Title: In Re Reinstatement of Navrkal
Citation: 270 Neb. 391, 703 N.W.2d 247
Docket Number: 808, 809, 810, 811, 812
State: Nebraska
Issuer: Nebraska Supreme Court
Date: September 9, 2005

703 N.W.2d 247 (2005) 270 Neb. 391 In re Petition for REINSTATEMENT OF the license of Harvey J. NAVRKAL, M.D., to practice medicine and surgery. Harvey J. Navrkal, M.D., appellee, v. State of Nebraska on behalf of the Nebraska Department of Health and Human Services Regulation and Licensure and the Nebraska chief medical officer, appellant. No. S-04-808. Supreme Court of Nebraska. September 9, 2005. *249 Jon Bruning, Attorney General, and James D. Smith, Lincoln, for appellant. Charles M. Pallesen, Jr., of Cline, Williams, Wright, Johnson &amp; Oldfather, L.L.P., Lincoln, for appellee. HENDRY, C.J., CONNOLLY, GERRARD, STEPHAN, McCORMACK, and MILLER-LERMAN, JJ. McCORMACK, J. Harvey J. Navrkal, M.D., seeks reinstatement of his license to practice medicine and surgery, which was revoked in 1997. The State of Nebraska on behalf of the Department of Health and Human Services Regulation and Licensure and the Nebraska chief medical officer appeals the decision of the district court for Lancaster County, which ordered that Navrkal's license be reinstated. We reverse, and remand with directions. Navrkal graduated from the University of Nebraska Medical Center in 1990. Following his graduation, he entered a family practice residency program in Lincoln, Nebraska. He was suspended from that program in July 1991 to undergo treatment for alcohol dependency and was reinstated in September upon completing his treatment. One month later, he suffered a relapse and resigned from the program. Navrkal went on to become a licensed physician in Colorado in April 1994. Because of his past issues with alcohol and depression, his Colorado license was subject to a 5-year probationary term and numerous terms and conditions designed to address his alcohol problems. Just 2 months after Navrkal received the license, it was suspended. The Colorado Board of Medical Examiners suspended the license because Navrkal had been suspended from his residency program in Colorado for "significant attendance lapses and marginal performance" and also for missing two urine tests required under the terms of his license. His Colorado license is still suspended today. Navrkal applied for a medical license in Nebraska in 1996. In letters to the then Nebraska Department of Health Professional and Occupational Licensure Division, Navrkal informed it that he had successfully completed a treatment program for alcoholism and had been sober for 2 years. He also wrote that he took full responsibility for his past lapses and was agreeable to any reasonable stipulations on his license. His application was also supported by several letters of recommendation. On April 4, 1996, the Nebraska Board of Examiners in Medicine and Surgery (board) granted a license to Navrkal subject to a 5-year probationary period. Among the terms and conditions attached to his license, Navrkal was required to abstain from the consumption of alcohol and submit a practice plan for approval by the board. The board subsequently approved a practice plan that permitted Navrkal to practice at the Douglas County Hospital in Omaha, Nebraska. Despite having been approved to practice medicine only at the Douglas County Hospital, Navrkal also began practicing occasionally at the Schuyler Memorial Hospital in Schuyler, Nebraska. Navrkal *250 claimed that he erroneously thought he had been approved to practice in Schuyler. Navrkal "moonlighted" at the hospital in Schuyler without authorization for approximately 1 year. While working at the Douglas County Hospital in early 1997, Navrkal met T.M., a female patient in the hospital's psychiatric ward. The details of Navrkal's relationship with T.M. were set forth in the State of Nebraska's petition to revoke Navrkal's license. Navrkal did not contest any of the following allegations from that petition: As mentioned, the State filed a petition for disciplinary action against Navrkal on June 27, 1997. The petition sought to revoke Navrkal's medical license because of his relationship with T.M., his consumption of alcohol in violation of the terms of his probationary license, and his practicing medicine in Schuyler without approval. On October 17, 1997, the chief medical officer approved an agreement between Navrkal and the State that resulted in the revocation of his license. Under the terms of the revocation, Navrkal could not seek reinstatement of his license for 2 years. The terms of the revocation also stated that "any future reinstatement of [Navrkal's] license is completely discretionary and that he has received no promises or assurances that his license will be reinstated." Navrkal was 34 years old in 1997. Although he was eligible to apply for reinstatement in 1999, Navrkal testified that he did not apply at that time because he "wasn't ready. I was still struggling with the depression and I'd had a relapse of alcohol abuse." That year, he was arrested in Texas for driving under the influence. During the stop, Navrkal refused to take a breath test when the arresting officer did not agree to release him if such a test "was negative." Navrkal eventually pled no contest to a charge of reckless driving, for which he was placed on 1-year's probation, received a suspended sentence of 30 days' imprisonment, was fined $200, and ordered to complete 100 hours of community service. *253 Navrkal earned a juris doctor degree from the University of Texas School of Law in 2000 and a master of laws degree from the University of Houston Law Center in 2002. Since 1997, he has earned 324 credit hours of continuing medical education and has authored more than a dozen papers and presentations concerning medical legal issues. At the time of the hearing before the board in this case, Navrkal was employed with Medical Law Associates, where he participated in medical case reviews involving medical legal issues. He had applied to take the Texas bar examination in July 2003, his second attempt at passing the examination. Navrkal was also nearing completion of his thesis for a master's degree in public health at the University of Texas Health Science Center. Navrkal was engaged to be married in October 2003. Since 1997, Navrkal has addressed his alcohol and depression issues in several ways. He began seeing a psychiatrist and a psychologist. The record contains a letter from Dr. Edgar Nace, a psychiatrist Navrkal met regularly with from October 1997 to September 1998. Nace met Navrkal again in February 2003 to review Navrkal's progress over the prior few years. Nace had the following to say about Navrkal: Navrkal has also participated in a monitoring program and a voluntary drug screening program through the Texas Medical Association. At the time of the hearing before the board, Navrkal had been sober for 3 years, 9 months. He has been actively involved in International Doctors of Alcoholics Anonymous meetings. In addition to the letter from Nace, Navrkal's application was accompanied by numerous letters of recommendation from doctors, lawyers, the pastor of his church, and others he has worked with. At the time of the board hearing, Navrkal had been accepted into two residency programs: one at the University of Massachusetts and the other at Louisiana State University. His participation in either program was subject to having his Nebraska license reinstated. Navrkal testified that if his Nebraska license were to be reinstated, he would "probably" move to Massachusetts or Louisiana and enter into *254 one of those two programs. Navrkal testified that physicians' health rehabilitation committees in Massachusetts and Louisiana had indicated their willingness to work with and support Navrkal should he relocate to either of those states. On November 6, 2002, Navrkal filed a petition for reinstatement of his medical license. A hearing was held before the board on June 6, 2003. During the hearing, evidence was received that established the facts recited above. While testifying, Navrkal repeatedly said that he took full responsibility for his past actions. In a written personal statement, Navrkal wrote: The board recommended, by a unanimous vote, to reinstate Navrkal's license with numerous terms, conditions, and restrictions. The board forwarded its recommendation to the chief medical officer. The chief medical officer rejected the recommendation of the board and denied reinstatement of Navrkal's license. The chief medical officer stated: Navrkal filed a petition for review of the chief medical officer's decision in the district court pursuant to the Administrative Procedure Act (APA). The court reversed the chief medical officer's decision and ordered that Navrkal's license be reinstated. The court reached that conclusion after first determining that Navrkal had the burden of proving by the preponderance of evidence that his license should be reinstated. The court then found that Navrkal had proved, not merely by a preponderance but by clear and convincing evidence, that his license should be reinstated. The State filed this timely appeal, and we granted its petition to bypass the Nebraska Court of Appeals. The State assigns that the district court erred in (1) concluding that a medical license is to be reinstated after discipline revocation when the applicant satisfies a burden of proof evidentiary standard; (2) failing to clearly or accurately determine the elements of proof which must be established for reinstatement; (3) concluding that if an applicant must satisfy an evidentiary standard, the applicable standard is *255 preponderance of the evidence; (4) disregarding the chief medical officer's finding and conclusion that the board's probation requirements were inadequate to monitor Navrkal; (5) finding that Navrkal had an alcohol relapse when he was arrested for driving under the influence in 1997, rather than 1999, and had no law enforcement contacts after 1997; and (6) reversing the chief medical officer's decision. A judgment or final order rendered by a district court in a judicial review pursuant to the APA may be reversed, vacated, or modified by an appellate court for errors appearing on the record. Lein v. Nesbitt, 269 Neb. 109, 690 N.W.2d 799 (2005). When reviewing an order of a district court under the APA for errors appearing on the record, the inquiry is whether the decision conforms to the law, is supported by competent evidence, and is not arbitrary, capricious, or unreasonable. Id. Whether a decision conforms to law is by definition a question of law, in connection with which an appellate court reaches a conclusion independent of that reached by the lower court. Id. An appellate court, in reviewing a district court judgment for errors appearing on the record, will not substitute its factual findings for those of the district court where competent evidence supports those findings. Id. Licenses to practice medicine and surgery are issued by the Nebraska Department of Health and Human Services Regulation and Licensure (hereinafter department) under the provisions of the Uniform Licensing Law, Neb.Rev.Stat. § 71-101 et seq. (Reissue 1996 &amp; Cum.Supp.2002). The Uniform Licensing Law provides for the disciplinary revocation of licenses, § 71-147, as well as the reinstatement of licenses previously revoked, § 71-161.04(2). A petition for reinstatement is first considered by the board. § 71-161.06. The board makes a recommendation to the director of the department regarding reinstatement, § 71-161.07(1), although the duties of the director may be performed, as in this case, by the chief medical officer. See § 71-155.01 and Neb.Rev.Stat. § 81-3201(2) (Supp.2003). Upon receiving an affirmative recommendation from the board, an applicant may apply to the director of the department for reinstatement. § 71-161.20(1). (Emphasis supplied.) § 71-161.20(2). Generally, the word "may," when used in a statute, will be given its ordinary, permissive, and discretionary meaning unless it would manifestly defeat the statutory objective. Spaghetti Ltd. Partnership v. Wolfe, 264 Neb. 365, 647 N.W.2d 615 (2002). It is clear from a review of the applicable statutes that the director's or chief medical officer's decision to reinstate a license to practice medicine and surgery is a discretionary one; an applicant is not entitled to have his or her license reinstated as a matter of right upon satisfying any particular quantum of proof. See, also, State v. Hinze, 232 Neb. 550, 441 N.W.2d *256 593 (1989) (there exists no vested right to practice medicine; rather, it is conditional right subordinate to police power of State to protect and preserve public health). The parties recognized this in the 1997 agreement revoking Navrkal's license, which provided that "any future reinstatement of [Navrkal's] license is completely discretionary." Such discretion, however, is not boundless. As provided in § 71-161.20(2), the director may reverse or modify the recommendation of the board if the board's recommendation is (a) in excess of statutory authority; (b) made upon unlawful procedure; (c) unsupported by competent, material, and substantial evidence in view of the entire record; or (d) arbitrary or capricious. A judgment or final order rendered by a district court in a judicial review pursuant to the APA may be reversed, vacated, or modified by an appellate court for errors appearing on the record. Lein v. Nesbitt, 269 Neb. 109, 690 N.W.2d 799 (2005). When reviewing an order of a district court under the APA for errors appearing on the record, the inquiry is whether the decision conforms to the law, is supported by competent evidence, and is not arbitrary, capricious, or unreasonable. Id. The chief medical officer found that Navrkal "seeks reinstatement of his Nebraska license in order to allow his ... return to practice outside of Nebraska." The chief medical officer determined that the recommendations of the Board were inadequate to afford the public protection by appropriately monitoring Navrkal if he was practicing outside the State of Nebraska. The district court, in reversing the chief medical officer's decision, "presume[d] that the jurisdiction to which Navrkal applies to practice will have its own acceptance guidelines for new applicant's [sic] to the medical community and will take into consideration Navrkal's prior disciplinary actions, when determining the terms and conditions of any license it grants Navrkal." There is no evidence in the record to support such a presumption. Therefore, we find error on the record and reverse the district court's order. Navrkal contends that denying reinstatement of his license to practice medicine would amount to illegal discrimination under title II of the Americans with Disabilities Act of 1990. He also raises a number of constitutional arguments with respect to the hearing before the board and other aspects of his petition for reinstatement. None of these arguments were included in his petition for review filed in the district court, and none were decided by the district court. Where a cause has been appealed to a higher appellate court from a district court exercising appellate jurisdiction, only issues properly presented to and passed upon by the district court may be raised on appeal to the higher court. In the absence of plain error, where an issue is raised for the first time in the higher appellate court, it will be disregarded inasmuch as the district court cannot commit error in resolving an issue never presented and submitted for disposition. McQuinn v. Douglas Cty. Sch. Dist. No. 66, 259 Neb. 720, 612 N.W.2d 198 (2000). Therefore, we decline to consider these arguments. We conclude that the decision of the chief medical officer, performing the acts of the director under § 71-155.01 in denying the reinstatement of a license to practice medicine and surgery, is a discretionary one and that an applicant is not entitled to have his or her license reinstated as a matter of right. We further conclude that the district court erred in reversing the decision of the chief medical officer denying reinstatement *257 of Navrkal's license. Accordingly, we reverse the district court's order and remand the cause with directions to reinstate the order of the chief medical officer. REVERSED AND REMANDED WITH DIRECTIONS. WRIGHT, J., not participating.