Opinion ID: 1187073
Heading Depth: 1
Heading Rank: 4

Heading: gross negligence agency expertise

Text: (4a) The agency and the court found that Franz' choice of Anaheim was gross negligence because Wollweber was a high-risk patient, Anaheim had no adequate ICU, and Franz made the choice  without regard to his patient's needs  in order to obtain surgical privileges he did not have elsewhere. They also ruled that he committed gross negligence by scheduling surgery before selecting the surgeon. He contends that those findings lack substantial evidence because the Board offered no expert testimony that acts of that kind demonstrate the want of even scant care or an extreme departure from the ordinary standard of conduct, the definition of gross negligence. ( Gore v. Board of Medical Quality Assurance (1980) 110 Cal. App.3d 184, 196 [167 Cal. Rptr. 881]; Cooper v. Board of Medical Examiners (1975) 49 Cal. App.3d 931, 941 [123 Cal. Rptr. 563]; both quoting Van Meter v. Bent Construction Co. (1956) 46 Cal.2d 588, 594 [297 P.2d 644].) [4] The Board answers that any gap in the record was filled by the panel's expertise in medical matters. Because two of the panel's three members were doctors, the Board urges, it could apply special knowledge in assessing gross negligence by a doctor and needed no expert testimony on the pertinent medical standards. Moreover, as we have seen, four of the seven members of the Division that adopted the panel's decision also were doctors. On mandamus review, the Board argues, courts must defer to this off-the-record agency expertise. The argument lacks merit. California law provides for judicial review of agency decisions to revoke or suspend medical licenses. (See Code Civ. Proc., § 1094.5; Yakov v. Board of Medical Examiners (1968) 68 Cal.2d 67, 69-71 [64 Cal. Rptr. 785, 435 P.2d 553].) Whatever the expertise of certain members of the panel and the Division, we cannot impute similar knowledge to a reviewing judge untrained in medical matters. Yet the trial court is confined to the record of the agency hearing, except in certain cases when evidence was improperly excluded or not previously available with due diligence. (Code Civ. Proc., § 1094.5, subd. (e); City of Fairfield v. Superior Court (1975) 14 Cal.3d 768, 774-775 [122 Cal. Rptr. 543, 537 P.2d 375].) Therefore the agency record must provide as complete a basis for judicial review as due diligence makes feasible. [5] It must include any technical matter necessary to enable a lay judge to determine whether the agency's decision has adequate support. To rule that the agency record must be complete enough to allow judicial review of technical questions imposes no unreasonable burden on the administrative process. The Board did introduce medical standards testimony as to most of the gross negligence findings in this case, and inclusion of that kind of testimony appears routine in discipline matters. (See, e.g., Gore v. Board of Medical Quality Assurance, supra, 110 Cal. App.3d 184, 195; Cooper v. Board of Medical Examiners, supra, 49 Cal. App.3d 931, 941.) (5), (6) (See fn. 6.) We do not, of course, hold that agency adjudicators may not apply their expert opinions to decide issues of legislative fact. (See 3 Davis, Administrative Law Treatise (2d ed. 1980) § 15.2, p. 138. [6] ) A unique efficiency of many agencies is the professional competence they bring to matters delegated to them by the Legislature. We think an agency factfinder may, for example, reject uncontradicted opinion testimony that his own expertise renders unpersuasive. (See McCarthy v. Industrial Commission (1927) 194 Wis. 198 [215 N.W. 824, 825-826]; 2 Davis, Administrative Law Treatise (1958) § 15.13, pp. 424-425; Cal. Administrative Agency Practice (Cont.Ed.Bar 1970) Hearing Procedure, § 3.34, p. 167.) A fortiori, the same expertise may govern even when the record contains no opinion evidence at all. Yet due process requires, when in an adjudication an agency intends to rely on members' expertise to resolve legislative-fact issues, that it notify the parties and provide an opportunity for rebuttal. (See, e.g., Jaffe v. State Department of Health (1949) 135 Conn. 339 [64 A.2d 330, 338, 6 A.L.R.2d 664]; 3 Davis, Administrative Law Treatise (2d ed. 1980) supra, § 15:1 et seq., p. 133 et seq.; cf. In re Ruffalo (1968) 390 U.S. 544, 550-551 [20 L.Ed.2d 117, 121-122, 88 S.Ct. 1222], rehg. den., 391 U.S. 961 [20 L.Ed.2d 874, 88 S.Ct. 1833].) The California Administrative Procedure Act requires notice and opportunity to rebut whenever an agency intends to take official notice ... of any generally accepted technical or scientific matter within the agency's special field, [or] of any fact which may be judicially noticed by the courts of this State. (Gov. Code, § 11515; see Evid. Code, § 450 et seq.) [7] The agency's notification must be complete and specific enough to give an effective opportunity for rebuttal. It must also help build a record adequate for judicial review. If it meets those requirements we can see no prejudice to the parties. [8] We cannot accept the premise of Brennan v. State Bd. of Medical Examiners (1950) 101 Cal. App.2d 193 [225 P.2d 11] that it is improper for the board to decide ... questions [of violation of professional standards] upon the basis of the opinions held by the several members of the board, and that [ n ] either the board nor the court could render a just decision except in reliance upon expert testimony. (P. 196, italics added.) As Brennan notes, fairness is satisfied when a party [is] apprised of the evidence against him so that he may have an opportunity to refute, test and explain it, ... ( Ibid., quoting English v. City of Long Beach (1950) 35 Cal.2d 155, 159 [217 P.2d 22, 18 A.L.R.2d 547].) (4b) Some questions concerning medical negligence require no expertise. Technical knowledge is not requisite to conclude that complications from a simple injection ( Bardessono v. Michels (1970) 3 Cal.3d 780, 790 [91 Cal. Rptr. 760, 478 P.2d 480, 45 A.L.R.3d 717]), a surgical clamp left in the patient's body ( Leonard v. Watsonville Community Hosp. (1956) 47 Cal.2d 509, 515 [305 P.2d 36]), or a shoulder injury from an appendectomy ( Ybarra v. Spangard (1944) 25 Cal.2d 486, 488-490 [154 P.2d 687]) indicate negligence. Common sense is enough to make that evaluation. Only where the professional significance of underlying facts seems beyond lay comprehension must the basis for the technical findings be shown and an opportunity for rebuttal given. (Cf. Cobbs v. Grant (1972) 8 Cal.3d 229, 236 [104 Cal. Rptr. 505, 505 P.2d 1].) We think the record here supports a lay inference that the choice of the Anaheim hospital was grossly negligent. There was ample evidence that Wollweber was a high-risk patient who had suffered pulmonary complications after prior operations. The operation itself was major and serious; and Franz expected complications, including pneumonia. Yet witnesses confirmed that Anaheim had no ICU, cardiac care unit, or respirator. Olivet, its titular chief of surgery, was not a surgeon and did not consider himself a surgery supervisor. The hospital granted surgical privileges on a casual basis, required no formal evidence of competence, and maintained no consistent system of evaluating physicians it allowed to operate on its premises. It had no surgical residents or readily accessible surgical resources. Thus when Ali refused to attend in Wollweber's crisis Olivet felt compelled to perform emergency surgery himself. After the operation Wollweber continued to show pulmonary weakness, and Fernandez finally found it necessary to transfer him to Good Samaritan. He later explained to Olivet: [Wollweber needs] a modern type of treatment. This is a respiratory problem of a certain entity, of a certain degree. With modern medicine and the type of things available in a modern institution  this is only a 24-bed hospital  I feel that this patient is entitled to the best. Olivet in retrospect admitted that Wollweber should have been in a hospital where he could receive intensive care. When a patient faces risky surgery of a kind that previously has caused him difficulty, common sense requires he be admitted to a hospital that can cope with foreseeable complications. Franz knew the patient's history. His prior use of privileges at Anaheim had exposed him to the conditions there. In any event he had an obligation to be aware of them. It is common knowledge that populous Orange County has many hospitals with modern facilities and qualified staffs. Several are mentioned in the record. No expertise is necessary to conclude that Franz' choice of Anaheim for Wollweber's operation was an extreme departure from the acceptable standard of medical care in that county. [9] Accordingly there was no need for the panel to give notice of its own opinion or allow an opportunity for rebuttal. The trial court could resolve the issue on the record presented. (7) The same is not true, though, of the court's finding that scheduling surgery before choosing a surgeon was grossly negligent. Passaro did testify that the surgeon is responsible for independent diagnosis and evaluation of the need for an operation. Moreover, the Board's brief on appeal explains why premature scheduling involves the vice of interfering with the surgeon's independent role. However, Ali apparently was retained the same day as surgery was scheduled or within a day or two afterward. There is no evidence he could not have cancelled the operation had he found it unnecessary after independent examination. There was no expert testimony that Franz' conduct in this instance was an extreme departure from community medical standards. Common knowledge does not supply the link between premature scheduling and independent surgical evaluation. The record does not disclose the basis of either the panel's or the Division's expert opinion on the issue, and Franz had no opportunity to refute that opinion. Hence the record was inadequate for a trial court finding that the scheduling of surgery before a surgeon was selected constituted gross negligence. The finding cannot be sustained.