IN THE COURT OF APPEALS OF IOWA

No. 22-1313

Filed November 21, 2023

JOHN DOE,

Plaintiff-Appellant,

vs.

IOWA BOARD OF MEDICINE,

Defendant-Appellee.

________________________________________________________________

Appeal from the Iowa District Court for Polk County, Celene Gogerty, Judge.

A physician appeals the district court’s denial of his petition for judicial 

review challenging the Iowa Board of Medicine’s order to submit to a clinical 

competency evaluation and, ultimately, citing him for one count of professional 

incompetency. AFFIRMED.

Michael M. Sellers and Trent W. Nelson of Sellers, Galenbeck & Nelson, 

Clive, for appellant.

Brenna Bird, Attorney General, and Katie F. Carl, Assistant Attorney 

General, for appellee.

Heard by Greer, P.J., and Ahlers and Buller, JJ.
2

GREER, Presiding Judge.

Dr. John Doe challenges the district court’s denial of his petition for judicial 

review of the Iowa Board of Medicine’s (the Board) decision to cite him for

professional incompetence. Dr. Doe makes multiple arguments on appeal related 

to both the order for a clinical competency evaluation that came before the 

professional incompetence charge and the Board’s ultimate decision, following a 

contested case hearing, to cite him for professional incompetence. Because we 

find that objections to the clinical competency evaluation order are moot and 

untimely and that the Board’s findings on professional incompetency are supported 

by substantial evidence, we affirm the district court’s denial.

I. Background Facts and Prior Proceedings.

Dr. Doe is a licensed physician with specialties in occupational and 

emergency medicine practicing in rural Iowa. He was issued an Iowa medical 

license in 2011. Between 2014 and 2016, the Board learned of two malpractice 

settlements between Dr. Doe and two separate patients.

1

 The first settlement 

involved a patient (patient 1) who fell out of bed and hit her head on her nightstand 

in November 2012. She reported pain in her right arm, right shoulder, and neck, 

and went to the emergency room (ER), where Dr. Doe treated her. She was 

discharged from the ER with muscle relaxers and pain medication and sent home. 

After she was sent home, she became increasingly confused and agitated. 

Patient 1 returned to the ER the next day, where Dr. Doe again examined her. 

After she could no longer move her legs, her family requested that she be 

1 These are administrative file numbers 02-2014-625 and 02-2016-139.
3

transferred to a hospital in Des Moines. In Des Moines, she was diagnosed with

a dislocation of her cervical spine and spinal cord injury that required surgery. After 

spinal surgery, patient 1’s condition declined, and she died in December 2012. In 

July 2014, Dr. Doe’s malpractice insurer issued a National Practitioner Data Bank 

report to the Board disclosing that a confidential settlement resolved the matter 

with patient 1.

The second settlement involved a patient (patient 2) who was just over six 

weeks pregnant in September 2013. She reported abdominal pain and went to the 

ER, where Dr. Doe was on duty. Dr. Doe diagnosed her with a urinary tract 

infection (UTI), discharged her with pain medication, and sent her home. At home, 

she noticed bleeding while she was going to the bathroom. She spoke with Dr. 

Doe the next morning, and he told her that she had a UTI and should stay home. 

The same day, she went to her obstetrician, who discovered that she had an 

ectopic pregnancy. At a hospital in Omaha, patient 2 had the pregnancy 

terminated and her left fallopian tube removed. After patient 2 brought a 

malpractice suit, she settled with Dr. Doe for $50,000 in March 2017.

In September 2014, the Board sent Dr. Doe an evaluation on the Board’s 

point system for analyzing personal liability claims.2 The Board sent Dr. Doe an 

investigative inquiry in November 2014 informing him of their awareness of the first 

settlement and requesting a response within twenty days; Dr. Doe did not 

2 The Board uses this form to determine whether to open an investigation after an 

insurance company informs the Board of a malpractice settlement. The point 

system required investigation of the physician by the Board only if they scored 

seven points or more. Dr. Doe makes mention of this form in his brief but, as we 

discuss below, it goes to his probable cause analysis, which we find is moot. 
4

respond.3 Then, in March 2016, the Board sent Dr. Doe a letter related to its 

awareness of patient 2 initiating a malpractice suit against him. The letter 

contained the following information: “[a]fter careful consideration, the Board 

concluded that the matter does not warrant investigation and the Board closed the 

file. A file was opened but no investigation was undertaken. The information will 

remain part of your permanent record with the Board.”

In September 2016, the Board filed a statement of charges against Dr. Doe 

for failing to comply with its request for a response in the investigation of the first 

settlement. In February 2017, Dr. Doe entered into a settlement agreement with 

the Board resolving those charges. In that settlement agreement, Dr. Doe was 

warned for failing to respond or comply with the Board investigation and assessed 

a $2500 civil penalty. In March, Dr. Doe settled the malpractice case with patient 2

for $50,000. After learning of the settlement, the Board decided to open an 

investigation in April.

The same month Dr. Doe also received an investigative inquiry related to 

the second settlement, requesting a detailed response with pertinent medical 

records and legal documents. In May, Dr. Doe responded with details and 

attached medical records and legal documents. He also described what he had 

learned from failing to diagnose patient 2’s ectopic pregnancy.

Also in May 2017, Dr. Doe’s attorney passed along to Dr. Doe a confidential 

letter of warning from the Board regarding the first settlement. The Board wrote

3 The Board attempted to obtain a response from Dr. Doe through repeated 

contacts: via phone in February 2015, March 2015, May 2015, August 2015, 

January 2016, and March 2016; via letter in August 2015; and via email in January 

2016.
5

that the letter “concludes the Board’s investigation of this case” but also that “[t]he 

Board reserves the right to review and reconsider this matter should it be deemed 

appropriate.” The Board requested that Dr. Doe submit his own letter in response 

describing what he had learned from the matter within sixty days. Some 130 days 

later, in September 2017, Dr. Doe submitted the requested letter through his 

attorney. 

Then, on September 15, 2017, the Board emailed Dr. Doe and his attorney

a confidential clinical competency evaluation order demanding that Dr. Doe submit 

to a clinical competency evaluation through the Center for Personalized Education 

for Physicians (CPEP) within ninety days. The Board relied on the two settlements

as probable cause for doing so. In the order, the Board wrote that it had “serious 

concerns about [Dr. Doe’s] treatment of [patient 1]” and was “concerned that [Dr. 

Doe] did not make arrangements for an MRI to rule out a spinal cord injury, 

particularly given her persistent symptoms.” The Board also wrote that it had 

“serious concerns about [Dr. Doe’s] evaluation, testing, and treatment of [patient 2]

. . . and [Dr. Doe] should have performed a pelvic exam and ordered labs and an 

ultrasound to rule out an ectopic pregnancy.” 

Dr. Doe did not object to the request for the clinical competency evaluation 

or request a hearing. Instead, over two hundred days later, he completed the 

clinical competency evaluation at CPEP, which lasted over two days in April 2018. 

Apart from undergoing two days of in-person testing with three simulated patients, 

an electrocardiogram (ECG) interpretation, and a multiple-choice exam, the 

evaluation also involved a review of charts from twenty-four of Dr. Doe’s February 

2018 patients submitted by Dr. Doe along with interviews with three medical 
6

consultants who specialized in emergency medicine. Before the in-person testing, 

Dr. Doe also completed an intake questionnaire and interview via phone.

The CPEP assessment4 concluded that Dr. Doe demonstrated deficiencies 

in medical knowledge, clinical judgment and reasoning, patient care 

documentation, practice-based learning, and communication skills. It also stated 

that Dr. Doe’s “clinical judgment and reasoning were not adequate. His 

documentation was inadequate in actual patient charts and acceptable, with need 

for improvement, for the Simulated Patient (SP) encounters. [Dr. Doe’s] 

communication skills were inadequate with SPs . . . .” The Board ordered Dr. Doe

to participate in a structured individualized educational intervention including 

multiple required study programs: point-of-care experience, an educational 

preceptor, continuing medical education, and a self-study and clinical assessment. 

In August 2019, the Board issued a statement of charges that alleged one 

count of professional incompetency against Dr. Doe based on the results of the 

CPEP evaluation.5 In April 2021, Dr. Doe moved for summary judgment, 

reconsideration of lack of probable cause to issue the statement of charges, and 

motion to expunge the order requiring his competency evaluation, the result of 

which became part of the basis for the professional incompetency charge. In its 

response to the motion, the State argued that Dr. Doe’s challenges to the CPEP 

evaluation were untimely and moot because Dr. Doe had already submitted to the 

4 The CPEP report is nineteen pages long and addresses medical knowledge and 

patient care, clinical judgment and reasoning, patient care documentation and 

communication skills after reviewing charts, testing and conducting interviews of 

Dr. Doe.

5 This charge was issued pursuant to Iowa Code sections 147.55, 148.6(2)(g) and 

(i), and 272C.10(2) (2019) and Iowa Administrative Code rule 653-23.1(2).
7

evaluation. The State also moved to exclude expert witness testimony including 

an occupational medicine practitioner and radiologist, the executive director of the 

Board, and two attorneys and to strike proposed exhibits, including letters of 

opinion by the expert witnesses. 

The administrative law judge (ALJ) denied Dr. Doe’s motion for summary 

judgment, finding that there was no authority for summary judgment in a contested 

case proceeding. The ALJ also denied the request for reconsideration and 

expungement, finding that Dr. Doe “had an opportunity to object to the Board’s 

order for clinical competency evaluation that was issued in September 2017. In 

order to have done so, however, he would have had to file the objection within 

[fourteen] days of the issuance of the evaluation order.” But, because Dr. Doe “did 

not file such an objection . . . he has waived objection to the evaluation order in 

this disciplinary proceeding. Accordingly, whether there was probable cause [to 

order him to complete the competency evaluation] is no longer an issue that [Dr. 

Doe] may raise.” In a separate written ruling, the ALJ also denied the State’s 

motion as to all five challenged witnesses. In this written denial, the ALJ reiterated

that Dr. Doe “did not file an objection to the evaluation order when it was issued in 

2017 and therefore waived any objection to the evaluation order.” 

In May 2021, the Board held a contested case hearing on the matter. Dr. 

Doe submitted the CPEP evaluation as an exhibit at this hearing and never 

objected to its admission or use during the proceeding. At the hearing, the Board’s 

chief investigator, the medical director of CPEP, two medical professionals, Dr. 

Doe’s past attorney, and Dr. Doe testified. 
8

At the hearing, the medical director of CPEP testified about the competency 

evaluation methodology. The two medical professionals reviewed the medical 

records of the cases underlying the two malpractice settlements and presented 

their determinations of the appropriate standard of care for those two patients. 

Neither medical professional was present when Dr. Doe treated those patients and 

neither one had met Dr. Doe. Neither one was familiar with the entire CPEP 

evaluation of Dr. Doe nor the CPEP evaluation process; they had not reviewed the 

twenty-four patient files that Dr. Doe submitted to CPEP either. Dr. Doe challenged 

the reasoning for entering into the first settlement through testimony by his former 

attorney, but the ALJ sustained the State’s objection to that testimony, finding “[t]he 

question of whether the competency evaluation was appropriate and whether the 

Board had probable cause to believe that there were concerns about competency 

is not an issue in this proceeding.” In his testimony, Dr. Doe explained his 

educational background, his licensure, and his work experience. Dr. Doe also 

testified that he asked questions about CPEP before attending the evaluation 

because his attorney at the time did not know anyone who had taken a test at 

CPEP before; his previous attorney also helped him write his letters to the Board 

explaining what he had learned from the treatment of the two patients and received 

communications from the Board including the order for a clinical competency 

evaluation. Lastly, Dr. Doe testified that he was very nervous before the CPEP 

evaluation and did not feel that it was an accurate depiction of his skills as a 

physician.

After the hearing and the close of the record, in September 2021, Dr. Doe 

moved for consideration of additional proposed exhibits—a letter from Dr. Doe’s 
9

ER supervisor, four letters from Dr. Doe’s colleagues, and documents related to 

medical competency testing in Texas—which the Board denied. 

The Board issued its findings of fact, conclusions of law, decision and order 

at the end of September 2021. In the order, “the Board found the comprehensive 

assessment performed by CPEP to be a reliable measure of [Dr. Doe’s] 

professional competency, despite [Dr. Doe’s] testimony to the contrary.” The 

Board also found that Dr. Doe’s evidence in the form of testimony by the two 

medical experts did not outweigh the CPEP assessment because “[n]either of the 

experts had reviewed the CPEP report in its entirety, nor did they review [Dr. Doe’s] 

[twenty-four] patient files that were reviewed by the CPEP clinical consultants as 

part of the comprehensive evaluation.” Lastly, the Board was “satisfied that the 

evaluation that [Dr. Doe] underwent at CPEP . . . is an accurate demonstration of 

[Dr. Doe’s] knowledge and professional competency.” Ultimately, the Board cited 

Dr. Doe for professional incompetence and placed him on probation for five years,

which required that he follow the recommendations from the CPEP assessment, 

participate in worksite monitoring, submit quarterly reports, make appearances

before the Board upon the Board’s request, and pay a quarterly monitoring fee. 

Dr. Doe requested a rehearing in October 2021, the State resisted, and the 

Board denied the request in December 2021. In denying the request, the Board 

found that Dr. Doe failed to demonstrate that his proposed exhibits were not 

available at the time of the May 2021 hearing or good cause for introducing the 

exhibits after the hearing. In January 2022, Dr. Doe filed a petition for judicial 

review of the Board’s decision. The district court held a hearing in June 2022 and 
10

in July 2022, and ultimately denied the petition by written ruling. Dr. Doe now 

appeals.6

II. Standard of Review.

We review a district court’s denial of a petition for judicial review of agency 

action for correction of errors at law. Strickland v. Iowa Bd. of Med., 764 

N.W.2d 559, 561 (Iowa Ct. App. 2009). We apply the standards set forth in the 

Administrative Procedure Act, Iowa Code chapter 17A (2022), to determine 

whether our conclusions are the same as those of the district court. Doe v. Iowa 

Bd. of Med. Exam’rs, 733 N.W.2d 705, 707 (Iowa 2007). “Pursuant to Iowa Code 

section 17A.19(10), a court must reverse agency action when any one of several 

enumerated circumstances exists and ‘substantial rights of the person seeking 

judicial relief have been prejudiced’ as a result.” Mosher v. Dep't of Inspections & 

Appeals, 671 N.W.2d 501, 508 (Iowa 2003) (quoting Iowa Code § 17A.19(10)).

“It is not the role of the court to reassess the evidence or make its own 

determination of the weight to be given the various pieces of evidence.” Doe v. 

Iowa Bd. of Pharmacy, No. 14-0089, 2014 WL 6682050, at *3 (Iowa Ct. App. 

Nov. 26, 2014). Rather, “[i]t is the agency’s duty ‘as the trier of fact to determine 

the credibility of the witnesses, weigh the evidence, and decide the facts in issue.

We are bound by the agency’s findings so long as they are supported by 

6 While the appeal was pending before our court, Dr. Doe submitted a notice of 

additional authorities. We strike that notice and have not considered that material 

as it was outside of the record on appeal. See Jensen v. Sattler, 696 

N.W.2d 582, 584–85 (Iowa 2005) (“[A] party may not use such a notice to interject 

additional written argument into an appeal.”); see also Iowa R. App. P. 6.801 

(defining the composition of the record on appeal); In re Marriage of Keith, 513 

N.W.2d 769, 771 (Iowa Ct. App. 1994) (“We are limited to the record before us and 

any matters outside the record on appeal are disregarded.”).
11

substantial evidence.’” Christiansen v. Iowa Bd. of Educ. Exam’rs, 831 

N.W.2d 179, 192 (Iowa 2013) (citation omitted). “Evidence is substantial if ‘a 

reasonable person would find it adequate to reach the given conclusion, even if a 

reviewing court might draw a contrary inference.’” Bush v. Bd. of Trs., 522 N.W.2d 

864, 866 (Iowa Ct. App. 1994) (citation omitted).

III. Analysis.

Doe raises four arguments on appeal. Three are related to the order for the 

clinical competency evaluation at CPEP: whether the Board had authority to 

reopen closed investigations, if there was probable cause for the order, and 

whether notice was given to Dr. Doe to contest the order. The other argument 

made is that the Board failed to consider material and relevant evidence of Dr. 

Doe’s competency at the May 2021 contested case hearing. We begin with the 

arguments related to the order for the clinical competency evaluation.

A. Order to Undergo Clinical Competency Evaluation.

Doe submitted to the competency evaluation without formally objecting to it 

as allowed under the rules, but he continues his attempt to revisit the probable 

cause findings underlying the order and the notice he got regarding his ability to 

contest the order for evaluation. So, we look to the mootness doctrine on this 

question because mootness is a threshold question. Homan v. Branstad, 864 

N.W.2d 321, 327 (Iowa 2015). But Dr. Doe has three problems—one and two 

relate to mootness and the third deals with the record we review on appeal: (1) he 

failed to timely object to the order setting the clinical competency evaluation, (2) 

he voluntarily submitted to the evaluation, and (3) the evaluation was presented as 

evidence at the contested case hearing by Dr. Doe without objection by Dr. Doe.
12

“[C]ourts do not decide cases when the underlying controversy is moot.” 

Belin v. Reynolds, 989 N.W.2d 166, 171 (Iowa 2023) (citation omitted). An issue 

is moot when “it no longer presents a justiciable controversy because the issues 

involved are academic or nonexistent.” Homan, 864 N.W.2d at 328 (citing Iowa 

Bankers Ass’n v. Iowa Credit Union Dep’t, 335 N.W.2d 439, 442 (Iowa 1983)). An 

issue is academic or nonexistent when it would not “be of force and effect with 

regard to the underlying controversy.” Id. (citing Women Aware v. Reagan, 331 

N.W.2d 88, 92 (Iowa 1983)); accord Belin, 989 N.W.2d at 171 (explaining that an 

order to produce documents that the defendants had already turned over would 

have no force or effect in the underlying controversy). In other words, 

“[m]ootness . . . generally applies where there is a lack of a real live controversy 

which deprives the court of the ability to provide the parties with a remedy.” Irving 

v. Emp. Appeal Bd., 883 N.W.2d 179, 187 (Iowa 2016); accord Vasquez v. Iowa 

Dep’t of Hum. Servs., 990 N.W.2d 661, 667 (Iowa 2023) (finding no real live 

controversy when the department had already paid for the surgeries that it 

contested on appeal).

Here, Dr. Doe completed the CPEP evaluation in April 2018 without 

objection. The results of the evaluation were considered by the Board in its 

determination to charge him with one count of professional incompetency. Dr. Doe 

not only submitted to the CPEP evaluation without objection, he also made it part 

of his own evidence in the May 2021 contested case hearing on the professional 

incompetency charge. Any ruling on this issue would not change the fact that the 

CPEP evaluation already exists and was used as evidence at the contested case 

hearing, as such there is no live controversy over the evaluation order because Dr. 
13

Doe already submitted to the evaluation and used it in his own case without 

objection7, and as such, we find Dr. Doe’s challenges to the order now moot.

In addition, Dr. Doe’s challenges to the order to submit to a clinical 

competency evaluation are untimely as they come long after September 2017; Dr. 

Doe waived his right to object by failing to do so during the appropriate time frame. 

“Iowa Code section 272C.9(1) [(2019)] provides the Board with the authority to 

order a licensee to submit to a physical, mental, or clinical competency 

examination so long as there is ‘probable cause’ to do so.” Skaufle v. Iowa Bd. Of 

Med. Exam’rs, No. 07-0875, 2008 WL 942290, at *3 (Iowa Ct. App. 2008). The 

Iowa Administrative Code lays out the requirements and timeline for objecting to 

an order for a clinical competency evaluation: 

A licensee who is the subject of a board evaluation order and who 

objects to the order may file a request for hearing. The request shall 

be filed within [fourteen] days of issuance of the evaluation order. A 

licensee who fails to timely file a request for hearing to object to an 

evaluation order waives any future objection to the evaluation order 

in the event formal disciplinary charges are filed for failure to comply 

with the evaluation order or on any other grounds.

Iowa Admin. Code r. 653-24.4(3). The fourteen-day window for objection to the 

order and a request for a hearing closed in September 2017. Although Dr. Doe 

was represented by counsel and both he and his counsel received the order to 

submit to a clinical competency evaluation via email, Dr. Doe testified at the May 

2021 contested case hearing that he decided to take the evaluation. And, without 

objecting or requesting a hearing, Dr. Doe did in fact take the evaluation at CPEP 

7 We also note that when a party introduces evidence and then later complains 

about the court’s error on considering it, waiver applies. See State v. Trane, 984 

N.W.2d 429, 435 (Iowa 2023) (noting Trane waived error as to the court’s 

consideration of evidence he introduced).
14

over the course of two days in April 2018. Dr. Doe did not object to the order for 

this clinical competency evaluation until after the Board received the results and 

relied on those results as the basis for its professional incompetency charge. Dr. 

Doe’s objection comes long after the fourteen days provided for in the Board’s 

regulations for objection and, as such, he waived any right to object to the order.

Dr. Doe attempts to wrap his untimely and moot challenges to the order for 

a clinical competency evaluation into analysis regarding whether the Board had 

probable cause to issue the order. But “[t]he question of whether probable cause 

exists is the type of issue that can be raised and decided at a contested case 

hearing.” Irland v. Iowa Bd. of Med., No. 21-0331, 2022 WL 610449, at *2 (Iowa 

Ct. App. Mar. 2, 2022). Here, while Dr. Doe was represented by counsel, he failed 

to object to the clinical competency order and thus triggered a contested case 

hearing where he could question the Board’s probable cause. See Iowa Code 

§ 272C.4 (outlining one of the duties of the Board as establishing “procedures by 

which complaints which relate to licensure or to licensee discipline shall be 

received and reviewed by the board”). Because Dr. Doe did not request a hearing 

in September 2017, he waived any future objections to the order—including his 

objections in this appeal. The ALJ weighed in and rejected Dr. Doe’s objections 

based on probable cause underlying the evaluation order, finding that because the 

objections were to a moot issue and untimely, it would not address the underlying 

merits, and we find the same here.

Dr. Doe also attempts to raise a due process challenge to the clinical 

competency order. Here, again, Dr. Doe’s challenge is untimely and misplaced. 

Under the United States and Iowa Constitutions, “no person shall be deprived of 
15

life, liberty, or property, without due process of law.” U.S. Const. amend. XIV; Iowa 

Const. art. I, § 9. The type of agency action determines the due process afforded 

to the parties involved. Greenwood Manor v. Iowa Dep’t of Pub. Health, 641 

N.W.2d 823, 833 (Iowa 2002). The order for a clinical competency evaluation was 

other agency action. See Strickland, 764 N.W.2d at 562 (explaining that only the 

hearing that follows an objection to an order for a clinical competency evaluation 

is a contested case proceeding); Irland, 2022 WL 610449, at *2 (finding that an 

order for a competency evaluation only provides the opportunity to request a 

contested case proceeding in the form of a hearing). In the case of other agency 

action, “[p]arties are only entitled to those procedures voluntarily promulgated by 

the agency, and to the general requirement that the agency act reasonably.” 

Greenwood Manor, 641 N.W.2d at 834 (citing Farmers State Bank v. Bernau, 433 

N.W.2d 734, 740 (Iowa 1988)); accord Hartwig v. Bd. of Nursing, 448 N.W.2d 321, 

323 (Iowa 1989) (holding that even an omitted procedural step required by statute 

or regulation does not give rise to a due process violation without a showing of 

prejudice). And to the extent that Dr. Doe believed he had no administrative 

remedy, yet was adversely affected by the order to submit to a clinical competency 

evaluation, he has no explanation for why he then did not seek judicial review 

under Iowa Code section 17A.19(1) (2022) at the time he received the order—

before complying with it. 

Finally, the Iowa Administrative Code provides the due process afforded to 

those ordered to undergo a clinical competency evaluation, and requires that the 

content of the order include:
16

a. Probable cause. A showing by the board that there is 

probable cause to order the licensee to complete an evaluation.

b. Nature of evaluation or screening. A description of the type 

of evaluation or screening that the licensee must complete.

c. Evaluation facility. The name and address of the examiner 

or evaluation or treatment or screening facility that the board has 

identified to perform the evaluation.

d. Scheduling the evaluation. The amount of time in which the 

licensee must schedule the required evaluation.

e. Completion of the evaluation. The amount of time in which 

the licensee must complete the evaluation.

f. Board release. A requirement that the licensee sign all 

necessary releases for the board to communicate with the evaluator 

or the evaluation or treatment program and to obtain any reports 

generated by the program.

Iowa Admin. Code. r. 653-24.4(1). The order for a clinical competency evaluation 

provided to Dr. Doe contained exactly those six items and therefore did not fail to 

provide Dr. Doe with sufficient notice to satisfy due process requirements. 

Although Dr. Doe argues that the Board failed to provide him notice of his ability to 

object to the order—and thus present evidence at a contested case hearing

questioning the Board’s probable cause—the Board was not required to give such 

notice, so that failure is not a basis for relief now.8

B. Failure to Consider Evidence.

Next, we turn to Dr. Doe’s assertion that the Board failed to consider 

relevant evidence he presented at the May 2021 contested case hearing—when 

the Board was deciding whether to cite Dr. Doe for professional incompetence—

8 To the extent that Dr. Doe alleges that he was unaware of the law governing the 

Board’s authority, in his February 2017 settlement agreement on the charge of 

failing to respond or comply with a Board investigation, Dr. Doe accepted charges 

under Iowa Administrative Code rule 653-24.2. The Board’s authority for ordering 

a physical, mental, or clinical competency evaluation is contained in the same 

chapter, at rule 653-24.4.
17

and thus, relied only upon the competency assessment to make its decision.

9

 

Much of Dr. Doe’s argument develops around the theme that CPEP is a 

“strawman” organization that “rubberstamps” and benefits from the Board’s 

requested outcome and that the CPEP evaluation is an “ill-begotten assessment 

by a self-interested reviewer.”

10 But, the contested case proceeding was related 

to the charge of professional incompetence only. And to that end, the ALJ 

managing the hearing allowed Dr. Doe to present his offered exhibits and 

testimony by two medical experts and Dr. Doe’s past legal counsel. Dr. Doe also 

offered testimony to explain his position. And, during the proceeding, at no point 

did the State object to any of this evidence, so the ALJ made no ruling refusing to 

admit any of Dr. Doe’s offered evidence. At the same time, much of the evidence 

presented by Dr. Doe related to his moot and untimely challenges to the order for 

the clinical competency evaluation. 

The district court, in its appellate capacity, found no abuse of discretion by 

the Board as it did consider and discuss all evidence presented at the hearing. On 

appeal, Dr. Doe urges that the Board decision was 

not supported by the quality of evidence that would be deemed 

sufficient by a neutral, detached and reasonable person pursuant to 

Iowa Code § 17A.19(10)(f); is the product of reasoning so illogical as 

9 Dr. Doe did attempt to introduce five letters of support from medical colleagues,

but the Board denied their admission. See Iowa Admin. Code r. 653-25.24(2)(e)

(providing that a party seeking to reopen the record in a contested case proceeding 

in order to offer additional evidence must demonstrate that the offered evidence is 

material and arose after the close of the original hearing record, or good cause 

exists for the party’s failure to present the evidence at the original hearing and the 

party had not waived the right to present additional evidence). Dr. Doe failed to 

demonstrate that the letters could not be procured prior to the hearing in May 2021. 

10 To put it simply, Dr. Doe contends the CPEP gets thousands of dollars for 

evaluating a physician and then thousands more for recommending and providing 

the classes and training required for licensure.
18

to render it wholly irrational pursuant to Iowa Code § 17A.19(10)(i); 

is the product of decision making in which the agency did not 

consider a relevant and important matter relating to the propriety or 

desirability of the action in question pursuant to Iowa Code 

§ 17A.19(10)(j); and is otherwise unreasonable, arbitrary, capricious 

and an abuse of discretion. Iowa Code § 17A.19(10)(n).

So to the extent that Dr. Doe’s argument involves any failure of evidence to support 

the Board’s decision to cite him for professional incompetence, we consider 

whether there was substantial, relevant evidence presented at the contested case 

hearing to support the Board’s ruling. “Evidence is substantial when ‘a neutral, 

detached, and reasonable person’ would find it sufficient ‘to establish the fact at 

issue when the consequences resulting from the establishment of that fact are 

understood to be serious and of great importance.’” Dawson v. Iowa Bd. of Med. 

Exam’rs, 654 N.W.2d 514, 518 (Iowa 2002) (referencing Iowa Code 

§ 17A.19(10)(f)(1)). 

Here, we find that the Board’s ultimate conclusions surrounding the 

professional incompetency of Dr. Doe were supported by substantial evidence. 

We note on this point that it is not our role to review whether the Board could have 

reached a different conclusion, but merely whether the conclusion that it did reach 

was backed by adequate support such that a reasonable person could come to the 

same result. See Bush, 522 N.W.2d at 866. “Where evidence is in conflict or 

reasonable minds might disagree about the conclusions to be drawn, the court is 

bound to accept the agency’s findings.” Eaves v. Bd. of Med. Exam’rs, 467 

N.W.2d 234, 237 (Iowa 1991) (citing Aluminum Co. of Am. v. Emp. Appeal Bd., 449 

N.W.2d 391, 394 (Iowa 1989)). 
19

At the May 2021 hearing, the Board heard testimony by CPEP’s medical 

director on CPEP’s evaluation methodology and ultimate conclusions regarding 

Dr. Doe, and the CPEP report was admitted into evidence. While Dr. Doe crossexamined CPEP’s medical director and questioned CPEP’s methodology, the 

Board had substantial evidence for it to find, based on the results of the CPEP 

evaluation, that Dr. Doe was not meeting professional standards: he was deficient 

in medical knowledge, clinical judgment and reasoning, patient care 

documentation, practice-based learning, and communication skills. CPEP’s staff 

came to this conclusion after Dr. Doe completed an intake questionnaire and 

phone interview, examined three simulated patients, interpreted an ECG, 

completed a multiple-choice exam, submitted charts from twenty-four patients, and 

interviewed with three medical consultants who specialized in emergency 

medicine. The Board, in its order, explained that it gave the opinions of Dr. Doe’s 

medical experts limited weight because they had not reviewed the same detailed 

information found in the CPEP report, including the twenty-four patient charts, and 

found that Dr. Doe’s testimony that he was nervous the day of the exam did not 

undermine the CPEP’s results and was, in fact, concerning because Dr. Doe 

worked in ERs, a high-pressure environment.

When reviewing the record as a whole, we find substantial evidence to 

support the Board’s finding of professional incompetency and that the conditions 

imposed were reasonable given that evidence.

IV. Conclusion.

Because we find Dr. Doe’s challenges to the order for a clinical competency 

evaluation moot and untimely and that there was substantial evidence presented 
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at the May 2021 contested case hearing for the Board to find that Dr. Doe engaged 

in professional incompetence, we find no basis to overturn the Board’s decision.

We affirm the district court’s denial of Dr. Doe’s petition for judicial review.

AFFIRMED.