IN THE SUPREME COURT OF IOWA No. 18–0353
Filed February 14, 2020
MARK B. IRLAND,
Appellant,
vs.
IOWA BOARD OF MEDICINE,
Appellee.
On review from the Iowa Court of Appeals.
Appeal from the Iowa District Court for Polk County, Arthur E.
Gamble, Judge.
Physician seeks further review of the decision of the court of appeals
that affirmed the district court’s dismissal of his petition for judicial review
of the Iowa Board of Medicine’s “Confidential Warning Letter” imposing
conditions on his return to practice. DECISION OF COURT OF APPEALS
VACATED; DISTRICT COURT JUDGMENT REVERSED AND CASE
REMANDED WITH DIRECTIONS.
David L. Brown and Tyler R. Smith of Hansen, McClintock & Riley,
Des Moines, for appellant.
Thomas J. Miller, Attorney General, and Jordan G. Esbrook (until
withdrawal) and Anagha Dixit, Assistant Attorneys General, for appellee. 2
WATERMAN, Justice.
In this appeal, we must determine whether the Iowa Board of
Medicine can use a “Confidential Letter of Warning” to impose conditions
on a physician’s return to the practice of medicine over his objection,
without a finding of probable cause, and without judicial review.
The Board opened its investigation into an emergency room
physician after the death of a patient in his care. The physician voluntarily
ceased practicing medicine. The Board closed its investigation without a
finding of probable cause that the physician had violated any rule or
standard of practice, which is a prerequisite to imposing discipline. Yet
the Board issued a letter telling the physician that if he returns to
practicing medicine, the Board will order him to “complete a
comprehensive clinical competency evaluation.” The physician filed a
petition for judicial review alleging the Board’s letter constituted illegal
agency action. The Board moved to dismiss, arguing that its action is
unreviewable because it imposes no present discipline, closes the Board’s
investigation, and any future action is not ripe for review. The district
court agreed and granted the Board’s motion to dismiss. The court of
appeals affirmed the dismissal while acknowledging that the Board’s
action prevented the physician from freely resuming his practice. We
granted the physician’s application for further review.
On our review, we determine the district court erred by ruling the
Board’s letter was not judicially reviewable. The Board lacks the statutory
authority to impose discipline without finding probable cause of a violation
and without giving the physician an opportunity to challenge the alleged
violation. The warning letter effectively imposed discipline—the
competency evaluation—should the physician return to practice. The
Board thereby circumvented the due process safeguards and public 3
reporting requirements codified in the governing statutes. We vacate the
decision of the court of appeals, reverse the district court’s dismissal
ruling, and remand with directions for the district court to order the Board
to rescind the offending provisions in this letter without prejudice to the
Board’s ability to reopen its investigation into the physician’s conduct.
I. Background Facts and Proceedings.
Dr. Mark B. Irland, a licensed physician who practiced primarily in
Marengo, Iowa, received a “Confidential Letter of Warning” from the Iowa
Board of Medicine dated November 29, 2017. As the state agency
responsible for licensing and regulating physicians who practice medicine
in Iowa, the Board has the authority to investigate complaints against
physicians and impose disciplinary sanctions. See Iowa Code § 272C.3
(2017).
The Board sent Dr. Irland the letter after reviewing a complaint
about his medical care. The Board’s letter raised “serious concerns”
regarding his treatment of a twenty-nine-year-old male patient who died
after Dr. Irland “failed to recognize the seriousness of [the patient’s]
medical condition[,] ignored the concerns of other health care
professionals involved in his treatment,” and “failed to transfer him for
over six hours” despite the seriousness of his condition. The Marengo
Memorial Hospital conducted an internal investigation and revoked
Dr. Irland’s clinical privileges for emergency medicine “due to serious
concerns about [his] clinical competency, inadequate medical record
keeping and poor documentation, disruptive behavior and
unprofessionalism, and substandard care which may have contributed to
a catastrophic patient outcome.” Dr. Irland appealed the hospital’s
disciplinary determination, and the hospital upheld the revocation. 4
The Board’s letter echoed the hospital’s concerns and “advise[d]”
Dr. Irland “to carefully review [his] treatment” of the patient, “take
appropriate steps to avoid similar concerns in the future,” and “submit a
paper to the Board describing what [he] learned from this matter” within
sixty days. The letter continues, in relevant part,
The Board also noted that you are not practicing medicine at this time. Therefore, the Board has chosen not to initiate further action in this matter at this time. However, the Board advises that you provide it written notice at least sixty (60) days prior to returning to the practice of medicine. If you choose to return to the practice of medicine, the Board will take appropriate action, including but not limited to, issuing an order requiring you to complete a comprehensive clinical competency evaluation, to ensure that you are able to practice medicine with reasonable skill and safety. While the Board has chosen not to pursue formal disciplinary action in this matter at this time, please note that failure to conform to the minimal standard of care in the future may be grounds for formal disciplinary action against your Iowa medical license. Pursuant to Iowa Code chapter 272C, this CONFIDENTIAL LETTER OF WARNING does not constitute a formal disciplinary action, nor is it a public record. . . .
This CONFIDENTIAL LETTER OF WARNING concludes the Board’s investigation of this case. The Board reserves the right to review and reconsider this matter should it be deemed appropriate.
(Emphasis added.) The Board sent its confidential letter to Dr. Irland
without his consent, without charging him with any disciplinary violation,
without opening contested case proceedings, and without any finding of
probable cause that Dr. Irland committed a violation.
On December 29, Dr. Irland filed a petition for judicial review,
asserting that the letter constituted illegal agency action under Iowa Code
section 17A.19. The Board filed a motion to dismiss pursuant to Iowa
Code section 272C.3(1)(d), which states, “Notwithstanding the provisions
of [Iowa Code] chapter 17A, a determination by a licensing board that an
investigation . . . should be closed without initiating a disciplinary 5
proceeding is not subject to judicial review pursuant to section 17A.19.”
On February 16, 2018, the district court determined that the letter’s
“advisory and warning language” were not disciplinary sanctions that
transformed it into a final agency action subject to judicial review. As
such, the district court concluded it was without authority to review the
letter and granted the Board’s motion to dismiss. Dr. Irland appealed, and
we transferred the case to the court of appeals.
On March 6, 2019, the court of appeals affirmed. The court of
appeals “acknowledge[d] the letter of warning is colored with advisories
that have the appearance of sanctions,” but it found the letter did not
amount to sanctions because there were no mandatory actions and no
identifiable repercussions if Dr. Irland did nothing (that is, if he never
resumed practicing medicine). Yet the court of appeals recognized the
letter effectively prevented Dr. Irland from again practicing medicine
without meeting the Board’s conditions.
At oral argument, the Board acknowledged the letter sent to Irland was “a hybrid” because it did not inform him of what the Board may do in the future but what it will do, essentially freezing Irland in his current status of not practicing medicine in the State of Iowa. (“[T]he Board will take appropriate action, including . . . .”) But, by issuance of this hybrid letter of warning, the Board has effectively concluded there was no probable cause to file disciplinary charges. [Iowa Admin. Code] r. 653—24.2(5)(e). In light of these rules, we conclude the letter’s reference to the competency evaluation is a threat without teeth because the Board may not enter such an order without reconsideration of its prior decision, making a probable-cause determination, and affording due process to Irland, including a contested-case hearing. Thus, we do not view the unconventional letter as a sanction or a form of disciplinary action.
(First alteration in original.) The court of appeals determined that the
letter was not subject to judicial review because Dr. Irland had not been 6
adversely affected by a final agency action given that nothing the Board
“advised” in the letter resulted in Board action or sanctions.
We granted Dr. Irland’s application for further review.
II. Standard of Review.
We review a district court’s dismissal of a petition for judicial review
for correction of errors at law. LSCP, LLLP v. Kay-Decker, 861 N.W.2d 846,
854 (Iowa 2015). “We apply the standards set forth in the Administrative
Procedure Act, Iowa Code ch. 17A, to determine whether our conclusions
are the same as those of the district court.” Doe v. Iowa Bd. of Med.
Exam’rs, 733 N.W.2d 705, 707 (Iowa 2007).
The Board acted without commencing contested case proceedings.
Accordingly, “[t]he board’s action in this case constitutes ‘other agency
action,’ and as such, we review to determine whether the board committed
an error of law, or acted unreasonably, capriciously, or arbitrarily.” Id.
“Agency action is considered arbitrary or capricious when the decision was
made ‘without regard to the law or facts.’ ” Id. (quoting Greenwood Manor
v. Iowa Dep’t of Pub. Health, 641 N.W.2d 823, 831 (Iowa 2002)).
III. Analysis.
We must decide whether Dr. Irland is presently entitled to judicial
review of the Board’s letter that requires him to undergo a competency
evaluation if he resumes practicing medicine. The Board argues, and the
court of appeals and district court agreed, that the confidential letter is
not a reviewable final agency action because Dr. Irland has not yet been
adversely affected and any future discipline is not ripe for review. We
disagree. In our view, the letter by its plain language presently restricts
Dr. Irland’s ability to return to practicing his profession. The Board’s letter
makes clear it “will order” the competency evaluation should he resume
practicing medicine. The Board cannot use a “confidential letter of 7
warning” to sidestep procedural requirements for imposing and reporting
discipline.
We begin by reviewing the Board’s authority to impose and report
on disciplinary violations. “Chapter 272C was enacted, in part, to protect
the public safety by ensuring competency in the medical profession. The
board is given broad discretion and great responsibility to fulfill this goal.”
Doe, 733 N.W.2d at 712. The Board is authorized under Iowa Code section
272C.3 to investigate complaints against licensees and issue licensee
discipline. In doing so, the Board is subject to its own rules. See Auen v.
Alcoholic Beverages Div. of the Iowa Dep’t of Commerce, 679 N.W.2d 586,
590 (Iowa 2004) (stating that the enabling act and rules constrain the
agency’s authority).
The Board’s procedure for processing complaints and conducting
investigations is outlined in Iowa Administrative Code 653—24.2. The
Board begins by opening a complaint file upon receiving “appropriate
information.” Iowa Admin. Code r. 653—24.2(1). If the Board has
jurisdiction over the complaint, the matter is assigned to its complaint
review committee. Id. r. 653—24.2(1)(a). The complaint review committee,
pursuant to the guidelines set out in rule 653—24.2(2)(c), then reviews the
complaint and may take one of four actions: (1) close the complaint file for
specified reasons, (2) recommend that the Board’s screening committee
close the file without an investigation, (3) “[r]equest an investigation by
seeking a letter of explanation from the physician, medical records, or
both,” or (4) “[r]equest a full investigation.” Id. r. 653—24.2(2)(b), (c). The
complaint review committee’s recommendation is then reviewed by a
screening committee that may take one of four actions: (1) recommend that
the Board close the complaint file without conducting an investigation;
(2) “[r]equest an investigation by seeking a letter of explanation from the 8
physician, medical records, or both”; (3) review any letters of explanation
received and recommend that the Board close the investigative file with or
without issuing an informal letter; or (4) “[r]equest a full investigation for
board review.” Id. r. 653—24.2(3).
Finally, the Board reviews the screening committee’s
recommendations. After its review, the Board may (1) “[c]lose the
complaint file without investigation[;]” (2) “[c]lose the investigative file that
has been partially or fully investigated, with or without issuing an informal
letter[;]” or (3) “[r]equest further investigation.” Id. r. 653—24.2(4).
Investigations are conducted pursuant to rule 653—24.2(5). If an
investigation occurs, the Board reviews the investigative record and may
take one of several actions. Id. r. 653—24.2(5)(e). The Board may (1) close
the investigative file without taking action; (2) “[r]equest further
investigation, including peer review;” (3) meet with the licensee to discuss
the pending investigation; (4) “[i]ssue an informal letter of warning or
education;” (5) file a statement of charges, which commences a contested
case proceeding; or (6) “[r]equest a combined statement of charges and
settlement agreement.” Id. r. 653—24.2(5)(e)(1)–(6).
The Board argues that its letter to Dr. Irland is a valid letter of
warning under Iowa Administrative Code rule 653—24.2(5)(e)(4), which
states,
If the board concludes that there is not probable cause to file disciplinary charges, the board may issue the licensee an informal letter of warning or education. A letter of warning or education is an informal communication between the board and the licensee and is not formal disciplinary action or a public document.
(Emphasis added.) As such, the Board asserts its letter to Dr. Irland is
not a “formal disciplinary action” subject to judicial review. Dr. Irland
contends the letter actually imposes discipline. We agree with Dr. Irland. 9
The Board’s letter went beyond mere warnings, and it made clear that if
Dr. Irland resumes practicing medicine, then he must undergo the
competency evaluation. The Board effectively imposed conditional
discipline without formal action or a finding of probable cause. We
conclude the Board’s letter exceeds the scope of rule 24.2(5)(e)(4).
We have recognized that the legislature may by statute expressly
exempt certain agency actions from judicial review under chapter 17A.
Lewis Cent. Educ. Ass’n v. Iowa Bd. of Educ. Exam’rs, 625 N.W.2d 687,
691 (Iowa 2001) (en banc). Iowa Code section 272C.3(1)(d) is such a
statute, which allows the Board to “[d]etermine in any case whether an
investigation, or further investigation, or a disciplinary proceeding is
warranted.” Further, this statute explicitly states that the Board’s decision
to close an investigation without instituting disciplinary proceedings is not
subject to judicial review.
Notwithstanding the provisions of chapter 17A, a determination by a licensing board that an investigation is not warranted or that an investigation should be closed without initiating a disciplinary proceeding is not subject to judicial review pursuant to section 17A.19.
Iowa Code § 272C.3(1)(d). The Board relied on section 272C.3(1)(d) in its
motion to dismiss and asserted that judicial review is unavailable because
it closed the investigation without initiating a disciplinary proceeding. The
district court and the court of appeals concluded this statute foreclosed
judicial review of the Board’s letter to Dr. Irland.
Their determinations, in our view, rest on a flawed premise—that
the letter to Dr. Irland imposed no discipline. The letter by its terms
de facto disciplined Dr. Irland by requiring a competency evaluation if he
returns to the practice of medicine. We will not allow licensing boards to
evade judicial review by placing disciplinary action within a “confidential 10
letter of warning” that purports to close the investigation without initiating
a disciplinary proceeding. To do so elevates form over substance and, in
fact, allows discipline to be imposed without the procedural safeguards of
contested case proceedings and without the reporting obligations that
safeguard the public by disclosing disciplinary actions.
When, as here, the Board’s letter actually imposes discipline, section
272C.3(1)(d) does not apply to preclude judicial review. “Licensee
discipline” is defined as “any sanction a licensing board may impose upon
its licensees for conduct which threatens or denies citizens of this state a
high standard of professional or occupational care.” Id. § 272C.1(4).
Section 272C.3(2) delineates permissible sanctions to be imposed as
licensee discipline apart from revocation and suspension of licenses,
including requiring “additional professional education or training, or
reexamination, or any combination, as a condition precedent to the
reinstatement of a license or of any privilege incident thereto.” Id.
§ 272C.3(2)(d) (emphasis added). Indeed, a clinical competency
examination is such a form of discipline. Iowa Admin. Code r. 653—
25.25(1)(g). The Board’s letter effectively imposed such discipline
requiring Dr. Irland to undergo a competency evaluation if he resumes
practicing medicine.
In our view, the Board’s action violated its own rules. Rule 653—
24.4 governs the procedure for ordering a competency evaluation. Id.
r. 653—24.4. The rule requires that the Board issue an order that
specifies the “showing by the board that there is probable cause to order
the licensee to complete an evaluation.” Id. r. 653—24.4(1)(a). The order
must identify the nature of the evaluation, the facility to perform the
evaluation, and the time to complete it. Id. r. 653—24.4(1)(b)–(e). The
physician has a right to object to the evaluation order through a contested 11
case hearing. Id. r. 653—24.4(3). Here, the Board is requiring a
competency evaluation upon Dr. Irland’s return to practice without any
finding of probable cause and without allowing him to object through the
procedure outlined in the Board’s own rule. 1
We recognize that the Board and a physician can agree to
disciplinary measures through an informal settlement and without a
contested case procedure. See Iowa Code § 272C.3(4)(a). 2 But Dr. Irland
never consented to the discipline imposed in the Board’s confidential
letter.
We agree with the court of appeals that the Board’s letter effectively
“freezes” Dr. Irland from practicing medicine. The Board’s clear statement
that it will take action against Dr. Irland if he tries to return to the practice
of medicine amounts to a sanction.
If you choose to return to the practice of medicine, the Board will take appropriate action, including but not limited to, issuing an order requiring you to complete a comprehensive clinical evaluation, to ensure you are able to practice medicine with reasonable skill and safety.
1The Board’s letter also states, The Board . . . advises that you submit a paper to the Board describing what you have learned from this matter. Please submit the paper to [the Legal Director of the Board of Medicine] within sixty (60) days of this letter. The Board cites no authority for this seemingly mandatory directive: “Please submit the paper . . . within sixty (60) days . . . .” As with the competency evaluation, we question the Board’s authority to require a physician to submit a potentially self- incriminating letter when at the same time the Board is declining to conduct an actual investigation. 2Iowa Code section 272C.3(4)(a) provides, Nothing contained in this section shall be construed to prohibit informal stipulation and settlement by a board and a licensee of any matter involving licensee discipline. However, licensee discipline shall not be agreed to or imposed except pursuant to a written decision which specifies the sanction and which is entered by the board and filed. 12
(Emphasis added.) In fact, it is a sanction specifically listed in the
Administrative Code under rule 653—25.25(1)(g). While the Board does
have the authority to impose the sanction of a clinical competency
evaluation, it may do so over the physician’s objection only after a
contested case proceeding. See id. r. 653––25.25. Dr. Irland never
received a contested case hearing. The Board bypassed the requisite
statement of charges and contested case hearing and instead imposed
discipline within a confidential letter of warning. The letter effectively
requires Dr. Irland to undergo a competency evaluation if he resumes
practicing medicine. The Board’s action has no support in its governing
statute or administrative rules.
Imposing discipline through a confidential letter of warning
circumvents several reporting requirements. To protect the public from
incompetent physicians, board-imposed discipline is a public record. See
Iowa Code § 272C.3(4)(b) (“All health care boards shall file written
decisions which specify the sanction entered by the board with the Iowa
department of public health which shall be available to the public upon
request.”); id. § 272C.6(4)(a) (A decision imposing
discipline is a public record.); Board Overview, Iowa
Bd. of Med., https://medicalboard.iowa.gov/Board-overview
[https://perma.cc/JQ5X–9DFX] (“[T]he [B]oard is charged with enforcing
these rules and laws to protect the public from licensees who do not
practice medicine and acupuncture within prevailing and acceptable
standards of the practices . . . .”). The public can access this information
through a search engine on the Board’s website that is available to “find
or verify physicians” where “[l]icensing details, including public
disciplinary action or sanctions taken by the Iowa Board of Medicine
against a license, will be displayed.” Find a Physician Search Engine, Iowa 13
Bd. of Med., https://eservices.iowa.gov/PublicPortal/Iowa/IBM/
licenseQuery/LicenseQuery.jsp?Profession=Physician (last visited
Feb. 10, 2020).
Federal law also requires that regulators disclose discipline through
an adverse action report to the National Practitioner Data Bank (NPDB).
See Costa v. Leavitt, 442 F. Supp. 2d 754, 755–56 (D. Neb. 2006)
(reviewing federal NPDB reporting requirements); see, e.g., Leo v. Bd. of
Med. Exam’rs, 586 N.W.2d 530, 532 (Iowa Ct. App. 1998) (noting
physician’s discipline was reported to the NPDB).
The Board must report adverse licensure actions to the NPDB, 3 and
hospitals and other health care entities must report adverse clinical
privileges actions. Health Res. & Servs. Admin., U.S. Dep’t of
Health & Human Servs., NPDB Guidebook E-31 to E-34,
E-63 to E-66 (Oct. 2018), https://www.npdb.hrsa.gov/resources/
aboutGuidebooks.jsp; NPDB Reporting Requirements and
Query Access, U.S. Dep’t of Health & Human Servs.,
https://www.npdb.hrsa.gov/resources/tables/reportingQueryAccess.jsp
3Adverse licensure actions that the Board must report include [a]ny adverse action taken by the state licensing or certification authority as a result of a formal proceeding, including: revocation or suspension of a license, certification agreement, or contract for participation in a government health care program; reprimand; censure; or probation. Health Res. & Servs. Admin., U.S. Dep’t of Health & Human Servs., NPDB Guidebook E-63 (Oct. 2018), https://www.npdb.hrsa.gov/resources/aboutGuidebooks.jsp. Additionally, the Board must report, among other things, [a]ny negative action or finding by the state licensing or certification authority that, under the state’s law, is publicly available information, including, but not limited to, limitations on the scope of practice, liquidations, injunctions, and forfeitures. This definition also includes final adverse actions rendered by a state licensing or certification authority – such as exclusions, revocations, or suspension of license or certification – that occur in conjunction with settlements in which no finding of liability has been made (although such a settlement itself is not reportable). Id. at E-64. 14
[https://perma.cc/KG9M-6LN8]. Although NPDB reports are not
available to the public, they are accessible to state licensing boards and
health care entities. NPDB About Us, U.S. Dep’t of Health &
Human Servs., https://www.npdb.hrsa.gov/topNavigation/aboutUs.jsp
[https://perma.cc/NG47-T4GD].
In fact, hospitals are required to request information from the NPDB whenever a physician applies for a position on its medical staff or for clinical privileges, and also every two years to check the status of each physician who currently is on its medical staff or has clinical privileges.
Costa, 442 F. Supp. 2d at 756. The NPDB serves as a valuable “workforce
tool that prevents practitioners from moving state to state without
disclosure or discovery of previous damaging performance.” NPDB About
Us, U.S. Dep’t of Health & Human Servs. (stating the NPDB’s mission is
“[t]o improve health care quality, protect the public, and reduce health
care fraud and abuse in the U.S.”).
Cloaking discipline within confidential warning letters undermines
the public’s right to know when a physician’s competence has been called
into question by a licensing board. We note Dr. Irland is not currently
practicing medicine. What stops him from practicing in another state
without undergoing the competency evaluation that the Iowa Board of
Medicine ordered in secret? Conversely, why shouldn’t Dr. Irland be able
to presently challenge the obstacle the Board has imposed on his right to
practice?
We next turn to whether the Board’s confidential letter is subject to
judicial review under Iowa Code section 17A.19. “Except as expressly
provided otherwise by another statute referring to this chapter by name,”
section 17A.19 is the “exclusive means by which a person or party who is
aggrieved or adversely affected by agency action may seek judicial review 15
of such agency action.” Iowa Code § 17A.19. Under section 17A.19(1), “[a]
person or party who has exhausted all adequate administrative remedies
and who is aggrieved or adversely affected by any final agency action is
entitled to judicial review thereof under this chapter.” Id. § 17A.19(1).
“Agency action” is defined in chapter 17A as
includ[ing] the whole or a part of an agency rule or other statement of law or policy, order, decision, license, proceeding, investigation, sanction, relief, or the equivalent or a denial thereof, or a failure to act, or any other exercise of agency discretion or failure to do so, or the performance of any agency duty or the failure to do so.
Id. § 17A.2(2). “Under Iowa Code section 17A.23, all agency action is
subject to the Iowa Administrative Procedure Act, and thus to the judicial-
review provisions of section 17A.19.” Lewis Cent. Educ. Ass’n, 625 N.W.2d
at 691; see also Iowa Code § 17A.23.
We determine the Board’s letter constitutes “agency action” under
section 17A.2(2). The Board has the authority to discipline a physician
after reviewing the investigative record, and it has discretion to determine
the proper action to be taken. See Iowa Admin. Code r. 653—24.2(5)(e).
The Board’s decision to impose sanctions for a licensee’s misconduct is
“within the statutory mandate of the agency [and is] peculiarly within its
discretion and area of expertise. Clearly, then, such matters constitute
agency action.” Genetzky v. Iowa State Univ., 480 N.W.2d 858, 861 (Iowa
1992). We also determine that the Board’s letter constitutes final agency
action given that it “conclude[d] the Board’s investigation of this case” and
imposed discipline without any path for Dr. Irland to appeal within the
agency. The Board has not identified any existing administrative remedies
available to challenge its letter that Dr. Irland failed to exhaust. Given the
Board’s position that its conditional future discipline was not ripe for
review, any effort by Dr. Irland to seek relief within the agency would have 16
been futile. We conclude Dr. Irland was aggrieved or adversely affected by
the Board’s action because he is unable to resume practicing his chosen
profession without triggering the competency evaluation.
We hold the Board’s letter is subject to judicial review under Iowa
Code section 17A.19(1). The district court erred by granting the Board’s
motion to dismiss.
IV. Disposition.
For the foregoing reasons, we vacate the decision of the court of
appeals and reverse the district court’s dismissal ruling. We remand this
case for entry of an order by the district court directing the Board to
rescind the provisions in its confidential letter of warning that require a
competency evaluation upon Dr. Irland’s return to practicing medicine.
Nothing in this opinion precludes the Board from reopening its
investigation into Dr. Irland’s conduct and following proper procedures to
determine if discipline is warranted.
DECISION OF COURT OF APPEALS VACATED; DISTRICT COURT
JUDGMENT REVERSED AND CASE REMANDED WITH DIRECTIONS.
All justices concur except McDonald, J., who takes no part.