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Neravetla v. Department of Health

Court of Appeals of Washington, Division 2

April 11, 2017


          MELNICK, J.

         Shantanu 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.

         We conclude that MQAC did not err in its interpretation of the term "mental condition" and that the statute at issue[1] 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.


         In June 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.

         Dipboye 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.

         On 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 behavior.

         Two 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 recommended evaluators.

         Neravetla 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)."[2] 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 illness.

         WPHP 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 2012.

         On 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.

         Neravetla 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[3] and that MQAC lacked jurisdiction.

         Neravetla 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.

         The presiding officer[4] 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.

         MQAC 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.

         After hearing testimony, MQAC entered a final order and findings of fact and conclusions of law.[5] 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.

         MQAC 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.

         MQAC's 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.

         Neravetla filed a petition for judicial review to set aside MQAC's final order. The superior court affirmed the MQAC decision. Neravetla appeals.


         I. Mental Condition

         Neravetla 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.[6] We disagree.

         A. Legal Principles

         We review this case under the Administrative Procedure Act (APA), [7] 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).

         When 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 261.

         "[T]he 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.

         We 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 (1991)).

         "A 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 ...

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