Opinion ID: 2328582
Heading Depth: 2
Heading Rank: 2

Heading: In the practice of medicine

Text: Petitioner challenges the Board's conclusion that the filing of his application for renewal of his license occurred in the practice of medicine. He asserts that the conduct is not within the purview of the statutory definition. [5] He argues that there is a legally insufficient relationship between the statutory definition of practice and Petitioner's conduct, the relationship being that submitting false statements impedes the Board's ability to make informed decisions regarding physician qualifications and adequately safeguard the public health. The deficiency, Petitioner asserts, rests in the fact that the Health Claims Arbitration Office alerts the Board to all claims filed, pursuant to Maryland Code (1974, 2006 Repl. Vol.), § 3-2A-04(b)(6) of the Courts & Judicial Proceedings Article. [6] Therefore, according to Petitioner, the non-disclosure of malpractice matters in fact does not impede the Board's functioning. The Board counters that we, as well as the Court of Special Appeals, have rejected a narrow interpretation of the term in the practice of medicine. The Board adds that its interpretation of what constitutes practice of medicine is entitled to deference. We first examined the breadth of conduct falling within the meaning of in the practice of medicine, in McDonnell v. Commission on Medical Discipline, 301 Md. 426, 483 A.2d 76 (1984). In McDonnell, we considered whether a physician's attempt to intimidate adverse expert witnesses in a medical malpractice case was conduct that comes within the meaning of in his practice as a physician. [7] Id. at 428, 483 A.2d at 76. Physician McDonnell, concerned that the experts were inexperienced, communicated with them directly and threatened to have transcripts of their depositions disseminated to the local and national medical communities. Id., 483 A.2d at 76-77. The experts testified against McDonnell, despite his intimidation. Id. at 429, 483 A.2d at 77. After the trial concluded, McDonnell was reprimanded for immoral conduct of a physician in his practice as a physician. Id. at 429-30, 483 A.2d at 78. Before this Court, McDonnell admitted the impropriety of his actions, but asserted that those actions did not occur in his practice as a physician. Id. at 433, 483 A.2d at 79. We concluded that, although McDonnell's conduct was improper, it was not sanctionable, id. at 434, 483 A.2d at 80, because it was clear that the legislature did not intend that a physician's general moral character would be subject to sanction, id. at 436, 483 A.2d at 81. We rejected the argument that the statute extended to immoral conduct simply because, in some manner, it had a general or associative relationship to the physician in his capacity as a member of the medical profession. Id. at 436, 483 A.2d at 81. Instead, we held that sanctionable conduct must be directly tied to the physician's conduct in the actual performance of the practice of medicine, i.e., in the diagnosis, care, or treatment of patients. Id. at 437, 483 A.2d at 81. Not surprisingly, Petitioner relies on McDonnell as support for a narrow interpretation of the statute. McDonnell, however, does not stand for the general proposition Petitioner advances. Moreover, McDonnell is not the last word on the subject. We have consistently recognized that in the practice of medicine applies not only to diagnosing and treating patients, but also to misconduct relat[ing] to the effective delivery of patient care. Finucan, 380 Md. at 597, 846 A.2d at 389. In Finucan, we held that a physician's engaging in sexual relationships with patients occurred in the practice of medicine because his behavior went to the heart of his duties as their family doctor. Id. at 599-600, 846 A.2d at 390-91. Similarly, in Banks we held that a physician's engaging in a pattern of sexually harassing hospital employees, 354 Md. at 76-77, 729 A.2d at 385, was in the practice of medicine because his on-duty conduct negatively affected the working environment, which needed at all times to be conducive to the practice of medicine, and his conduct was a threat to the teamwork approach of health care, id. at 75, 729 A.2d at 384. Likewise, in Cornfeld, the Court of Special Appeals, applying the reasoning of Banks and Finucan, held that conduct similar to Petitioner's occurs in the practice of medicine. 174 Md.App. at 473-79, 921 A.2d at 903-07. The physician, Cornfeld, while being investigated about his conduct during a surgery he had performed, made false statements at both the hospital peer review stage of the investigation and during the Board's subsequent investigation and disciplinary proceedings. Id. at 467, 921 A.2d at 899. The court affirmed the Board's determination that Cornfeld's misconduct occurred in the practice of medicine because peer review proceedings serve[] an important patient care purpose. Id. at 479-80, 921 A.2d at 906-07. Moreover, Cornfeld's false statements related to instructions he had given to others in rendering surgical care; consequently, his conduct was directly related to medical treatment and surgery, within the statutory definition of practice medicine. Id. at 481, 921 A.2d at 907. In so holding, the Court of Special Appeals recognized that a sufficient relationship between conduct and patient care can be established by showing that the physician abused his status as a physician in a manner that either harmed patients, created a substantial risk of harm to them, or diminished the standing of the medical profession as caregivers. 174 Md.App. at 477-78, 921 A.2d at 905-06. In the present case, the Board made no legal error in concluding that Petitioner's submission of his license renewal application occurred in the practice of medicine. We made plain in Banks that, in considering whether a physician's conduct was within the statutory requirement of `in the practice of medicine,' a critical factor has been whether the conduct occurred while the physician was performing a task integral to his or her medical practice. 354 Md. at 74, 729 A.2d at 384. Petitioner's completion and filing of his application to renew his physician's license is unquestionably a task integral to his ... practice. Without a license, Petitioner would have no authority to practice. Moreover, the Board did not err in adopting the ALJ's finding that filing a license renewal application is sufficiently intertwined with patient care. We appreciate that the Board must be able to rely on the accuracy of information conveyed in license applications in order to investigate and determine physicians' fitness to practice medicine. A physician's submission of false information regarding malpractice claims in license renewal applications impedes the Board's ability to make accurate determinations about a physician's continued fitness. Although, at best, false information might merely delay investigation, at worst, false information could form the basis upon which the Board renews or grants a license, potentially to an unfit applicant. The Board is entitled to expect truthful submissions, particularly with respect to information concerning suits for malpractice, given that such suits directly raise questions regarding a physician's fitness to practice. Petitioner argues that his falsehood in connection with the pending Wagner case is ultimately immaterial to the Board's licensing decision, because the Board has independent means of investigating whether a physician has been involved in any malpractice litigation through the Maryland Judiciary Case Search, and the Board receives malpractice filing information pursuant to statute from the Health Claims Arbitration Office. The argument is meritless. The purpose of disciplinary proceedings against licensed professionals is not to punish the offender but rather as a catharsis for the profession and a prophylactic for the public. McDonnell, 301 Md. at 436, 483 A.2d at 81. It is of no consequence that the Board would otherwise discover the lie, or, for that matter, that no patient was harmed by the physician who undertakes to lie about a malpractice claim. Giving to the Board the deference to which it is entitled in the interpretation and application of § 14-404, we cannot say that the Board erred in concluding that Petitioner's falsehood concerning the pendency of the Wagner malpractice case was conduct in the practice of medicine.