Lokesh Babu Vuyyuru, M.D. v. Virginia Board of Medicine

COURT OF APPEALS OF VIRGINIA
Present: Judges Kelsey, Petty and Senior Judge Bumgardner
Argued at Richmond, Virginia
LOKESH BABU VUYYURU, M.D.
MEMORANDUM OPINION * BY
v. Record No. 0610-07-2 JUDGE WILLIAM G. PETTY
JANUARY 15, 2008
VIRGINIA BOARD OF MEDICINE
FROM THE CIRCUIT COURT OF CHESTERFIELD COUNTY
Herbert C. Gill, Jr., Judge
Thomas H. Roberts for appellant.
Ishneila I.G. Moore, Assistnat Attorney General (Robert F.
McDonnell, Attorney General; David E. Johnson, Deputy Attorney
General; Jane D. Hickey, Senior Assistant Attorney General, on
brief), for appellee.
In this appeal from an agency decision, appellant, Lokesh Babu Vuyyuru, M.D. seeks
reversal of the Virginia Board of Medicine’s (“the Board”) revocation of his medical license. While
Vuyyuru raises twenty-six questions on appeal, his argument, taken as a whole, addresses only two:
whether the Board’s findings were supported by substantial evidence, and whether Vuyyuru was
afforded due process before the Board. 1 For the reasons stated below, we hold the Board did not
err, and we affirm the revocation of Vuyyuru’s license to practice medicine.
*
Pursuant to Code § 17.1-413, this opinion is not designated for publication.
1
As to the questions presented that were not addressed in the argument section of his
brief, Vuyyuru stated: “In many instances to ask the question is to answer it[;] therefore
although not each question is addressed further in the brief, and due to the brevity enjoined,
respondent asserts and preserves each error referenced above.” While pithy, this statement in no
way comports with of our Rules of Court. According to Rule 5A:20(e), the appellant’s opening
brief must contain “[t]he principles of law, the argument, and the authorities relating to each
question presented.” Because “[w]e do not deem it our function to comb through the record . . .
in order to ferret-out for ourselves the validity of [the parties’] claims[,] ” Fitzgerald v. Bass, 6
I. BACKGROUND
On appeal, we view the evidence in the light most favorable to the Board, the party
prevailing below. Hilliards v. Jackson, 28 Va. App. 475, 479, 506 S.E.2d 547, 549 (1998). We
also “take due account of the presumption of official regularity, the experience and specialized
competence of the agency, and the purposes of the basic law under which the agency has acted.”
Crutchfield v. State Water Control Bd., Dep’t of Envtl. Quality, 45 Va. App. 546, 555, 612
S.E.2d 249, 254 (2005) (citing Code § 2.2-4027).
After receiving several complaints, the Board summarily suspended Vuyyuru’s license to
practice medicine, based upon its finding that his continued practice of medicine could be a
substantial danger to the public health and safety, pursuant to Code § 54.1-2408.1. The Board also
instituted proceedings for a formal hearing regarding the revocation of Vuyyuru’s license.
Following a formal hearing and after considering evidence and testimony from both the Attorney
General and Vuyyuru, the Board revoked Vuyyuru’s medical license. The Board based its action on
several findings of fact. Specifically, the Board found that Vuyyuru’s misconduct led to the
performance of unnecessary medical procedures, physical harm to patients, and, in one case, a
patient’s death. The Board also found that Vuyyuru violated several regulations relating to the
administration of conscious sedation and recordkeeping regarding controlled substances. Moreover,
the Board determined that he had refused to provide copies of requested records to investigators
from the Department of Health Professions.
Accordingly, the Board revoked Vuyyuru’s medical license. The Chesterfield County
Circuit Court affirmed the Board’s decision. This appeal followed.
Va. App. 38, 56 n.7, 366 S.E.2d 615, 625 n.7 (1988), we will not address those issues for which
Vuyyuru did not favor us with a legal argument.
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II. ANALYSIS
We begin with the applicable limitations upon our review of this case. In appeals of
administrative decisions, in accordance with settled legal precedents, “the burden is upon the
appealing party to demonstrate error.” Carter v. Gordon, 28 Va. App. 133, 141, 502 S.E.2d 697,
700-01 (1998). Moreover, our review is limited to determining “whether the agency acted in
accordance with law,” “whether the agency made a procedural error which was not harmless
error,” and “whether the agency had sufficient evidential support for its findings of fact.”
Crutchfield, 45 Va. App. at 553, 612 S.E.2d at 253; see also Johnston-Willis, Ltd. v. Kenley, 6
Va. App. 231, 242, 369 S.E.2d 1, 7 (1998).
A. Substantial Evidence
Vuyyuru argues that the Board’s factual determinations were not supported by substantial
evidence. In reviewing an agency decision, we give deference to an administrative agency’s factual
determinations, and review them only to ascertain whether they are supported by substantial
evidence. Code § 2.2-4027. Our Supreme Court has explained that “[t]he ‘substantial evidence’
standard . . . is designed to give great stability and finality to the fact-findings of an
administrative agency. The phrase ‘substantial evidence’ refers to ‘such relevant evidence as a
reasonable mind might accept as adequate to support a conclusion.’” Virginia Real Estate
Com’n v. Bias, 226 Va. 264, 269, 308 S.E.2d 123, 126 (1983) (quoting Consol. Edison Co. v.
NLRB, 305 U.S. 197, 229 (1938) (emphasis added)). Thus, “[u]nder this standard . . . the court
may reject the agency’s findings of fact ‘only if, considering the record as a whole, a reasonable
mind would necessarily come to a different conclusion.’” Id. (quoting B. Mezines,
Administrative Law § 51.01 (1981)) (emphasis in original).
Here, the record contains an abundance of relevant evidence supporting the Board’s
factual findings. The Board conducted a formal hearing and listened to the testimony of
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numerous witnesses, including the testimony of expert witnesses who testified that Vuyyuru’s
actions violated the applicable standards of care. Moreover, the Board reviewed profuse medical
records and other documentary evidence involving the care of several specific patients as well as
information arising from inspections of Vuyyuru’s medical office. Because we are unable to say
upon a review of this evidence that a reasonable mind would necessarily come to a different
conclusion than that reached by the Board, we will not disturb the Board’s factual findings on
review.
B. Due Process
Vuyyuru argues that the Board did not afford him due process in the revocation
proceeding. “[T]he minimum requirements of constitutional due process which must attend
administrative hearings [are] timely and adequate notice, the right to confront adverse witnesses
and present one’s own evidence, the right to the assistance of retained counsel, and an impartial
decision maker.” Hladys v. Commonwealth, 235 Va. 145, 147, 336 S.E.2d 98, 99 (1988) (citing
Goldberg v. Kelly, 397 U.S. 254, 271 (1970)).
Our standard for reviewing the application of due process standards in an administrative
setting is well settled. Although we generally give great deference to an agency decision, “[i]f
the issue falls outside the area generally entrusted to the agency, and is one in which the courts
have a special competence, i.e., the common law or constitutional law, there is little reason for
the judiciary to defer to an administrative interpretation.” Johnston-Willis, 6 Va. App. at 243-44,
369 S.E.2d at 8. Accordingly, when a litigant contends that he was deprived of due process
during an administrative proceeding, we review the administrative proceedings de novo, giving
no deference to the judgment below. See id.; see also Dep’t of Prof’l & Occupational Regulation
v. Abateco Servs., 33 Va. App. 473, 479, 534 S.E.2d 352, 355 (2000).
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Specifically, Vuyyuru contends that the Board violated his due process rights because
(1) the amended statement of particulars, which notified him of the charges against him, was
inadequate because it “consisted of compound charges in a conclusory factual accusatory
fashion”; (2) the Board permitted non-board members to attend a closed session; (3) the Board
was represented by an attorney from the Attorney General’s office; (4) the proceedings were
tainted by the pre-hearing distribution of evidence; and (5) Board members who were part of the
decision to suspend Vuyyuru’s license also took part in the revocation hearing. We discuss each
in order.
1. Notice
According to the United States Supreme Court, “[p]rocedural due process rules are meant
to protect persons not from the deprivation, but from the mistaken or unjustified deprivation of
life, liberty or property.” Carey v. Piphus, 443 U.S. 247, 259 (1978). In furtherance of that goal,
procedural due process rules exist to “guarantee[] that a person shall have reasonable notice and
opportunity to be heard before any binding order can be made affecting the person’s rights to
liberty or property.” McManama v. Plunk, 250 Va. 27, 34, 458 S.E.2d 759, 763 (1995).
Code § 2.2-4020(B) codifies the due process notice requirement in administrative
hearings. Pursuant to Code § 2.2-4020(B)(iii) the Board was required to give Vuyyuru
“reasonable notice of the . . . matters of fact and law asserted or questioned by the [Board].”
Vuyyuru argues that the Board failed to give him reasonable notice of the charges against him
because, he alleges, the Board’s findings were “at fatal variance with the charges alleged
against” him and that the charges as stated in the Board’s amended statement of particulars were
vague and overbroad.
An accused, whether in a criminal or civil context, “is entitled to have stated in plain and
unequivocal terms” the charges against him. Casper v. City of Danville, 160 Va. 929, 932, 169
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S.E. 734, 735 (1933). In order to fulfill that requirement, the statement or bill of particulars
“should be directed at those charges to which the [Board] expects to introduce supporting
testimony.” Id. at 933, 169 S.E. at 735.
Here, the Board fulfilled that requirement because its amended statement of particulars
referenced particular incidents regarding specific patients or detailed instances of recordkeeping
violations and stated exactly what statutes or regulations the Board believed Vuyyuru may have
violated. Moreover, there was no variance between the statement of particulars and the Board’s
findings. Instead, the Board determined the Vuyyuru had violated the same provisions that were
listed in the amended statement of particulars. Simply put, there is nothing in the record to
indicate that Vuyyuru did not have sufficient reasonable notice to prepare his defense and answer
to the Board’s allegations at the formal hearing.
2. Attendance Of Non-Board Members
Vuyyuru also argues that the Board’s decision to allow people who were not members of
the Board of Medicine to attend the Board’s closed session violated his due process right to a
neutral decision-maker. Vuyyuru relies on Virginia Board of Medicine v. Fetta, 244 Va. 276,
421 S.E.2d 410 (1992), as authority for this argument; however, his reliance is misplaced.
Initially, we note that the issue decided in Fetta was whether the circuit court, upon hearing an
appeal from an agency decision, had the authority to remand a case to the administrative agency
with instructions to dismiss the proceedings against Dr. Fetta. Id. at 279, 421 S.E.2d at 411. Our
Supreme Court held that while circuit courts cannot “undertake . . . agency action directly,” they
have the power to “specify exactly what shall be done on remand.” Id.
In its opinion, the Supreme Court noted as an aside that the trial court had correctly
decided that the board violated Code § 54.1-110(A) because it allowed only four board members
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to participate in the formal hearing along with the hearing officer. 2 At the time Fetta was
decided, Code § 54.1-110(A) provided that the hearing officer could hear the case alone or with
the full board. 3 Here, however, Vuyyuru challenges the attendance of Board staff and the
Assistant Attorney General assigned to advise the Board on procedural matters at the closed
session, a different legal question from that decided in Fetta.
Further, Vuyyuru’s argument is without merit because the Board is specifically
authorized to “permit nonmembers to attend a closed meeting if such persons are deemed
necessary or if their presence will reasonably aid the public body in its consideration of a topic
that is a subject of the meeting.” Code § 2.2-3712(F). In this case, the Board properly followed
its procedure for allowing nonmembers to sit in on the meeting: a member of the Board made a
motion to include nonmembers in the closed session that was seconded and approved by a vote
of all of the Board members present.
Moreover, “‘[w]ithout a showing to the contrary, state administrators are assumed to be
men of conscience and intellectual discipline, capable of judging a particular controversy fairly
on the basis of its own circumstances.’” Hladys, 235 Va. at 148, 366 S.E.2d at 100 (quoting
Withrow v. Larkin, 421 U.S. 35, 55 (1975)). The presumption that public officials have acted
correctly may only “be overcome by evidence of bias or improper conduct.” Id. (citations
omitted). Vuyyuru did not make a showing of prejudice on this record.
2
The issue that the Court decided in Fetta was “whether the circuit court abused its
discretion in” dismissing the charges against Fetta, instead of remanding the case to the board for
disposition. Fetta, 244 Va. at 280, 421 S.E.2d at 412. Thus, the Court’s actual holding in Fetta
has no application here.
3
The current version of Code § 54.1-110(A) reads, in pertinent part: “When a hearing
officer presides, the regulatory board shall determine whether the hearing officer is to hear the
case alone or with a panel of a health regulatory board convened pursuant to § 54.1-2400 or
whether the board is to hear the case with the hearing officer.”
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3. Representation By An Assistant Attorney General
Vuyyuru contends that his right to a neutral decision maker was per se infringed upon
because an Assistant Attorney General advised the Board on procedural matters, while another
Assistant Attorney General prosecuted the case against him. For the following reasons, we hold
that this argument is also without merit.
The General Assembly has directed the Attorney General to “render[] and perform[]” all
legal service for “every state . . . board . . . including the conduct of all civil litigation in which
any of them are interested . . . .” Code § 2.2-507(A). The statute also provides that:
The Attorney General may represent personally or through one or
more of his assistants any number of state departments,
institutions, divisions, commissions, boards, bureaus, agencies,
entities, officials, courts, or judges that are parties to the same
transaction or that are parties in the same civil or administrative
proceeding and may represent multiple interests within the same
department, institution, division, commission, board, bureau,
agency, or entity.
Id.
The outcome of this case is controlled by a prior decision of our Supreme Court. 4 In
Hladys, 235 Va. at 145, 366 S.E.2d at 98, the Court addressed the issue of the Attorney
General’s office both advising a state agency and prosecuting a case before it. The Court
determined that the Attorney General correctly complied with the mandate of then Code
4
In making his argument, Vuyyuru relies upon Legal Ethics Opinion No. 1038 (1988).
There, the Committee considered a situation in which an assistant attorney general was assigned
to advise a professional regulatory board while another assistant attorney general was assigned to
prosecute a case before the regulatory board. While the Committee did not find any impropriety
or violation of ethical standards, it did give suggestions to preserve “the appearance of fairness,”
including: (1) that the assistant attorney general advising the board should not sit in on
deliberations; (2) that the two assistant attorneys general should not collaborate or communicate
with each other regarding the case; and (3) that the two assistant attorneys general should be
supervised by different lawyers at the Attorney General’s office. However, according to Rule
6:IV(10), legal ethics opinions are “advisory only.” They “have no legal effect and [are] not
binding on any judicial or administrative tribunal.”
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§ 2.1-121 to “render ‘all legal service’ in civil matters for the Commonwealth and all its
agencies.” Id. at 148, 366 S.E.2d at 100. After noting that “[t]he official conduct of assistant
attorneys general is entitled to a presumption of honesty and fairness” the Court held:
[i]n the absence of a showing of bias or improper conduct [on the
part of the assistant attorneys general], we will assume that their
conduct was proper and that the impartiality of the tribunal was
unimpaired. No showing of bias or improper conduct was made in
this case, and the institutional connection between the two assistant
attorneys general involved in this proceeding did not, per se,
impair [appellant’s right to procedural due process].
Id. at 149, 366 S.E.2d at 100.
Here, Vuyyuru has not shown bias or improper conduct. Rather, he asserts that the mere
fact that two assistant attorneys general were involved in this case requires reversal. In light of
the Supreme Court’s holding in Hladys, we must disagree.
4. Pre-hearing Distribution Of Evidence
Vuyyuru argues that the proceedings before the Board were tainted by the pre-hearing
distribution of evidence among the members of the Board. According to Code § 2.2-4020(C),
presiding officers conducting formal administrative proceedings have the authority to, inter alia,
“regulate and expedite the course of the hearing.” In this case, the presiding officer chose to
expedite the hearing by circulating the copious evidentiary exhibits prior to the hearing. We
cannot say that he abused his discretion by doing so.
Moreover, even assuming arguendo that the hearing officer’s actions were an abuse of
discretion, Vuyyuru has not met his burden to show that such error was not harmless. See J.B. v.
Brunty, 21 Va. App. 300, 305, 464 S.E.2d 166, 169 (1995) (A party alleging that an agency
failed to comply with required procedure “must demonstrate such failure was not mere harmless
error.”). According to Fetta, 244 Va. at 283, 421 S.E.2d at 414, procedural violations that “could
have had a significant impact on the ultimate decision so as to undermine the ‘substantiality of
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the evidential support’ for the factual findings” are the kind of procedural violations that are not
harmless and require reversal. However, Vuyyuru has made no showing of that kind of error
here.
5. Presence Of The Same Board Members At Both The Summary
Suspension Hearing And The Revocation Hearing
Finally, Vuyyuru argues that the presence of the same Board members at both the
summary suspension hearing and the revocation hearing deprived him of his due process right to
a neutral decision-maker.
Again relying on Fetta, 244 Va. at 276, 421 S.E.2d at 410, Vuyyuru argues that the
attendance of Board members who were familiar with the case from the summary suspension
hearing tainted the decision-making process. As discussed supra, the Fetta decision is inapposite
to this case. Indeed, our Supreme Court was very careful to differentiate the situation in Fetta
from cases “deal[ing] with the presumption of regularity of administrative decisions, and . . .
[determining whether] a member of an administrative agency who has prior knowledge of the
case may still participate in the agency’s decision.” Id. at 280, 421 S.E.2d at 412.
Here, as in Hladys, 235 Va. at 148, 366 S.E.2d at 100, the “presumption that public
officials have acted correctly” applies. This presumption may only be “overcome by evidence of
bias or improper conduct, but no such showing was made in the case before us.” Id. (citation
omitted). Once again, Vuyyuru cannot make that showing on this record.
III. CONCLUSION
For the reasons explained above, we affirm the Board’s decision to revoke Vuyyuru’s
license to practice medicine.
Affirmed.
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