[Cite as M.M. v. State Med. Bd. of Ohio, 2020-Ohio-360.]

IN THE COURT OF APPEALS OF OHIO 

TENTH APPELLATE DISTRICT 

[M. M.], M.D., : 

 Appellant-Appellant, : 

 

v. : No. 18AP-839 

 (C.P.C. No. 18CV-5813)

State Medical Board of Ohio, : 

 (REGULAR CALENDAR) 

Appellee-Appellee. : 

 

 

D E C I S I O N 

Rendered on February 4, 2020 

 

On brief: Dinsmore & Shohl LLP, and Elizabeth Y. Collis, for 

appellant. Argued: Elizabeth Y. Collis.

On brief: [Dave Yost], Attorney General, and Emily A. 

Pelphrey, for appellee. Argued: Emily A. Pelphrey.

 

APPEAL from the Franklin County Court of Common Pleas 

BRUNNER, J. 

{¶ 1} Appellant-appellant, M.M., M.D., appeals from an appellate decision and 

judgment of the Franklin County Court of Common Pleas entered on October 18, 2018, 

affirming the June 27, 2018 order of appellee-appellee, State Medical Board of Ohio ("the 

board"), that placed permanent limitations and restrictions on appellant's license to 

practice in the State of Ohio. Because we find the common pleas court did not abuse its 

discretion, we affirm its decision. 

I. FACTS AND PROCEDURAL BACKGROUND 

{¶ 2} On October 18, 2018, the Franklin County Court of Common Pleas affirmed 

the board's June 27, 2018 order ("the order") that permanently limits and restricts 

appellant's license such that her "medical practice shall not involve direct patient care in an 

inpatient setting." (Order at 1, attached to July 10, 2018 Notice of Appeal.) The board 
No. 18AP-839 2 

issued its order pursuant to R.C. 4731.22(B)(19)1 after finding appellant presently incapable 

of practicing medicine according to acceptable and prevailing standards of care due to her 

diagnosis of schizoaffective disorder, bipolar type, and behavioral issues that led to her 

being terminated from her residency program in October 2017. 

{¶ 3} The facts of this matter are generally undisputed. The record establishes that 

appellant was diagnosed with bipolar I disorder in March 2011, while she was in medical 

school. She was treated with mood stabilizing and antipsychotic medications. On discharge 

from treatment, appellant completed an outpatient program and then received ongoing 

treatment in an outpatient setting until April 28, 2014. 

{¶ 4} In 2014, appellant graduated from medical school and moved to Cleveland 

for a 36-month residency with The MetroHealth System ("MetroHealth"). She began 

seeing Thomas Thysseril, M.D., for her psychiatric care. At her initial evaluation in 2014, 

Dr. Thysseril noted that appellant had attempted suicide twice and had been hospitalized 

twice. Dr. Thysseril diagnosed appellant with bipolar I disorder, depressed mild, and 

 

1 R.C. 4731.22(B)(19) states in pertinent part as follows: 

(B) The board, by an affirmative vote of not fewer than six members, shall, 

to the extent permitted by law, limit, revoke, or suspend a license * * * for 

one or more of the following reasons: 

* * * 

(19) Inability to practice according to acceptable and prevailing standards of 

care by reason of mental illness or physical illness, including, but not limited 

to, physical deterioration that adversely affects cognitive, motor, or 

perceptive skills. 

* * * If the board finds an individual unable to practice because of the 

reasons set forth in this division, the board shall require the individual to 

submit to care, counseling, or treatment by physicians approved or 

designated by the board, as a condition for initial, continued, reinstated, or 

renewed authority to practice. An individual affected under this division 

shall be afforded an opportunity to demonstrate to the board the ability to 

resume practice in compliance with acceptable and prevailing standards 

under the provisions of the individual's license or certificate. For the 

purpose of this division, any individual who applies for or receives a license 

or certificate to practice under this chapter accepts the privilege of practicing 

in this state and, by so doing, shall be deemed to have given consent to 

submit to a mental or physical examination when directed to do so in writing 

by the board, and to have waived all objections to the admissibility of 

testimony or examination reports that constitute a privileged 

communication. 
No. 18AP-839 3 

relational problems. The record indicates that Dr. Thysseril still was treating appellant as 

of the time of the underlying proceedings. 

{¶ 5} In 2015, appellant disclosed her mental illness on her training certificate 

application. The board ordered her to submit to a psychiatric evaluation by Stephen 

Noffsinger, M.D., a board-certified psychiatrist. At that time, Dr. Noffsinger diagnosed 

appellant with bipolar I disorder, most recent episode depressed, in full remission. 

Dr. Noffsinger opined that appellant was incapable of practicing medicine according to 

acceptable and prevailing standards of care, but opined further that appellant's diagnosis 

was amenable to treatment. Consequently, on June 10, 2015, appellant entered into a 

Consent Agreement that placed appellant's training certificate on probation, which 

included continuing psychiatric treatment, monitoring by a physician at appellant's place 

of employment, and interviews with the board for a minimum of three years. It is 

undisputed that appellant fully complied with the Consent Agreement. 

{¶ 6} By letter dated October 3, 2017, appellant was notified that she was being 

terminated from her residency program at MetroHealth effective October 6, 2017, 34 

months into her 36-month residency program. The termination letter detailed appellant's 

ongoing performance, behavior, and patient care issues. The letter recounted that 

appellant had been placed on administrative leave on May 25, 2017 due to a number of 

incidents and observations by management that brought into question appellant's ability 

to perform her essential functions as a family medicine resident in a manner that was 

professional and safe for herself, her patients, and colleagues. The letter referenced several 

recent incidents, including appellant's verbal outbursts toward co-workers, accusations 

that co-workers had targeted and attacked her, yelling and crying during meetings, her 

failure to listen to co-workers and consider relevant patient information, and a physical 

reaction to a posted scheduling board that lead to a physical altercation with a co-worker. 

{¶ 7} The October 3, 2017 termination letter also noted an assessment that 

appellant's treating psychiatrist had provided on or about July 27, 2017. The termination 

letter included the following: 

Unfortunately, your provider's assessment does not provide 

assurance that you will be able to immediately and consistently 

perform such essential functions as appropriate and respectful 

communication and interpersonal interactions with team 

members, appropriate and safe reactions to and problem 
No. 18AP-839 4 

resolution regarding workplace issues, and effective leadership 

attendant to being a senior resident. Your provider concluded 

that you may be able to perform in a "low-stress outpatient 

setting" or administrative setting, but he explained that you are 

expected to have continued behavioral issues and reactions 

during periods of high work stress and intensity. * * * 

(Hearing Examiner's Report and Recommendation at ¶ 16.) 

{¶ 8} Thereafter, by letter dated October 31, 2017, MetroHealth informed the board 

that it had "reason to believe that a violation of [R.C.] 4731.22(B)(19) has occurred" 

regarding appellant due to her behavior from May 19-24, 2017. (Hearing Examiner's 

Report and Recommendation at ¶ 17.) 

{¶ 9} Based on the report from MetroHealth, the board sent appellant a certified 

letter notifying her it had reason to believe she was in violation of R.C. 4731.22(B)(19) and 

ordering her to submit to another psychiatric evaluation by Dr. Noffsinger. Appellant was 

evaluated by Dr. Noffsinger on November 1, 2017. 

{¶ 10} In a report dated January 16, 2018, Dr. Noffsinger notified the board that, as 

a result of the evaluation, he diagnosed appellant with schizoaffective disorder, bipolar 

type. Dr. Noffsinger opined that appellant's condition rendered her incapable of practicing 

medicine according to acceptable and prevailing standards of care. He further opined that 

appellant's practice should be limited to a low-stress administrative type of practice in 

which she would not engage in direct patient care, in either an inpatient or outpatient 

setting. 

{¶ 11} On February 14, 2018, the board issued a Notice of Summary Suspension and 

Opportunity of Hearing ("the notice") advising appellant that it had reason to believe she 

was in violation of R.C. 4731.22(B)(19). By letter dated February 16, 2018, appellant 

requested a hearing on the allegations contained in the notice. 

{¶ 12} An administrative hearing was held before a board-appointed hearing 

examiner on April 17-18, 2019. The evidence in the record before us includes numerous 

documents in addition to the testimony of witnesses and evidence admitted at the 

administrative hearing. 

{¶ 13} Appellant appeared at the hearing with counsel and presented evidence and 

testimony. In addition to testifying herself, she called two witnesses to testify on her behalf: 

Thomas Thysseril, M.D., her treating psychiatrist since 2014; and Sheng Liu, M.D., her 
No. 18AP-839 5 

academic advisor at MetroHealth. Appellant also stipulated to the authenticity and 

admissibility of the board's exhibits. 

{¶ 14} Three witnesses were called to testify on behalf of the board. First, Stephen 

Noffsinger, M.D., the board-certified psychiatrist who evaluated appellant in 2015 and 2017 

at the board's request, testified as to his psychiatric evaluations of appellant and his 

opinions as to appellant's ability to practice medicine. Second, Leanne Chrisman-Khawam, 

M.D. (hereafter referred to as "Dr. Chrisman"), currently an assistant professor and the 

director of the Transformative Care Continuum at Ohio University Heritage College of 

Osteopathic Medicine in Warrensville Heights, Ohio, who had been appellant's monitoring 

physician at MetroHealth, testified as to her observations of, and experiences with, 

appellant at MetroHealth. Third, Annette Jones, M.D., a compliance officer for the board, 

testified as to her involvement with appellant's performance under the Consent Agreement 

appellant entered into in 2015 and communications with or concerning appellant. 

{¶ 15} On April 26, 2018, the hearing examiner issued a 31-page report and 

recommendation that found the evidence adduced at the hearing established that appellant 

suffered from an "[i]nability to practice according to acceptable and prevailing standards 

of care by reason of mental illness or physical illness, including, but not limited to, physical 

deterioration that adversely affects cognitive, motor, or perceptive skills," as set forth in 

R.C. 4731.22(B)(19). (Hearing Examiner's Report and Recommendation at 25.) The 

hearing examiner recommended that appellant's certificate to practice medicine and 

surgery be permanently limited and restricted so that she would not be involved with direct 

patient care, either inpatient or outpatient. The hearing examiner also recommended that 

appellant be placed on probation for at least 2 years. Finally, the hearing examiner 

recommended that appellant's certificate be fully restored upon successful completion of 

probation, but permanently limited and restricted to bar direct patient care. 

{¶ 16} The board considered the Report and Recommendation at its June 13, 2018 

meeting, at which time it heard from both appellant and the board. After reviewing the 

evidence, the board issued its order on June 27, 2018. The draft minutes of the board 

meeting indicate discussion among the board members regarding the testimonial and 

documentary evidence adduced at the hearing. A physician member of the board observed 

that "the board takes action based on behavior, not diagnosis," and that appellant's 
No. 18AP-839 6 

"behavior is controllable with additional treatment and additional consideration given to 

her practicing environment." (June 13, 2018 Board Minutes Excerpt.) The board member 

proposed modifying the hearing officer's recommended sanction, to allow appellant's 

practice to include direct patient care in an outpatient setting. Following discussion, seven 

members of the board voted to amend the hearing examiner's proposed order to, among 

other things, limit appellant from practicing in an inpatient setting, and to suspend 

appellant's license until two board-certified psychiatrists recommend that she is able to 

safely and competently practice medicine in an outpatient and/or administrative setting. 

Seven members of the board then voted to approve the hearing examiner's Findings of Fact, 

Conclusions of Law, and Proposed Order, as amended. The amended order suspends 

appellant's license for an indefinite period of time. The order contains six conditions for 

reinstatement or restoration of appellant's license, all of which appellant must meet before 

the board will consider reinstating or restoring her license. The order further provides that, 

upon reinstatement or restoration, appellant's license will be subject to specified 

probationary terms, conditions, and limitations for a period of at least three years. The 

order states that, upon successful completion of probation, appellant's certificate will be 

fully restored, but permanently limited and restricted so as to "not involve direct patient 

care in an inpatient setting." (Order at 1.) 

{¶ 17} Appellant appealed the board's order to the common pleas court pursuant to 

R.C. 119.12. The parties briefed the matter, after which the common pleas court issued a 

decision and entry affirming the board's order, finding that the order is supported by 

reliable, probative, and substantial evidence and is in accordance with law, pursuant to R.C. 

119.12. The trial court concluded its decision with the following observation: 

Though Appellant disagreed with the severity of the sanction, 

[she] did not and could not contest the legitimacy of the 

sanction. The restriction imposed is one legally authorized and 

within the Board's authority. This Court does not have the 

ability to change a sanction if – as in this case – the sanction is 

supported by reliable, probative and substantial evidence. 

(Emphasis sic.) (June 27, 2018 Decision and Entry at 8.) 

{¶ 18} Appellant now appeals the common pleas court's decision. 

II. ASSIGNMENT OF ERRORS 

{¶ 19} Appellant presents for our review a single assignment of error: 
No. 18AP-839 7 

The Franklin County Court of Common Pleas erred by 

affirming the Findings, Order and Journal Entry dated 

June 27, 2018 (the "Order") of the State Medical Board of Ohio 

(the "Board"). 

{¶ 20} Appellant argues that the common pleas court abused its discretion when it 

affirmed the board's order because the board's decision is not supported by reliable, 

probative, and substantial evidence and is not in accordance with law for three reasons: 

(1) "there is no evidence that [appellant's] impairment is permanent," (2) "the [b]oard 

relied on testimony from an expert who based his opinion on incomplete information and 

gave inconsistent testimony," and (3) the board "is applying its enforcement duties in an 

arbitrary manner." (Appellant's Brief at v-vi, 1.) 

III. LAW AND DISCUSSION 

A. Standard of Review 

{¶ 21} An appeal from an administrative agency is governed by R.C. 119.12, which 

states in pertinent part as follows: 

The court may affirm the order of the agency complained of in 

the appeal if it finds, upon consideration of the entire record 

and any additional evidence the court has admitted, that the 

order is supported by reliable, probative, and substantial 

evidence and is in accordance with law. In the absence of this 

finding, it may reverse, vacate, or modify the order or make 

such other ruling as is supported by reliable, probative, and 

substantial evidence and is in accordance with law. 

Under this provision, "a reviewing trial court is bound to uphold the order if it is supported 

by reliable, probative, and substantial evidence, and is in accordance with law." Pons v. 

Ohio State Med. Bd., 66 Ohio St.3d 619, 621 (1993). Evidence for purposes of R.C. 119.12 is 

reliable, probative, and substantial when it "is dependable; that is, it can be confidently 

trusted," is "relevant in determining the issue," and has "some weight; it must have 

importance and value." Our Place, Inc. v. Ohio Liquor Control Comm., 63 Ohio St.3d 570, 

571 (1992). 

{¶ 22} This Court has previously addressed the common pleas court's role in 

reviewing the administrative record. In Glasstetter v. Rehab Servs. Comm., 10th Dist. No. 

13AP-932, 2014-Ohio-3014, ¶ 14, we held: 

The common pleas court's " 'review of the administrative 

record is neither a trial de novo nor an appeal on questions of 
No. 18AP-839 8 

law only, but a hybrid review in which the court "must appraise 

all the evidence as to the credibility of the witnesses, the 

probative character of the evidence, and the weight thereof." ' " 

Akron v. Ohio Dept. of Ins., 10th Dist. No. 13AP-473, 2014-

Ohio-96, ¶ 19, 9 N.E.3d 371, quoting Lies v. Ohio Veterinary 

Med. Bd., 2 Ohio App.3d 204, 207, 2 Ohio B. 223, 441 N.E.2d 

584 (1st Dist.1981), quoting Andrews v. Bd. of Liquor Control, 

164 Ohio St. 275, 280, 131 N.E.2d 390 (1955). The court "must 

give due deference to the administrative determination of 

conflicting testimony, including the resolution of credibility 

conflicts." ATS Inst. of Technology v. Ohio Bd. of Nursing, 10th 

Dist. No. 12AP-385, 2012-Ohio-6030, ¶ 29, 985 N.E.2d 198, 

citing Crumpler v. State Bd. of Edn., 71 Ohio App.3d 526, 528, 

594 N.E.2d 1071 (10th Dist.1991). The court must defer to the 

agency's findings of fact unless they are " 'internally 

inconsistent, impeached by evidence of a prior inconsistent 

statement, rest upon improper inferences, or are otherwise 

unsupportable.' " Kimbro v. Ohio Dept. of Adm. Servs., 10th 

Dist. No. 12AP-1053, 2013-Ohio-2519, ¶ 7, quoting Ohio 

Historical Soc. v. State Emp. Relations Bd., 66 Ohio St.3d 466, 

471, 1993 Ohio 182, 613 N.E.2d 591 (1993). However, the 

common pleas court reviews legal questions de novo. Akron at 

¶ 19, citing Ohio Historical Soc. at 471. 

{¶ 23} Our role in reviewing the common pleas court's appellate review of an 

administrative appeal is limited to determining if the common pleas court abused its 

discretion. Smith v. State Med. Bd. of Ohio, 10th Dist. No. 12AP-234, 2012-Ohio-4423, 

¶ 13, citing Roy v. Ohio State Med. Bd., 80 Ohio App.3d 675, 680 (10th Dist.1992). An 

abuse of discretion occurs when a trial court's discretionary judgment is unreasonable, 

arbitrary, or unconscionable. State ex rel. McCann v. Del. Cty. Bd. of Elections, 155 Ohio 

St.3d 14, 2018-Ohio-3342, ¶ 12; State v. Meek, 10th Dist. No. 16AP-549, 2017-Ohio-9258, 

¶ 23. Even under an abuse of discretion standard, however, "no court has the authority, 

within its discretion, to commit an error of law." (Quotations and citations omitted.) Shaw 

v. Underwood, 10th Dist. No. 16AP-605, 2017-Ohio-845, ¶ 25; State v. Akbari, 10th Dist. 

No. 13AP-319, 2013-Ohio-5709, ¶ 7. In other words, " '[a] court abuses its discretion when 

its ruling is founded on an error of law or a misapplication of law to the facts.' " 

Independence v. Office of the Cuyahoga Cty. Executive, 142 Ohio St.3d 125, 2014-Ohio4650, ¶ 49, (O'Donnell, J., dissenting), quoting Doe v. Natl. Bd. of Med. Examiners, 199 

F.3d 146, 154 (3d Cir.1999). Absent an abuse of discretion on the part of the common pleas 

court, this Court may not substitute its judgment for that of the board or the common pleas 
No. 18AP-839 9 

court. Pons at 621, citing Lorain City School Dist. Bd. of Edn. v. State Emp. Relations Bd., 

40 Ohio St.3d 257, 260-61 (1988). 

{¶ 24} The common pleas court found the board's order to be supported by reliable, 

probative, and substantial evidence and in accordance with law, as required by the 

governing statute, R.C. 4731.22(B)(19). This Court has de novo review of questions of law. 

Gross v. Ohio State Med. Bd., 10th Dist. No. 08AP-437, 2008-Ohio-6826, ¶ 16, citing 

Chirila v. Ohio State Chiropractic Bd., 145 Ohio App.3d 589, 592 (10th Dist.2001), citing 

Steinfels v. Ohio Dept. of Commerce, Div. of Secs., 129 Ohio App.3d 800, 803 (10th 

Dist.1998), appeal not allowed, 84 Ohio St.3d 1488. See also Univ. Hosp., Univ. of 

Cincinnati College of Medicine v. State Emp. Relations Bd., 63 Ohio St.3d 339, 343 (1992); 

Big Bob's, Inc. v. Ohio Liquor Control Comm., 151 Ohio App.3d 498, 501 (10th Dist.2003). 

Thus, when reviewing this appeal of a common pleas court's appellate review of a state 

administrative order, this Court uses the same standard as the common pleas court in 

determining whether the board's order is in accordance with law. Our legal review, 

therefore, is independent and without deference to the common pleas court's 

determination. 

B. Assignment of Error 

{¶ 25} The board argues the record contains reliable, probative, and substantial 

evidence to support its order finding appellant in violation of R.C. 4731.22(B)(19). After 

giving full consideration to appellant's case at its June 13, 2018 meeting, the board adopted 

the hearing examiner's report but modified the recommended sanction. The board 

determined the evidence before it established that appellant suffered from an "[i]nability 

to practice according to acceptable and prevailing standards of care by reason of mental 

illness or physical illness, including, but not limited to, physical deterioration that adversely 

affects cognitive, motor, or perceptive skills," as set forth in R.C. 4731.22(B)(19). 

Accordingly, the board issued an order that permanently limited and restricted appellant's 

license in a manner consistent with the authority vested in the board under R.C. 

4731.22(B)(19). See generally June 13, 2018 Board Minutes Excerpt. 

{¶ 26} On appeal, the common pleas court upheld the board's order, finding that it 

was supported by reliable, probative, and substantial evidence in the record and was in 

accordance with law. 
No. 18AP-839 10 

{¶ 27} Appellant challenges the common pleas court's decision for the following 

reasons: 

There is no evidence in the record to support a finding that 

[appellant] is permanently impaired such that her medical 

license should be subject to a permanent limitation or 

restriction. The Board relied on expert testimony that was 

based on incomplete information and was internally 

inconsistent. The Board applied its enforcement duties in an 

arbitrary manner. 

Accordingly, the Board issued an Order that is unsupported by 

reliable, probative, and substantial evidence and is not is 

accordance with law. Therefore, the Franklin County Court of 

Common Please abused its discretion and erred in affirming 

the Board's Order, and the Board's Order should be vacated, 

and this case should be remanded to the Board with 

instructions to remove the permanent practice restriction and 

to impose a sanction consistent with the evidence in this case. 

(Appellant's Brief at 1-2.) 

{¶ 28} We disagree with appellant's argument. First, nothing in R.C. 4731.22 

requires the board to make a factual finding or to show evidence that an impairment could 

be permanent before it imposes a sanction under division (B)(19). Moreover, we find the 

record contains reliable, probative, and substantial evidence that appellant's impairment is 

permanent. Dr. Noffsinger testified at the hearing that appellant's schizoaffective sisorder 

renders her incapable of practicing medicine according to acceptable and prevailing 

standards of care, for multiple reasons. He stated that appellant has a history of being so 

ill due to her disorder that she becomes impaired and is unable to practice medicine, and 

that she has required various psychiatric medications over the course of years in order to 

either treat her active symptoms of her illness, or to prevent a relapse of her symptoms. He 

observed that, despite ongoing treatment, appellant "has experienced recurrent episodes of 

paranoia as evidenced by those 2016 and 2017 events that substantially impacted her 

judgment, her behavior, her capacity to recognize reality, and to professionally interact with 

patients, peers and supervisors." (Hearing Tr. at 61.) 

{¶ 29} Dr. Noffsinger also testified that, in his opinion, appellant's disorder is 

amenable to treatment. He did not, however, opine that appellant's disorder can be cured. 

To the contrary, Dr. Noffsinger testified as follows: 
No. 18AP-839 11 

The schizoaffective disorder is a chronic relapsing disorder, 

and, * * * given her history of multiple episodes of depression, 

mania, and freestanding paranoia, it's likely to reoccur, and 

when it does occur it can be disabling, it can make her unable 

to practice. 

So for that reason she requires treatment with medications in 

order to prevent a reoccurrence of her disabling symptoms. 

At least my interpretation of the Board rules indicates that 

under Rule 4731.2801, this term "inability to practice" includes 

an inability to practice in accordance with such standards 

without appropriate treatment, monitoring, or supervision. 

And, in fact, she does indeed require medication treatment for 

the symptoms of her schizoaffective disorder. So because she 

needs medication treatment to sustain her ability to practice, 

she is, by definition, unable to practice. 

(Emphasis added.) (Hearing Tr. at 60-62.) Dr. Noffsinger's testimony provides reliable, 

probative, and substantial evidence that appellant's disorder, or impairment, is permanent. 

{¶ 30} Second, appellant argues that the board erred in relying on Dr. Noffsinger's 

testimony because he based his opinion on incomplete information and gave inconsistent 

testimony. Dr. Noffsinger acknowledged on cross-examination that he had not spoken with 

appellant's current monitoring physician, her academic advisor, or her treating psychiatrist 

before forming his opinion. Nonetheless, his testimony as to the information he relied on 

in connection with both evaluations he conducted of appellant prior to forming his opinion 

regarding appellant's disorder is highly credible. He testified that, based on the information 

he was provided in connection with his 2015 psychiatric evaluation of appellant, he 

diagnosed appellant with bipolar I disorder, most recent episode depressed, in full 

remission. He defined dipolar I disorder as requiring at least one manic episode which 

results in either a hospitalization or significant social or occupational dysfunction and can 

be treated successfully with medication. Dr. Noffsinger also testified that, in talking with 

appellant in connection with the 2017 evaluation, he found her version of events different 

from the documentation he set forth in his report to the board. He opined that appellant 

did not have "especially good insight" into her condition. (Hearing Tr. at 67.) 

Dr. Noffsinger further testified that his 2017 evaluation of appellant found new evidence of 

paranoia and offered as examples several episodes of appellant's behavior at MetroHealth, 
No. 18AP-839 12 

including her allegations that staff were harming, even killing, patients to retaliate against 

her. 

{¶ 31} Additionally, Dr. Noffsinger testified about records received from 

Dr. Thysseril stating that, "when [appellant's] stress level becomes high, she may become 

verbally aggressive and uncooperative." (Hearing Tr. at 48.) Dr. Noffsinger stated that 

"this is where [Dr. Thysseril is] recommending that [appellant] not practice in a high stress 

inpatient environment." (Hearing Tr. at 48-49.) Dr. Noffsinger noted updated records 

from Dr. Thysseril changed appellant's diagnosis to bipolar I disorder mixed with paranoia 

mild. Dr. Noffsinger testified that, even though Dr. Thysseril and he agree about appellant's 

bipolar I disorder diagnosis and her paranoia, they disagree about the nomenclature. He 

explained: 

[T]here's no such thing as Bipolar I disorder with paranoia. 

That's why I changed my diagnosis to schizoaffective disorder, 

which I think more accurately incorporates the paranoia into 

the diagnosis. But regardless, we even have Dr. Thysseril 

embracing the paranoia as part of the diagnosis. 

(Hearing Tr. at 49.) 

{¶ 32} Dr. Noffsinger further explained that he had changed appellant's diagnosis 

because, "with the multiple reports of [appellant's] paranoia by multiple people, that did 

not occur in the context of a manic or depressive episode, * * * that * * * justified a change 

in diagnosis to schizoaffective disorder." (Hearing Tr. at 57-58.) 

{¶ 33} Dr. Noffsinger also testified that he had concerns about Dr. Thysseril 

conducting a forensic evaluation of appellant. First, Dr. Thysseril is appellant's treating 

psychiatrist. Second, nothing in Dr. Thysseril's resume indicates that he is qualified to 

conduct the forensic psychiatric evaluation required here. Dr. Noffsinger explained as 

follows: 

This is a forensic evaluation. This is a psychiatric evaluation 

occurring in a legal context, so by definition it's a forensic 

evaluation that requires specific methodology and training in 

order to know how to conduct the forensic evaluation 

appropriately. 

* * * 

[Dr. Thysseril's] resume does not describe his doing a forensic 

psychiatry fellowship and does not describe Board certification 
No. 18AP-839 13 

either in psychiatry or forensic psychiatry. So based on his 

resume, I would say no, he's not been trained or certified to 

conduct forensic evaluations. 

(Hearing Tr. at 65.) 

{¶ 34} Dr. Noffsinger also testified that Dr. Thysseril, in conducting his own 

examination, appeared to have reviewed Dr. Noffsinger's report "but he does not describe 

reading any of the other documents such as the MetroHealth program documents from Dr. 

Chrisman or Dr. Zack, Dr. Alexander, or any of [appellant's] past records." (Hearing Tr. at 

65.) Finally, Dr. Noffsinger testified that he disagreed "with [Dr. Thysseril's] methodology, 

his diagnosis, his qualifications, and his conclusions." (Hearing Tr. at 66.) 

{¶ 35} The record demonstrates that appellant's assertion that the board's reliance 

on Dr. Noffsinger's expert testimony is unfounded. The board is the trier of fact in this 

matter and, as such, determines the credibility and reliability of expert witnesses. The 

board's determination is entitled to a measure of deference. McRae v. State Med. Bd. of 

Ohio, 10th Dist. No. 13AP-526, 2014-Ohio-667. The board asserts that its acceptance of Dr. 

Noffsinger's opinion is "entitled to a strong measure of deference and cannot be overturned 

here simply because [appellant] disagrees." (Appellee's Brief at 19-20.) We agree. 

{¶ 36} Third, appellant alleges that the board applied its enforcement duties in an 

arbitrary manner. We do not find this allegation persuasive. The board found appellant in 

violation of R.C. 4731.22(B)(19), which authorizes the board to impose a range of sanctions. 

As we have discussed, it is well-established law that a reviewing court cannot modify a 

sanction authorized by statute if the board order imposing the sanction is supported by 

reliable, probative, and substantial evidence and is in accordance with law. Henry's Café, 

Inc. v. Ohio Bd. of Liquor Control, 170 Ohio St. 223 (1959). 

{¶ 37} The sole issue before this Court is whether, on consideration of the record, 

the order is supported by reliable, probative, and substantial evidence and is in accordance 

with law. We find the board had reliable, probative, and substantial evidence for placing 

permanent restriction on appellant's license under R.C. 4731.22(B)(19). Therefore, the 

court of common pleas committed no error in upholding the board's order and appellant's 

assignment of error is overruled. 
No. 18AP-839 14 

IV. CONCLUSION 

{¶ 38} Having independently reviewed the record, we find that the common pleas 

court did not abuse its discretion on appellate review when it affirmed the board's order 

permanently restricting appellant's license to practice in Ohio. Accordingly, we overrule 

appellant's sole assignment of error and affirm the judgment of the Franklin County Court 

of Common Pleas. 

Judgment affirmed. 

BROWN and NELSON, JJ., concur.