Source: https://law.justia.com/cases/arizona/supreme-court/1965/7239-0.html
Timestamp: 2019-04-26 04:37:37+00:00

Document:
ARIZONA STATE BOARD OF MEDICAL EXAMINERS, Appellant, v. Clarence Laurence CLARK, Appellee.
Supreme Court of Arizona. En Banc.
*206 Wade Church, Former Atty. Gen., Robert W. Pickrell, Atty. Gen., by Charles T. Stevens, Asst. Atty. Gen., for appellant.
Johnson, Darrow, D'Antonio, Hayes & Morales, Tucson, for appellee.
Dr. Clarence L. Clark, the appellee, filed an application for a license to practice medicine and surgery in the State of Arizona with the State Board of Medical Examiners on December 3, 1958. On June 22, 1959, the Board cited Dr. Clark pursuant to A.R.S. § 32-1452A to show cause why his application should not be denied. Dr. Clark filed a sworn answer and thereafter a hearing was held at which Dr. Clark was the only witness. After the hearing the Board secured a deposition in support of one of the Specifications, at the taking of which Dr. Clark was represented by counsel. On October 16, 1959, the Board entered an order denying Dr. Clark's application. Dr. Clark then filed a Petition for Review in Maricopa County Superior Court, under the provisions of A.R.S. § 32-1453B. After reviewing the entire record of the hearings before the Board, including the deposition of Dr. George M. Cowan of Duluth, Minnesota and letters submitted by Dr. Clark, hearing arguments of counsel, and considering the briefs, as required by the statute, the trial judge set aside the order of the Board, and directed it to issue the appropriate license. The Board of Medical Examiners has appealed to this court pursuant to A.R.S. § 32-1453H.
Dr. Clark was graduated in 1940 with an M.D. degree from the St. Louis University School of Medicine in Missouri. *207 At the time of the filing of the application he was, and now is, licensed to practice medicine in the States of Missouri, Michigan and Minnesota.
Dr. Clark may be refused a license only if he has been guilty of unprofessional conduct and charges have been proven by competent evidence after notice and hearing. He cannot be denied a license to practice in Arizona merely because accusations have been made against him by an out of state medical society. See In re Abbatangelo's Petition, Nev., 397 P.2d 182.
"(l) Any conduct or practice contrary to recognized standards of ethics of the medical profession or any conduct or practice which constitutes a danger to the health, welfare or safety of a patient or the public."
*208 The complaint, although inartfully drawn, was legally sufficient to confer jurisdiction on the Board to hear and determine the matter. Some of the Specifications include charges that are barred by the two year statute of limitations provided in A.R.S. § 32-1452C. See also, Eastman v. Southworth, 87 Ariz. 394, 351 P.2d 992. The Board in reaching the decision which it now asks us to affirm concedes that it erred in considering barred matters which were abandoned for the first time on this appeal.
This section of the statute, with minor changes not material to the problem involved here, is taken from the judicial review section of the Model State Administrative Procedure Act § 12(7), 9C Uniform Laws Annotated page 184. This act was suggested for general adoption by the Commissioners on Uniform State Laws to apply the principles of the Federal Administrative Procedure Act.
"The above section is one of the most important in the act. * * * "The crux of any plan for judicial review of the decisions of administrative tribunals lies in the scope of review to be allowed.... Almost [sic] every court that has had to deal concretely with the problem has vacillated in the course of time from one pole to the other. The full range of review extends from a complete trial de novo on the one hand to review limited to controverted questions of law on the other. * * *"
This legislative history contradicts the Board's contention that its denial of a license to Dr. Clark must be upheld by the Superior Court if there is any evidence in the record to sustain its decision. That rule no longer applies under A.R.S. § 32-1453G.
"Entire record" as used in the State Act, and "whole record", as used in the Federal Act, are synonymous.
When the legislature adopted A.R.S. § 32-1453G it had knowledge of the extensive research into the problem of judicial review of administrative decisions by Congress and the committees which reported to it. Where the legislature adopts the provisions of a Uniform or Model Act, this court will presume that the legislature acted with knowledge of the construction placed upon the proposed act by its draftsmen, and intended to adopt it. Salt River Val. etc. Assn. v. Peoria Ginning Co., 27 Ariz. 145, 231 P. 415; Arnett v. Clack, 22 Ariz. 409, 417, 198 P. 127, 129; Maestro Music, Inc. v. Rudolph Wurlitzer Company, 88 Ariz. 222, 232, 354 P.2d 266, 273.
The Board furnished the court below with the entire record. The Board, in its brief, in this court, quotes excerpts from that record which it believes support its position. These are the texts of the 4th, 5th and 6th Specifications from the St. Louis County Society's charges, together with summaries of Dr. Clark's testimony with regard to these charges, and a summary of Dr. Cowan's deposition, with regard to Specification 6.
The Board urges that the rule of Davis v. Arizona State Dental Board, 57 Ariz. 255, 112 P.2d 877 limiting review to jurisdictional questions is applicable. The statute regulating the practice of dentistry at the time Davis was decided specifically provided for judicial review in the Superior Court only in the case of the revocation of a license, and then by a writ of certiorari. A.R.S. § 32-1264. Since 1954, however, judicial review of administrative action in the Superior Court, in the absence of special provisions, has been governed by the Administrative Review Act. A.R.S. § 12-901 et seq. The limitations on judicial review in the Superior Court set forth in Davis have been nullified by statute A.R.S. § 12-901 et seq.
"* * * It should be observed here that this is an appeal from a judgment of the superior court denying relief to *211 the appellant, and upon familiar principles this court need inquire only whether there was evidence of a substantial nature to support the judgment of the court below. [citing cases]. Similarly, where reasonable minds might differ on the inferences to be drawn from a particular set of facts, the appellate court will not substitute its own conclusions for those reached by the trial court. [citing cases]"
See also Universal Camera, supra, 340 U.S. at 490, 71 S. Ct. 456 and National Labor Relations Board v. Pittsburgh Steamship Co., 340 U.S. 498, 71 S. Ct. 453, 95 L. Ed. 479.
"We have repeatedly held that we will not disturb the findings and judgment of the trial court when supported by substantial evidence, and that all the evidence and inferences therefrom must be reviewed by this court in the light most favorable to sustain the judgment of the lower court. Bohmfalk v. Vaughan, 89 Ariz. 33, 357 P.2d 617 (1960). "However in the very nature of judicial review, this court is not bound by conclusions of law of the trial court as applied to its findings of fact. Combustion Engineering, Inc. v. Arizona State Tax Commission, 91 Ariz. 253, 371 P.2d 879 (1962)."
The Board considered 10 Specifications. On this appeal an attempt is made to justify only three of these. In examining those portions of the record which have been brought before us, we find evidence was offered to support the Board's decision only with regard to Specification 6. This evidence is Dr. Cowan's deposition. The Specification charges "unethical conduct of a minor degree." It brings three separate charges of seeing the patients of Dr. Cowan without his permission and makes a fourth charge of giving a patient inadequate care.
"DR. McNALLY: Now, you were never presented with these facts at any grievance committee? *212 "DR. CLARK: I was never told about these things until these charges were submitted to me in this manner here. Now, one would think that these things, if there's anything of a controversial nature, that I should have at least been presented with these things to offer some sort of an answer because then I could have gotten that nurse down on the floor and made her give her testimony. But I had no defense, don't you see?"
We cannot say the trial judge erred in his evaluation of the evidence in finding that this portion of the record does not show guilt of unprofessional conduct.
Specification 6(b) charges Dr. Clark with having told the wife of one of Dr. Cowan's patients not to consent to electric shock treatment for her husband. Dr. Clark categorically denied this charge. Dr. Cowan testified in his deposition that a nurse had told him that the wife of the patient said Dr. Clark told her not to sign the authorization. In its brief in this court the Board does not rely on this incident.
Specification 6(c) was barred by the Statute of Limitations.
"I checked her chart because the charge nurse reported to me that this patient was quite disturbed, and it was her feeling that patient was not getting adequate treatment. Therefore, I checked her chart on June 12, 1958, following which I wrote an informal note which I clipped to the chart asking Doctor Clark that he should request psychiatric consultation."
"* * * I had already requested psychiatric consultation on this patient and if he had looked on the other page in there he would have seen it." * * * * * * "* * * It had a very simple explanation. If I had an opportunity to simply sit down with a few people and get the charts out Prior to all this, it would've been obvious."
"MR. HAYES: You were never notified that you couldn't? "DR. CLARK: I was never notified that I couldn't perform these that this particular procedure was not within my privileges. I might add, as far as proctoscopic and rectal biopsies were concerned, I'm sure the average practitioner *213 is qualified to do these in his office; I know that I did several of them weekly."
The testimony does not show what hospital privileges Dr. Clark had, who granted these privileges, or what inference of lack of competence might be drawn from the lack of these privileges, if in fact he did lack them. The trial judge did not find this testimony to be substantial evidence to support the charge of professional misconduct and we cannot say that he was in error.
"Any dire concern that I had was essentially allayed by the fact that her clinic tests were essentially normal, her blood sugar had come down to 200 and the patient was responding well. These things were all in the nurses' notes. Consequently, as I say, I was just about to come down, in fact, I had gone home to have a bite to eat, I hadn't had anything since early that morning and my wife had a hot meal for me because it was such a miserable night and so on. I ate my dinner and I was just about to leave when the phone rang. They told me that they had seen the patient twenty minutes before and she was responding nicely, everything appeared to be perfectly normal and the nurse walked into the room and she had expired." * * * "All I did, as you well know, that any patient that is admitted into a hospital, an approved institution, has to have some record in there and the information that the intern had given me and so forth and what I'd known about her previously was about all I could put into the chart, which I did."
At most, the trial judge had before him a difference of opinion with regard to hospital record keeping. The testimony was undisputed that everything that could be done for the patient was done by the members of the hospital staff who were present when she was brought in and who were in touch with Dr. Clark by telephone. The records were not falsified by Dr. Clark in any way and there was no showing that the signing of the form was unlawful.
In all three Specifications now relied on by the Board, the unprofessional conduct charged relates to alleged violations of the rules of the St. Louis County Medical Society, or a Duluth Hospital, or the Principles *214 of Medical Ethics of the American Medical Association, particularly Sections 3, 5 and 10 thereof, which are quoted in the Board's brief. The evidence submitted to us does not show any clear violation of these sections of the Principles of Medical Ethics of the American Medical Association. More important, as applied in the licensing and revocation cases "unprofessional conduct" has been construed to include serious offense, such as intentional violations of law or recognized professional standards. In Aiton v. Board of Medical Examiners, 13 Ariz. 354, 114 P. 962 (1911), the first Arizona case upholding a statute regulating the practice of medicine, the court gave "unprofessional conduct" a restricted meaning in order to avoid the contention that the phrase was unconstitutionally vague. The definition in Aiton has been superseded by the statutory definition in A.R.S. § 32-1401 quoted above. Fitzpatrick v. Board of Medical Examiners, 96 Ariz. 309, 394 P.2d 423. "Unprofessional conduct" cannot be given any definition which would make it subject to constitutional attack on grounds of vagueness. State Board of Technical Registration v. McDaniel, 84 Ariz. 223, 232, 326 P.2d 348, 352; State v. Gee, 73 Ariz. 47, 54, 236 P.2d 1029, 1034.
"The Board of Health has no right to prescribe a code of medical ethics, and then declare a breach of that code unprofessional and dishonorable conduct; * * *." Aiton v. Board of Medical Examiners, 13 Ariz. at 360, 114 P. at 963.
Still less has the St. Louis County (Minn.) Medical Society any right to prescribe a code of ethics for the state.
"In the first place, the evidence must be substantial; in the second place, it must still look substantial when viewed in the light of the entire record. That does not go so far as saying that a decision can be reversed on the weight of the evidence. It does not go quite so far as the power given to a circuit court of appeals to review a district-court decision, but it goes a great deal further than the present law, and gives the court greater opportunity to reverse an obviously unjust decision * * *."
The trial judge here properly applied the standards of modern judicial review to reverse an unjust decision of the Board.
LOCKWOOD, C.J., STRUCKMEYER, V.C.J., and UDALL and McFARLAND, JJ., concur.
 The present statute regulating the practice of medicine is Laws 1964, Ch. 27. It is a complete revision of the prior statute, and nothing said herein necessarily applies to the present law. Quotations and section references herein are from the law as it was at the time relevant to this case.
 Prior to 1946, statutory provisions relating to judicial review generally provided for as limited a judicial review as was thought to be constitutionally permissible. The growth of federal administrative agencies led to a search for fairer standards of judicial review. The most important study was that of the Attorney-General's Committee of Administrative Procedure, which led to the passage of the Federal Administrative Procedure Act, 5 U.S.C.A. § 1001 et seq., in 1946. The states, including Arizona, took advantage of these studies, and generally revised their provisions for the judicial review of administrative decisions.
 "Section 3. A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily associate professionally with anyone who violates this principle."
"Section 5. A physician may choose whom he will serve. In an emergency, however, he should render service to the best of his ability. Having undertaken the care of a patient, he may not neglect him; and unless he has been discharged he may discontinue his services only after giving adequate notice. He should not solicit patients."
"Section 10. The honored ideals of the medical profession imply that the responsibilities of the physician extend not only to the individual, but also to society where these responsibilities deserve his interest and participation in activities which have the purpose of improving both the health and the well-being of the individual and the community."
 Quoted with approval in Universal Camera, supra, 340 U.S. at page 485, 71 S.Ct. at page 463.

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