Opinion ID: 1196968
Heading Depth: 1
Heading Rank: 9

Heading: Finding of Willfulness

Text: The Board decided that Kirbens violated Wyo. Stat. Ann. § 33-26-402(a)(xviii) by willful and consistent utilization of medical service or treatment which is inappropriate or unnecessary. Kirbens contends the record does not show by clear and convincing evidence that his actions constituted willful misconduct. He contends the statutory term willful is to be defined as willful misconduct. He provides a definition of willful misconduct from the criminal case of Norfolk v. State, 360 P.2d 605, 607 (Wyo.1961): Willful misconduct implies at least the intentional doing of something either with a knowledge that serious injury is a probable (as distinguished from a possible) result, or the intentional doing of an act with a wanton and reckless disregard of its possible result. (emphasis omitted.) The Board does not contest the application of this definition, relying instead on those portions of the record supporting its findings and conclusions that Kirbens' actions were not accidental, and were, therefore, willful actions in violation of the statute. We apply our general rule that we look to the ordinary and obvious meaning of a statute when the language is unambiguous. Parker Land, 845 P.2d at 1042. The term willful misconduct as used in the criminal context generally means an act done with a bad purpose. Blacks Law Dictionary 1600 (6th ed.1990). In the civil context, it often denotes an act which is intentional, or knowing, or voluntary as distinguished from accidental. Id. In the professional licensing context, the Board is not required to prove patient injury to establish willful acts nor should it be defined as in tort. See Medical Licensing Bd. of Indiana v. Ward., 449 N.E.2d 1129, 1141 (Ind.App. 4 Dist.1983); Dixon v. State Bd. of Optometric Examiners, 39 Colo.App. 200, 565 P.2d 960, 963 (1977). Because it is inappropriate to apply definitions from either a criminal or tort context, we review the Board's finding on the issue of willful to determine if the evidence establishes intentional, or knowing, or voluntary acts as distinguished from accidental. [A]gency action will be set aside if it is not supported by substantial evidence. Substantial evidence is relevant evidence which a reasonable mind might accept in support of the conclusions of the agency. The entire record is to be examined to determine if there is substantial evidence to support the agency's findings. The reviewing court does not substitute its judgment for that of the agency with respect to findings of fact if they are supported by substantial evidence. When the case comes before the supreme court, the findings of the agency are reviewed without according any special deference to the decision of the district court. The burden is assigned to the party challenging the sufficiency of the evidence to demonstrate that the Board's decision is not supported by substantial evidence. Devous v. Wyoming State Bd. of Medical Examiners, 845 P.2d 408, 414 (Wyo.1993) (citations omitted). The Board considered expert testimony, CT scans, medical records, and the April 1997 Assessment Report of the Colorado Personalized Education for Physicians Program in its review of the treatment provided to three patients. In its review, the experts testified that the records showed that Kirbens failed to properly document his diagnosis of and medical justification for the surgeries. Each patient's medical records and CT scans did not indicate sinus disease to the extent required which would justify surgery. The experts offered opinions that the CT scans and medical records indicated deficient medical decision making. One expert testified that of ten patients who had come to see him for a second opinion after Kirbens had recommended they undergo surgery, only one demonstrated a physical condition warranting surgery. The third expert who reviewed the same materials expressed the opinion that Kirbens had not performed unnecessary surgeries and that his conduct and medical judgment were within the applicable standard of care. That same expert, however, described the medical records as sketchy and inadequate and he was unable to tell from the records what Kirbens' thought processes were, Kirbens' judgment was not reflected in the notes; and Kirbens goes straight to a conclusion without the supportive history. From the medical records alone, the expert stated that it would be difficult to justify the surgery performed on one patient. From these facts, the Board concluded there was clear and convincing evidence that Kirbens' conduct exhibited willful and consistent utilization of medical services that were inappropriate and unnecessary. We find the Board's conclusion is justified from the underlying facts and affirm the decision that Kirbens violated this portion of the statute.