Opinion ID: 2512056
Heading Depth: 4
Heading Rank: 1

Heading: The application and settlement process

Text: Dr. Ann-Marie Yost, a neurosurgeon, accepted a short-term assignment at the Alaska Native Medical Center [1] and, in January 2005, applied to the State of Alaska, Division of Corporations, Business and Professional Licensing (the Division) for a license to practice medicine in the state. The license application included question 32(a): Have you ever been under investigation by any medical licensing jurisdiction or authority? Dr. Yost answered: No. In fact, as the Division soon became aware, Dr. Yost had five years earlier been the subject of an inquiry by the Washington state Medical Quality Assurance Commission, set in motion by a patient's complaint that Dr. Yost had misdiagnosed him. On March 31, 2005, Colin Matthews, a division employee assigned to conduct investigations for the Alaska State Medical Board (the Board), was tasked with resolving the discrepancy. According to Dr. Yost, she answered No to question 32(a) out of a good faith belief that the Washington inquiry did not constitute an `investigation' for purposes of the application. Dr. Yost said she understood the term investigation to mean a formal proceeding with interviews, discovery, and a hearing, none of which the Washington inquiry entailed. Indeed, the entirety of the Washington inquiry involved a letter sent to Dr. Yost informing her of the patient complaint and asking her to turn over relevant records and to write a statement about the case. The hospital's legal team handled all correspondence and, six months later, the case was closed with a finding of no violations and no need for disciplinary action. Dr. Yost considered the incident a nuisance complaint and stated that it did not even come to mind when she reached question 32(a) on the Alaska medical license application. Investigator Matthews had a different view of the incident. He understood that Washington had characterized its inquiry into Dr. Yost as an investigation and that Dr. Yost had been so notified. The initial letter to Dr. Yostreturn address Investigations Unitinformed her that this was a preliminary investigation, and that no charges have been issued in connection with this investigation. The final letter Dr. Yost received informed her that the investigation was complete. To Matthews, whether Dr. Yost's answer to question 32(a) was innocent oversight or intentional fraud was irrelevant; the answer was false, and the statute [2] prohibiting false answers on license applications was indifferent to the reason. [3] Faced with this dilemma, Dr. Yost could have allowed the application process to run its course; if the Board denied her application, she could have requested a hearing [4] complete with argument, discovery and testimony. [5] If this was unsuccessful, she could have appealed to the superior court, and if necessary appealed again to this court. [6] However, Dr. Yost was under a time constraint; her job with the Alaska Native Medical Center was set to begin the next day, April 1, 2005, and neurosurgeons in Alaska are not easily replaceable. In search of a solution, Matthews consulted a board member who offered the opinion that this case should be dealt with just as similar cases had been handled in the past: Dr. Yost could enter into a memorandum of agreement (MOA) by which she would be granted a license, but the Board would impose a $1,000 fine and a reprimand. As soon as Dr. Yost signed the draft MOA, she could be issued a temporary license so she could begin her job. Then, if the Board adopted the MOA at its next meeting, a permanent license would be issued and the fine and reprimand would be imposed. If the Board rejected the MOA, Dr. Yost would be back where she started, free to pursue the hearing process. On April 1, 2005, Dr. Yost's anticipated first day of work, Matthews called her and explained the MOA process, then spoke by phone with Dr. Yost's attorney, David Thorner, to work out the details. When an acceptable agreement was reached, Matthews faxed a copy of the proposed MOA to Thorner. That afternoon, Dr. Yost came into the Division office, signed the MOA, and was issued a temporary license. This case arises from a disagreement about what else happened that day. Dr. Yost alleges that she signed the MOA on the express condition that before the agreement could be adopted as final, she would have the opportunity to appear before her peers on the medical board to explain directly her response to question 32(a), and ask that no action be taken against her. She alleges that Matthews, on behalf of the Division, orally promised her and her attorney that she would have this opportunity, and that this condition was fundamental to her participation in the MOA. In her affidavit, Dr. Yost said that she wholeheartedly disagreed with the allegations against her and would never have signed the [MOA] without the assurance made by Investigator Matthews that I would have a chance to explain myself to the Board at the meeting where the draft agreement would be presented. For its part, the Division acknowledges that Matthews told Dr. Yost that the Board's meetings were open to the public and offered to accommodate her request to listen in by teleconference, but the Division denies representing to Dr. Yost or her attorney that she would have an opportunity to address the Board, or even guaranteeing the time at which the matter would be considered. The disagreement about what exactly Dr. Yost had been promised would have major ramifications. On April 21, 2005, the Board met to consider, among other things, whether Dr. Yost's MOA should be adopted as final. Dr. Yost and Thorner were prepared to telephone in to the meeting at 3:30 PM, the time they expected the matter would be considered. [7] The Board was running ahead of schedule, however, and it reached the Dr. Yost matter at 12:30 PM. The executive administrator of the Board, Leslie Gallant, advised the Board that Thorner wished to be on the phone while the matter was discussed but, despite several calls to his office and cell phone, Thorner could not be reached. Then, without Thorner or Dr. Yost on the line, the Board unanimously voted to adopt the MOA as final. The next day, Thorner sent a letter to the Board saying: Dr. Yost signed the [MOA] with the understanding that she would be permitted to submit mitigating and explanatory information to the Alaska State Medical Board on April 21, 2005. Subsequently, Mr. Matthews confirmed with my office that the matter would be presented to the Board at 3:30 ... and that Dr. Yost and I would be permitted to participate by telephone. Unfortunately, the matter was presented at 12:30 ... when I was in a deposition in another matter, with my cell telephone off. When I got out of that deposition ... [I] learned that the hearing had already taken place.... Unfortunately, Dr. Yost was denied the opportunity of making her presentation to the Board. The purpose of this letter is to request that this matter be placed on the docket of the next board meeting for reconsideration.... Weeks later, Thorner wrote again, but he did not receive a reply to either letter. Then, in a letter dated June 6, 2005, Dr. Yost was informed that the case was now closed based on the Board's April 21, 2005 approval of the [MOA] you signed on April 1, 2005. Dr. Yost has not practiced medicine in Alaska since her brief term at the Alaska Native Medical Center concluded in May 2005.