Washington Appellate Court Affirms Physician’s Disruptive Behavior Affected His Ability To Safely Practice Medicine

162017_132140396847214_292624_nIn its April 11, 2017 decision, the Court of Appeals of the State of Washington Division II (“Appellate Court”) affirmed the Department of Health, Medical Quality Assurance Commission’s (“MQAC”) final order requiring a medical doctor to undergo a psychological evaluation if he seeks licensure in Washington, finding that MQAC did not err in its interpretation of the term “mental condition.”

RCW 18.130.170(1)

RCW 18.130.170(1) states: “If the disciplining authority believes a license holder may be unable to practice with reasonable skill and safety to consumers by reason of any mental or physical condition, a statement of charges in the name of the disciplining authority shall be served on the license holder and notice shall also be issued providing an opportunity for a hearing. The hearing shall be limited to the sole issue of the capacity of the license holder to practice with reasonable skill and safety. If the disciplining authority determines that the license holder is unable to practice with reasonable skill and safety for one of the reasons stated in this subsection, the disciplining authority shall impose such sanctions under RCW 18.130.160 as is deemed necessary to protect the public.”

MQAC found that the doctor had a “mental condition” that affected his ability to practice with reasonable skill and safety. The doctor alleged on appeal that MQAC violated his due process rights, that there was insufficient evidence to support the decision, that MQAC’s decision was arbitrary and capricious, and that the presiding officer violated the appearance of fairness doctrine.

The Underlying Facts

In June 2011, the doctor began a one-year residency program at Virginia Mason Medical Center (“VMMC”) in Seattle, Washington. In the initial weeks of the program, the residency program director received complaints about the doctor’s performance, relating to his professionalism, accountability, attendance, communication, and patient care. The doctor was given a verbal warning. Nonetheless, the doctor continued to have issues with attendance and communication, and he was then given a written warning and placed on probation. A social worker also filed a patient safety alert with VMMC because of the doctor’s “belligerent” interactions with a nurse.

The doctor was required to attend coaching sessions and a class with a psychologist and communication skills coach, who found the doctor to be “bitterly angry, with little insight and little ability to reflect on his own behavior in relationships with others.”

Subsequently, VMMC referred the doctor to the Washington Physicians Health Program (“WPHP”) for a mental status evaluation due to his interaction with the nurse in the patient safety alert incident and his failure to take accountability for his actions or adequately process direct feedback on his behavior. WPHP found the doctor to be disconnected and non-responsive to queries, and to be “confused, defensive, angry, and upset, raising his voice with the interviewers.” WPHP referred the doctor to obtain a comprehensive evaluation at Pine Grove Behavioral Health Center (“Pine Grove”).

Pine Grove found the doctor to be “defensive, lacking insight, blame-shifting, and denying and minimizing how his internship was at risk at VMMC.” Pine Grove diagnosed the doctor with an “Occupational problem (disruptive behavior) (Axis I); and prominent obsessive-compulsive and narcissistic traits (R/O personality disorder NOS with obsessive-compulsive and narcissistic traits) (Axis II).” The Pine Grove evaluators recommended that before the doctor return to his residency program, he participate in an intensive six-week residential treatment program (however, Pine Grove did not diagnose the doctor with any mental illness).

WPHP reported the doctor to MQAC due to its concern about the doctor’s ability to practice medicine (the doctor had had no contact with WPHP, WPHP did not know where he was, and WPHP did not know that the doctor had gone to Pine Grove for an evaluation).

Subsequently, the residency program terminated the doctor and later MQAC issued charges against the doctor that alleged that sanctions should be imposed because the doctor was “unable to practice with reasonable skill and safety pursuant to RCW 18.130.170(1).” After a hearing, MQAC concluded that the Department proved by clear and convincing evidence that the doctor’s ability to practice with reasonable skill and safety was sufficient impaired by an occupational problem to trigger the application of RCW 18.130.170(1), and that in determining the appropriate sanctions, public safety must be considered before the rehabilitation of the doctor. RCW 48.130.160.

The final order provided that if the doctor sought licensure in Washington for a health care credential, he “shall undergo a psychological evaluation by a WPHP approved evaluator and follow whatever recommendations are contained in that evaluation.”

The doctor filed a petition for judicial review to set aside MQAC’s final order. The superior court affirmed the MQAC decision, and the doctor appealed to the Appellate Court.

The Appellate Court’s Decision

The doctor argued on appeal that MQAC incorrectly interpreted the term “mental condition” too broadly and that it must mean a diagnosable mental illness. The Appellate Court held that the doctor’s occupational problem, disruptive physician behavior, would satisfy the requirements of the statute’s provision despite not being a diagnosable mental illness in the Diagnostic and Statistical Manual, and that a person of common intelligence would likely conclude that the term does not require an actual diagnosable mental illness, only a mental condition that affects a person’s ability to work with patients safely. The Appellate Court therefore affirmed the superior court’s decision that had affirmed MQAC’s decision.

Source Neravetla v. Department of Health, State of Washington, No. 48394-7-II.

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