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

NO. 03-0 4 -00 752 -CV

Ar m ando Sanc he z , 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 , 261S T JUDICIAL DISTRICT NO. GN40098 2 , HO NORAB LE LORA J. LIVI NGSTON , JUDGE PRESIDI NG

O P I N I O N App e ll an t A r

ma n d o Sa n c h e z, M
. D
. , a

p p e a ls th e d is tr ic t c o u rt’ s f in a l j u d g me nt aff irming the order

of the Te x as State B oard of Medica l Ex aminers revoking Sanche z ’s m ed i cal 1 license and imposing an administrative penalty and costs. This disciplinary action wa s predicated up on fa c t fi nd ing s that Sanc he z ha d so lic ite d the mur de r of a fo rm e r patie nt. I n s ix iss ue s o n a pp e a l, Sanc he z co nte nd s th a t the a dmi nis tr a tiv e law j ud g e c omm itt e d e vid e nti ary and pr oc e dura l e rr or s in finding that Sanchez had solicited the f ormer patient’s murder; tha t substantial evidence did not support those fac t findings; that such f indings, if proper, were not leg ally sufficie nt support for the statut or y g ro un d und e r whic h d isc ipl ine wa s im po se d; a nd that th e B oa

rd e rr e d in makin g c e rt a in chang es to the administrative lawjudge ’s proposal fo r decision. W e will aff irm the district court’s judg ment.2 BACK GR OUND Prior to the disciplinary

proce eding s from wh i ch t h is appea l arose, Sanc hez held a license to practice medicine issued by the B oard. Sanc hez prac ticed industrial medicine, involving worke rs’ c ompensation claims. He ha d prac ticed in the Houston ar ea sinc e 1987.

I n connec tion with a worke r’s compensation c laim, D r. Sanchez had asse ssed one of his patients, M.G., with an 8% impairment ra ting. In a subseque nt independent medic al examination, M.G. was assessed only 4% impairment. The Texas Workers Com p en s ation Commi ssion adopted t h e 4 % re commendation, which ha d the ef fec t of reduc ing the amount of M.G.’s bene fits. M.G., for whatever re as o n, was a ng ere d at Dr. Sanc hez. Sanchez testified that M. G. c a me to h is o ff

ic e and thr e a te ne d to kil l Sanc he z, his famil y , his sta ff , an d his s ta ff

’s fa mil ie s. L ater , at an e vening social g ather ing a t a house Sanc hez owned, M.G. appea red unexpectedly

at the fr on t do or a t a late ho ur —it wa s unk no wn ho w M .G . lea

rn e d of t he g a the ri ngor

that Sanc he z wo uld be ther e—ag ain threatened Sanc hez and his f amily , stated that he kne w wher e Sanche z li ved, and mentioned descriptive details of S anche z’s home and family . Sanchez deduc ed that M.G. ha d been stalking him and his fa

mily
. A frie nd of Sanche z who was also pre sent at the g ather ing, T ony Sappington, a chiropra ctor with some mar tial arts experienc e, initially voiced e ag erne ss, before others re strained him, to “whip his [ M.G.’s] b u t t an d throw him in the backyard,” and (at least fig uratively ) “bur y him.” (We note this remar k beca use it is releva

nt to some disputed fac ts we discuss below). L ater that evening , Sappington, pe rce iving that Sanc hez fea red f or his and his family ’s safe ty , loaned Sanchez a shotg un and sug g es t ed that he se ek advic e fr om some of the police of fice rs who we re3

among their patients. Sapping ton offer ed to introduce Sanc h e z t o H o u s to n Po li c e De partment off

icer Glen Hill, who was ma rried to Sapping ton’s cousin and ha d immediate family who wer e his freque nt patients.

Sappington a

rra ng ed for Offic er H ill to meet with Sanchez at Sapping ton’s office on Fr iday , October

6, 2000. Ex actly what transpired at this meeting is disputed. Hill, S apping ton, and Sanc he z e a c h te sti fi e d at th e dis c ipl ina ry he ari ng . A ll a g re e d th a t H ill sh ow e d u p in po lic e un if

or m; that Sappington introduc ed Sanche z to Hill and left at s ome poi nt there afte r t o attend to patients; that Sanchez explained his pr oblems with M.G .; a nd that Hill made notes of the inf ormation, explained the pr oc e ss f

or fi lin g a c omp la int , an d ass ur e d him that HPD wo uld g e t to wo rk on the matte r. I t is also undisputed that at some point, Sanchez, who originally was from Mexi co, mentioned that he had a brothe r who wa s a Feder ale—a n office r i n the M exican fede ral police forc e—and ma de a r emar k to the eff ect that in Me x ico, one could pa y a F eder ale to “take ca

re” of the likes of M.G., a

nd alluded to drinking be er on M.G.’ s g rave .

Of fi c e r H ill re c ounte d th a t Sanc he z ma de thi s r e mark wh ile th e pa ir

wa s a lon e , in response to Hill’s ex planation of the pr ocedur es for filing a police re port and other

lawful mea

ns of obtaining pr otection from M.G. Acc ording to H ill, Sanche z “sa id he didn’t want any thing like that done, that he ha d a brothe r who wa s a F eder ale in Mexico and that if this was in M ex ico that that night he would be drinking a bee r on top of the patient’s g rave .” T h i s co n fu s ed Hill, so he asked Sanchez what the doc tor wante d him to do, and Sanchez responde d by sug g esting that Hill could ge t a gun, held his hand up as if pointing a gu n , an d s ai d “boom, boom , boom.” Hill interprete d Sanchez’s re marks to mean that he wa nted M.G. killed. Hill claimed that he w as “shoc ked,4

surprised,” and beg an looking around the room for a came ra, w onderingif he wa s being “set up.” He told Sanc hez that he “had to think about it,” and left the meeting
. Hill testified that there w as no doubt in his m ind that he was be ing a sked to kill M.G.

Sanc he z and Sa

pp ing ton , by c on tr a st, e a c h tes tif ie d that Sanc he z ma de the F e de ra le
rema rk while Sapping ton was still pre sent, following an exchang e in which mention wa s made of Sa pp ing ton ’s ini tia l r e mark s a bo ut b e a tin g up M. G. and bury ing him in the ba c ky ard
. Hi ll a lle g e dly responde d t o t h e ef

fe ct that “y ou don’t bury them . . . [y ]ou alway s burn them.” Sapping ton char acte rized all of these rema rks as in je st. Sanchez, on the other hand, rec alled that Hill made a n additional comment, which Sanc hez f o u n d “ p r e tt y disturbing,” to the eff

ect that this was why

burned, abandone d car s were sometimes found on fre ewa y s with bodies inside, so there wouldn’t be “a tr ace of it.” Ac cordingto Sanchez, Hill then stated, “[W] ell, we’ re not g oing to kill any one,” which Sanchez interpre ted as Hill “kind of impl[y ing] some kind of may be.” T o this, S anche z claims that he re sponded to the ef

fec t that if he wanted M.G. killed, he would ca ll his brother the F eder ale, that Fe dera l es “are ba sically

assassins,” a

nd that he wa s sure that his brother would “eve n be drinking beer o n t o p of [M.G.’s] grave.” Sanc hez denied pointing his fing er like a g un and makingthe “boom, boom, boom” re mark.

Dr
. Sanc he z a dd e d that wh e n he ra ise d the ide a of his c on ta c tin g a loc a l c on sta

ble to make a repor

t, O ffice r Hill dism issed the idea, sug g esting that at most, M.G. would ge t arre sted, g et out on bail, kill Dr. Sanchez, and flee to Mexi co. Acc ording to Sanchez, Hil l assure d him that he would “take car e of” the problem beca use he wa s Sappington’s f riend, a nd would call Sanche z later. Sanc he z pr of

e sse d th a t “ [o]bv iou sly , my imp re ssi on wa s that he [Hil l] wa s g oin g to h e lp m e ou t in5

so me wa y [but ] Idid

n’ t kn owwh a t he me ant. ” Sanc he z furt he r t e sti fi e d th a t H ill tol d him n ot t o divulge any

thing to Sapping ton, and it is undisput ed that both m en l ef t the offic e without talking to Sapping ton.

Hill imm ediately

repor ted his perc eption of t he conversation to his superiors at the Houston Poli ce D epar

tment. T hey decide d that Hill should i nvestig ate the matter, and he was g iven
an unmar ked patr ol car

equipped with micropho n es and transmitt ing e quipment for re cording
c o n v e r s a ti o n s . A r

r an g e me n ts w e r e a ls o ma d e to r e c o r d te le p h o n e c a ll s b e tw e e nH il l a n d Sa n c h e z. Be tween O ctober

6 and 9, 2000, HPD re corde d seven te lephone a nd in-person c onversations betwee n Dr. Sanc hez and Off icer Hill. Over objec tion, what purported to be copies of the rec orded
conver sations were admitted into evidence , as we ll as transcr iptions of those recor dings.

I t is undisputed that during this pe riod, Dr. Sanchez met with O ffice r H i l l sever al tim e s in his un mark e d pa tr ol ca

r i n v ari ou s H ou sto n r e sta ur ant p ark inglot s, that Sanc he z ag re e d to pay Hi l l for pur

poses including buy ing a n unreg istered gun, and that Sanche z actually delivere d $ 8 , 0 0 0 to Hill. However , Hill and Sanchez offe r diffe ring interpre tations of their mee tings a nd
conver sations. Hill understood that Sanchez was hiringhim to kill M.G. Sanchez insisted that he
wa s h ir ingHi ll t o r e so lve the M. G. p rob lem thr ou g h s ome un sp e c if ie d me ans tha

t he va g ue ly understood as possibly

incl u d in g h a v in g M
. G . arr ested a

nd deporte d, intimi dated, or boug ht off—but that ne ve r i nc lud e d kill inghim . In f a c t, i t is un dis pu te d th a t Sa nc he z ne ve r u se d a

te rm su c h a s “ kil l”
or “ mur de r” to de sc ri be the a c t he inte nd e d Hill to co mmi t, tho ugh the re wa s evi de nc e that H ill did so repe atedly

and without corr ection, cla rification, or question from Sanche z. Duri ngthe a ft e rn oo n of Oc tob e r 6, Of fi c e r Hi ll c a lle d D r. Sanc he z, a c c or din g to H ill ,6

and inf or me d h im that he wa s “ int e re ste d in do ing wh a t he ha d a sk e d me to do and we ne e de d to ta lk about it.” Hill stated that, without a doubt, Sanchez commented that he thought Hill needed to g et a gun. The p a ir

a g r e e d to me e t l a te r

th a t d ay a t a lo c a l r e s ta

u r an t a n d it is u n d is p u te d

th a t, a t the appointed time and plac e, Sanche z got into Hill’s unmarked c ar. H ill testi fied that the pa ir discussed the n e e d n o t t o d i v u l g e t h e i r d e a l i n g s t o S a p p i n g t o n o r o t h e r t h i r d p art i e s . A c c o r d ing to H ill , Sanchez indicated that he and Sapping ton were planning to ride mot orcycles and g o out that evening and would be “ visible,” which Hill inter prete d as the c onstruction of an a libi. Hill also claimed that Sanchez urg ed him to commit the act that evening . Hill recounte d that he off ere d a pric e of $20,000, “half befor e the a ct and then ha lf afte r,” e x plaining that h e would nee d money to obtain an
unre g ist e re d gun , a

nd Sanc he z ult imate ly

re so lve d to pay th a t amou nt. Hi ll a dd e d th a t th e pa ir discussed whe n Sanchez could g et the ca sh from his bank and whether Sanchez would want pr oof of the a ct bef

ore his second pay

ment. Hill emphasized that Sanchez assure d him that he was “ sure, 100 perc ent sure” that he wa nted the ac t done. Sanchez testified that Hill c alled him later that eve ning “ [b] asica lly to follow up” on their ea rlier mee ting. Hill did not testify reg ardingany such conve rsation, and it was not among those that wer e re corde d. Sanchez re counted that Hill stated: “Something in relation that he’ s probably g oing to have a—use a differ ent g un to have to use. H e nee ded some money beca use he
wa nte d to may

be g ive so me mon e y to the g uy to g e t aw ay fr om my lif e . He a lso —it

is h ard fo r m e to remembe r exactly

what it wa s , b u t from what Ican r eca ll, something alongthe lines of he ma y have to
. . . need to pay some friends or whateve r to—Ididn’t g o into particulars w ith him—t o be able to intimidate the g entleman, may be call I mmigration De partment. I don’t know. Idon’t know.7

Idon’t know exactly

what he me ant, but that’s what he said.” The followingmorning , Offic er H ill called D r. S an chez. Acc ording to Hill, he informed Sanc hez that he was una ble to commit the act the pr evious nig ht be cause of the we ather , and inqui red whether Sanchez still wanted him to g o forwa rd. I t is undisput ed that the pa ir ag ree d to meet ag ain, and did meet aga in in Hill’s car at the same location as the pr evious day . Hill testified that Sanchez ag ree d to ge t $8,000 from his bank that day so Hill could buy a gun. Hill added that during this conversation, he expli citly mentioned “killing” M.G. at lea st three times and that Sanchez
ne ve r i nte rr

up te d h im t o s ay th at he did n’ t w ant M .G . k ill e d o r t

hat H ill ha d mi sund e rs too d h im. S an ch ez, on the other ha

nd, admitted that Hill had asked him for money but testified that “I

think he wa s g oing to g et some stuff, includinga gun to intim idate [M.G.] ”

After the meeting , Sanchez admit s, “I went to the bank and .
. . g ot the money ,” and
re un ite d with Hi ll in the pa rk ing lot of a

dif fe re nt r e sta

ur ant. I t is un dis pu te d th a t Sanc he z g a ve Hi ll the money ; Hill reca lled rec eiving “a big wad of US c urre ncy in $100 bills .” Hill testified that he asked Sanc hez whether

he wa s “sure ,” and Sanchez responde d, “One -wa y ticket.” Hill asked, “O neway ticket? For

me? ” Sanche z, accor ding to Hill, re sponded, “N o. For y our g un.” Hill claimed he then aske d Sanchez whethe r he w anted Hill to kill M.G., t o wh i ch Sanche z reiterate d, “One -wa y ticket.” Sanc hez, Hill added, assure d Hill that he was “ very sure,” and sure “100 per cent,” as Sanchez didn’t have a choic e and w ould not be able to forg ive hi mself i f M.G. harme d his children. Hill also asserted that he invited Sanchez to call his pag er if Sanc hez chang ed his mind about having M.G. killed, to which Sanche z responded, “N o, no, g o on. . . . Move for war d as fa st as y ou can.” Sanchez later

acknow ledg ed alluding to a “one -wa y ticket , ” but insist ed that he unde rstood theThe c ourt also orde red D r. Sanche z not t o have a ny contac t with M.G. 2 8 rema rk to ref er to a bus ticket to transport M.G. ba ck to Mexico. On Monday , October

9, Hill called Sanche z and arra ng ed anothe r mee ting late r that da y a t th e same re sta

ur ant p ark inglot a s the ir la st me e tin g . Hi ll tes tif ie d that at this me e tin g he tol d Sanc he z that hi s p ro ble m ha d b e e n ta ke n c are of

the pr e vio us e ve nin g and tha t H ill jus t ne e de d “ to g et a little more money

from him.” Sanche z, ac cording to H ill, inquired whether Hill ha d a picture , but did not ins ist on s ee i n g o n e. Hi ll added that Sanche z ex plained that he c ould not ge t the
rema inder o f t h e m o n ey that day beca use the ba

nks were closed for

Columbus Day , but could do
s o t h e f o l l o w i n g d ay. After Sanchez depa

rted the meeting , he wa s arr ested by HPD personne l and subsequently

char g ed with solicitation of capital murde r. Howe ver, pr osecutors later off ere d, and Sanchez ac cepte d, a plea

barg ain wher eby

he plea ded nolo contende re to the cha rg e of solicitation of ca pital murder a

nd the district court e ntere d an orde r of de fer red a djudication, sentenc ing Sanc hez to t e n y e ars ’ c omm

un ity su pe rv isi on , a $5 ,0 00 fi ne , fo rf e iture of the $8 ,0 00 tha

t he pa id O ff

ic e r H ill , and 500 hours of

community

service
. 2
P ROCEDURAL HISTORY Sub se qu e ntl y , th e B oa

rd do c ke te d a

fo rm a l di sc ipl ina

ry c omp la int a g a ins t Dr. Sanc hez. The B oard a lleg ed two g rounds upon which it sou gh t t o i m p o s e dis cipline: (1) Sanchez’ s b ei n g “convic ted” of a fe lony , see Act of Ma

y 13, 1999, 76th L eg ., R.S., ch. 388, § 1, 1999 Tex. Gen. L aws 1431, 1517 ( am en ded 2003) ( curr ent ver sion at Tex. Occ. Code Ann.9

§ 164.051(a) (2)( A) (West 2004)) ; and (2) Sanc hez’s committing the “pr ohibited p ra ctice” of “unprof essional conduc t that is li kely to dece ive or de fra

ud the pu b l i c, as pr ovided by Section 164.053, or injure the public.” See Tex. Occ
. Code Ann. §§ 164.051(a) (1) (West 2004), .052(a)( 5) (West Supp. 2006). The complaint was r efe rre d to the State Offic e of A dminist rative H ear ings, a nd a hea ring was he ld before an administrative law judge (AL J ) in J une 2003. Ba sed on the e viden ce summarized above, a s well as the tape s and transc ripts of Offic er H ill’s conversations with Dr. Sanchez, t he AL J made the following finding s of fa ct that ar e
re le va nt t o th is a

pp e a l:
7. Duringthis [ initial Octo b er 6, 2000] m eetingbetwee n Dr. Sanc hez and Offic er H ill, Dr. Sanchez indicated to O ffice r Hill that he wanted M.G . killed. Of fi c e r H ill tol d Dr
. Sanc he z that he ha d to thi nk a bo ut h is r e qu e st a

nd wo uld contac t Dr. Sanche z later.

. . . . 10. Offic er H ill’s testim ony and the tape rec orded c onversations between Dr. Sanc hez and Off

icer Hill es t ab l i sh by

a pre pondera

nce of the evidenc e that Dr. Sanc hez solicited Office r Hill to kill M.G. 11. Dr. Sanc h ez agr ee d to pay Offic er H ill $20,000 to ki ll M.G. On Oc t o b er 7 , 2000, Dr. Sanc hez paid Offic er H ill $8,000 cash as a pa rtial pay ment of the a g ree d price . Dr. Sanc hez ag ree d to pay Offic er H ill the balanc e of $12,000 a fter M.G . was killed. 12. Dr. Sanc hez solicited Office r Hill to murder M.G. Th e AL J con c lud e d th a t D r. Sanchez’ s o rd e r o f d e fe rr e d a dju dic a tio n w a s n ot a “convic tion” that could support discipline under the then-a pplicable v er s ion of section 164.051(a) (2)( A). The AL J also reje cted the B oard’ s argument that the evidenc e supported a
c on c lus ion

that D r. Sanc he z “c omm it[e d] un pro fes siona l or

dis ho no ra

ble c on du c t th a t is lik e ly

toThat provision define s “pra cticing medicine” as “the diag nosis, treatment, or of fer to treat 3 a mental or phy sical disease or disorder or a phy sical def ormity or injury by any sy stem or method, or the a tte mpt to e ff

e c t c ur e s of tho se c on dit ion s, . . .” Te x. Oc c . Cod e Ann. § 1 51 .0 02 (a )( 13 ) ( Wes t Supp. 2006). 10 dece ive or defr aud the public, as provided by Section 164.053
. . . .” Se e id . § 164.052(a) (5). The AL J observed

t h at s ec t i o n1 6 4
. 0 5 3 d ef

i n es “u np ro fe s s i o n al o r d i s h o n o rab l e c o n d u ct l i k el y t o d ec eive or def raud the public” to inc lude, in r eleva nt pa rt, commission of “an act that violates a ny state or f e d e r a l l aw i f t h e a c t is connected with the physician’s practiceof medicine ,” but provides that “[p] roof of

the commission of [s uch] act while in the practice of me dicine or under the guise of the practi ce o

f me dicine is sufficient for the boar d’s ac tion.” Id
. § 164.053(a) (1), ( b) (West 2004) (empha ses adde d). The A L J rea soned that t his statutory structure require d the B oard to e stablish not
on ly that Sa nc he z’s a c ts we re “ c on ne c te d wi th” his pr a c tic e of me dic ine , b ut w e re un de rt a ke n “ wh ile in the prac tice of me dicine or under the g uise of pra cticing medicine.” Reasoning that the evidenc e did not establish this disciplinary g round as the Board had construed it, the AL J declined to make finding s and conc lusions to s upport that g round. Howeve r, i n its conclusion of law 5, the AL J stated that “ Dr . Sa

nc he z’s so lic itatio n o f m

ur de r o f M .G . d id n ot o c c ur wh ile Dr . Sa

nc he z wa s e ng a g e d in the pra ctice of

medicine, a s that term is defined in Te x . Occ . Code § 151.002(a) (13).” 3 Howeve r, the AL J did conclude that the Boa rd cou l d discipline Dr. Sanche z for “unprof essional or dishonorable c onduct likely to . . . inj ur e the public.” Se e id . §§ 164.051(a) (1), .052(a) (5) ( emphasis adde d). The AL J rea soned that unlike “unre asonable or dishonorable c onduct likely to dece ive or de

fraud the public,” a cate g ory of acts expli citly limit ed by section 164.053 and its requireme nt that criminal ac t s be “c onnecte d with the phy sician’s pra ctice of medicine,”11

“unre asonable or dishonorable conduc t l i k el y t o . . . inj ur e the public” is subject to no such limit ation. I n this connection, the AL J made f in d i ng of fa ct 18 that “Dr . Sanchez’s conduc t was likely to result i n t h e d ea t h of M.G. and, thus, wa s likely to injure the public,” a

nd the following
c on c lus ion s o f l aw:
3. Ba sed on F inding of Fa ct No. 12, Dr . Sanchez committed unprofe ssional and dishonorable c onduct that was likely to inj u re t he public, in violation of Tex. Occ. Code § 164.052( a)( 5). 4. Tex. Oc c. Code § 164.051 and 164.52(a) (5) authorize the Boa rd to discipline Dr . Sa nc he z fo r h is unp ro fe ssi on a l and dis ho no ra

ble c on du c t th a t w a s li ke ly to injure the public.
I n its final order, the Boa rd adopte d all of the propose d fi n d i n gs of fa ct and conclusions of lawexcept for c onclusion of law 5 ( “Dr . Sanche z’s soli citation of murder of M.G. did no t occ ur wh ile Dr . San c he z wa s eng a g e d in th e pr a c tic e of me dic ine , a s th a t te rm

is d e fi ne d in Tex. Occ. Code § 151.002( a)( 13)”) , and conc lusions of law 9, 10, and 11, in which the AL J stated that t h e Board “should” revoke Dr. Sanc hez’s medical lice nse, impose a $5,000 a dminist rative pe na lty , a nd imp os e a $1 ,4 80 .3 5 f

e e to c ov e r t

he c os t of the tr ans c ri pt. Re g ard ingits de c isi on to delete c onclusion of law 5, the B oard state d: (1 ) t he Com pla int in t his matte r d id no t a lle g e and the B oa rd Sta ff did no t atte mpt

to prove that Dr. Sanche z’s soli citation of murder occur red w hile Dr
. S an ch ez was ac tu a ll y e n g a g e d in th e p r a c ti c e o f me d ic in e . T h a t w a s n e v e r an is s u e in th is case . There fore , this Conclusi on is not an issue that should be deter mined by the B oard. (2) this Conclusion of L aw is not nece ssary to support the Conclusion of L aw No. 3, stating that Dr. Sanche z commit ted unpr o f e s s io n a l a n d d is h o n o r a b le conduct that wa s lik e ly t o i n j u r e t h e p u

b l i c . T h a tC o n c l u s i o no f L aw i s s u f

f i c i e n tt o i mp o s e o nthi s B o ar d th e d u ty to ta k e d is c ip li n ar

y a c ti o na g a in s t D r . Sa

n c h e z.The B oard e mphasized that it “is cha rg ed with the duty

and has the sole authority to make 4 the final de cision in this m atter, a nd that includes the de cision as to the appr opriate sa nctions.” 12 (3) this Conclusion c ould be interpre ted as a dopting the A L J ’s re asoning , as stated on pag e 28 and 29 of the Proposal for Dec ision, that S ection 164.053(a )(1) of the Ac t require s not only a showing that the improper conduct c ould be “c onnecte d with the ph y sic ian’ s me dic a l pr a c tic e ,” a s r e qu ir e d b y the statut e , b ut a lso that th e a c t mu st occur “in the pra ctice of

medicine or

under the g uise of the p ra ct i ce o f medicine .” The B oard de clines to adopt this rea soning a s the policy of the B oard. Sin c e i ti s u n n e c e s s ar

y f o r t h e B o ar d

t o m a k e s u c h a

C o n c l u s i o no f

L aw i nthi s matter, the B oard ha s determined tha t this C onclusion of L aw should be de leted fr om the Fina l Order
. See Tex. Gov’t Code Ann. § 2001.058(e) (West 2000).

Th e B oa rd a do pte d a ll o f t

he AL J’s r e c omm e nd a tio ns fo r s anc tio ns state d in conclusions of law9, 10, and 11, but f ormally deleted the se conc lusions because they wer e, in the Boa rd’s view , “in ac tuality

rec ommendations . . . rather than conc lusions of law.” 4 Sanchez s oug ht judicial revie w of the Board’ s order in district court. Af ter a hear ing
on the m erits , th e d is tr ic t c o u rt r e n d e r e d a f in a l j u d g me n t a f

f ir mi n g th e B o ar d ’ s f

in a l o r d e r. This appea l followed.
DI SCU SSIO N

The six i ssues that Dr. Sanc hez bring s on appea l can be divided into essentially two g roups. I n his first set of issues, Sanche z complains of leg al er ror in conne ction with the Boa rd’s fo ur fi nd ing s o f f

a c t th a t he so lic ite d M .G .’ s murd e r. Spe c if ic a lly , h e ur g e s th a t th e AL J abu se d it s dis c re tio n in

a dmi tti ngc op ies and tr ansc ri pts of the HPD re c or din g s o f h is c on ve rs a tio ns wi th Offic er Hill, that the AL J err ed in a pply ing a preponde ranc e-of -the-e vidence rathe r than a h i gherSanchez’s fifth, third, a nd second issues, r espec tively
. 5 On this basis, Sanchez’s first issue cha llen ges t he B oard’ s conclusion that he violated 6 section 164.052(a )(5) of the oc cupations code
. Simi larly , Sanchez urge s in his six th issue that the Boa rd ac ted ar

bitrarily and ca priciously and abused its discretion by failing to “consider

the require ment that the alleg ed ac t be within the prac tice of me dicine,” a nd thus “did not consider the fac tors that wer e relevant to its decision and consider ed irre levant fa ctors.” A n ag ency decision may be found a

rbit rary and ca pricious if it is based on leg ally irrele vant fa ctors or if le g ally rele vant fac tors wer e not consider ed. City of El Paso v. Public Util. Comm’n , 883 S.W .2d 1 7 9 , 184 (T e x. 19 94 ); Centerpoint Energy Houston Elec., LL C v. Publi c Util. Comm’n , 212 S.W .3d 389, 400 (Tex. App.—Austin 2006, pet. abate d). His fourth issue. 7 See Tex. R. Evi d. 1002, 1003. 8 13 burden of proof, a nd that the finding s are not supported by substantial evidence
. 5 Dr. Sanc hez’s second se t of issues challen ges wh et h er the findings of fac t that he solicited M.G.’s m urder can, as a matter of l aw, support the di sciplinary g round that he “ commit[ ted] unprofe ssional or dishonorable c onduct that is likely to . . . i n

j u re t h e p ublic” under

section 164.052(a) (5) without a dditional f indings or c onclusions that those acts we re c ommitt ed within or “under the cloak of” the prac tice of me dicine. Related to this question, Sanchez complains that the 6 Boa rd improper ly

omitted the AL J ’s conc lusion of law 5. 7
Adm ission of the recor din gs and transcr ipts

We f ir st a dd re ss D r. S anch e z’s a sse rt ion tha t th e AL J abu se d it s d isc re tio n in admitting copie s of t he HPD tape rec ording s of his conver sations with Office r Hill and transc riptions of tho se re c or din g s, and

that su ch admissi on

wa s h arm fu l. A lth ou g h h e state s th is a rgume nt i n terms of the “ best evidenc e” r ule, S an c h e z ’ s u l t i m a t e c o m p l a i n t i s t h a tt h e B o ar d f a i l e d t o l ay a 8 sufficie n t foundation that either the orig inal or duplicate audiotapes w ere authentic.Sanchez complains that the Boa rd failed to introduc e evidenc e meeting t h e s ev en -p art 9 predic ate f

or the a dmission of recor dings state d in Cummings v. Je ss Edwards, Inc. , 445 S.W .2d 767 (Tex. Civ. App.—Corpus C hristi 1969, writ ref ’d n.r.e.): (1) a showing that the re cordingdevice was c a pa ble of takin g te sti mony ; ( 2) a sh ow ingthat th e op e rator of the device wa s c omp e te nt; (3 ) e sta bli sh me nt o f t

he a uth e nti c ity

of the c or re c tne ss o f the re c or din g ; (4 ) a sh ow ingthat c ha

ng e s, additions, or deletions have not be en made ; (5) a show ing of the manner

of the pre servation of the rec ording ; (6) identificat i o n o f t h e s p eakers; and ( 7) a showing that the testimony

elicited wa s voluntarily

made without any

kind of induceme nt. Id . at 773. Howe ver, the Ed war ds c ri te ri a did not survive the adoption of rule 901 of t he rule s of evidenc e. An gle ton v . S tate , 971 S.W .2d 65, 69 (Tex. Crim. App. 1998). 14 See Tex. R. Evi d. 901.

We r eview administrative ruling s reg ardingthe admissibilit y of evide nce unde r the
same a buse-of -discre tion standard that we apply to trial courts. Austin Chevrolet, Inc. v . Motor Vehicle Bd. , 2 12 S.W. 3d 42 5, 43 2 ( Te x. App.— Aus ti n 2006 , p e t. d e nie d) ; City of A ma ril lo v. Railroad Comm’n , 894 S
. W
. 2 d 4 9 1 , 495 (Tex. App.—Austin 1995, writ denied). The test for abuse of discretion is whether the ruli ng was unre asonable or ar bitrary or made “without ref

ere nce to any g uid i n g rul es or pr inciples.” Cire v. Cummings , 134 S.W .3d 835, 839 (Tex. 2004) (citing Downer v. Aquam arine Operators, Inc

. , 70 1 S.W. 2d 23 8, 24 1 (T e x. 19 85 )); Sh esh un off

v . S he sh un off , 172 S.W .3d 686, 701 (Tex. App.—Austin 2005, pet. denied). Under rule 901, the r equire ment of authentication “is satisfied by evidenc e suff

icient to support a finding that the matter in que stion is what its propone nt c laims.” Tex. R. Evid. 901(a). 9 Such evidenc e may

include testimony

by a witness with knowledg e that a matter is w hat it is claimed to be and id e n ti f

ic a ti o no f a v o ic e b y o p in io nb a s e d

o nh e ar in g th e v o ic e u n d e r c ir c u ms ta

n c es
connec ting it with the all ege d s p eake r. Id . 9 01 (b )( 1) , ( 5) . F ur the r, the pr e dic a te fo r a dmi ssi bil ity under r ule 901 may

be prove n by

circ umstantial evidence
. Se e W all ac e v . S tate , 782 S.W .2d 854,15

856-57 n.6 (Te x . Crim. App. 1989).

The AL J admitted the tapes in the belief that Offic er Hill ha d testified that the tape s
and tr ans c ri pt w e re a c c ur a te re pr e se ntatio ns of his c on ve rs a tio ns wi th Dr
. Sanc he z. Th e re c or d is not a model of c larity

in that reg ard. O ffice r Hill was neve r d i re ct l y as ked whe ther the ta pes the mse lve s a c c ur a te ly re fl e c te d his c on ve rs a tio ns wi th Dr
. Sanc he z. N on e the le ss, his te sti mony is
s u s ceptible to the interpretation that the transcriptions ac cu ra t el y re fl ec t edt h e c o n v er s at i o n s . In turn, Hill testified that the transc riptions accur ately ref lec t ed t h e content of the tapes, with the
e xce pti on of min or de ta ils tha t di d n ot a lte r t

he me anin g of

the ir c on te nt. He a dd e d th a t th e du pli c a te tapes wer e acc urate copies of the orig inals and that he rec og nized his voi ce a nd that of Dr. Sanc hez
on the ta pe s. Of fi c e r Hi ll a lso e xpla ine d ho w his patr ol c ar and te le ph on e ha d b e e n e qu ipp e d w ith microphones that tra

nsmitt ed to rec ording device s and that he had worn a rec ording device during his c on ve rs a tio ns wi th D r. Sanc he z. F ur the r, duri nghis te sti mony re g ard ingthe c on ve rs a tio ns , H ill
c on tin ua ll y re fe re nc e d th e fa c t th a t th e y ha d b e e n ta

pe d. We c on c lud e that th e AL J did n ot a bu se its dis c re tio n in

c on c lud ingtha

t the or ig ina l and du

pli c a te a ud iot a pe s, a s w e ll a s th e tr ans c ri pti on s,
we re a c c ur a te re pr e se ntatio ns of Of fi c e r H ill ’s c on ve rs a ti on s wi th D r. Sanc he z. We ov e rr ule Sanchez’s fifth issue.
Burden of

proof We next addre ss Sanchez’s claim that, bec ause his alleged co n d uct was a criminal offe nse, the B oar d s h o u l d have be en held to a hig her bur den of pr oof than “ preponde ranc e of the evidenc e. ” Sa

n c h e z i n s is ts th a t t

h e B o ar d s h o u ld h a v e b e e nr e qu ir e d

to p r o v e it s a ll e g a ti o n s by “cle ar and convincing evidenc e” or “beyond a re asonable doubt.” Sanche z additionally argues that16

beca use medica l disciplinary

proce eding s are “pena l in nature,” due proc ess re quires a hig her standard of

proof than a

“mer e pre pondera

nce of the evidenc e.” This Court has previously observe d that “ag ency license- revoc ation proce eding s are civil in nature,” and “that in civil cases ‘no doc trine is more fir mly established than that issues of f act
are resolved by

a pre pondera

nce of the e v i d en ce .’” Gran e k v . Te x as Sta te Bd

. o f M e d. Ex am ’r

s , 1 7 2 S
. W
. 3 d

7 6 1 , 7 7 7 (T ex . Ap p . —

Au s t i n2 0 0 5 , n o p et
. ) ( qu o t i n g Pretzer v. M oto r V eh i cl e Bd. , 125 S.W .3d 23, 38-39 (Te x . App.—Austin 2003), aff ’d in par t and re v ’d in p ar t , 138 S.W .3d 908 (Tex. 2004)). In Granek, we squarely reje cted the c ontention that due proc ess re quires a hig her burden of proof in license revoc ation proceed i n gs , an d noted that “Te x as applies the c lear and convincingstandard in c ivil cases only in ‘ extraordinary circ umstances,’ such as c ivil commit ment hear ings and involuntary

termination of par ental rig hts.” Id
. We continue to reg ard this ana ly sis as persua siv e. No r does Sanchez sugg est any rea son why , in a licensing proce eding , an alleg ation of conduct c onstitut ing a criminal offe nse should, f or that rea son alone, be subject to a hig her standa rd
o f p roof than an alleg ation of non-c riminal conduct. Cf. He ili gm an n v . R os s , 16 S.W . 931, 931 (Tex. 1891) (“T here is no force in the positi o n t h at b eca use the fa cts of the c ase ma y involve a
c ri min a l a c t th e re sh ou ld b e a g re a te r o r m or e c e rt a in d e g re e of pr oo f tha n is re qu ir e d in ot

he r c ivi l
a c tio ns .” ); see also State v. Gray , 1 7 5 S
. W
. 2 d 2 2 4 , 2 2 5 (T ex . 1 9 4 3 ) ( i nci v i l fo rf ei tu re p ro ce ed i n g, iss ue of wh e the r p ro pe rt

y ow ne r h a d c omm itt e d o ff e ns e of “ e xhibi tin g slo t ma c hin e s f or the purp os e of g aming . . . had to b e d et er m i n ed only from a pr eponder ance of the e vidence , not bey ond
a re asonable doubt.”).

S an ch ez al s o re l i es u

p o n o u r c h ar ac t er i z at i o no f t h e B o ar d ’s l i ce n s i n g p ro ce ed i n gsRestated her e for the re ader ’s conve nience : 10 7. Duringthis [ initial October 6, 2000] meeting bet we en Dr. Sanchez and Offic er Hill, Dr. S anche z indicated to Offic er H ill that he wanted M.G. killed. Of fi c e r H ill tol d Dr
. Sanc he z that he ha d to thi nk a bo ut h is r e qu e st a

nd wo uld contac t Dr. Sanche z later.

. . . . 1 0
. O f f ic e r H il l’ s te s ti mo n y an d th e ta p e r e c o r d e d c o n v e r s a ti o n s b e tw e en Dr
. Sanchez and Of

fice r Hi l l est ablish by

a pre pondera

nce of the evidenc e that Dr. Sanc hez solicited Office r Hill to kill M.G. 11. Dr. Sanc hez ag ree d to pay Offic er H ill $20,000 to k i l l M.G. 17 a s “ c ivi l” to a

rgue that th e AL J abus ed it s d isc re tio n in a dmi tti nge vid e nc e of

Sanc he z’s no lo contende re ple a in violation of article 27.02 of the c ode of c rimi n al proc edure . Article 27.02 pr ov ide s th a t a

ple a of no lo c on te nd e re “ may

no t be us e d a g a ins t th e de fe nd ant a s an a dmi ssi on in any civil suit based upon or growing out of t he act upon which the c riminal prosec ution is based.” Tex. Code Crim. P roc. A nn. art. 27.02(5) (West 2007)
. The AL J ag ree d, holding that Sanc hez’s plea was inadmissibl e as an admi ssion of g uilt, although the or der of defe rre d adjudication wa s admissibl e o n other g rounds. We acc ording ly assume that the AL J did not rely on the plea a s
e v id e n c e o f Sa

n c h e z’ s g u il t. See Herfor d v . S tate , 139 S.W .3d 733, 735 & n.7 ( Tex. App.—Fort Worth 2004, no pet.). We overrule Sanchez’s third issue.
Sub stantial evidence

Dr. S an ch ez next asser ts that the Boa

rd’s fa ct finding s—7, 10, 11, and 12—supporting its lega l conclusions reg ardingdisciplinary g rounds ar e not supported by substantial evidenc e. 10On Oct o b er 7, 2000, Dr. Sanc hez paid Offic er H ill $8,000 cash as a pa rtial pay ment of the a g ree d price . Dr. Sanc hez ag ree d to pay Offic er H ill the balanc e of $12,000 a fter M.G . was killed. 12. Dr. Sanc hez solicited Office r Hill to murder M.G.
18 Th e APAa

uth or ize s c ourt s to “ te st the a g e nc y ’s fi nd in g s, inf e re nc e s, c on c lus ion s, and dec isions to determine whethe r they are rea sonably

supported by

substantial evidence considering the reliable and probative evidenc e in the rec ord as a whole.” Te

x as De p’ t of Pu b. Sa fe ty v. Latimer , 9 3 9 S
. W
. 2 d 2 4 0 , 2 4 4 (T ex . Ap p . — Au s t i n 1 9 9 7 , n o p et
. ) ( ci t i n g Texas He alth Faciliti es Comm’n v. Charter Me d.-Dallas, Inc. , 665 S.W .2d 446, 452 (Tex. 1984) ). We a re to pre sume that the ag ency

decision is supported by

substantial e vidence , and Sanchez has the burde n of over coming that presumption. Granek, 1 7 2 S
. W
. 3 d at 7 7 8 ( c i t i n g Charter , 665 S.W .2d at 452). We may not substitut e our judg ment for that of the a g ency , and may consider only

the re cord on w hich the ag ency b as ed its decision. Id. We consider only the re liable and pr obative evide nce in this rec ord. See Tex. Gov’t Code Ann. § 2001.174(2)( E) (West 2004).

T h e cr u x o f a sub s t an t i al ev i d en ce an al y s i s i s wh et h er t h e a gen cy ’s fa ct u al fi n d i n gs
are rea sonable “ in light of the e vidence from which the y wer e purpor

tedly inferr ed.” Granek, 172 S.W .3d at 778 (citing J ohn E. Powers, Age nc yAd jud ic ati on s 163 (1990)) . Substantial evidence do es no t me an a

larg e or c on sid e ra

ble a mou nt o f e vid e nc e , b ut r a the r s uc h r e le va nt e vid e nc e a s a
rea sonable mind might a cce pt as ade quate to support a c onclusion of fa ct. H i n k l e yv . T e x a s Sta te Bd

. of Me d. Ex am ’r

s , 140 S.W .3d 737, 743 (Tex. App.—Austin 2004, pet. denied). T he evide nce in t he re c or d ma

y a c tua lly pr e po nd e rate a g a ins t th e a g e nc y ’s de c isi on and ne ve rt he le ss a mou nt t o19

s u b s ta n ti a l e v id e n c e. L a timer , 9 39 S.W. 3d a t 24 4. Th e a g e nc y

de te rm ine s th e me anin g , w e ig ht, and cr edibility

to assign co n fl i ct i n g evidenc e, Texas State Bd. of Me d. Exam’ rs v. Sche ffey, 949 S.W .2d 431, 437 (Tex. A pp.—Austin 1997, pet. denied) , and we may not set aside an a g ency decision bec ause te stimony was c onflictin g o r d i s p u ted or be cause it did not compel the ag ency ’s decision. Fi r em en ’s & Policeme n’s Civil Serv. Comm’n v . Brinkmey er , 662 S.W .2d 953, 956 (T e x. 19 96 ). We a

re ult imate ly

con cern ed wi th t

he re a so na

ble ne ss o f t

he a g e nc y ’s or de r, no t it s
corr ectne ss. Se e id
.

A cour t revie wing an ag ency

action “sha ll rever se and r emand the c ause to the a g ency wh en substantial rig hts of the appe llant have be en pre judiced by

an ag ency ’s finding s that are not
re a so na bly su pp or te d b y su bs tanti a l e vid e nc e c on sid e ri ngthe re lia ble e vid e nc e in t

he re c or d a s a whole.” Hinkley , 1 40 S.W. 3d a t 74 3; see Tex. Gov’t Code Ann. § 2001.174(2)( E). A trial cour t’s ultimate determination whe ther substantial evide nce suppor ts an ag ency ’s orde r is a question of law, which we revie w de novo. Texas De p’t of Pub

. S

a f et y v. Jack

son , 76 S.W .3d 103, 106 (Tex. App.—Houston [14t h Dist.] 2002, no pet.).

We have pr eviously

summarized t h e re liable and pr obative evide nce in the r ecor d. Severa l key fac ts tending to support the AL J ’s finding s were undisputed: Dr. Sanche z and Office r Hill met sever al times under cir cumstance s that could rea sonably be conside red suspicious, Sanche z avoided infor

ming Sapping ton about his dealing s with Hill even thoug h Sappington a nd Hill were g ood friends, Sanc hez paid Hill $8,000 , an d t h i s pay ment was for

purposes that include d Hill’s purcha se of a

g un. Hil l al s o testified unequivoca lly that afte r he e x plained leg al proc edure s for20

a dd re ssi ngM. G. ’s thr e a ts, Sanc he z tol d him that “ he did n’ t w ant a ny thi nglik e that do ne ,” tol d H ill “per haps he c ould ge t a g un,” and sa id, “boom, boom, boom,” while holding his ha nd up as if he w as ho ldi nga g un . D ur ingsu

bs e qu e nt m e e tin g s, Hi ll t e sti fi e d, Sanc he z dis c us se d the ne e d f or Hi ll t o purcha se an unr eg istered gun and told him that the act nee ded to be done on a particula r nig ht when Sanchez would be “ visible” with his friends. At their f inal m ee t i n g , Hill recounte d that Sanchez asked if the re w as a picture to c onfirm that the act had been done and ag ree d to pay Hill more money for c ompleting the a ct. Hill also testified that he re peate dly used the ter

m “kill” to describe the ac t he wa s planning to co m m i t o n M.G. and that Sanc hez never sug g ested ther e had be en
a m i s u n d er s t an d i n g.

Although Sanc hez offer ed contr overtingevidenc e, the AL J cou l d rea sonably have conclude d that Hill’s version of the conversations was more plausible. Sanchez’s ac count beg s the questions, for example, why he would pay

for Hill to purcha se an unlicensed gun and to ensure such
se c re c y if the ir ob je c tiv e wa s to have M. G. arr e ste d, dep ort e d, or int imi date d, and

why he wo uld want a photo, e x cept to see the body . I n any event, we must re solve evidentiar y ambig uities in fa

vor of the a dminist rative or der w ith a finding of substantial evidenc e to support the AL J ’s dec is i o n. Railroad Comm’n v. Torch Ope rating Co. , 912 S.W .2d 790, 792 (Tex. 1995).

We c on c lud e t

h a t s u b s t a ntia l e vid e nc e su

pp or ts the c ha lle ng e d f

ind ing s. We o ve rr

ule Sanchez’s sec ond issue.
Are the fact fin din gs suf fi cient to support the Board’s discipli nary grounds ? Dr. Sanc hez asserts that fa ct finding s 7, 10, 11, and 12 ca nnot, as a matter of statutory
c on str uc tio n, su pp or t the B oa rd ’s c on c lus ion that he “ c omm itt e d un pr of e ssi on a l or d is hono ra

ble21

conduct that is likely to .
. . injure the public” under section 164.052(a) (5) without a d ditional f in d in g s o r

c o n c lu s io n s e s ta

b li s h in g th a t h is a c ts w e r e “ r e late d to p r o f e s s io n a l d e r e li c ti o nin

the prac tice of me dicine or c onduct under the cloak of

medical tre atment.” Statutory constructio n p re s ents questions of law that we revie w de novo. Bragg

v . E d wa rd s A q u if e r A u th. , 71 S.W. 3d

72 9, 73 4 ( Te x. 20 02 ); Edwards Aquifer Auth. v. Chemical Lime, Ltd. , 212 S.W .3d 683, 697 (Tex. A pp.—Austin 2006, pet. filed). I n construing a statute, our objective is to deter

mine and g ive ef

fec t to the l egi slature’ s intent. Texas De p’t of Protective & Regulatory Serv

s. v. Me ga Child C

are, Inc

. , 1 45 S.W. 3d

17 0, 17 6 ( Te x. 20 04 ); se e als o Tex. Gov’t Code Ann. § 312.005 (West 2005)
. We a scer tain that intent “first and f oremost” f

rom the statute’s lang uag e as written. Le x ing ton In s. Co. v . S

tra y ho rn , 209 S.W .3d 83, 85 (Tex. 2006). We must consider the statute as a whole, not individual provisions in isolation, and we should not g ive on e pr ov isi on a me anin g ou t of ha rm ony or inc on sis te nt w ithoth e r p ro vis ion s, e ve n th ou g h it mi gh t b e s u s ce ptible to such a construc tion standing a lone. Texas De p’t of Transp. v. Needham , 82 S.W. 3d

31 4, 31 8 ( Te x. 20 02 ); Fitzgerald v. Advanc ed Spin e F i xa t i o n Sys., Inc

. , 996 S.W .2d 864, 866 (Tex. 1999).

The Medic al Prac tice Ac t establishes the Boa rd as an ag ency of the executive bra nch “with the power to r egulate the prac tice of me dicine.” T ex. Occ. Code Ann. § 152.001 ( West S upp. 2006). “Pra cticing medicine” is defined a s “the diag nosi s , treatment, or offe r to treat a mental or phy sical disease or disorder or a phy sical def

ormity or i njury by any sy stem or m ethod, or the attempt to effe ct cur es of those c onditions, by a per son who (A) publicly profe ss es t o b e a p h y sician or surg eon; or (B ) direc tly or indirectly char g es money or other c ompensation for those se rvice s.” Id.22

§ 151.002(a) (13) ( West S upp. 2006). T h e Boa rd is empower ed to adopt rule s and bylaws as
nece ssary to “re g ulate the pr actice of medicine i n t h is state” and “ enfor ce this subtitle.” Id
. § 1 53 .0 01 (We st 2 00 4) . I t is a lso e mpo we re d to re fu se to a dmi t pr os pe c tiv e lic e ns e e s to its examination, to refuse to issue license s, and “to take disciplinary action ag ainst a per son” base d on g rounds enumer ated in sec tion 164.051 o f t h e occupations code. Se e id
. § 164.051(a) . Some of these g rounds ar e ce rtain ac ts committ ed within the pra ctice of medicine. Se e id
. § 164.051(a) (6) (“f ails to pr actice medicine in an a cce ptable prof essional manner

consistent with public health and welfa re.” ), (7) (pee r re view or hospital disciplinary action whe n Boa

rd finds that ac tion was based
on “unprof

essional conduct or profe ssional inc ompetence that was likely to ha rm t h e p ublic”), ( 8 ) ( “ is s u b je c t t o r e p e a te d

o r r e c u r r in g me r it o r io u s h e a lt

h c ar e li a b il it y c la im s th a t i nth e b o ar d ’s opinion e vidence profe ssional inc ompetence likely to injure the public”) . Other g rounds, howeve r,
c on c e rn tr a its of fi tne ss o r c ha

ra c te r t hat ma y imp a c t—d ir e c tly

or ind ir e c tly —th e pe rs on ’s a

bil ity to prac tice medicine
. Se e id
. § 164.051(a) (2) ( conviction of fe lony or misdemeanor

involving mora l tur pit ud e ), (4 ) ( “ is una

ble to p ra c tic e me dic ine wi th r e a so na ble sk ill and

sa fe ty to p a tie nts be c a

us e of (A) i l l n es s; (B) drunkenne ss; (C) excessive use of dr ug s, narc otics, chemica ls, or another
su bs tan ce; or

(D ) a me nta l or

ph y sic a l c on dit ion ” ), (5 ) ( “ is f ound by a c ourt jud g me nt t o be of unsound mind”)
.

Section 164.051 also includes a m ong the g rounds for de nial or disciplinary action the commission of “an a ct proh i b i t ed u nder Sec tion 164.052.” See id. § 164.051(a) (1). Sec tion 164.052 enumer ates sever al “prohibited prac tices” by “[a] phy sician or an a pplicant for a

license.” See id. § 1 6 4
. 0 5 2 ( a )
. M an y o f th e s e g r o u n d s inv o lv e d e c e p ti o nin ta k in g a me d ic a l e x amination,23

obtaining a

license, or

in the repr esentingor holding forth of the licensing status of oneself or one’ s aff iliates. Se e id
. § 164.052(a) (1)- (3), (6)- (15), (17). Howeve r, “pr ohibited prac tices” a lso include “us[ing] alcohol or drug s in an intemperate manner that, in the board’ s op i n i o n , could enda ng er a patient’s life,” id
. § 1 64 .0 52 (4 ), and “ c omm itt [ing ] unp ro fe ssi on a l or dis ho no ra

ble c on du c t th a t is likely to dece ive or de fra

ud the public, as provide d by Section 164.053, or injure the public.” Id
. § 164.052(5). The y

also include performing or procuring , or aiding or abetting the procurement of a “c riminal abortion,” or

attempting suc h acts. Id
. § 164.052(16). Se c tio n 1 64 .0 53 , in

tur n, de fi ne s “ un

pr of e ssi on a l or dis ho no ra

ble c on du c t li ke ly

to dece ive or de fra

ud the public” “ [f] or purpose s of Section 164.052(a )(5) .” Id
. § 164.053(a) . The definition “includes c onduct in which a phy sician
. . . commits a n act that violates a

ny state or f eder al law if the a ct is connec ted wit h the phy sician’s pra ctice of medicine.” Id
. § 164.053(a) (1). As the Boa rd obser ves, the plain languag e of se ction 164.052(a) (5) incor porate s the limit ati o n s and de fi nit ion s o f s e c tio n 1 64 .0 53 on ly wi th r e g ard

to “ un pr of e ssi on a l or dis ho no ra

ble c on du c t that is l i k el y t o d ece ive or de fra ud the public.” Id
. § 164.052(a) (5) ( “committ[ ing] unprofe ssional or dishonorable c onduct that is likely to dece ive or defr aud the public, a s provided by Section 164.053,
or inj ur e the pu

bli c .” ). Conve rs e ly , sec tio n 164 .0 53 de fi ne s only “ un pr of e ssi on a l or

dis ho no ra

ble
c on du c t lik

e ly to d e c e iv e or de fra ud thepu bli c ” under

section 164.052 (a )(5). Id
. § 164.053 (e m p h a s i s a d d e d )
. N e i t

h e r p r o v i s i o n p ur po rt s to lim it “ un

pr of e ssi on a l or

dis ho no ra

ble c on du c t li ke ly to . . . inj ur e thepu bli c .” Thus, re ad in isolation, nothing in either se ction 164.052(a) (5) or section 16 4. 05 3 w ou ld p re ve nt “ an a c t th a t vi olate s any state
. . . la

w” that is not

“conne cted with the ph y sic ian’ s p ra c tic e of me dic ine ” fr om c on sti tut ing“ un pr of e ssi on a l or

dis ho no ra

ble c on du c t li ke ly24

to . . . injure the public.” Se e id
. §§ 164.052(a) (5), .053( a)( 1).

Dr. Sanc hez, however , points ou t t hat sec tion 164.052 refe rs to “prohibited practices ” and

that th e te rm

“ pr a c tic e ” or

“ pr a c tic e s” thr ou g ho ut t

he Me dic a l Pr a c tic e Ac t re fe rs to the pra ctice of

medicine. See id. §§ 151.001 (subtitle may by cited as “ the Medic al Practice Act”) , .002(12) ( defining“phy sician” a s “per s o n l icense d to practice m edicine in this st ate.” ), .002(13) (def ining “ prac ticing me dicine”) ; 164.052(a) ( “phy sician or license a pplicant commits a prohibited practice if
. . . .”) ( emphase s added) . Fr om this st atutory context, S anche z urge s us to infer le g i s l a t i v e i n t e n t t h a t t h e “ p r o h i b i t e d p r a c t i c e ” o f “ u np r o f e s s i o n a l o r d i s h o n o r a

b l e c o n d u c t t h a t is lik e ly to .
. . inj ur e the pu

bli c ” re fe rs so le ly to a c ts o r c on du c t c omm itt e d w ith in o r u nd e r t he g uis e of his prac tice of me dicine.

Dr. Sanc hez also emph a s iz e s th a t t h e le g is la tu re spe cifica lly

enumer ated c erta in ty

pes of cr iminal violations that could serve as bases for Boa rd discipline—and that these do not include his vio la tio n. As pr e vio us ly no te d, se c tio n 16 4. 05 3 in c lud e s v iol a tio ns of state and fe de ra l la w “ if the ac t is connecte d with the phy sician’s pra ctice of medicine” among the ac ts constituti ng “unprof essional or dishonora

ble conduc t likely

to dece ive or de fra

ud the public” unde r sec tion 16 4. 05 2( a )( 5) . San chez a lso ob se rv e s th a t se c tio n 1 64 .0 51 , at r e le va nt t ime s, inc lud e d a s a d i s c i p l i n ar

y g r o u n d o n l y convic tions for f

elonies and misdemea

nors involving mora l turpitude, and did not encompass his or der of defe rre d adjudication. Act of Ma y 13, 1999, 76th L eg ., R.S., ch. 388, § 1, 1999 Tex. Gen. L aws 1431, 1517 (ame nded 2003) ( curr ent ver sion at Tex. Occ. Code Ann.As noted pre viously , this provision was subsequen tly amende d to include being 11 “convic ted of, or is placed on deferred adjudication, com munity supervision or deferre d dispositi on for a fe lony or misdemeanor

involving mora l tur

pitude.” Act of Ma

y 23, 2003, 78th L eg ., R.S., ch. 202, § 31, 2003 Tex. Gen. L aws 841, 841 (e mphasis added)
. We also note that the B oard a dopted a r ule in 2003—afte r Sanche z’s alleg ed conduc t was committed—providing that unprofessional a nd dishonorable c onduct that is likely to dece ive, d e f r a u d , o r i n j u r e t h e p u

b l i c w i t h i nt h e m e an i n g o f t h e A c ti n c l u d e s t h e c o m m i s s i o no f a f e l o n y, whether or not there is a complaint, indictment, or conviction. 28 Tex. Reg. 10496 ( 2003) (c odified at 22 Tex. Admin. Code § 190.8(2)(S)(i) ( 2006)) ( proposed Sept. 5, 2003). The rule doe s not require that the commission of the felony be conne cted to the pr actice of medicine
. B e fo re the AL J, Sanc he z ar g ue d th a t th e te rm “ un pr of e ssi on a l” de no te d th a t th e a c t mu st 12 be c onne c te d to the pr a c tic e of me dic ine . Sa

nc he z do e s n ot a dv anc e thi s v ie w o n a pp e a l. 25 § 164.051(a) (2) (West 2004)). Sanchez contends that by specify ing only these ty pes of c riminal 11 violations that could be a basis for Boa rd discipline, the leg islature manife sted intent to preclude the use of other

criminal violations as a ba sis for discipline, and that this specific intent must control our construction of se ction 164.052(a) (5)’ s more g ener al “unprof essional or dishonorable conduct that is likely to . . . injure the public.” We d isa g re e wi th D r. Sanc he z’s c on str uc tio n o f “ un

pro fe ssi on a l or

dis ho no ra

ble conduct that is likely

to
. . . injure t he publi c” under section 164.052(a)( 5). Unde r the provision’s plain lang uag e, the a ct of soliciting mur der is one “ likely to
. . . injure t he publi c,” and S anche z does
no t c ha lle ng e the B oa

rd ’s fa c t fi nd ing that c on du c t lik e ly to re su lt in the de a th of M. G. is “ lik e ly

to injure the public.” Nor is there any serious dispute that such a n act is “dishonora

ble” unde r any ordinary meaningof that term, if not a lso “unprofe ssional.” 12 We also conclude that the Medica l Practice Act, construe d as a whole, does not manifest leg islative intent to strictly limit section 164.052’s “ prohibited prac tices” solely to acts or conduct c ommitt ed within or in the g uise of medic al p ra ctice. T o the contra ry , section 164.052We also note that section 164.057 require s the B oard to suspend a phy sician’s lice nse on 13 proof that the phy sician has be en initially convicted of

a fe lony . Tex. Occ. Code Ann. § 164.057 (We st 2 00 4) . L ike wi se , s e c tio n 16 4. 05 8 p ro vid e s th a t, “ [r]e g ard le ss o f t he of fe ns e ,” the B oa

rd sh a ll suspend the license of a phy sician serving a prison term in a state or f eder al penitentiar

y during the term of inca

rce ration. Id . § 164.058 (West 2004). 26 ref lects a br oader

i n t en t t o preve nt unqualified or other wise unfit individuals from prac ticing medicine. Many of the “prohibited prac tices” conce rn fra ud or misconduct by

license ap

pli c an ts in obtaining a

license, see Tex. Occ. Code Ann. § 164.052( a)( 1)-( 3), (8) , (11), ( 12); misrepre sentation of a person’ s licensing status or medica l cre dentials, id
. § 164.052(a) (9), ( 10), (13) -(15) , (17); and false or misleading adver

tising. Id. § 164.052(a) (6), (7). Other “prohibited pra ctices” include using alcohol or dr

ug s in an “intemper ate manne r that, i n the board’s opinion, could endang er a patient’s life.” Id . § 164.052(a) (4). These “prohibited prac tices,” while obviously conce rned with preve nting unqu a li f ie d o r u n f it p e r s o n s f

r o m a c tu a ll y

h ar mi n g in d iv id

u a l p a ti e n ts , a ls o r e f

le c t a b roade r leg islative intent to ensure public trust and c onfidenc e that it is s af e to seek c are from Te x as ph y sic ians . T he se du a l c on c e rn s are a lso re fl e c te d in the oth e r dis c ipl ina

ry g ro un ds e nume rate d in section 164.051. S

e e id. § 1 64.051(2) ( conviction of fe lony or cr ime involving mora l turpitude), (4) ( illness, drunkenness, e x cessive dr ug use, or “ a mental or

phy sical condition” re nderingperson “unable to prac tice medicine with rea sonable skill and s afe ty ”), ( 5) (“ found by a cour t judgment to be of unsound mind”). 13

The B oard a cted c onsistently with this leg islative intent in concluding that Sanchez’s solicitation of M.G.’s m urder is “unprof essional or dishonorable conduct that is likely to . . . injure t h e p u b l i c . ” E v e n i f n o t d i r e c t l y r e l a t e d t o h i s p r a c t i c e o f m e d i c i n e , S an c h e z ’ s a c t s s e r ve to undermine public trust a

nd confide nce in the sa fety of Tex as m edicine, if

not manifesting behavior sWe e xpre ss no op ini on re g ard ing the a pp lic a tio n o f s e c tio n 1 64 .0 52 (a )( 5) be y on d th e fa c ts 14 prese nted her e. 27 that w ou ld a c tua lly e nd ang e r patie nts
. Al tho ug h we c an fo re se e c a se s w he re the B oa rd c on c e iva bly could “stre tch” the a

pplication of sec tion 164.052(a)( 5) beyond its permissible bounds, as Sanchez
c on te nd s o c c ur

re d h e re , a

ph y sic ian’ s so lic itatio n o f c a pit a l murd e r i s n ot o ne of the m. 14 Finally , we a

re not pe rsuade d by

Dr. Sanc hez’s contention that the leg isl at u re ’s specific inclusion of cer

tain ty pes of cr iminal violations as B oard disciplinar y g rounds evidenc es in te n t to li mi t th e s c o p e o f o th e r , in d e p e n d e n t d is c ip li n ar y g r o u n d s
— s u c h a s u np r o f e s s ional or dishonorable conduct likely to injure the public—whe re suc h conduct a lso constitutes a criminal violation. Sanchez’s logic would imply that the leg islature’s inclusion of excessive drunke nness and drug usag e as both a section 164.051 disciplinary g round and a section 164.052 (a ) “ p ro h i b ited p ra ct i ce ” are limit ed to that which r esults in a criminal convic tion. See T e x. O c c . Co d e Ann. §§ 164.051(a) (1), ( 4), .052(a )(4)
.

We h old that th e B oa

rd ’s fa c t f ind ingthat D r. Sanc he z sol ic ite d M .G .’ s m urd e r i s sufficie nt as a matter of l aw to support its conclusion of law 3, “B ased on F inding of

Fa ct No. 12, Dr. Sanc hez c ommitt ed unprof essional and dishonora

ble conduc t that was likely to injure the public, in violation of Tex. Occ. Code § 164.052(a )(5)
. ” T h i s conclusion, in turn, supports the B oard’ s conclusion of law

4, “Te x . Occ
. Code § 164.051 and 164.52(a) (5) authorize the Boa rd to discipline Dr. Sanc hez for his unprofe ssional and dishonorable conduct that was likely to injure the public.” We o ve rr ule Dr . Sa

nc he z’s fi rs t and

sixthiss ue s.28

T h e B o a rd ’s mod i f

i ca ti o n o f th e A L J ’s PFD Sanch e z a ls o claims that the B oard violate d the APA in deleting the AL J ’s conc lusion of law 5, which, as previously discussed, stated that “Dr
. Sanchez’s solicitation of murder of M.G. did no t oc c ur wh ile Dr . Sa

nc he z wa s e ng a g e d in

the pr a c tic e of

me dic ine , a s th e te rm

is d e fi ne d in Tex. Occ. Code 151.002(a)( 13).” An age ncy may modify an AL J ’s orde r or c hang e an A L J ’s finding of fac t or conclusion of law only if the ag ency

deter mines that: (1) the AL J improperly applied or int e rp re te d the law, a g e nc y ru le s o r p oli c ie s, or pr ior a dmi nis tr a tiv e de c isi on s; ( 2) the AL J bas e d h is de c isi on on a pr ior a dmi nis tr a tiv e decision

that is inc or

re c t; o r ( 3) a

fi nd ingof

fa c t c on ta ins a technica l error

requiringcorr ection. Te x . Gov’t Code Ann. § 2001.058(e)
. The a g ency is require d to expl ain with partic u l ar i t y its specific re ason and le g al basis for e ach c hang e made
. Granek, 172 S.W .3d at 780-81. The ag ency must “articulate a rational connection betwe en an unde rlying ag ency policy and the a ltered f

inding of fac t or conc lusion of law.” Levy v . Texas St ate Bd. of Med. Ex am ’r s , 966 S.W .2d 813, 815 (Tex. App.—Austin 1998, no pet.). Our disposition of Sanchez’s first and six th issues also defe ats his contention here
. As ea rlier n o t ed , t he B oard e x plained that conc lusion of law 5 was unne cessa ry to support the disciplinary g round on which the Boa rd had ultimately relied—tha t D r. Sanche z h ad comm itted
un pr of e ssi on a l and

dis ho no ra

ble c on du c t tha t wa s like ly to inj ur e the pu bli c —a nd did no t a c c ur a te ly
re fl e c t agency po li cy . We a g re e that, i n li g ht o f t he B oa rd ’s oth e r f

ind ing s and

c on c lus ion s,
c on c lus ion

of law 5 wa s unn e c e ssa

ry . I t wa s with in the B oa

rd ’s dis c re tio n to del e te it, and it d id s o in compliance w ith section 2001.058(e)
. See Pierce v . Texas Racing Comm’n , 212 S.W .3d 745, 753 (Tex. App.—Austin 2006, pet. filed); F . Scott McC o wn & M o n i ca L eo, W hen Can an Agenc

ySee also Smith v. M ontemayor , No. 03-02-00466-CV, 2003 Tex. App. L EXI S 5099, at 15 *26-27 (Te x . App.—Austin J une 19, 2003, no pet.) (mem. op.). 29 Ch a n g e th e F

in din g s o r Co n c lu s io n s o

f a n A d m in is tra ti v e La w J

u d g e? , 5 0 Ba

y lor L . Rev. 65, 86 (1998) ; see also Tex. R. App. P . 44.1. We overrule Sanchez’s four th issue. 15
CO NC LU SION Havingov err

uled Dr. Sanc hez’s issues on appea l, we af firm the judg ment of the dis tr ic t c ourt
.

____________________________________ Bob Pembe rton, J ustice Be fore J ustices Pury ear , Pemberton and H enson Affir med Filed: J une 27, 2007