Court Opinion

ID: 9377991
Source: CourtListenerOpinion
Date Created: 2023-03-09 15:08:12.1546+00
Date Added: 2024-06-11T17:17:18.266299
License: Public Domain

[Cite as Khemsara v. Ohio Veterinary Med. Licensing Bd., 2023-Ohio-718.]

                              COURT OF APPEALS OF OHIO

                            EIGHTH APPELLATE DISTRICT
                               COUNTY OF CUYAHOGA

BHARAT K. KHEMSARA, DVM.,                            :

                Plaintiff-Appellant,                 :                     No. 111845

                v.                                   :

OHIO VETERINARY MEDICAL                              :
LICENSING BOARD,

                Defendant-Appellee.                  :

                               JOURNAL ENTRY AND OPINION

                JUDGMENT: AFFIRMED
                RELEASED AND JOURNALIZED: March 9, 2023

       Administrative Appeal from the Cuyahoga County Common Pleas Court
                              Case No. CV-21-953348

                                           Appearances:

                Kubyn & Ghaster and R. Russell Kubyn, for appellant.

                David Yost, Ohio Attorney General, and Caroline E. Mills,
                Assistant Attorney General, for appellee.

EILEEN A. GALLAGHER, J.:

                  Appellant Bharat Khemsara appeals from a decision of the Cuyahoga

County Court of Common Pleas affirming an adjudication order issued by appellee

the Ohio Veterinary Medical Licensing Board (the “Board”) that revoked

Khemsara’s license to practice veterinary medicine. Khemsara claims that the
common pleas court erred and abused its discretion in affirming the Board’s

adjudication order because (1) he was denied due process due to a lack of proper

notice of alleged licensure violations and the Board’s “sham proceedings” and (2)

the Board’s decision to revoke his veterinary license was “unconstitutional, illegal,

arbitrary, capricious, unreasonable and unsupported by the preponderance of

substantial, reliable, and probative evidence.” For the reasons that follow, we affirm

the common pleas court.

Procedural and Factual Background

               Khemsara became a veterinarian in 1965 and was first licensed to

practice veterinary medicine in the state of Ohio in 1977. During the time period at

issue, he operated a veterinary clinic, the Euclid Veterinary Clinic, in Euclid, Ohio.

               The Board is charged with regulating the practice of veterinary

medicine in Ohio. See R.C. Chapter 4741. The Board has the authority to initiate

disciplinary action against a licensee who violates the provisions of R.C. 4741.22(A),

including the rules of the Board and professional standards governing the proper

methods to be used in the care and treatment of animals. R.C. 4741.22(A)(1).

               In early March 2021, the Board received a complaint from Barbara

Petras regarding the care Khemsara had provided to her cat, Blago, when the cat was

experiencing “breathing distress.” Petras alleged that Khemsara had misdiagnosed

and mistreated her cat, ultimately resulting in the cat’s death. Specifically, Petras

alleged:
      My cat, 6 year old male tabby, BLAGO, was brought to the vet clinic
      (Khemsara) on 2/24/21,[1] Saturday[,] by my son, Brenton Petras. The
      cat was exhibiting breathing distress. Cat was given an [x]-ray and dx
      with pneumonia by Khemsara. Was given Clavamox (2 boxes) and
      Disal water pills as going home treatment. Cat was given medications
      in the office, and bill was $544. The next day the cat was not improving.
      My son took the cat back on the following Monday. Charge was $59 for
      a shot to make the cat eat. Was told it will take time. Cat still worsened.
      Office was called next day. Told to bring in cat for treatment next day
      for same shot. Was told by the office staff to decide to spend money or
      decide not to. Cat was given a breathing treatment with albuterol. And
      office staff sent home breathing machine. Cat still not eating or
      drinking. I, Barbara, was giving the cat subQ fluids on my own to keep
      the cat alive. Cat not eating or drinking for 5 days. Called office again
      to complain about worsened condition and was told to get a second
      opinion. Went to Dr. Philip Price in Eastlake OH on Thursday 2/25/21.
      Told needed x[-]ray. I declined [x-]ray and told Dr. Price to get [x-]ray
      from Dr. Khemsara. Dr. Khemsara did not answer phone during work
      hours on that Thursday, 2/25/2002. Cat was treated with shot from
      Dr. Price and [a]ntibiotic. Cat worsened. Friday took cat back for [x-
      ]ray and [c]at died on [x-]ray table. Was told cat had cardiomyopathy
      clearly seen on [x-]ray taken. I called Dr. Khemsara multiple times on
      Friday to get [x-]ray over to Dr. Price before the [a]ppointment.
      Khemsara delayed critical care to my cat, by #1 having no outgoing
      greeting on the answering machine and not answering his phone with
      urgent requests, and not responding timely to the [x-]ray medical
      release to Dr. Price. My cat could not lay on it’s [sic] side because it was
      filled with fluid. Dr. Khemsara misdiagnosed my animal and caused
      immense pain and suffering to my animal as well as myself and my son
      as we tried to save our beloved animal.

               On March 5, 2021, the Board’s executive director, Theresa Stir

(“Stir”), sent letters to Khemsara and Price notifying them of the complaint and

requesting that they submit copies of Blago’s medical records and a signed narrative

      1   Although Petras’ complaint indicates that her son first brought Blago to
Khemsara’s clinic for treatment on Saturday, February 24, 2021, February 24, 2021 was
a Wednesday, not a Saturday. Khemsara’s records indicate that Petras’ son brought Blago
in for treatment on Saturday, February 20, 2021.
of events to the Board. Khemsara and Price submitted documents, including copies

of x-rays, in response to the Board’s request.2

               The medical records Khemsara submitted documented two visits to

his office on February 20 and February 22, 2021. According to the medical records,

on February 20, 2021, Blago “presented at the clinic for inappetence,” was

dehydrated and “heart sounds” could not be heard “due to fluid build-up.” A

radiograph was performed; “images of heart and lungs [were] unclear due to

excessive fluid in the thoracic cavity.”       A “[p]roblems [l]ist” identified two

conditions: (1) respiratory infection and (2) “[c]ongestive heart failure; prognosis:

poor.” The records further reflect that Khemsara administered Midazolam (after

which Blago was able to eat when offered food), a B-12 liver injection, Lasix and

Zimeta and prescribed Clavamox, Prednisone and Cyproheptadine.

               According to the medical records submitted by Khemsara, Blago was

back at the clinic two days later because he had “returned to not eating.” The records

reflect that Blago was dehydrated, that “heart sounds” could not be heard “due to

fluid build-up” and that a blood test and heart medication had been recommended

but that the “owner refused.” A “[p]roblems [l]ist” identified two conditions: (1)

respiratory infection and (2) “[a]dvanced CHF; prognosis: poor.”          The records

reflect that Khemsara administered Midazolam, Ampicillin, Lasix and Albuterol to

Blago and “[s]ent home breathing machine with [o]wner.”

      2 The record reflects that, in response to the Board’s request, Khemsara submitted
medical records and that Price submitted a narrative and medical records.
               The medical records Price submitted documented two visits to his

office on February 25 and February 26, 2021. In the narrative he provided, he

stated:

      After discussion it seemed as though the owner was satisfied with the
      diagnosis and treatment provided at Euclid. I had suggested further
      lab work including x-rays and routine blood work to clarify the
      situation as 5 days had gone by. The owner didn’t want to do any lab
      work and seemed to be wishing that I pick up treatment where Euclid
      left off. It seemed that they were having a communication issue with
      Euclid. I had little to go by and I certainly couldn’t render a second
      opinion.

               Price indicated that a physical examination of the cat on February 25,

2021 revealed that the cat was “dyspnic and had a sub normal temperature,” which

led Price to conclude that the cat was either “in critical terminal condition losing

temperature or * * * had responded to the [C]lav[a]mox and [L]asix” provided by

Khemsara.     Price stated that he administered a higher dose of Lasix and an

antibiotic, Baytril, but “stressed the need for some diagnostics as a guide to further

treatment.”

               The medical records reflect that Petras’ son returned with Blago the

following day and asked “which lab work might be the most meaningful.” Price

indicated that “[g]iven the choice,” he chose x-rays over bloodwork and that Blago

died as he was being x-rayed, likely due to respiratory failure.

               Price related that he called Khemsara’s clinic several times on

February 25 and 26, 2021 in an attempt to obtain or discuss the prior x-ray that had

been taken, but received no response until after the cat had died. He indicated that
the x-ray Khemsara had taken “appeared similar to mine but the condition was a bit

less progressed”; “[m]ore open lung was visible on their x-ray with lots of pulmonary

edema.”    Price stated that he “suspected” Blago had cardiomyopathy but that he

could not “confirm a specific diagnosis” because a necropsy was not performed.

               On April 20, 2021, following a review of the documents submitted,

the Board issued a Notice of Opportunity for Hearing to Khemsara (the “notice” or

“notice of opportunity for hearing”). The notice charged Khemsara with violations

of R.C. 4741.22(A)(1) and Ohio Adm.Code 4741-1-10 for providing veterinary

medical care that fell below the minimum standards of veterinary care and resulted

in the death of Petras’ cat as follows:

      a.     You documented fluid in the chest but did not take action to
             treat;

      b.     You were unable to hear heart sounds indicating that the
             prognosis was poor. However, you did not offer any alternative
             treatments or a referral to a specialist or a more equipped
             veterinary facility.

               The notice also indicated that this was Khemsara’s seventh

disciplinary case before the Board. The notice listed each of the prior disciplinary

actions that had been taken against Khemsara “for standard of care and/or medical

records violations.”

               In response to the notice, Khemsara requested a hearing.           An

administrative hearing was held on September 8, 2021. Khemsara was represented
by counsel at the hearing. Stir, Kimberly Riker-Brown, D.V.M., and Khemsara

testified at the hearing.3

               Stir, a registered nurse and attorney in good standing in the state of

Ohio, stated that she had been the Board’s executive director for 15 years. She

described the allegations Petras had made against Khemsara as set forth in her

complaint, explained the investigation that had been conducted of those allegations,

identified the documents in the Board’s file and testified regarding service of

required notices on Khemsara.

               Stir then proceeded to describe (1) the condition of the cat and

Khemsara’s diagnoses and treatment as documented in the medical records

Khemsara provided to the Board, i.e., which she described as treating the cat for

“[l]ikely pneumonia or some such thing like that,” and (2) the condition of the cat

and Price’s treatment and diagnoses as reflected in the medical records and

narrative Price provided to the Board, i.e., which she described as diagnosing the cat

with “suspected cardiomyopathy.”

               Stir testified that, based on the medical records submitted to the

Board, the cat was brought in to Khemsara due to concerns of “inappetence, not

having an appetite or eating.” She indicated that a radiograph was performed which

      3  In addition to the witness testimony, the notice of opportunity for hearing,
Khemsara’s request for hearing, notices related to the scheduling of the hearing, the
Board’s case file (including Petras’ complaint, correspondence to Petras regarding her
complaint, the Board’s letters to Khemsara and Price, the medical records received from
Khemsara and Price and the narrative received from Price), documents evidencing the
prior disciplinary actions against Khemsara and a narrative produced by Khemsara on
the date of the hearing were admitted into evidence at the hearing.
showed that the cat’s heart and lungs were unclear due to excessive fluid in the

thoracic cavity. When asked whether that “[w]ould * * * signal or flag any kind of a

medical condition,” Stir responded: “Well, there’s all kinds of things that it could

lead to. I mean, you would think pneumonia or — but when — congestive heart

failure or — but when there’s — you need to have a clear picture to make an accurate

diagnosis.”

               As to whether “any other additional diagnostics * * * should have been

considered” at that time, Stir stated, based on her “background as a nurse” and her

“experience as the executive director for the board,” “Lab work should have been

done as well I would think. I don’t know. Maybe a specialist probably because

clearly there was something going on that they couldn’t diagnose because of the

fluid.” Stir stated that she was not familiar with at least two of the medications

Khemsara had prescribed for Blago.

               Over Khemsara’s objection, although Stir admitted that she was “not

familiar with, you know, animal care,” and had no education in veterinary medicine

or treating animals, the Board permitted Stir to offer her opinion regarding the

standard of care provided by Khemsara:

      Q.      What types of things could have — what other types of
              alternatives * * * would have been available to treat that
              condition to the extent that you’re aware?

      A.      They could have intubated the cat. They could have done other
              things, especially with the diagnostics. I would have probably at
              least gotten blood work to see what other medications would
              have been more compatible.
      Q.     And kind of the same question for any of the treatment or testing
             done regarding the difficulty hearing the heartbeat, what types
             of things could have been considered to address that condition?

      A.     I probably would have sent it — referred it on to somebody who
             could have done either an office visit, ultrasound or gotten a
             clearer [x]-ray.

      Q.     Is there any documentation in the medical record that any of
             those alternatives were discussed with the client or presented at
             all?

      A.     No.

      Q.     Okay. Based on the information contained in the medical chart,
             the records and the test results, and your experience as a nurse
             and as the executive director of the veterinary board for 15 years,
             and the test results for Barbara Petras’s cat, have you reached an
             opinion to a reasonable degree of medical certainty as to whether
             the standard of care used when treating Ms. Petras’s cat departed
             from the minimal standards of care of similar veterinarians
             under similar circumstances?

      A.     I don’t believe that it rose to the minimal standards of care.

      Q.     And what is that opinion based on?

      A.     Based on that they — I don’t believe that this veterinarian was
             capable of treating the animal adequately.

               When asked whether the treatment of cardiomyopathy would be the

same or different from the treatment of pneumonia, Stir responded, “It would most

likely be different,” but she could not “expand” or “explain” her response even “a

little bit” when asked to do so.
                Stir also testified regarding Khemsara’s disciplinary history and

identified various documents that documented that history4 as follows:

      •        Adjudication Order (dated August 24, 2004) for Case File #03-
               03-072 — Violations of R.C. 4741.22(A) and O.A.C. 4741-1-03(A)
               and (B)(6)(a) for “not properly reading the blood work for
               ‘Harley’ and making an improper diagnosis, having expired
               drugs in his pharmacy, not mainting [sic] proper controlled
               substance logs and not having a lock box for your controlled
               substances” — One month suspension with 15 days suspended, a
               $250 fine and payment of $780 in costs.

      •        Adjudication Order (dated May 10, 2007) for Case File #05-06-
               127 — Violations of R.C. 4741.22(A) and (AA) and Ohio
               Adm.Code 4741-1-03(A) and 4741-1-21(I) for failure to
               “adequately communicate the complications during surgery of
               the spay of ‘Mandy’ to the owners or to the veterinarian who
               would be releasing the dog to the owners” and deficient
               treatment records regarding the complications during the
               surgery — Two-week suspension and submission of 10 surgical
               records that “meet the Board’s satisfaction.”

      •        Settlement Agreement (dated January 2011) for Case File #10-
               10-026 — Involving alleged violations of R.C. 4741.22(Y) and
               Ohio Adm.Code 4741-1-21(A) — Payment of investigative costs
               of $430, completion of a course on recordkeeping and
               submission of five surgical records following completion of the
               recordkeeping course.

      •        Settlement Agreement (dated March 2015) for Case File #14-15-
               113 — Involving alleged violations of R.C. 4741.22(A) and (Y) and
               Ohio Adm.Code 4741-1-10 and 4741-1-21 — Payment of $2000
               fine and completion of four continuing education courses on
               medical records, radiology, oncology and physical examinations.

      •        Settlement Agreement (dated March 2019) for Case File #18-19-
               127 — Involving alleged violations of R.C. 4741.22(A)(25) and
               Ohio Adm.Code 4741-1-21 — Payment of $1000, completion of a
               continuing education course on medical records and submission

      4   Khemsara stipulated to the admissibility of these documents.
            of 10 medical records that comply with Ohio Adm.Code 4741-1-
            21 to the board quarterly for one year.

      •     Adjudication Order (dated April 15, 2021) for Case File #18-19-
            127 & 20-20-036 — Violations of R.C. 4741.22(A)(18) and (25)
            and Ohio Adm.Code 4741-1-21 for performing veterinary
            medicine while under suspension and for failure to document
            physical examination findings or site of vaccine injection in
            medical records — 30-day suspension, payment of $1000 fine
            and cost of the hearing and a written reprimand.

              On cross-examination, Stir testified that she had not spoken with

Petras or Price regarding the treatment of Blago or the allegations against

Khemsara. She stated that neither Petras nor Price had been subpoenaed to testify

at the hearing. Stir could not say whether Price disagreed with the treatment

Khemsara provided Blago and acknowledged that Price had stated that when Blago

was brought into his office for treatment, Blago’s “[p]rognosis was guarded at best

or grave for any long term survival.” Stir further acknowledged that, according to

Khemsara’s notes, Petras had refused a recommended blood test for Blago but stated

that she did not know why Petras had refused the test because Khemsara did not

document the reason for her refusal. Stir indicated, however, that an individual’s

finances should not impact the standard of care that is owed a patient.

              Riker-Brown, a veterinarian, a Board member and an associate

partner at Shoreland Animal Hospital in Toledo, Ohio, also testified at the hearing.

Khemsara objected to Riker-Brown’s testimony based on (1) her position as a Board

member, (2) the lack of notice to Khemsara that she would be testifying, (3) the

Board’s failure to provide an expert report for her testimony and (4) the lack of
separation of witnesses. The Board chair overruled Khemsara’s objections on the

grounds that (1) Riker-Brown had the same credentials as Khemsara and was simply

a veterinarian providing her opinion to “fellow veterinarian[s],” (2) Riker-Brown

had recused herself from participating in the proceedings, including from

deliberating and voting on the matter, due to her role as a witness in the case and

(3) Khemsara had not requested separation of witnesses. Riker-Brown testified that

the other Board members knew and understood, prior to the commencement of the

hearing, that she would be testifying as a witness in the case and would not be

participating in the hearing as a Board member. Three of the five remaining Board

members (who participated in the hearing as Board members) were veterinarians,

one was a veterinary technician and one was a member of the public.

              Riker-Brown testified that she had been certified to practice

veterinary medicine in the state of Ohio since 2003, that she had been working at

Shoreland Animal Hospital for 18 years and that she had previously worked at two

other small animal hospitals in Toledo and a mixed animal practice in Oregon.

Riker-Brown indicated that she regularly reviews medical charts, records and test

results of patients that she has not seen in person and that review and reliance upon

medical records is an accepted practice within the veterinary medical community.

              Riker-Brown stated that she first learned that she would be testifying

at the hearing that morning and that, based on her ten-minute review of the medical

records and test results for Blago, she had developed an opinion “within a

reasonable degree of veterinary certainty as to whether the standard of care used
when treating [Petras’] cat departed from the minimal standards of care of similar

veterinarians under similar circumstances.” She testified that, in her opinion,

Khemsara’s treatment of Blago “fell below the standard of care,” i.e., that “the cat

was not treated to the standard of care of veterinary medicine * * * in 2021.”

               Riker-Brown explained that it could be “clearly seen” from the

radiograph taken by Khemsara on February 20, 2021 that the cat had cardiomegaly

(an enlarged heart) and pulmonary edema (fluid in the interstitial space in the

lungs). She stated that Zimeta, which Khemsara had administered to Blago on

February 20, 2021, “is only labeled * * * to treat fevers” in horses and dogs, is “not

labeled in cats” and causes “irreversible bone marrow suppression in cats.” She

indicated that Khemsara took only a single radiograph in diagnosing Blago (when

“at least two or three views” in different positions were needed “to accurately get a

diagnosis and accurately treat a [cat] that’s in respiratory distress”) and that he had

failed to run blood work to look for “[a]nything that caused respiratory distress.” In

addition, Riker-Brown noted that Prednisone, one of the medications Khemsara

prescribed to treat Blago, is “contraindicated in pneumonia and cardiac disease”

because it “is an anti-inflammatory,” “suppresses the immune system” and “makes

the heart function poorly.” She further indicated that the Lasix Khemsara had

administered to Blago at the clinic to address the fluid in the cat’s lungs was

insufficient because Lasix has a “very short” half-life and that additional Lasix

should have been sent home with Blago to provide continued relief.
               With respect to the treatment Khemsara provided when Blago was

“not eating again” on February 22, 2021, Riker-Brown stated that Khemsara

administered an additional Lasix injection and Albuterol, which is used to treat

asthma, not pneumonia or cardiac heart failure. She testified that a follow-up x-ray

should have been taken and blood work done; however, she noted that Khemsara

had recommended blood work and the owner had refused. She stated that, in her

view, additional Lasix should have, again, been sent home with Blago to provide

continued relief, that Blago should have also been given oxygen therapy and that

Blago should have been referred to a specialist because “the cat was decompensating

more than what Dr. Khemsara could provide treatment for.” Riker Brown testified

that a specialist could have offered a cardiac ultrasound, which could have revealed

why Blago was experiencing congestive heart failure or an enlarged heart, and

offered heart medication or other treatments to help the heart function better.

               On cross-examination, Riker-Brown acknowledged that she had not

spoken to Petras, Khemsara or Price in developing her opinion that Khemsara had

violated the minimum standard of care. She stated that, even though Blago had

passed away in Price’s care, in her opinion, Price’s care did not fall below the

standard of care. She explained: “The cat died in his care because it was so

decompensated because it wasn’t treated appropriately the first two times it was

seen * * *. So Dr. Price didn’t have a chance to treat the cat.”

               Riker-Brown stated that if Khemsara had made additional

recommendations to the owner, they should have been reflected in Blago’s medical
records. She indicated that, in her opinion, a client’s finances do not impact the

standard of care that is owed to them and that she would present the same plan of

care for all clients, regardless of their finances.

               Khemsara testified that he operated a “small animal clinic” in Euclid,

Ohio, that it was a walk-in clinic that did not make appointments and that most of

his clients were “poor people.” Khemsara stated that he remembered Petras, that

she had not previously been at the clinic and that she brought the cat in when the

“[p]rognosis was very poor,” “[g]one too far.”

               Khemsara testified that, on February 20, 2021, Petras brought in her

eight-year-old cat, complaining of inappetence. He stated that, during the physical

exam of the cat, heart sounds were not clearly heard, so he performed an x-ray, and

the radiograph confirmed a fluid build-up in the thoracic cavity. He indicated that

he informed Petras that the cat had congestive heart failure and that the prognosis

was very poor. He said that he gave the cat “some shots” and an IV, after which the

cat began eating. He stated that he gave the cat Lasix, B-12, a liver injection and a

Zimeta intramuscular injection.

               Khemsara testified that Petras came back with her cat two days later,

complaining of inappetence and a nonproductive cough. He stated that he then

asked Petras “how much [she was] willing to pay for treating her 8-years-old cat?”

He indicated that Petras responded that she was going to treat the cat herself and

“come back after two days.” He stated that Petras never returned to the clinic and,

instead, went to Price. When asked why he did not perform more than one x-ray,
Khemsara responded: “For diagnosing X-ray why you need three X-rays? People

don’t want to pay money. Took minimum care to do the job.” Khemsara also stated

that he had offered to do bloodwork, but that Petras had declined it. With respect

to why he did not refer Petras to a specialist, Khemsara at first testified that “she

didn’t come back so I could send her to a specialist or what.” Later, he testified that

he told Petras “the first time” she came to the clinic, “We told her we couldn’t —

prognosis very poor. Go to some other place. Go to specialist,” but that “[s]he didn’t

want to spend money.” Khemsara stated that Price did not do anything different

than he would have done and that he did not believe anything could have been done

to save Blago.

                 At the hearing, Khemsara produced a narrative that had not been

previously provided to the Board. He testified that the narrative had been created a

“few weeks” earlier and was typed up by his “help,” i.e., a girl at his clinic, whose

name he could not remember and who was not in the room when he treated Blago.

Khemsara stated that everything contained in the narrative was “correct and true.”

                 After Khemsara’s direct examination, the Board chair, who was also a

veterinarian, noted that veterinarians are taught to obtain at least two views when

performing an x-ray to confirm a diagnosis or to get a closer diagnosis and

questioned Khemsara why the failure to do so in this case was not a violation of the

standard of care. She also asked Khemsara (1) why it was not a violation of the

standard of care to prescribe Prednisone (which she indicated could cause a cat to

go into acute congestive heart failure) to a cat with known or suspected congestive
heart failure, “especially without documenting it to the owner,” (2) why the cat was

treated with Albuterol, which is expensive and stressful for the cat, when there was

no diagnosis of asthma and (3) why if Khemsara had referred Petras elsewhere for

further treatment or recommended that the cat return for a recheck, as he had

claimed, no notes to that effect were included in the medical records.

              Khemsara did not have a meaningful response to any of the chair’s

inquiries. With respect to the Prednisone, Khemsara stated that the cat “had a lung

problem too” and that with “[p]neumonia, you have to give steroid, too.” The chair

disputed this and stated that “[s]teriods were contraindicated.” With respect to the

Albuterol, Khemsara stated that it would help “[a] little bit for this condition, but

not help one hundred percent, but the cat not eating.” The chair disputed that

Albuterol would help with the cat’s eating issues. When asked whether it had

occurred to him that the cat was not eating because it could not breathe well,

Khemsara replied, “No.”

              Following the hearing, the Board went into a deliberative session.

After deliberating, the Board voted to revoke Khemsara’s license.          The chair

explained the Board’s decision as follows:

      [W]e have come to the finding of revoking the license of Dr. Bharat
      Khemsara for standard of care violation as alleged on this notice 21-21-
      030 for inappropriate therapy based on the differential diagnosis and
      the poor prognosis that contributed to the demise of the cat, and also
      in discussion and deliberation taking into consideration the multiple
      violations since 2003 and apparent lack of learning and recordkeeping
      and so forth, and we find it in the public’s best interest that we pursue
      revocation.
              On September 9, 2021, the Board issued a written adjudication order

revoking Khemsara’s veterinary license, stating that the Board found that the

charges against Khemsara had been proven and that the Board had voted to revoke

Khemsara’s license to practice veterinary medicine for the following reasons:

      1.    The board found that Dr. Khemsara provided inappropriate
            medical therapy in face of the differential diagnosis and the poor
            prognosis which contributed to the demise of the cat.

      2.    The [b]oard also took into consideration the multitude of
            previous violations and disciplinary actions against Dr.
            Khemsara.

              Khemsara filed an administrative appeal of the Board’s decision with

the Cuyahoga County Court of Common Pleas. On July 26, 2022, the common pleas

court affirmed the Board’s decision, concluding that the Board’s decision did not

violate Khemsara’s due process rights, was supported by reliable, probative and

substantial evidence and was in accordance with the law.

              Khemsara appealed to this court, raising the following two

assignments of error for review:

      1.    The lower appellate court erred to the prejudice of the Appellant
            and abused its discretion by affirming the Appellee’s revocation
            of the Appellant’s license to practice veterinary medicine based
            upon the Appellee’s failure to provide adequate, proper, and
            effective notice of the alleged licensure violations, depriving the
            Appellant of the constitutional right to due process of law, and
            conducting sham proceedings.

      2.    The lower appellate court erred to the prejudice of the Appellant
            and abused its discretion by affirming the Appellee’s revocation
            of the Appellant’s license to practice veterinary medicine as such
            was     unconstitutional,      illegal,   arbitrary,   capricious,
             unreasonable, and unsupported by the preponderance of
             substantial, reliable, and probative evidence.

Law and Analysis

      Standard of Review

               The standard of review for an appeal to common pleas court from an

administrative order revoking a license is contained in R.C. 119.12(M). Capital Care

Network of Toledo v. Ohio Dept. of Health, 153 Ohio St.3d 362, 2018-Ohio-440, 106

N.E.3d 1209, ¶ 24. In an administrative appeal under R.C. 119.12, a common pleas

court may affirm an administrative order “if it finds, upon consideration of the entire

record and any additional evidence the court has admitted, that the order is

supported by reliable, probative, and substantial evidence and is in accordance with

law.” R.C. 119.12(M); Pons v. Ohio State Med. Bd., 66 Ohio St.3d 619, 621, 614

N.E.2d 748 (1993). R.C. 119.12(M) requires a reviewing common pleas court to

conduct two inquiries: (1) a hybrid factual/legal inquiry and (2) a purely legal

inquiry. As to the hybrid inquiry, i.e., whether the administrative order is supported

by reliable, probative, and substantial evidence:

       “[T]he common pleas court must give deference to the agency’s
      resolution of evidentiary conflicts, but ‘the findings of the agency are by
      no means conclusive.’ * * * ‘Where the court, in its appraisal of the
      evidence, determines that there exist legally significant reasons for
      discrediting certain evidence relied upon by the administrative body,
      and necessary to its determination, the court may reverse, vacate, or
      modify the administrative order.”’ Ohio Historical Soc. v. State Emp.
      Relations Bd., 66 Ohio St.3d 466, 470-471, 613 N.E.2d 591 (1993),
      quoting Univ. of Cincinnati v. Conrad, 63 Ohio St.2d 108, 111, 407
      N.E.2d 1265 (1980). * * * “[A]n agency’s findings of fact are presumed
      to be correct and must be deferred to by a reviewing court unless that
      court determines that the agency’s findings are internally inconsistent,
        impeached by evidence of a prior inconsistent statement, rest upon
        improper inferences, or are otherwise unsupportable.” Ohio Historical
        Soc., 66 Ohio St.3d at 471, 613 N.E.2d 591; VFW Post 8586 v. Ohio
        Liquor Control Comm., 83 Ohio St.3d 79, 81, 697 N.E.2d 655 (1998).

Bartchy v. State Bd. of Edn., 120 Ohio St.3d 205, 2008-Ohio-4826, 897 N.E.2d

1096, ¶ 37; Buckeye Relief, L.L.C. v. State Bd. of Pharm., 2020-Ohio-4916, 160

N.E.3d 767, ¶ 17 (8th Dist.); see also Capital Care Network at ¶ 25 (An

administrative appeal to the common pleas court “does not provide a trial de novo”;

“where the agency’s decision is supported by sufficient evidence and the law, the

common pleas court lacks authority to review the agency’s exercise of discretion,

even if its decision is ‘admittedly harsh.’”), quoting Henry’s Cafe, Inc. v. Bd. of

Liquor Control, 170 Ohio St. 233, 236-237, 163 N.E.2d 678 (1959).

               “Reliable” evidence is ‘“dependable”’ evidence that “can be

confidently trusted,” i.e., ‘“there must be a reasonable probability that the evidence

is true.”’ Bartchy at ¶ 39, quoting Our Place, Inc. v. Ohio Liquor Control Comm.,

63 Ohio St.3d 570, 571, 589 N.E.2d 1303 (1992). “Probative” evidence is ‘“evidence

that tends to prove the issue in question; it must be relevant in determining the

issue.’” Bartchy at ¶ 39, quoting Our Place at 571. Evidence is “substantial” if “it

has some weight, importance, and value.” Buckeye Relief at ¶ 17, citing Bartchy at

¶ 39.

               As to the whether the administrative order is “in accordance with the

law,” the common pleas court conducts a de novo review. Buckeye Relief at ¶ 17

(“With respect to the purely legal inquiry, while the reviewing [common pleas] court
must defer to the agency’s findings of facts, it ‘must construe the law on its own.’”),

quoting Bartchy at ¶ 38.

               Our role in reviewing the judgment of the common pleas court in such

a case is further constrained.     We review the common pleas court’s decision

regarding the evidentiary basis for the administrative order, i.e., whether the

administrative order is supported by reliable, probative and substantial evidence,

for abuse of discretion. Pons, 66 Ohio St.3d at 621, 614 N.E.2d 748; Buckeye Relief

at ¶ 19. With respect to purely legal questions, such as the construction of a statute

or constitutional provision, we conduct a de novo review. McClendon v. Ohio Dept.

of Edn., 2017-Ohio-187, 77 N.E.3d 523, ¶ 9 (8th Dist.); see also Harrison v. Ohio

Veterinary Med. Licensing Bd., 10th Dist. Franklin No. 08AP-408, 2008-Ohio-

6519, ¶ 7 (“[A]n appellate court does have plenary review of purely legal questions

in an administrative appeal.”). Thus, only if the common pleas court abused its

discretion or committed legal error, may the court of appeals may reverse, vacate or

modify the judgment of the common pleas court.

               A court abuses its discretion where its decision is unreasonable,

arbitrary or unconscionable. Blakemore v. Blakemore, 5 Ohio St.3d 217, 219, 450

N.E.2d 1140 (1983). Abuse of discretion is “a very high standard.” Supportive

Solutions Training Academy, L.L.C., v. Electronic Classroom of Tomorrow, 8th

Dist. Cuyahoga Nos. 95022 and 95287, 2013-Ohio-3910, ¶ 11. As the Ohio Supreme

Court explained in Pons:
      While it is incumbent on the [common pleas] court to examine the
      evidence, this is not a function of the appellate court. The appellate
      court is to determine only if the [common pleas] court has abused its
      discretion, i.e., being not merely an error of judgment, but perversity of
      will, passion, prejudice, partiality, or moral delinquency. Absent an
      abuse of discretion on the part of the [common pleas] court, a court of
      appeals may not substitute its judgment for those of the * * * board or
      a [common pleas] court. Instead, the appellate court must affirm the
      [common pleas] court’s judgment.

Pons at 621.

               Following a careful review of the record in this case, Khemsara has

not shown that the common pleas court erred or abused its discretion in affirming

the Board’s revocation of Khemsara’s license to practice veterinary medicine.

      Due Process and in Accordance with the Law

               In his first assignment of error, Khemsara challenges the common

pleas court’s determination that “the administrative proceeding did not violate [his]

due process rights.”

               The Fourteenth Amendment to the United States Constitution and

Ohio Constitution, Article I, Section 16, require that administrative proceedings

comport with due process. Edmands v. State Med. Bd. of Ohio, 10th Dist. Franklin

No. 14AP-778, 2015-Ohio-2658, ¶ 23, citing Mathews v. Eldridge, 424 U.S. 319, 96

S.Ct. 893, 47 L.Ed.2d 18 (1976), and Doyle v. Ohio Bur. of Motor Vehicles, 51 Ohio

St.3d 46, 554 N.E.2d 97 (1990). ‘“Although due process is flexible and calls for such

procedural protections as the particular situation demands, the basic requirements

of procedural due process are notice and an opportunity to be heard.’” (Citations

omitted.) Edmands at ¶ 23, quoting Fairfield Cty. Bd. of Commrs. v. Nally, 143
Ohio St.3d 93, 2015-Ohio-991, 34 N.E.3d 873, ¶ 42. Procedural due process requires

administrative agencies to give fair notice of the precise nature of the charges at

issue. Griffin v. State Med. Bd., 10th Dist. Franklin No. 11AP-174, 2011-Ohio-6089,

¶ 22. “In addition, the right to a hearing includes the right to appear at the hearing

prepared to defend oneself through testimony, evidence, or argument against the

charges brought.” Bennett v. Ohio Dept. of Edn., 4th Dist. Scioto No. 21CA3948,

2022-Ohio-1747, ¶ 39.

              Khemsara contends that he was denied due process because (1) the

notice of opportunity for hearing issued by the Board “violated [his] rights” and did

not comply with R.C. 119.07 and (2) the Board’s “sham proceedings” “eliminated

[his] opportunity to defend against the alleged licensure violations.” Khemsara’s

contentions are meritless.

              R.C. 119.07 states, in relevant part:

      Except when a statute prescribes a notice and the persons to whom it
      shall be given, in all cases in which section 119.06 of the Revised Code
      requires an agency to afford an opportunity for a hearing prior to the
      issuance of an order, the agency shall give notice to the party informing
      the party of the party’s right to a hearing. Notice shall be given by
      registered mail, return receipt requested, and shall include the charges
      or other reasons for the proposed action, the law or rule directly
      involved, and a statement informing the party that the party is entitled
      to a hearing if the party requests it within thirty days of the time of
      mailing the notice. The notice shall also inform the party that at the
      hearing the party may appear in person, by the party’s attorney, or by
      such other representative as is permitted to practice before the agency,
      or may present the party’s position, arguments, or contentions in
      writing and that at the hearing the party may present evidence and
      examine witnesses appearing for and against the party. A copy of the
      notice shall be mailed to attorneys or other representatives of record
      representing the party.
Khemsara does not explain how or why he contends the notice of opportunity for

hearing in this case did not meet the requirements of R.C. 119.07 or otherwise

“violated [his] rights.” For that reason alone, we could disregard his argument. ‘“If

an argument exists that can support [an] assigned error, it is not this court’s duty to

root it out.’” Strauss v. Strauss, 8th Dist. Cuyahoga No. 95377, 2011-Ohio-3831,

¶ 2, quoting Cardone v. Cardone, 9th Dist. Summit Nos. 18349 and 18673, 1998

Ohio App. LEXIS 2028, 22 (May 6, 1998); see also Rodriguez v. Rodriguez, 8th Dist.

Cuyahoga No. 91412, 2009-Ohio-3456, ¶ 7 (“[I]t is not the duty of an appellate court

to search the record for evidence to support an appellant’s argument as to any

alleged error.”); App.R. 12(A)(2).

               However, even if we were to consider the issue, the record reflects that

Khemsara was properly served with the notice, that the content of the notice

complied with R.C. 119.07 and that Khemsara had a reasonable opportunity to be

heard regarding the charges against him.

               The notice of opportunity for hearing specifically listed “the charges

or other reasons for the proposed action” — i.e., the complaint received from Petras

regarding the veterinary medical care provided to her cat, the Board’s review of the

medical records provided by Khemsara, its determination that Khemsara’s medical

care fell below the minimum standards of veterinary care because he “documented

fluid in the [cat’s] chest but did not take action to treat” and he was “unable to hear

heart sounds indicating that the prognosis was poor” but “did not offer any
alternative treatments or a referral to a specialist or a more equipped veterinary

facility” and the prior disciplinary actions taken against Khemsara, each of which

was specifically listed. The notice identified the specific laws and rule involved, i.e.,

R.C. 4741.22(A)(1) and Ohio Adm.Code 4741-1-10, and the notice informed

Khemsara that (1) he was entitled to a hearing if requested within thirty days; (2) at

the hearing, he could appear in person, by his attorney, or by such other

representative as the Board may permit to appear for him (or he could present his

position, arguments, or contentions in writing) and (3) at the hearing, he could

present evidence and examine witnesses appearing for and against him.

               Khemsara also contends that he was denied due process because (1)

“all of the members were biased, partial and prejudiced against [him] to such a great

degree that [it] adversely and negatively affected the [Board’s] ‘decision’ to revoke

[Khemsara’s] license,” (2) the Board “refused to allow certain questions [and]

procedural clarifications” at the hearing, (3) he was not provided a list of witnesses

in advance of the hearing, (4) Petras and Price were not subpoenaed to testify at the

hearing, (5) Riker-Brown was a Board member, not an “independent ‘expert’

witness,” and (6) Riker-Brown did not provide an expert report. Once again,

Khemsara’s arguments are unavailing.

               First, Khemsara has not shown that any of the Board members were

biased, partial or prejudiced against him. Although Khemsara asserts that one

Board member “stated on the Record that the board had made a decision prior to

the evidentiary hearing to revoke [Khemsara’s] license,” he includes no citation to
the record supporting this claim. Accordingly, we disregard it. App.R. 12(A)(2)

(“The court may disregard an assignment of error presented for review if the party

raising it fails to identify in the record the error on which the assignment of error is

based * * * as required under App. R. 16(A).”); App.R. 16(A)(7) (“The appellant shall

include in its brief * * * [a]n argument containing the contentions of the appellant

with respect to each assignment of error presented for review and the reasons in

support of the contentions, with citations to the authorities, statutes, and parts of

the record on which appellant relies.”).

               Likewise, Khemsara has not shown that he was denied due process

because the Board “refused to allow certain questions [and] procedural

clarifications” at the hearing. In his appellate brief, Khemsara does not identify the

specific “questions” he was allegedly precluded from asking or “clarifications” he

was allegedly precluded from seeking and does not explain how, if at all, the Board’s

“refus[al]” to allow such questions or clarifications adversely impacted the decision

in this case. R.C. 119.09 states that, at a R.C. 119.12 hearing:

      The agency shall pass upon the admissibility of evidence, but a party
      may at the time make objection to the rulings of the agency thereon,
      and if the agency refuses to admit evidence, the party offering the same
      shall make a proffer thereof, and such proffer shall be made a part of
      the record of such hearing.

Khemsara made no such proffer in this case.

               The rules of civil procedure, including its discovery provisions, do not

apply in administrative proceedings. See, e.g., Bennett, 2022-Ohio-1747, at ¶ 40

(“An administrative board meets ‘its duty as to “discovery” by supplying [a licensee]
with sufficient information enabling him [or her] to properly respond to the

charges.’”), quoting Carratola v. Ohio State Dental Bd., 9th Dist. Summit No.

18658, 1998 Ohio App. LEXIS 2020, 11-12 (May 6, 1998); Miccichi v. Ohio State

Dental Bd., 5th Dist. Tuscarawas No. 86AP-080063, 1987 Ohio App. LEXIS 6740,

6-7 (May 4, 1987). Pursuant to R.C. 119.09, a party to an administrative hearing

may request that the administrative board or agency issue a subpoena to compel the

attendance of a witness at the hearing.

               Riker-Brown recused herself and was not participating in the

proceedings as a voting member of the Board at the time she testified at the

administrative hearing. Khemsara never requested a list of witnesses nor did he

request that the Board subpoena Petras or Price to testify at the hearing.

Accordingly, the Board was not required to provide a list of witnesses or to subpoena

Petras or Price to testify at the hearing. See, e.g., Walters v. Ohio State Dept. of

Admin. Servs., 10th Dist. Franklin No. 06AP-472, 2006-Ohio-6739, ¶ 29 (“Pursuant

to R.C. 119.09, if requested by a party to the adjudicatory hearing, an administrative

agency must issue a subpoena to compel the attendance of a witness.”); Miccichi at

6 (“[I]t was not error for the Board to refuse to furnish a list of witnesses. In a normal

judicial action, an adverse party would be required to furnish a list of potential

witnesses. * * * This principle did not apply to the administrative hearing since the

Rules of Civil Procedure do not apply in an agency hearing.”); see also Bingham v.

Ohio Veterinary Med. Licensing Bd., 9th Dist. Summit No. 18510, 1998 Ohio App.

LEXIS 532, 17-20 (Feb. 11, 1998) (rejecting argument that right to a fair and
impartial hearing was violated because board was exposed to evidence during

investigation that was not subject to cross-examination); Westlake v. Ohio Dept. of

Agriculture, 10th Dist. Franklin Nos. 08AP-71 and 08AP-72, 2008-Ohio-4422, ¶ 19

(“[A]dministrative agencies are, generally, not bound by the strict rules of evidence

applied in court. * * * Thus, hearsay is not precluded in administrative hearings.

* * * [H]earsay evidence may be considered in administrative proceedings where the

statement is not inherently unreliable and constitutes substantial, reliable, and

probative evidence.”).

              Further, the Board was not required to provide an expert report or to

present “independent” expert testimony establishing Khemsara’s violation of the

standard of care. As Khemsara acknowledges in his appellate brief, (Br. at 14), the

Board was not required to present expert testimony to support its charges against

Khemsara. See, e.g., Lies v. Ohio Veterinary Med. Bd., 2 Ohio App.3d 204, 211-212,

441 N.E.2d 584 (1st Dist.) (expert testimony about reasonable standards of

veterinary practice not mandatory in disciplinary proceedings before the state

veterinary medical board). The purpose of expert testimony is generally to assist a

factfinder in understanding issues that require scientific or specialized knowledge

or experience beyond common knowledge and experience. The majority of the

Board here were veterinarians. As such, they possessed the specialized knowledge

necessary to determine the standard of veterinary medical care and were able to rely

on their own knowledge and experience in determining whether Khemsara’s

conduct fell below that minimum standard of care. See, e.g., In re Griffith, 66 Ohio
App.3d 658, 663-664, 585 N.E.2d 937 (10th Dist.); cf. Pons, 66 Ohio St.3d at 623,

614 N.E.2d 748, citing In re Williams, 60 Ohio St.3d 85, 87, 573 N.E.2d 638 (1991),

and Arlen v. State, 61 Ohio St.2d 168, 173, 399 N.E.2d 1251 (1980).

              In this case, the record reflects that the Board provided sufficient

information to Khemsara to enable him to effectively and meaningfully respond to

the charges presented against him. As detailed above, the Board served Khemsara

with a notice of opportunity for hearing that apprised him of the charges against

him, his right to an administrative hearing and his right to have an attorney

represent him at that hearing. Khemsara retained and was represented by counsel

throughout the administrative process. The record reflects that all the documentary

evidence the Board and its witnesses reviewed and relied upon related to the charges

against Khemsara was made available to Khemsara prior to the hearing. The Board

provided Khemsara with copies of its case file, including Petras’ complaint and the

medical records and narrative it had received from Price. At the hearing, Khemsara

had the opportunity to offer witness testimony and other evidence on his behalf, to

make arguments on his behalf, to testify on his behalf and to cross-examine the

witnesses presented by the Board.

              Based on the record before us, Khemsara has not shown that the

common pleas court erred in determining that his due process rights were not

violated. Khemsara’s first assignment of error is overruled.
      Determination that Reliable, Probative and Substantial Evidence
      Supports the Board’s Decision

              In his second assignment of error, Khemsara argues that the common

pleas court erred and abused its discretion in determining that the Board’s decision

to revoke Khemsara’s license to practice veterinary medicine was supported by

“reliable, probative and substantial evidence.”

              R.C. 4741.22(A)(1) states, in relevant part:

      The state veterinary medical licensing board may * * * revoke the
      license * * * of * * * any person holding a license * * * to practice
      veterinary medicine * * * who * * * [i]n the conduct of the person’s
      practice does not conform to the rules of the board or the standards of
      the profession governing proper, humane, sanitary, and hygienic
      methods to be used in the care and treatment of animals.

              Ohio Adm.Code 4741-1-10 states:

      The board shall, pursuant to section 4741.22 of the Revised Code and
      to the extent permitted by law, take action against the license of any
      veterinarian or the registration of a veterinary technician for a
      departure from, or the failure to conform to, minimal standards of care
      of similar practitioners under the same or similar circumstances,
      whether or not actual injury to the patient is established.

              The Board revoked Khemsara’s license to practice veterinary

medicine because it found that Khemsara had provided “inappropriate medical

therapy in face of the differential diagnosis and the poor prognosis which

contributed to the demise of the cat” and due to the “multitude of previous violations

and disciplinary action” against Khemsara.
              The common pleas court, finding reliable, probative and substantial

evidence existed in the record to support the Board’s decision, upheld the Board’s

adjudication order.

              Khemsara argues that the Board’s decision was not supported by

reliable, probative and substantial evidence and that the common pleas court,

therefore, erred and abused its discretion in affirming the Board’s adjudication

order because: (1) Khemsara provides an “important service to the community[,]

including a walk-in clinic * * * that helps lower income individuals and their pets,”

which was ignored by the Board and the common pleas court; (2) Stir lacked the

expertise to opine regarding the standard of care owed by Khemsara, had never

personally spoken with Khemsara, Petras or Price and did not have “first-hand

personal knowledge of the presentation, examination, diagnosis, and treatment of

the cat” and (3) the common pleas court “improperly focused” on certain aspects of

Stir’s and Riker-Brown’s testimony regarding what Khemsara did or should have

done differently in treating Blago.

              Although we agree that Stir, a nurse and attorney who had no

education or training in veterinary medicine, lacked the expertise to render a proper

expert opinion regarding the standard of care Khemsara provided to Blago, her

testimony was not the only evidence presented at the hearing.

              As detailed above, Blago’s medical records, the testimony of Riker-

Brown, Khemsara’s testimony (including his responses to questions by the Board

chair as she sought to clarify why Khemsara made certain choices and failed to make
others when seeking to diagnose and treat Blago) and the evidence of prior

disciplinary action for medical records violations, standard of care violations and

practicing while under suspension also supported the common pleas court’s

determination that reliable, probative and substantial evidence existed in the record

to support the Board’s adjudication order.

              Based on the record before us, we cannot say that common pleas court

acted arbitrarily, unreasonably or unconscionably or otherwise erred in affirming

the Board’s decision to revoke Khemsara’s license to practice veterinary medicine.

The common pleas court’s decision affirming the Board’s adjudication order was

detailed and well-reasoned. It is not our role to weigh the evidence or to substitute

our judgment for that of the Board and/or the common pleas court. Harrison v.

Ohio Veterinary Med. Licensing Bd., 10th Dist. Franklin No. 08AP-848, 2009-

Ohio-2856, ¶ 15, citing Pons, 66 Ohio St.3d at 621, 614 N.E.2d 748. Khemsara’s

second assignment of error is overruled.

              Judgment affirmed.

      It is ordered that appellee recover from appellant the costs herein taxed.

      The court finds there were reasonable grounds for this appeal.

      It is ordered that a special mandate be sent to the Cuyahoga County Common

Pleas Court to carry this judgment into execution.
      A certified copy of this entry shall constitute the mandate pursuant to Rule 27

of the Rules of Appellate Procedure.

EILEEN A. GALLAGHER, JUDGE

ANITA LASTER MAYS, A.J., and
MARY J. BOYLE, J., CONCUR