Opinion ID: 6329191
Heading Depth: 2
Heading Rank: 2

Heading: Was the PDUSH’s Decision Arbitrary and Capri-

Text: cious or Unsupported by Substantial Evidence?
As discussed above, this case presents a knotty question due to the layered standards of review. We must decide whether it was arbitrary and capricious for the PDUSH to find that the DAB’s decision was clearly contrary to the evidence. We review this question de novo, giving no deference to the district court’s decision. See Minnick, 775 F.3d at 935. The first layer of review, under the arbitrary and capricious standard, is a familiar one. This standard has been described in many ways, but in all articulations it is deferential. Under it, we will disturb an agency’s determination only if it lacks a “rational basis.” White Eagle Co-op. Ass'n v. Conner, 553 F.3d 467, 474 (7th Cir. 2009); see also Doran v. Wilkie, 768 F. Ap- p'x 340, 349 n.6 (6th Cir. 2019) (“[T]he arbitrary-and-capricious standard of 38 U.S.C. § 7462(f) … mirrors the standard of review of administrative actions under the Administrative Procedure Act” (citing 5 U.S.C. § 706(2))). Only if the agency relied on factors that Congress did not intend it to consider, failed to consider an important aspect of the problem, or failed to articulate a satisfactory connection between the facts found and the choice made will we find the agency’s action invalid. Sierra Club v. U.S. Env’t Prot. Agency, 774 F.3d 383, 393 10 No. 21-1045 (7th Cir. 2014); see also Motor Vehicle Mfrs. Ass’n of U.S., Inc. v. State Farm Mut. Auto. Ins. Co., 463 U.S. 29, 43 (1983). We do not “reweigh evidence, resolve conflicts, decide questions of credibility, or substitute [our] judgment for that of the [agency].” Burmester v. Berryhill, 920 F.3d 507, 510 (7th Cir. 2019) (quoting Lopez ex rel. Lopez v. Barnhart, 336 F.3d 535, 539 (7th Cir. 2003) (per curiam)). Still, the agency must provide a “logical bridge” between the evidence and its conclusion. See Kastner v. Astrue, 697 F.3d 642, 646 (7th Cir. 2012) (quoting Craft v. Astrue, 539 F.3d 668, 673 (7th Cir. 2008)); see also State Farm, 463 U.S. at 43 (noting that an agency “decision of less than ideal clarity” will be upheld “if the agency’s path may reasonably be discerned” (citation omitted)). On the other hand, the second standard of review layer— the “clearly contrary to the evidence” standard that the PDUSH was required to employ in reviewing the DAB’s decision—is far less familiar. In fact, the parties point to only one case that interprets the standard in this context, and the Court’s own efforts to find other cases have proven fruitless. Because we find it to be well-reasoned, we adopt the interpretation proposed by the only court to have taken up this question. In Savu v. United States, the district court took a plain language approach in interpreting this standard: “Given their plain and ordinary meanings, ‘clearly’ means ‘without doubt; obviously.’ And ‘contrary to the evidence’ means ‘conflicting with the weight of the evidence presented at a contested hearing.’” No. SA-18-CV-00993-JKP-ESC, 2021 WL 1615562, at  (W.D. Tex. Apr. 26, 2021) (quoting Clearly, Oxford Dictionaries, https://premium.oxforddictionaries.com/us/definition/ american_english/clearly (last visited Mar. 25, 2022); Contrary No. 21-1045 11 to the Evidence, Black's Law Dictionary (11th ed. 2019)). Combining the plain meanings of these two phrases, the Savu court ruled that the PDUSH could reverse the DAB’s decision as “clearly contrary to the evidence” only if the PDUSH showed that it would be obvious to an ordinary person that the DAB’s decision conflicted with the weight of the evidence. Id. We see no reason to depart from this straightforward approach here and therefore analyze the PDUSH’s decision using this articulation of the “clearly contrary to the evidence” standard. Layering these two standards on top of one another, we will vacate the PDUSH’s decision if it did not articulate some rational basis for why the DAB’s decision obviously conflicted with the weight of the evidence.
trary to the Evidence” Standard Dubnow argues that the PDUSH’s decision was arbitrary and capricious because it reflects a failure to give proper deference to the DAB’s decision under the required “clearly contrary to the evidence” standard. We agree for two reasons. First, the PDUSH’s decision indicates that he failed to evaluate the question posed to him and thereby “fail[ed] to consider an important aspect of the problem.” Adventist GlenOaks Hosp. v. Sebelius, 663 F.3d 939, 942 (7th Cir. 2011). The allegation in Charge One in its entirety reads as follows: Inappropriate Refusal of Care and/or Diversion. Specification: On or about April 29, 2017, at ap- proximately 2:01 p.m., you inappropriately re- fused care to and/or diverted a seven-month old 12 No. 21-1045 [sic] infant in full cardiac arrest en route via ambulance to the [FHCC ED] to Lake Forest Hos- pital[,] which delayed potentially life-saving treatment. The infant was pronounced dead at 2:46 p.m. at Lake Forest Hospital. In his four-sentence description of his findings, the PDUSH’s conclusion appears to rest on his finding that “there was no need to divert the ambulance to another facility.” But whether there was a need to divert the ambulance is not at all the question the PDUSH, or even the DAB, was required to answer. The relevant question for the DAB was whether the diversion was appropriate; if so, Dubnow’s removal could not be sustained. But to conclude, as the PDUSH did, that treating the patient at the hospital was possible, or even appropriate, is not to conclude that diverting the ambulance to a betterequipped hospital would have been inappropriate. And, moreover, this is not the question the PDUSH was tasked with answering. Rather, the PDUSH was tasked with deciding whether the DAB’s conclusion on that question was clearly contrary to the evidence. As such, the PDUSH’s conclusion that there was “no need” to divert the patient is two steps removed from the analysis Congress tasked him with performing under 38 U.S.C. § 7462(d). More generally, even if we could conclude that the PDUSH found that diversion was inappropriate, the PDUSH appears to have substituted his judgment for the DAB’s, in explicit violation of the statute. In fact, the VA itself says as much, writing in its brief, “The charge was that Dubnow’s diversion of the ambulance was inappropriate; the Board found that it was not, and the PDUSH found that it was.” But, again, this is insufficient for the PDUSH to overturn the DAB’s No. 21-1045 13 conclusion. In order to overturn the DAB’s conclusion, the statute requires that the PDUSH find not only that diversion was inappropriate but also that any conclusion by the DAB to the contrary would appear to the ordinary person to be obviously against the weight of the evidence. Because it is entirely devoid of a discussion of the DAB’s numerous, detailed findings, the PDUSH’s opinion contains no rational basis for such a sweeping conclusion. The VA argues that the PDUSH did answer the appropriate question under the relevant standard because his opinion letter stated, “Upon careful consideration of the facts of the case, I do not concur with the Board’s findings regarding Charge One as it is clearly contrary to the evidence,” and also cited the standard multiple times elsewhere. But “[m]erely parroting the standard without showing its application renders review of a DAB decision arbitrary and capricious.” Savu, 2021 WL 1615562, at . The PDUSH failed to grapple at all with any of the reasons the DAB advanced for overturning the charge against Dubnow. The PDUSH need not mention or analyze every piece of evidence in the record. Cf. Terry v. Astrue, 580 F.3d 471, 475 (7th Cir. 2009) (per curiam) (noting that, in determining social security disability benefits, administrative law judges need not examine and discuss every piece of evidence). But when Congress explicitly directs that a DAB’s decision may only be reversed upon a finding that it was clearly contrary to the evidence, any such reversal should contain some analysis constructing a “logical bridge” between the evidence and the conclusion that the DAB’s finding was obviously against the weight of that evidence. See Kastner, 697 F.3d at 646. Merely listing a few reasons that support the conclusion opposite the 14 No. 21-1045 DAB’s, without any discussion of the evidence relied on by the DAB, is not enough to meet this minimal bar. Accordingly, we conclude that the PDUSH’s decision in this action was arbitrary and capricious.
duct Against the Community Standard of Care Dubnow also argues that the PDUSH’s failure to evaluate his decisions on April 29, 2017, against the community standard of care provides an independent reason to vacate the PDUSH’s decision. We decline to create such a broad rule stating that any failure by the PDUSH to evaluate a physician’s conduct against the community standard of care renders the PDUSH’s decision arbitrary and capricious. While one would expect that an analysis of the physician’s conduct against the community standard of care would play a part (and perhaps even a substantial part) in the PDUSH’s decision in a case such as this, which asks whether the physician’s conduct was “inappropriate,” we decline to establish a rule that any decision lacking such an analysis is per se deficient. Instead, we interpret this argument as simply putting forth another example of how the PDUSH failed to provide a rational basis for his decision. The DAB concluded that “[t]he community standard of care was met for the patient by the decision to redirect the ambulance,” and this conclusion appears to have played a predominant role in the DAB’s ultimate conclusion that Dubnow’s actions were not inappropriate. Because the PDUSH was tasked with evaluating whether the DAB’s findings were clearly contrary to the evidence, one would expect to see some discussion in the PDUSH’s opinion of the DAB’s rather significant conclusion on this point. The No. 21-1045 15 total absence of any such discussion suggests that the PDUSH misunderstood his role as a deferential reviewer of the DAB’s findings. To be sure, the evidence as to whether Dubnow’s actions met the community standard of care is, contrary to Dubnow’s assertions, mixed. For example, while the DAB did conclude that Dubnow met the standard of care, Dr. Holt (the Director of the FHCC) testified to the DAB: “We have all the equipment. We have the nursing staff trained to do this. We had the room available. Help me here. I don’t understand how we’re not capable of doing pediatric emergencies.” In sum, a review by the PDUSH of the evidence regarding whether Dubnow met the standard of care may very well reveal that the DAB’s finding on the issue was clearly contrary to the evidence. But this does not excuse the PDUSH from meaningfully analyzing the evidence to determine whether this is, in fact, the case.