Opinion ID: 1700188
Heading Depth: 1
Heading Rank: 5

Heading: are experts required to establish the standard of care and whether it was violated?

Text: In deciding this issue, the court is called upon to balance two sets of well established legal principles. It is beyond argument that the State of South Dakota has a legitimate interest for the protection of its citizens to regulate the practice of dentistry, including licensing and supervisory powers which naturally must include the power to discipline or exclude the unqualified. Semler v. Oregon Bd. of Dental Examiners, 294 U.S. 608, 55 S.Ct. 570, 79 L.Ed. 1086 (1935). In addition to its general interest in protecting consumers and regulating commercial transactions, the state bears a special responsibility for maintaining standards among members of the licensed professions. Ohralik v. Ohio State Bar Assn., 436 U.S. 447, 460, 98 S.Ct. 1912, 1920, 56 L.Ed.2d 444, 456 (1978). The purpose of disciplinary proceedings and suspensions is not to punish the professional but is rather to protect the public from further wrongdoing. Matter of Voorhees, 294 N.W.2d 646, 647 (S.D.1980). On the other hand, it is also well established that one who has secured a license to practice dentistry has a property right in that license which cannot be taken from him without due process of law. Greene v. McElroy, 360 U.S. 474, 79 S.Ct. 1400, 3 L.Ed.2d 1377 (1959); Willner v. Committee on Character & Fitness, 373 U.S. 96, 83 S.Ct. 1175, 10 L.Ed.2d 224 (1963); Farney v. Anderson, 56 Ill.App.3d 677, 14 Ill. Dec. 346, 372 N.E.2d 151 (1978); Hake v. Ark. Med. Bd., 237 Ark. 506, 374 S.W.2d 173 (1964); c.f. Lee v. South Dakota Department of Health, 411 N.W.2d 108, (S.D. 1987). The formality and procedural requisites of a hearing to address the issue of professional negligence and misconduct depends on the nature of the subsequent proceedings and the importance of the interests involved. Cleveland Bd. of Ed. v. Loudermill, 470 U.S. 532, 105 S.Ct. 1487, 84 L.Ed.2d 494 (1985), Boddie v. Connecticut, 401 U.S. 371, 91 S.Ct. 780, 28 L.Ed.2d 113 (1971). In this matter, the agency hearing is the first and only time at which a de novo factual determination of the dentist's competence will be made. Further, the seriousness of the outcome of the hearing on the dentist's right to continue to practice his profession is obvious: It has been repeatedly held in this state that the revocation of a license of a professional man carries with it dire consequences. It not only involves necessarily disgrace and humiliation, but it means the end of his professional career. In a proceeding so serious, due process of law requires a definite charge, adequate notice and a full, fair and impartial hearing. Smith v. Dept. of Registration, 412 Ill. 332, 106 N.E.2d 722, 728 (1952). A majority of the courts that have addressed this issue have required expert testimony to establish the standard of care to which the professional is held and whether that professional's conduct fell below that standard. Farney, supra ; Hake, supra ; Medical Licensing Bd. of Indiana v. Ward, 449 N.E.2d 1129, 1141 (Ind.App. 1983); Dailey v. North Carolina St. Bd. of Dental Exam., 309 N.C. 710, 309 S.E.2d 219 (1983); Franz v. Bd. of Med. Quality Assurance, 31 Cal.3d 124, 181 Cal.Rptr. 732, 642 P.2d 792 (1982); Arthurs v. Bd. of Registration, 383 Mass. 299, 418 N.E.2d 1236 (1981); Dotson v. Texas St. Bd. of Medical Exam., 612 S.W.2d 921 (Tex.1981); McKay v. St. Bd. of Med. Exam., 103 Colo. 305, 86 P.2d 232 (1938); Bd. of Dental Exam. v. Brown, 448 A.2d 881 (Me.1982); Gilbert v. State, 119 Wis.2d 168, 349 N.W.2d 68 (1984); Spray v. Bd. of Med. Exam., 50 Or.App. 311, 624 P.2d 125 (1981). These jurisdictions have advanced several reasons for requiring expert testimony in administrative hearings. Some have held that the due process protections of the Constitution require that the professional in danger of losing his license has the right to confront, cross-examine and rebut the witnesses' testimony and evidence sought to be placed in the record to establish his incompetence. Greene, supra ; Farney, supra ; Wood v. Tex. Bd. of Med. Exam., 615 S.W.2d 942 (Tex.Civ.App.1981). [3] A second rationale which also applies to this case is that the boards in many states are not totally comprised of professionals. Many of them contain lay members who are not trained in that particular profession. It has been held that it is improper for the Board to rely on its own expertise in determining competency rather than expert testimony on the record as some of the members do not hold this type of expertise. [4] Ward, supra . In South Dakota, the Board of Dentistry is required by SDCL 36-6-1 to have two of its seven members be individuals who are not dentists. [5] The rationale most often relied upon by these jurisdictions is that expert testimony is required to be placed in the record to allow proper judicial review by appellate courts. When the administrative body applies its own expertise outside the hearing record to set the standard of care and a determination whether a professional violated it, the appellate courts, who are lawyers by training, lack the expertise to review findings of a board concerning medical, dental or any multitude of professions and occupations. [6] Ward, supra ; Franz, supra ; Dotson, supra ; McKay, supra ; Gilbert, supra . `This startling theory [that the Board could use its own expertise without the evidentiary basis of that expertise appearing in the record], if recognized, would not only render absolute a finding opposed to uncontradicted testimony but would render the right of appeal completely inefficacious as well. A board of experts, sitting in a quasi-judicial capacity, cannot be silent witnesses as well as judges.' The board may put its expertise to use in evaluating the complexities of technical evidence. However, the board may not use its expertise as a substitute for evidence in the record. Dailey, supra, 309 S.E.2d at 227, citing Arthurs, supra, 418 N.E.2d at 1244. There are a substantial minority of jurisdictions which have rejected this proposition and have allowed agency findings of negligence without expert testimony based solely on the expertise of the board members. Jaffe v. Dept. of Health, 135 Conn. 339, 64 A.2d 330 (1949); Ferguson v. Hamrick, 388 So.2d 981 (Ala.1980); Kundrat v. Commonwealth, 67 Pa.Cmwlth. 341, 447 A.2d 355 (1982); Davidson v. State, 33 Wash.App. 783, 657 P.2d 810 (1983); Arlen v. State, 61 Ohio St.2d 168, 399 N.E.2d 1251 (1980); Bd. of Chiropractic v. Clark, 713 S.W.2d 621 (Mo.App.1986); Appeal of Beyer, 122 N.H. 934, 453 A.2d 834 (1982); Sillery v. Bd. of Medicine, 145 Mich.App. 681, 378 N.W.2d 570 (1985). These jurisdictions find that the boards are best qualified by training and expertise to make determinations of competence and therefore expert testimony is unnecessary. The problem with this rationale is that it does not offer any explanation as to how an appellate court is to review the record which is absent of any expert testimony on the standards of the particular professions involved or their violation. [7] Therefore, this court adopts the rationale of the majority of jurisdictions and holds that where the issues of competence and negligence are of a complicated nature, expert testimony is required to establish the proper competency standards and whether or not they are met. To do otherwise would render this appellate court's review meaningless, as absent expert testimony, we cannot, by telepathy, act as mind readers determining from an empty record the factual determinations of the Board members. Farney, supra . [8] Administrative expertise would then be on its way to becoming `a monster which rules with no practical limits on its discretion.' Arthurs, supra, 418 N.E.2d at 1244, citing Baltimore & Ohio R.R. v. Aberdeen & Rockfish R.R., 392 U.S. 87, 92, 89 S.Ct. 280, 283, 21 L.Ed.2d 219 (1968). [9] This holding has obvious well-recognized exceptions. There is the Board's power granted it by SDCL 1-26-19(3) concerning judicial notice. [10] The scope of this statute is limited by the legislature to judicially cognizable or generally recognized technical or scientific facts. Further, it is obvious from the record that this statute did not come into play in this matter as a basis for the Board's finding of the appellant's lack of professional competence. There is no reference in the record to any facts being judicially noticed which would have then given appellant his right to refute the officially noticed matters. Wood, supra . A second exception to the above rule is where the acts of the professional are so obvious that expert testimony is unnecessary or where the outcome would not have occurred absent negligence, i.e. operating on the wrong knee or leaving surgical instruments in the body after surgery. Van Zee v. Sioux Valley Hospital, 315 N.W.2d 489 (S.D.1982); Magbuhat, supra, at 46; Block v. McVay, 80 S.D. 469, 126 N.W.2d 808 (1964). Also, no expert testimony would be necessary for the commission of acts which are blatantly illegal or improper, such as charging for work not done or overbilling at outrageous fees, Matter of Schultz, 375 N.W.2d 509 (Minn. App.1985); forgery, Voorhees, supra ; personal conversion of client trust funds, Gottschalk v. S.D. State Real Estate Commission, 264 N.W.2d 905 (S.D.1978); or sexual molestation of patients, c.f. State v. Schnaidt, 410 N.W.2d 539 (S.D.1987). Another exception would be where the person who holds the license stipulates or admits to an allegation. Brown, supra ; Arlen, supra . However, any such admission must be explicit. [11] Smith, supra .