Neravetla, M.D. appeals the Department of Health, Medical
Quality Assurance Commission's (MQAC) final order
requiring him to undergo a psychological evaluation if he
seeks licensure in Washington. MQAC found that Neravetla had
a "mental condition" that affected his ability to
practice with reasonable skill and safety.
conclude that MQAC did not err in its interpretation of the
term "mental condition" and that the statute at
issue is not unconstitutionally vague. Further,
MQAC did not violate Neravetla's due process rights,
sufficient evidence exists to support the decision,
MQAC's decision was not arbitrary and capricious, and the
presiding officer did not violate the appearance of fairness
doctrine. We do not review the summary judgment motion denial
or consider the evidentiary issues raised. We affirm.
2011, Neravetla began a one-year residency program at
Virginia Mason Medical Center (VMMC) in Seattle. In the
initial weeks of the program, the residency program director,
Dr. Larry Keith Dipboye Jr., received complaints about
Neravetla's performance. They related to his
professionalism, accountability, attendance, communication,
and patient care. Dipboye and Gillian Abshire, the manager of
the Graduate Medical Education program, gave Neravetla a
verbal warning. Nonetheless, Neravetla continued to have
issues with attendance and communication. VMMC gave Neravetla
a written warning and placed him on probation. A social
worker also filed a patient safety alert with VMMC because of
Neravetla's "belligerent" interactions with a
nurse. Administrative Record (AR) at 1962.
and VMMC then required Neravetla to attend coaching sessions
and a class with Dan O'Connell, Ph.D., a psychologist and
communication skills coach. O'Connell found Neravetla to
be "bitterly angry, with little insight and little
ability to reflect on his own behavior in relationships with
others." Clerk's Papers (CP) at 25.
February 9, 2012, VMMC referred Neravetla to the Washington
Physicians Health Program (WPHP) for a mental status
evaluation. The referral occurred because of Neravetla's
interaction with the nurse in the patient safety alert
incident and Neravetla's failure to take accountability
for his actions or adequately process direct feedback on his
doctors from the clinical staff at WPHP evaluated Neravetla.
Both doctors found Neravetla to be disconnected and
non-responsive to queries. They also found him to be
"confused, defensive, angry, and upset, raising his
voice with the interviewers." CP at 25. He also brought
WPHP's receptionist to tears. Based on their assessments,
WPHP referred Neravetla to obtain a comprehensive evaluation
at Pine Grove Behavioral Health Center, one of three
presented himself to Pine Grove without informing WPHP.
Psychiatrist, Teresa Mulvihill, M.D., and psychologist, Ed
Anderson, Ph.D., evaluated him. Anderson evaluated Neravetla
as "defensive, lacking insight, blame-shifting, and
denying and minimizing how his internship was at risk at
VMMC." CP at 26. The Pine Grove evaluators made their
evaluation based on their interactions with Neravetla, and
information provided by both VMMC and Neravetla. Pine Grove
diagnosed Neravetla 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)." CP at 26. The Pine Grove evaluators did
not feel comfortable recommending that Neravetla return to
his residency and recommended that before that occurred, he
participate in an intensive six-week residential treatment.
Pine Grove did not diagnose Neravetla with any mental
reported Neravetla to MQAC. WPHP indicated its concern about
Neravetla's ability to practice medicine because
Neravetla had had no contact with WPHP and WPHP did not know
where Neravetla was. WPHP did not know Neravetla had gone to
Pine Grove for an evaluation. Subsequently, the residency
program terminated Neravetla and VMMC held a grievance
hearing. Neravetla's limited license expired in July
March 18, 2013, MQAC issued charges against Neravetla. It
alleged that sanctions should be imposed because Neravetla
was "unable to practice with reasonable skill and safety
pursuant to RCW 18.130.170(1)." AR at 5.
denied the allegations and asserted that no grounds existed
to impose sanctions. He asserted defenses, including that he
did not suffer from any mental disorder and that MQAC
filed a motion for summary judgment before MQAC, arguing that
substantial evidence did not exist to prove he could not
practice with reasonable skill and safety because of a mental
condition. He included expert reports that concluded he had
never been diagnosed with any mental illness and that he was
fit for duty.
presiding officer denied Neravetla's motion for summary
judgment because genuine issues of material fact existed
regarding Neravetla's ability to practice with reasonable
skill or safety because of a mental condition.
held a hearing on the charges. At the beginning of the
hearing, the presiding officer asked a member of MQAC's
panel, Dr. Thomas Green, a former VMMC employee, whether he
could hear and assess the case in an impartial manner. Green
stated that although he did know some of the people involved
in the case, he had no doubt about his ability to give
Neravetla a fair hearing. Green agreed to voice any concerns
about his impartiality throughout the proceedings.
hearing testimony, MQAC entered a final order and findings of
fact and conclusions of law. MQAC made specific credibility
determinations in its findings of fact. MQAC determined that
the clinic staff from WPHP were credible because their
descriptions of their interactions with Neravetla were
consistent. In addition, it found Pine Grove's staff and
O'Connell to be credible.
accepted Anderson's conclusion that Neravetla suffered
from the condition of Disruptive Physician Behavior, an
occupational problem. Neravetla's demeanor as testified
to by witnesses, was consistent with the diagnosis. MQAC
found that this occupational problem interfered with
Neravetla's ability to communicate and work with others,
and if continued, would impede his ability to practice
medicine safely. His occupational problem rose to the level
that patient care would be adversely affected.
conclusions of law stated in relevant part:
2.4 The Department proved by clear and convincing evidence
that [Neravetla'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). . .
2.5 In determining the appropriate sanctions, public safety
must be considered before the rehabilitation of [Neravetla].
RCW 48.130.160. . . .
2.6 The Department requests that [Neravetla] be ordered to
comply with the Pine Grove treatment recommendations. The
Commission declines to do this.
CP at 32-33. The final order provided that if Neravetla
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." CP at 33.
filed a petition for judicial review to set aside MQAC's
final order. The superior court affirmed the MQAC decision.
argues that MQAC committed legal error by creating an
"Amorphous and Arbitrary" standard for the term
"Mental Condition." Br. of Appellant at 26. He also
argues that MQAC conflated the requirement that he have a
mental condition that prevents him from practicing safely
with unprofessional conduct. We disagree.
review this case under the Administrative Procedure Act
(APA),  and directly review the agency record.
Ames v. Health Dep't Med. Quality Health Assurance
Comm'n, 166 Wn.2d 255, 260, 208 P.3d 549 (2009). We
may reverse an administrative order (1) if it is based on an
error of law, (2) if it is unsupported by substantial
evidence, (3) if it is arbitrary or capricious, (4) if it
violates the constitution, (5) if it is beyond statutory
authority, or (6) when the agency employs improper procedure.
Ames, 166 Wn.2d at 260; RCW 34.05.570(3) (a), (b),
(c), (d), (e), (h), (i).
reviewing an administrative agency decision, we review issues
of law de novo. Ames, 166 Wn.2d at 260. We may
"then substitute our judgment for that of the
administrative body on legal issues." Ames, 166
Wn.2d at 260-61. However, we should "accord substantial
weight to the agency's interpretation of the law it
administers-especially when the issue falls within the
agency's expertise." Ames, 166 Wn.2d at
challenger has the burden of showing the department
misunderstood or violated the law, or made decisions without
substantial evidence." Univ. of Wash. Med. Ctr. v.
Dep't of Health, 164 Wn.2d 95, 103, 187 P.3d 243
(2008). "We do not reweigh the evidence." Univ.
of Wash. Med. Ctr., 164 Wn.2d at 103.
review "a challenge to an agency's statutory
interpretation and legal conclusions de novo under the error
of law standard." Greenen v. Wash. State Bd. of
Accountancy, 126 Wn.App. 824, 830, 110 P.3d 224 (2005).
"If a statute's meaning is plain, then the court
must give effect to the plain meaning as expressing what the
legislature intended." Campbell v. Dep't of Soc.
& Health Servs., 150 Wn.2d 881, 894, 83 P.3d 999
(2004). We evaluate a statute's plain language to
determine legislative intent. Greenen, 126 Wn.App.
at 830. "Under the plain meaning rule, courts derive the
meaning of a statute from the 'wording of the statute
itself.'" Strain v. W. Travel, Inc., 117
Wn.App. 251, 254, 70 P.3d 158 (2003) (quoting Rozner v.
City of Bellevue, 116 Wn.2d 342, 347, 804 P.2d 24
statute is ambiguous when, either on its face or as applied
to particular facts, it is fairly susceptible to different,
reasonable interpretations." Strain, 117
Wn.App. at 254. If the plain language is ambiguous, we
"may review the statute's legislative history,
including legislative bill reports, to help determine a
statute's intent." Greenen, 126 Wn.App. at
830. We examine the statute as a whole and its statutory