s fin e. W e don' t w ant t o s ee y our breast s, thank

y ou. W e bot h tho ug ht i t w as v er y i nappropr iat e. Finally , at the hea ring, D r. Brow n respo nde d as follows: Q Y ou'v e heard the tes ti mony of .

. . E. B. a nd .

. . A.B . t hat you offered to s how them y our

breast s. D id y ou do that? A N o . Q Di d yo u m a k e a re fe re n c e t o yo u h a vin g h a d su rg e ry? A N o . Q Di d y ou ev er

ex pose y oursel f to a pa ti ent? A N o . Al thoug h D r. Brow n deni ed that she offered to sh ow E.B . and A.B . her

breast s, the ALJ deter mined that E.B. and A.B. testi fied cre dib ly reg ardin g the inc ide nt and found that Dr . Brow n offered to sh ow her breas ts t o E .B

. and A. B. Non ethel ess , i n the foll ow ing
ana ly sis set out in th e PFD, the ALJ no ted that , und er the circum stan ces, th e of fer, w as not unprofessi onal or dish onorabl e conduct

. Dr . Brow n w as tal ki ng w it h her patient abo ut the prob lem s w ith her tee th an d w as att em pting to con sole her by show ing he r th at oth er p eop le have hea lth issues as w ell. Dr . Brow n's offer to show E.B. and A.B. her brea sts as a w ay of cons oli ng the pati ent w as not c onduc t that is l ik ely to br ing di sg ra ce or

di sc re diton D r. Brow n or on t he dental professi on. E.B. and A.B. are bot h female. D r. Brow n offered to sh ow the m th e results of

b reast surgery

t hath ad left her som ewhat disf igured—just as E.B. w as somew hat d is fig ured bec ause of he r teeth

. Therefore, the A LJ finds that Dr . Brow n's offer to E.B. and A.B. to show her breas t scars w as not dis honorabl e or

unprofessi onal co nductas defined by st atute and ru le.15

The ALJ al so w ro te that "Dr

. Brow n had und erg one breastsu rg er y . Al thoug h s he di d not h a ve b re a s tca n c e r, s h e in d ic a t e d t o se ve ra l p e o p le t h a tsh e d id

. Dr

. B ro wn d id h a ve breastdi seas e and has been di ag nosed w it h anot her form of ca ncer ." The ALJ found that"D r. Brow n's offer to show E.B ., a s ev enteen- y ear ol d g ir l, and A.B. , E. B.' s mot her , t he s cars o n her breast s from surg er

y w as appropr iat e g iv en th e circumsta nces a nd E. B.'s an ger and f rustration ." T he AL J conclud ed th at "Dr. Brown did not c ommit dis honorabl e c onduc t." Di sag re ein g w it h thi s d eter minatio n, t he Boa rd del eted the A LJ' s fin din g and
conc lus ion reg ardin g thi s b ehav ior and ex pla ine d, i n i ts W ri tten Rea sons and Leg al Base s for C hang ing the Admin is trati v e Law Judg e's Proposa l for Dec is ion , that (1 ) the A LJ faile d to prop erly

app ly and interpretagency rules regarding disho nora ble condu ct, (2) the AL J's deter minat ion w oul d c re ate a n i mpermi ss ibl e pol icy precede nt, (3 ) iti s a p propr iat e to est abl is h a c lea r precede nt t hat i t i s d is honorabl e for a dentis t to of fer to show

a pati ent t he den tist's priv ate bod y

parts in the course of the practice of den tistry even if it is to conso le the p ati ent, and ( 4) D r. Brow n's offer to show a pati ent sca rs on her

breas ts to cons ole the patient cons ti tutes co nductthati s l ik ely to dis g ra ce, deg ra de and br ing di sc re ditupon a dental l ic ensee and the d ental professi on. See T EX . G OV ' T C OD E A NN . § 2001.05 8( e)

. The Boa rd set ou t in its ow n f inding tha t "Dr. Brow n's of fer to show E.B. , a seventee n-y ear old g ir l, and A .B ., E .B.' s mot her , t he s cars o n her breast s from surg er

y w as not a ppropr iat e and c onst it utes di shono ra ble and unprofessi onal co nduct ." In t he Boa rd 's co ncl usi on of law , t he Boa rd co ncl uded t hat "D r. Brow n commi tted dis honorabl e c onduct" und er ch apter 22, s ect ion 108. 9 of the administrati v e c ode. See 22 T EX . A D M IN . C OD E A NN . § 108. 9( 6) (S tate Bd. of Dent al Ex am'rs, Di shono ra ble C onduc t) ; see als o T EX . O CC
. C OD E A NN . §16

263.002 (a )( 3) ( Ver non 200 4) ( p ro vidi ng thatthe pract ic e of denti str y i n a mann er

that const itute s dishon orab le cond uct is a groun d for disciplinary action ). Base d on our

rev iew of re cord and g iv ing si g nific ant de f e rence to t he Boa rd i n i ts field of ex per

ti se, see Cha rter

Med. , 665 S.W .2d at 452 , w e con clude thatrea s o n able minds co uld hav e reached t h e same conc lus ion as thatreache d by the Board. See Hi nkley , 140 S.W .3d a t 743

. A reason abl e mi nd mi g ht ac ceptsu ch re lev ant e v ide nce as adeq uate to suppo rt the B oard's co ncl usi on th at D r. Brow n's offer to show E.B . and A.B

. the s cars o n her breast s from surg er y w as not appropr iat e; that the compl ain ed- of behav ior
cons ti tuted di shono ra ble co nduct

. Acc ordin g ly , w e c oncl ude t hat t here w as subs tanti al
ev ide nce to s uppor

t t he Boa rd 's co ncl usi on th at D r. Brow n pract ic ed dent is tr y i n a mann er that cons ti tutes di shono ra ble co nductas defined in sec ti on 108. 9. See 22 T EX . A D M IN . C OD E A NN . § 108. 9( 6)

. W e s ust ain the Board's thi rd i ss ue. IV. Ina dequa te Den tal Records a nd Im perm issible Delegation of Denta l W ork In addi ti on to the dis honorabl e condu ct findi ng that prov ide s suppo rt for its disciplinary determ inatio n, th e Boa rd argues thatits decision i s su ppo rted by the AL J's
conc lus ion s a nd f in d in gs th a t D r. Brow n fail ed to ke ep adeq uate dental records on one pati ent a nd th at s he i mpermi ss ibl y del eg ated dental w or k to a non- denti st in one i nst ance. T he Bo ard ad opt ed th ese co nclusion s and f indings. The ALJ bas ed her conc lus ion thatD r. Brow n al low ed her non- denti st employ ees to ad jus t occ lus ion on T.M. 's teeth on her findi ng that the Board met it s b urden of proof to show that Dr. Brown a llow ed h er assistan ts to pe rform n on-d elegable den tal w ork on T .M. T he AL J w rote th e followi ng in her PFD: T.M. tes ti fied that Dr . Brow n cemented crow ns in her mouth, but that other individuals in the o f

f ice performe d adju stm ent s. T.M. de scribed th e pe ople17

w ho d id the adjust me nts as hy gienists. She indicate d tha t the se individuals put t he c ro w ns in h e r m o u th , had her bi te do w n, t hen remov ed th e c ro w ns and l eft the room to re tur n shortl y thereafter

and rec heck

the bit e. Acc ordin g to T .M., the hy gienist also f iled the crow ns an d the o p p o s in g too th. Dr. Vi nin g s t est ified thathe b eli ev ed from l ookin g a t the w or k i n T.M .' s mout h that itw as poss ibl e someone other than a li cens ed dent is t had per formed th e w or k. D r. Brow n tes ti fied th at s h e p e rf o rmed the w or k t o g ri nd th e tee th herse lf . T.M.'s cha rt also indicat es tha t a den tist groun d the tee th to make them fit

. The ALJ find s that T.M. 's tes ti mony aboutthe hy g ien is ts g ri ndi ng tee th inside h e r m o u th w as credible . Th e ALJ a lso f inds th at Dr. Brow n's testim ony and th e pa tient 's chart are credib le. Th e ALJ fin ds tha t it is li kely tha t bot h Dr. Brown and assistan ts adju sted T.M.'s te eth . Only den tists are per mitt ed to make adj ust ments to teeth in the mout h. Therefore, t he ALJ conc lud es that Dr . Brow n i mprop er ly delegate d an actthatmustbe per formed by a denti st, namely the re mov al of t ooth str uct ure, t o s omeone other than a l ic ensed dent is t. (R ecord c it ati ons omitted.) In ad dit ion , t he ALJ bas ed her co ncl usi on th at D r. Brow n fa ile d t o k eep ade q uate dental records on E.B. on her f ind ing s that E.B' s c har t c ontai ned nei ther

a w ri tten re v iew of medi cal his tor

y , a medi cal ex am, radi og ra phs and findi ng s, a treatment pla n, or a w ri tten infor mal cons ent n or

an e x pla nati on w hy

the char t w as inc omplet e. The ALJ' s anal y si s o n th e se f in d in gs a n d co n clu sio n in he r PF D se t o u t t h e fo llo wing: Dr . Brow n c ontends that she maint ain ed adeq uate re cords on E.B. but that E.B. st ole her

ch art after

D r. Brow n tol d E. B. t hat s he w as g oin g to document E.B. 's i nappropr iat e behav ior i n her ch art. D r. Brow n admits t hat s he re created E.B. 's chartafter she disc ov ered i t w as mis si ng . She al so admit s that the i nformati on i n the recreated char t w as not compl ete. T he ALJ finds that Dr . Brow n di d notmai ntai n adeq uate dental records on pat ien t E. B. T he Boa rd's rule s e stab lish t he ite ms th at ne ed to be includ ed in a p atien t's c h a rt

. T h e it e m s in c lu d e t h e n a m e o f t h e p a t ie n t , vit a l si gn s , m e d ic a l h is t o ry, ra dio g ra phs, etc

. E.B. 's ch art, as Dr . Brow n prov ide d i t t o the Board w as mis si ng mostof thes e i tems. I n addi ti on to the it ems req uired to be i ncl uded in the c har

t, the r ule i ndi cat es that if ce rt ain items are noti ncl uded i n the ch a rt, t he c har

t mus t i ndi cat e an ex pla nati on as to w hy the it em i s n ot include d. In th is case, Dr. Brown did not indicat e in the chart w hy item s w ere not inc lud ed. Therefore, the ALJ finds that Dr

. Brow n faile d to ke ep adeq uate pati ent records on E. B.18

(R ecord c it ati ons omitted.) D r. Brow n does not chal len g e the ALJ 's findi ng s a nd conclu sions regarding the ab ove v iolation s. The Board has offered more tha n one g ro und as a ba si s for i ts deci si on. Base d on
our de n ov o rev iew , w e concl ude t hat t he Boa rd 's di sc ipl ina ry dec is ion i s s uppor

ted b y the dis honorabl e c onduc t findi ng and the tw o v iol ati ons found by the ALJ and adopted by the Board. The Board's findi ng s a nd c oncl usi ons are s uppor ted by su b st a nti al ev ide nce. W hen an agency of

fers mo re than one groun d as the basis for its decision, w e w ill af f irm if w e f in d s ubst anti al ev ide nce suppo rt ing one g ro und ev en i f all bas es g iv en w oul d be ind ependent ly suffici ent to suppo rt the deci si on. Tex. Sta te Bd . of Med. Exam 'rs v. Sche ffey, 949 S.W .2d 4 31, 436 (Tex

. App.–A ust in 1997, w ri t den ied ); see City of C or pus Christi v. PUC , 188 S.W .3d 681, 695 (Tex . App.–Aus ti n 2005, pet. denied) . Not ing thatour re v iew i s u lt imat ely

co ncer ned w it h the reason abl eness of the a g ency 's order , noti ts
cor re ctn ess , see Sanchez , 229 S.W .3d at 511 , w e cou ld af f irm the B oard 's o rder on th is basis. V. Res ti tuti on In i ts sev enth is sue, the Board c o n te n ds that there i s more tha n a s ci nti ll a of
ev ide nce suppo rt ing rest it uti on to pati ent, T.M. I t al so ass erts that the d is tr ict c our t er re d in re v ersi ng the aw ard of rest it uti on and that har m is not a fact or to cons ide r in dete rmi nin g w hether rest it uti on s houl d be pai d. A. Subs tanti al Ev ide nce to S uppor t O rd er of Res ti tuti on As set ou t in our an alysi s of the Bo ard's f irst and seco nd issue s, the ALJ clearly analyz e d , found, and c oncl uded t hat D r. Brow n i mprop er ly al low ed her

as si sta nts to per form non- del eg abl e dental w or k on T.M

. See T EX . O CC
. C OD E A NN . § 258.001 ( Ver non19

Supp. 2008) , § 258.002 (V er non 2004) , § 259.008 (3 ) (V er non 200 4) ; 22 T EX . A D M IN . C ODE A NN . §§ 108 .1(3), 11 4.1 (2008 ) ( Sta te Bd . of Denta l Exam'rs, Perm itted Duties). Th e Boa rd ado pte d ALJ f inding 40 th at "Dr. Brown allow ed h er non -den tist em ployees to ad just
occ lus ion on T.M.' s teeth" and AL J c oncl usi on 9 that "Dr . Brow n i mpermi ss ibl y del eg ated den tal w ork to a no n-de ntist in one in stan ce." Altho ugh the A LJ att ribute d no conse quence for th is v iol ati on, w e c oncl ude t hat t his i s s ubst anti al ev ide nce to s uppor t t he Boa rd 's order t h a tDr

. B ro wn " s h a ll p a y re s t it u t io n t o p a t i e n tT

. M. " Re a s o n a b le m in d s co u ld h a ve re ached the same c onclus ion —th at D r. Brow n s houl d pay rest it uti on w hen s he v iol ated sta tutes and ru les byimprop er ly al low ing her

as si sta nts to per

form non- del eg abl e dent al
w or k o n T.M

. See Sizem ore , 759 S.W .2d a t 116

. B. Di str ict C our

t Er ro r T he Bo ard also co nte nds th at th e district court erred by reversing the Bo ard's award
o f res ti tu ti o n . T h e di st ric t c o u rt 's f in a l ju d gm e n t c o n clu d e d th e fo llo wing: W hil e the Board does hav e g eneral author ity to order rest it uti on as par

t of i ts pow ers i n di sc ipl ini ng dent is ts w ho are pl aced on probat ion , t hat p ow er i s n ot wit h o u tb o u n d a ri e s . T h e B o a rd is n o te m p o we re d t o m a k e a d ju d ic a t ive findi ng s c ontrar

y to the ALJ' s findi ng s to suppo rt suc h re sti tuti on. The ALJ found that Dr . Brow n w as not res ponsi ble for t he probl ems t hat T.M . had w it h her tee th, AL J Findings Nos. 30-39 , Conclusio n No. 8. T here fore, th e Boa rd er re d i n aw ardin g rest it uti on for T.M. i n thi s c ase. The di str ict cour

t impl ied ly

concl uded that the Board m ade f ind ing s c ontrar y to the ALJ' s fin din g s a nd th erefore, shoul d hav e c ompli ed w it h sec ti on 2001.05 8( e) by prov idi ng a writ te n reason and basi s for maki ng co ntrar

y findi ng s s uppor

ti ng rest it uti on. See T EX . G OV ' T C OD E A NN . § 2 0 0 1

. 0 5 8 (e ). A p p a re n t ly d e t e rm in in g t h a tt h e B o a rd fa il e d t o co m p ly, the d is tr ict c our

t c oncl uded t hat t he Board er re d in aw ardin g rest it uti on. W e di sag re e w it h th is re a so n in g.20

In reversi ng the re sti tuti on aw ard, t he di str ict c our t reli ed on the fol low ing ALJ findi ng s o f fact : 30. Dr . Brow n sug g est ed to T .M . that she w ear a nig ht g uard to prev ent damag e to her

teet h. 31. T.M. refused to w ear the nig ht g uard, an d her teet h c ra ck ed, c ausi ng her pai n. 32. Dr

. Brow n treated T.M. 's pai n and re ferred her to an endo donti st for root can als. 33. T.M. di d notretur n to Dr . Brow n for the p lac ement of crow ns unti l ov er one y ear after the ro ot c anal s w ere per formed. 34. During the intervening y ear, T .M.'s teet h sup er-erupt ed, leavi ng li ttle clearan ce for crow ns. 35. T.M. di d notco mplet e D r. Brow n's treatment pla n, thereby damag ing tooth number

15. 36. T h e re is no evi den ce in the record showing the cond ition of T.M.'s teeth at or

near the ti me the crow ns w ere s eated. 37. T he erosion in to the d ent in on to oth num ber 15 w as cau sed b y T.M.'s c on ti nu ed b r ux i s m. 38. T he f lat crow n o n t o o t h nu mb er 19 w as required due to T .M.'s br ux i s m. 39

. The mi s s i ng p orc el ai n on to ot h nu mb er 18 w as du e to T. M .' s b r ux i s m. The di str ict c our

t re ferenc ed ALJ co ncl usi on of l aw 8 w hic h prov ide s t hat "[ b]as ed on the findi ng s o f fact , D r. Brow n di d notv iol ate t he mi nimum s tandard of c are w it h respect t o the treat me nt of

T.M.s te eth . . . ." The se f indings and the co n c lu s io n ad dress the stand ard of care tha t the ALJ con clude d w as no t breach ed b y Dr. Brown i n he r treatm entof T.M. Sect ion 2001. 058 app lie s o n ly when a st ate a g ency ch ang es a findi ng of fact or
conc lus ion of

law

. Id. In this case, the Boa rd did no t ma ke ad judicat iv e f indings cont rary to t he ALJ 's findi ng s. Bas ed on our rev iew of the record, t he Boa rd 's order of re sti tuti on21

w as ba sed o n the ALJ f inding tha t Dr. Brow n a ll o we d a non -den tist em ployees to ad just
occ lus ion on T.M .' s t eeth and t he ALJ co ncl usi on th at D r. Brow n imper mis si bly del eg ated T.M. 's dent al w or k t o a n on- denti st in one i nst ance, both of wh ich w ere adopt ed by the Board. W e c anno t concl ude t hat t he Boa rd made find ing s a nd c oncl usi ons cont ra ry to thos e i denti fie d i n t he di str ict c our t' s fin al jud g ment. Therefore, the d is tr ict c our t er re d
w hen i t rev ersed the B oard's aw ard of rest it uti on. C. Harm Dr . Brow n as ser

ts, i n respon se to t his i ss ue, t hat t here i s n o basi s for the Board to
order rest it uti on for non- del eg abl e tas ks bec ause the d ental ca re prov ide d to T.M. di d not fall bel ow

the sta ndard of care. How ev er , Dr

. Brow n ci tes no author ity , and w e find none, to s uppor

t her arg ument. In t his ca se, i t is ir re lev ant that the ALJ found Dr

. Brow n did not v iol ate t he mi nimum stan dard of

care w ith respe ct to the treatm entof T.M. Dr. Brow n allowed her non -den tist
em ployee t o a djust o cclusion o n T .M.'s teet h. She impe rmissibly dele gated d ent al w ork to a non- denti st, thereby v iol ati ng the law . That v iol ati on of l aw , as i nter preted by the Board, i s t he bas is for t he aw ard of rest it uti on. See T EX . O CC
. C OD E A NN . § 263. 002 (V er non 200 4) . And, as set out abov e, the agen cy , not the co urt, is ch arg ed by l aw w it h dis creti on to fix

the penal ty

w hen i t det er mines thatthe sta tute has been vio la te d. See Sea rs , 759 S.W .2d a t 751

. Adoptin g the ALJ' s fin din g thatD r. Brow n al low ed hernond e n t is te m p lo ye e s t o a d ju s t o c c lu s io n o n T

. M. ' s t e e t h a n d h e r c o n c lu s io n t h a tDr

. B ro wn imper mis si bly

del eg ated dental w or k t o a non- denti st, the Board proper ly bas ed i ts order of rest it uti on on thi s v iol ati on. Har m, i n thi s c ase, i s n ot a factor to cons ide r in deter mini ng w hether rest it uti on s houl d be pai d. W e s ust ain the Board's se v enth is sue.D r . B r own al so cont ends t hat t he doct r i ne ofcol l at er al est oppel app l i es. However , herbr i efdoe s not 8 cont ai n a cl earand conci se ar gum ent f or t hi s cont ent i on, wi t h appr opr i at e ci t at i ons t o aut hor i t i es and t o t he re c o rd

. See T EX
. R. A PP
. P. 3 8 .1 (i). D r. B ro w n re fe rs u s to o n l y o n e c o l l a te ra l -e s to p p e l c a s e , see Cont ' l C an C o . v . M a r

s h a ll , 603 F. 2d 5 90, 596 ( 7t h C i r . 197 9) , t hat di scusses co l l at er al est oppel , and M a r s h a ll i s m ore f av or abl e t o t he Boar d' s posi t i on t han herown. I n M a r s h a ll , t he co ur t concl uded t hat t he " act ual l y l i t i gat ed" r equi r em ent of

t he d oct r i ne o fcol l at er al est oppel i s gen er al l y sat i sf i ed i ft he p ar t i es t o t he ori gi nal act i on d i s p u te d th e i s s u e a n d th e tri e r o f f a c t re s o l v e d i t. I d. Unl i k e t he p r esent case, i n M a r s h a ll , t her e was a t r i er off act i n t he or i gi nal pr oceedi ng, and t he M a r s h a ll cour t r ul ed t hat t he i ssue i n di sput e ha d be en r esol v ed b y th e tri e r o f f a c t. I d. 22 VI. Board's R emaini ng Is sues T he Bo ard's f if

th, sixth and e ighth issues raise con ten tions relat ed to Dr. Brown's practice of

den tistry

during her suspe nsion . By its fo u rt h i s s u e, th e Boa rd argues thatit proper ly di sregarded t he ALJ 's su ppor ti ng findi ng s o f factand proper ly del eted it s conc lus ion of law

thatthe Board's staff

prev ented Dr . Brow n f ro m compl y ing w it h ter ms of her ASO , specif ically

her participa tion in a me nto ring program and i n the pee r assistance prog ra m. H av ing co nclud e d , h o wev er , t hat t he Boa rd 's final order i s s uppor

ted b y s u b s t a n t ia l e vid e n c e o f a tle a s tt h re e o t h e r vi o la t io n s t h a ti n v o lve u n re la t e d co n d u c t , we nee d nota ddre ss t hese rem aining issues be cause they are not disp ositive of this app eal. See T EX . R. A PP . P. 47.4. VII. R es Judi cat a By a s ing le is sue in her cross -a ppeal , Dr

. Brow n cont ends that the doct ri ne of res judicat a ap plies in this case

. She a s s e rt s thatthe allegatio ns regarding disciplinary 8 matters t hat o cc ur re d i n 2002— all eg ati ons that now form t he bas is o f

the present d is c ip linaryaction —w ere ad dresse d in the 200 2 ASO . Becau se the allegations were address ed i n the ASO , D r. Brow n c lai ms t hat t hey hav e been final ly

adj udi cat e d or, w it h the e x er ci se of due di li g ence, sh oul d hav e be e n l it ig ated in that ear li er se ttl ement proceed ing

. The Board contends that res ju dic ata d oes not a ppl y bec ause the A SO d oes not q ual ify

as a fina l adj udi cat ion

.23 A. Appl ic abl e Law

and Standa rd of Rev iew In T exas courts, the doctrine of res judicata prevents the relitig ation of a claim or a
caus e of act ion thathas been final ly adj udi cat ed. Sta te & Cou nty Mut. Fire Ins. Co. v. Mi ller , 52 S.W .3d 6 93, 6 96 ( Tex . 200 1) ( per cu ri am); Kaufm an v

. Co mm 'n for

Lawyer Dis cip line , 197 S.W .3d 8 67, 8 72 ( Tex . Ap p.–C or pus Chr is ti 2006, pet. deni ed) , cer t. denied , 128 S. Ct . 331 ( 2007)

. Res jud ic ata als o prev ents li ti g ati on of rela ted matters t hat,
w it h the use of di li g ence, shoul d hav e been li ti g ated in the e ar li er su it

. Mi ller , 52 S.W .3d at 69 6; Kaufm an , 197 S.W .3d a t 872

. "The bar of a c lai m by

res jud ic a ta r eq uires proof of the foll ow ing el ements : (1 ) a pri or f ina l jud g ment on the mer it s b y a c our t of co mpetent jur isd ict io n ; (2) i denti ty of par ti es or thos e i n pr iv ity

w it h the m; and (3 ) a s econd ac ti on based on t he s ame cl aims thatw ere rais ed or co uld hav e been ra is ed i n the first act ion ." Ex parte Myers , 6 8 S. W .3 d 22 9 , 23 2 (T e x. Ap p .– T e xark a n a 2 0 0 2 , no pe t. ) (ci ti n g Am sta dt
v. United S tates

Br ass C or p. , 919 S.W .2d 644 , 652 (Tex. 1996 )). "T he question w het her re s judicat a appl ies in a g iv en i nst ance is a mi x ed q uest ion of law and fact." Myers , 68 S.W .3d a t 232 . "W hen a matter i nv olv ing both factual deter minat ion s a nd l eg al conc lus ion s i s d eci ded by the tr ial court , Texa s appel lat e c our ts g enerall y

us e an abuse of dis creti on s tandard of rev iew ." Id. (cit in g Pony Ex pr ess C our ier Corp. v. Morris , 921 S.W .2d 817 , 820 (Tex. App. –Sa n Ant onio 1 996 , no w rit) (per curiam )). How ev er , w hen t he par ti es do notdi sput e any f a ct u al deter minat ion upon w hic h the res judicat a ba r is base d, as in th is case, an d the only issue prese nte d for rev iew inv olves a purely l eg al deter minat ion , t he proper st andard of rev iew is de n ov o. Id. (ci ti n g W alker v. Pack er , 827 S.W .2 d 8 3 3 , 8 4 0 ( Tex . 199 0) ). Therefore, w e mustdete rmi ne, d e nov o,
w hether there has been a final adj udi cat ion

.24 B. Ana ly sis Dr . Brow n's ASO i ncl uded t he foll ow ing l ang uag e: A mediated settl ement conferenc e w as held in this case on June 10, 2003, at S OAH

. . . . An ag re ement w as re ached dur ing the m edi ati on and pursuantto that agreem ent , [D r. B ro w n] w ishes to w aive fu rther forma l adjud icatory proceed ing s. [D r. Brow n] v olu ntar il y ente rs i nto t h e f o llow ing Ag re ed Sett lementOrder

. [D r. Brow n], by si g nature bel ow , ac know led g es that [sh e] fully understa nds the n ature of the findi ng s of fact and conc lus ion s of l aw se t out h erein , t hat [ she] has been adv is ed of the ri g ht t o l eg al re pre se ntati on, and that[she] has be en giv en the opportu nity to forma lly conte st any Board a lle gat io n s in an ad ju d ica to ry pro ce e d in g. The ALJ and the dis tr ict cour t judg e determi ned that the ASO w as not a final adj udi cat ion of all disciplinary ma tters that occurred in 200 2, i nclud ing the ma tters tha t form th e ba sis of the presentdi sc ipl ina ry ac ti on. W e ag re e tha t t he proceed ing thatresul ted i n the signin g o f t h e ASO w as in the nature of a medi ati on, n ot a final a d jud ic ati on. The par ti es ar ri v ed ata s ettl ement; the meri ts of the c lai ms w ere notreache d. There w as no pr ior final j udg ment on the mer it s b y a cour t of c ompetentj ur is dicti on. See Myers , 68 S.W .3d a t 232

. The present appeal i s n ot from the r e lit iga ti on of a c lai m or a c ause of acti on th at w as final ly adj udi cat ed or

that
s h o u l d h a v e b e e n l i t i g a t e d i n a n e a r l i e r s u i t. See Mi

ller , 5 2 S

. W

. 3 d a t6 9 6

. T h u s , we conc lud e tha t t h e i ss ues about w hic h D r. Brow n now co mplai ns w ere notfinal ly l it ig ated and w ere not matters that, w it h the use of di li g ence, shoul d hav e been li ti g ated in an ear li er sui t. See M

il ler , 52 S.W .3d a t 696 ; Kaufm an , 197 S .W .3 d a t 8 7 2. Dr . Brow n di d not
e s t a b li s h t h e e le m e n to f " f in a l a d ju d ic a t io n , " a n d , t h e re fo re , re s ju d ic a t a d o e s n o ta p p ly. W e overrule Dr . Brow n's sole issue brought in he r cross-ap pea l.25 VIII

. Con cl usi on Acc ordin g ly , w e rev erse the j udg ment of the dis tr ict c our t an d r e nder

j udg ment
re ins tati ng the deci si on of the Board.

NE LDA V. RO DR IGU EZ J u s t i c e Opi nio n del iv ered and filed thi s 2 nd day

of Apr il , 200 9.