Opinion ID: 1864673
Heading Depth: 1
Heading Rank: 5

Heading: Substantial Evidence Standard.

Text: In its decision the board stresses the importance of the accuracy of medical and billing records prepared by physicians who the public expects to be truthful and honest in preparing records. With this statement there can be no disagreement. The board then concluded that the entries by Dr. Glowacki were made knowingly, not mistakenly, and were misleading, deceptive, and untrue statements. The board asserts that the knowingly element requires only that an act be done and that specific intent is not required. We have not yet decided this issue and deem it unnecessary to decide it now. Since there is no disagreement as to what acts Dr. Glowacki did and why he did them there was no fact resolution for the board to make. In deciding the consequences flowing from those acts by Dr. Glowacki, the board decided that any entries deliberately made in the anesthesia time record that could be misleading, absent explanation, are sufficient for sanctions. We believe that under this record more is required to meet the legal requirements of substantial evidence. The testimony in this record establishes without disagreement that anesthesia time ends when the physician no longer is in personal attendance of the patient. That can occur either when the patient is in the recovery room or the ICU. The doctor may personally attend the patient intermittently over a period of several hours. No claim is made by Dr. Glowacki or anyone else that the post-operative care was continuous or needed to be continuous. In fact, the record establishes that continuous personal attendance by the doctor is unnecessary and would be wasteful. The evidence presented to establish that the meaning of anesthesia time requires that an end time be fixed as soon as the patient is delivered to the ICU comes from the physician whose routine fits that interpretation. A clear demarcation line occurs when the anesthesiologist turns the patient over to a pulmonologist or other ICU personnel and does not return to give further care. But it cannot be said that the doctor has ceased personal attendance on delivery of the patient to the ICU when additional medical care is given thereafter for a period of time. There is no dispute in this record that Dr. Glowacki rendered the post-operative services to his patients for which he charged. The evidence establishes that he was entitled to be paid. The record shows that the physicians in 1985 and 1986 were unsure of how they should report their post-operative services and sought unsuccessfully to resolve the matter. Although the method chosen by Dr. Glowacki proved to be unwise, there is no evidence that this caused anyone to be misled to their detriment. Remedial action has been taken by Dr. Glowacki so that post-operative services provided to open-heart surgery patients are no longer included by him under the anesthesia time designation. Our review of the whole record pursuant to section 17A.19(8)(f) establishes that the decision in this matter is not supported by substantial evidence. For this reason the order of the Board of Medical Examiners is reversed. We remand for disposition in accordance with this decision. REVERSED AND REMANDED.