Lucas v. Ohio State Dental Bd. , 2024 Ohio 4986 ( 2024 )

[Cite as Lucas v. Ohio State Dental Bd., 2024-Ohio-4986.]
IN THE COURT OF APPEALS
FIRST APPELLATE DISTRICT OF OHIO
HAMILTON COUNTY, OHIO
ROBERT LUCAS, M.D., D.M.D., : APPEAL NO. C-240272
TRIAL NO. A-2202809
Appellant, :
vs. :
O P I N I O N.
OHIO STATE DENTAL BOARD, :
Appellee. :
Civil Appeal From: Hamilton County Court of Common Pleas
Judgment Appealed From Is: Affirmed
Date of Judgment Entry on Appeal: October 16, 2024
Lindhorst & Dreidame Co., LPA, Michael F. Lyon and Cullen P. Rooney, for Appellant,
Dave Yost, Ohio Attorney General, and Katherine J. Bockbrader, Assistant Attorney
General, for Appellee.
OHIO FIRST DISTRICT COURT OF APPEALS
BOCK, Presiding Judge.
{¶1} In this administrative appeal, appellant Dr. Robert Lucas challenges the
Ohio State Dental Board’s (“the Board”) indefinite suspension of his license to practice
dentistry. After one of Lucas’s patients passed away following a surgery, the Board
charged Lucas with two violations of the standard of care. Though the Board accepted
the hearing examiner’s finding of fact that Lucas was not at fault for the patient’s
death, the Board increased the hearing examiner’s recommended sanction, in part
based on “the outcome of the surgery.”
{¶2} We agree with Lucas that the record did not support the Board’s
increasing the sanction based on the outcome of the surgery as there was no causation
established in this case. But because the Board independently cited “the seriousness
of the situation” as a basis for increasing Lucas’s sanction, and that reason was
supported by the record, we hold that the trial court did not abuse its discretion in
affirming the Board’s order.
I. Facts and Procedure
A. Facts
1) Patient 1 passes away following surgery
{¶3} Patient 1, a 22-year-old male, died from complications that occurred
after he was sedated in preparation for Lucas to perform surgery to remove his wisdom
teeth.
{¶4} Lucas is a licensed medical doctor and is board certified in dentistry,
oral and maxillofacial surgery, and anesthesiology. In November 2018, Patient 1
consulted with Lucas to extract his wisdom teeth. At the initial consultation, Patient 1
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disclosed that he took medications for his heart, cholesterol, and diabetes. Patient 1
did not indicate any history of heart disease or high blood pressure.
{¶5} In December 2018, Patient 1 arrived at Lucas’s office for his wisdom-
teeth surgery. The surgery required general anesthesia.
{¶6} Daniel Boone, a paramedic employed by Lucas as a dental anesthesia
assistant, and Tricia Flights, a dental assistant, assisted Lucas in the surgery. Boone
performed the initial preparations for the surgery, including placing Patient 1’s IV line.
Lucas was not present in the room. Before sedating Patient 1, Boone noticed that
Patient 1’s blood pressure was “unusually high”—the reading was 240/161. Boone and
Flights, thinking that the reading may have been incorrect, took a new blood-pressure
reading which, at 245/145, was also high. Despite these high readings, Boone
administered the sedation medication. Boone did not record what time he
administered the medication.
{¶7} Shortly thereafter, Lucas entered the room. Though observing that
Patient 1’s blood pressure was high, Lucas intended to proceed with the planned
surgery. But soon after Lucas entered the room, Patient 1 began having complications,
including cardiac issues and trouble breathing. Lucas administered a reversal
medication to counter the sedation medication. Lucas instructed his staff to call
emergency medical services, which arrived and transported Patient 1 to the emergency
department at West Chester Hospital, where Patient 1 died a few hours later.
2) The Board indefinitely suspended Lucas’s license
{¶8} After Patient 1’s death, Lucas self-reported to the Board. The Board gave
Lucas notice that it was charging him with two violations of the standards of care: (1)
failing to recognize Patient 1’s high blood pressure and continuing with the procedure
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despite the high readings, and (2) failing to contemporaneously document all events
that took place during the emergency.
{¶9} After a hearing, the hearing examiner issued his recommendation. He
concluded that Lucas violated both standards of care. In the hearing examiner’s
conclusions of law, he stated that “there is no direct evidence that correlates the
administration of the medication to [Patient 1’s] resulting episode,” and did “not
conclude that [Lucas] was responsible for Patient #1’s passing.” He recommended a
one-year suspension and ten hours of continuing education in addition to that
required by statute.
{¶10} The Board adopted the hearing examiner’s findings of fact and
conclusions of law. But it modified the recommended sanction and imposed an
indefinite suspension. The Board specified that to be reinstated, Lucas had to serve at
least three months of the suspension and complete 60 hours of continuing education.
The Board explained that the modification was “due to the seriousness of the situation
and the outcome of the surgery.”
B. Procedural history
{¶11} Lucas filed this administrative appeal from the Board’s order
suspending his dental license. The magistrate’s decision affirmed the Board’s
sanctions. Lucas filed objections. The trial court overruled Lucas’s objections and
adopted the magistrate’s decision. Lucas appealed.
II. Law and Analysis
{¶12} In his sole assignment of error, Lucas argues that the trial court abused
its discretion in affirming the Board’s decision.
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A. Standard of review
{¶13} This court reviews the trial court’s judgment in an administrative appeal
for an abuse of discretion. Pons v. Ohio State Med. Bd., 66 Ohio St.3d 619, 621 (1993).
An abuse of discretion is “not merely an error of judgment.” Id. Instead, a trial court
abuses its discretion when its judgment is unreasonable, arbitrary, or unconscionable.
Blakemore v. Blakemore, 5 Ohio St.3d 217, 219 (1983). Absent a finding of an abuse
of discretion, an appellate court may not substitute its own judgment for the trial
court’s judgment. Pons at 621. But this court’s review on questions of law is de novo.
Bartchy v. State Bd. of Edn., 2008-Ohio-4826, ¶ 43.
B. Administrative appeals
{¶14} R.C. 119.12 governs appeals from administrative agencies’ orders. A trial
court must uphold the agency’s order if it finds, “upon consideration of the entire
record . . . that the order is supported by reliable, probative, and substantial evidence
and is in accordance with law.” R.C. 119.12(N). “In the absence of this finding,” the
court may “reverse, vacate, or modify the order or make such other ruling as is
supported by reliable, probative, and substantial evidence and is in accordance with
law.” Id.{¶15} The trial court is required to conduct “two inquiries: a hybrid
factual/legal inquiry and a purely legal inquiry.” Bartchy at ¶ 37. First, in determining
if the order is supported by reliable, probative, and substantial evidence, the trial court
must defer to the agency’s findings of fact. Id. But the agency’s findings “are by no
means conclusive,” and the trial court may reverse, vacate, or modify the order where
it finds, based on its view of the evidence, that “there exist[s] legally significant reasons
for discrediting certain evidence relied upon by the administrative body, and necessary
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to its determination.” Id., quoting Ohio Historical Soc. v. State Emp. Relations Bd.,
66 Ohio St.3d 466, 470-471 (1993). Courts must defer to a medical board’s
interpretation of the profession’s technical and ethical requirements. Pons at 621.
{¶16} Second, the trial court must ensure that the agency’s order is “in
accordance with the law,” and in doing so, the trial court construes the law on its own.
Ohio Historical Soc. at 471; see also TWISM Ents., L.L.C. v. State Bd. of Registration
for Professional Engineers and Surveyors, 2022-Ohio-4677, ¶ 3 (“the judiciary, not
administrative agencies, [] make[s] the ultimate determination about what the law
means. Thus, the judicial branch is never required to defer to an agency’s
interpretation of the law.”).
{¶17} When sufficient evidence and the law support an agency’s decision, the
trial court “lacks authority to review the agency’s exercise of discretion, even if its
decision is ‘admittedly harsh.’” Capital Care Network of Toledo v. Ohio Dept. of
Health, 2018-Ohio-440, ¶ 25; see Henry’s Cafe, Inc. v. Bd. of Liquor Control, 170 Ohio
St. 233 (1959), paragraph two of the syllabus (where an agency’s “order is supported
by reliable, probative and substantial evidence, . . . it can only affirm” that order).
C. R.C. 4715.30 disciplinary action against dentists
{¶18} The Board is authorized to discipline a licensed dentist for:
Providing or allowing dental hygienists, expanded function dental
auxiliaries, or other practitioners of auxiliary dental occupations
working under the certificate or license holder’s supervision, . . . to
provide dental care that departs from or fails to conform to accepted
standards for the profession, whether or not injury to a patient results.
R.C. 4715.30(A)(9).
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OHIO FIRST DISTRICT COURT OF APPEALS
{¶19} If the Board finds that a ground for discipline exists, it may sanction the
dentist. R.C. 4715.30(C).
D. The trial court did not abuse its discretion
{¶20} Lucas does not challenge the hearing examiner’s findings that he
violated the standards of care or the Board’s acceptance of those findings. Nor does he
argue that the Board imposed a sanction that it generally would not be authorized to
impose. He also does not take issue with the magistrate’s determination that the
board’s findings were supported by reliable, probative, and substantial evidence.
{¶21} Instead, Lucas challenges the Board’s modifying the hearing examiner’s
recommended sanction. Lucas specifically points to the Board’s explanation for the
modification in which the Board wrote, “The rationale for the modification is the
following: the Board in its expertise finds that due to the seriousness of the situation
and the outcome of the surgery, a suspension period, continuing education and a
probationary period was appropriate.” (Emphasis added.) Lucas argues that the
Board’s decision to increase his penalty based in part on “the outcome of the surgery”
means that the Board increased the penalty due to Patient 1’s death, despite the
hearing examiner’s statement that there was no evidence that Lucas caused his death.
{¶22} The magistrate stated that while “the Board’s language . . . could be
interpreted to reference the death of the Patient[,] it could also be as reasonably . . .
interpreted as referring to Lucas’[s] lack of standard of care and proof of correcting
those standards of care as they relate to the sedation and record keeping related to
those sedation procedures.” Ultimately, the magistrate concluded that the Board was
not required to adopt the hearing examiner’s recommended sanction and that the
sanction employed by the Board was otherwise authorized by law. The trial court
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OHIO FIRST DISTRICT COURT OF APPEALS
adopted the magistrate’s decision without additional analysis and denied Lucas’s
objections.
{¶23} We agree with Lucas that the Board’s reference to the “outcome of the
surgery” cannot reasonably be interpreted as referring to anything other than Patient
1’s emergency medical condition and death. At the hearing, Lucas presented testimony
that Patient 1’s medical emergency and death were not caused by the administration
of sedation medication. In addressing this evidence and argument, the hearing
examiner noted:
While perhaps true, and there is no direct evidence that correlates the
administration of the medication to his resulting episode, that argument
misses the point. They ignore that the standard of care was not observed
during this procedure. Indeed, had Patient #1’s blood pressure been
properly monitored, and had Respondent’s office obtained better
records regarding Patient #1’s medical history, it is quite possible that
the results would have been dramatically different, as his condition
could have been more promptly and appropriately addressed.
{¶24} While the hearing examiner found that there was a possibility that Lucas
was at fault, he did not determine that Patient 1 would have survived had Lucas not
violated the standards of care. There was no evidence of causation before the Board
upon which the Board could have relied to increase Lucas’s sanction based on “the
outcome of the surgery.”
{¶25} But the Board’s reason for increasing Lucas’s sanction was not limited
to “the outcome of the surgery.” Instead, it cited “the seriousness of the situation.”
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Lucas acknowledges that this language reasonably can be interpreted to refer to “the
lack of standard of care during the procedure.”
{¶26} We see no reason to read the Board’s stated reasons as conjunctive. The
Board relied on two independent reasons for modifying the sanction. And there is no
dispute that the Board’s sanction is authorized by law. Courts are not permitted to
substitute their judgment for that of the medical board regarding the appropriate
sanction, provided the Board’s decision was supported by reliable, probative, and
substantial evidence and was in accordance with the law. See Henry’s Cafe, Inc., 170
Ohio St. 233 (1959), paragraph two of the syllabus. The trial court determined that the
Board’s decision was supported by the evidence, and we agree.
{¶27} Because Lucas does not challenge one of the Board’s independently
stated reasons for modifying his penalty, he cannot demonstrate that the order was
not in accordance with the law. We hold that the trial court did not abuse its discretion
in affirming the Board’s order.
{¶28} We overrule Lucas’s assignment of error.
III. Conclusion
{¶29} For the foregoing reasons, we overrule Lucas’s assignment of error and
affirm the trial court’s judgment.
Judgment affirmed.
CROUSE and WINKLER, JJ., concur.
Please note:
The court has recorded its entry on the date of the release of this opinion.
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