MAINESUPREMEJUDICIALCOURT ReporterofDecisionsDecision: 2021ME28Docket: Ken-20-163Argued: February9,2021Decided: May13,2021Panel: MEAD,GORMAN,JABAR,HUMPHREY,HORTON,andCONNORS,JJ.

STEPHENDOANEv.

DEPARTMENTOFHEALTHANDHUMANSERVICES

CONNORS,J.

[¶1]StephenDoane,MD,appealsfromajudgmentoftheSuperiorCourt

(Kennebec County,Murphy, J.) affirming, pursuant to M.R. Civ. P. 80C and

5M.R.S. § 11007(4)(A) (2021), a decision by the Department of Health and

HumanServicesexcludinghimfromparticipationinandreimbursementfrom

Maine’sMedicaidprogram,MaineCare.WeaffirmthedecisionoftheSuperior

Court.

I.BACKGROUND

[¶2]ThefollowingfactsaredrawnfromtheDepartment’sfinaldecision,

whichadoptedthefindingsoffactmadebythepresidinghearingofficerinhis

recommended decision, and the procedural facts are taken from the court’s

2

record. See Palian v. Dep’t of Health and Hum. Servs., 2020 ME 131, ¶ 3,

242A.3d164.

A. TheBoard’s2015CensureDecisionand2012ConsentAgreement

[¶3] On March 10, 2015, Dr. Doane was censured by the Board of

Licensure inMedicine based on his prescription practices leading up to the

death,byapparentoverdose,ofapatientinMay2012.1

[¶4]AlthoughtheBoardvotedtoallowDr.Doanetoretainhismedical

license,itimposedseriousrestrictionsonhisabilitytopracticemedicine.He

wasrequiredtohavea“practicemonitor”reviewallofthecasesinwhichhe

prescribedcontrolledsubstancesandreporttotheBoardeveryfourmonths.

[¶5]Theserestrictionswereinadditiontopreviousrestrictionsimposed

bya2012consentagreementfollowingthedeathofadifferentpatientwho,in

2011,hadalsodiedof anapparentdrugoverdose. In entering that consent

agreement, Dr. Doane conceded that the conduct at issue, “if proven, could

1Byunanimousvote,theBoardfoundthatDr.Doanehadfailedtoconductallrequiredaspects

for evaluationof thepatient; failed to createawritten treatmentplan; failed todiscusswith thepatient the risks and benefits of the use of controlled substances; failed to implement awrittenagreementoutliningpatientresponsibilities,includingurine/medicationserumlevelscreening,pillcounts,thenumberandfrequencyofallprescriptionrefills,andthereasonsforwhichdrugtherapywould be discontinued; and failed to keep accurate and complete medical records. The BoardunanimouslyfoundthatDr.Doanedemonstratedincompetenceinhistreatmentofthepatientand,byafive-to-onevote,foundthathehadcommittedunprofessionalconductbyfailingtoappropriatelyfollowuponandrespondtoinformationobtainedfromotherdoctorsandreporters,aswellasfromeventsthatoccurredinhisownoffice,regardinghispatient’soverdoseonthemedicationsthathehadprescribed.

3

constitutegroundsfordisciplineandthedenialofhisapplicationtorenewhis

Maine medical license for unprofessional conduct pursuant to 32 M.R.S.

§3282-A(2)(F).”2Pursuanttotheconsentagreement,amongotherthings,he

could“nolongerprescribecontrolledmedicationsforpain,includingallopioids

and benzodiazepines, except for patients in skilled nursing facilities or

long-termcarefacilities,patients inhospicecare,orpatientswithmetastatic

cancer.”

B. TheDepartment’s2015DecisiontoTerminateDr.Doane’sParticipationinMaineCare

[¶6] In a letter dated April 9, 2015, approximately one month after

Dr.Doane’scensureandtheimpositionofadditionalrestrictionsbytheBoard,

theDepartmentnotifiedhimthatitwasterminatinghisparticipationinmedical

assistance programs, most significantly for this appeal, MaineCare.3 The

2 The consent agreement recited that the Board had sufficient evidence fromwhich it could

concludethatDr.DoanefailedtoadheretotheBoard’srulesontheuseofcontrolledsubstancesfortreatment of pain by “failing to obtainpatient A’s previousmedical records prior to prescribingcontrolled medications to patient A; failing to access and review the [prescription monitoringprogram]priortoprescribingtheamountanddosageofcontrolledmedicationstopatientA;failingtorecallthetelephonemessageregardingpatientAandherrecenthospitalizationandaccompanyingrespiratory distress prior to prescribing medications to patient A; and increasing the dosage(doubling),frequency,andtotalamount(doubling)ofnarcoticsprescribedtopatientAonlyfourdaysafter initially prescribing fifteen days’ worth of narcotics to patient A, which was done withoutobtainingpatientA’spreviousmedicalrecordsorreviewingthe[prescriptionmonitoringprogram].”

3BecausethebasisforterminationwasgroundedinstateandfederalMedicaidandMaineCareregulations,andnootherprogramhasbeenidentifiedbythepartiesonappeal,wedonotdiscussfurtheranyothermedicalassistanceprograms.

4

DepartmentstatedthatittookthisactionpursuanttotheMaineCareBenefits

Manual, 10-144 C.M.R. ch. 101, ch. I, §§ 1.03-6, 1.19-1, 1.19-3 (effective

January1,2014),4 and the “authority granted [to it] in the Code of Federal

Regulations.” The Department relied specifically on section 1.19-1(M), (O),

and(R)oftheManual,whichprovidesforsanctionsbasedontheviolationof

anylaw,regulation,orcodeofethicsgoverningtheconductofoccupationsor

professionsofregulatedindustries;failuretomeetstandardsrequiredbystate

or federal law for participation; and formal reprimand or censure by an

associationoftheprovider’speersforunethicalpractices.Seeid.§1.19-1(M),

(O),(R).5

[¶7]Dr.Doanerequestedaninformalreviewoftheterminationdecision,

which is the first step of the multi-tiered framework for an administrative

appeal under the Manual. See id. § 1.21;6 Palian, 2020 ME 131, ¶ 5,

242A.3d164. The Department affirmed its decision by a letter dated

September11,2015.

4 The locationsof variousMaineCareBenefitsManual sectionshave changedduring the time

relevanttothisappeal,butnosuchchangesimpactthisappeal.Thepartiesdonotcontendthatanychanges in theManualaffect our analysis. The relevantsections are currently locatedat10-144C.M.R.ch.101,ch.I,§§1.03-10,1.20-1,1.20-3(effectiveSept.17,2018).

5Currentlylocatedat10-144C.M.R.ch.101,ch.I,§1.20-1(M),(O),(R)(effectiveSept.17,2018).

6Currentlylocatedat10-144C.M.R.ch.101,ch.I,§1.23(effectiveSept.17,2018).

5

C. DoaneI

[¶8]OnSeptember23,2015,Dr.DoanefiledacomplaintintheSuperior

CourtseekingadeclaratoryjudgmentthattheDepartmentlackedjurisdiction

to terminate his MaineCare participation and contending that the District

Court—not the Department—had exclusive jurisdiction over licensing

decisions pursuant to 4 M.R.S. § 152(9) (2021) and M.R. Civ. P. 80G. The

SuperiorCourtagreedwithDr.DoanethattheDepartmentlackedjurisdiction,

and the Department’s administrative proceedings were stayed pending the

resolutionoftheDepartment’sappealoftheSuperiorCourt’sdecision.Doane

v.Dep’tofHealth&Hum.Servs.,No.CV-15-168,2016Me.Super.LEXIS125,at*3

(June30,2016).

[¶9]Onappeal,weruledthattheDepartmenthadjurisdiction.SeeDoane

v.Dep’tofHealth&Hum.Servs.,2017ME193,¶¶31-32,170A.3d269(DoaneI).

In so concluding, we noted “the functional distinctions between a [Board]

license revocation and a [Department] termination of participation in a

programthroughaprovideragreement.”Id.¶29.

D. FurtherAdministrativeandJudicialReviewoftheDepartment’sDecision

[¶10] With the administrative process revived after the issuance of

DoaneI, in 2018, the presiding officer for the Department issued his

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recommendationfollowinganevidentiaryhearingthathadbeenheldin2016

priortothestay.Inhisfindingsoffact,thepresidingofficeracknowledgedthe

Board’spreviousfindingsofseriousprofessionaldeficienciesbutnevertheless

recommendedreversaloftheDepartment’sdecisiontoterminateDr.Doane’s

participationinMaineCare.

[¶11] The actingCommissioner disagreedwith the presidingofficer’s

recommendation. In a decision dated October 10, 2018, the acting

Commissionerstated:

Iherebyadopt the findingsof factbutIdoNOTaccept theRecommendationoftheHearingOfficer. Instead, forthereasonsset forth below, I find that the Departmentwas correctwhen itterminated Stephen Doane, M.D., from participation in theMaineCareprogram.

Pursuant to the MaineCare Benefits Manual, Chapter I,

section 1.19-2(A), the Department has independent authority toexcludeaprovider fromparticipation in theMaineCareprogrambased on its consideration of factors set forth insection1.19-3(A)(1).ThisauthorityarisesoutoftheDepartment’sadministration of the MaineCare program which providesreimbursement for medical services provided to vulnerablelow-income,disabled,andhigh-riskpopulations.TheDepartmentproperly exercised its authority to exclude Dr. Doane fromparticipationintheMaineCarepopulationbybasingtheexclusionon theundisputedseriousandmultiple incidentsofprofessionalincompetencebyDr.Doaneoveranextendedperiodoftimeassetforth in [the Board’s censure decision and preceding consentagreement].

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[¶12]OnNovember9,2018,Dr.DoanefiledaRule80Cpetitioninthe

SuperiorCourt.ThecourtaffirmedtheDepartment’sdecision,andDr.Doane

timelyappealed.See5M.R.S.§11008(2021);M.R.App.P.2B(c).

II.DISCUSSION

[¶13] Dr. Doane argues the following: (1) the Legislature did not

articulatesufficientguidancewhenitdelegatedauthoritytotheDepartmentto

regulateMaineCarepursuant to22M.R.S. §42 (2021) and22M.R.S. §3173

(2021); (2) the Department’s decision to exclude him is precluded by the

Board’s decision not to withdraw or suspend his license; (3) there was

insufficient evidence to support theDepartment’s finaldecision; and (4) the

actingCommissionerprovidedinsufficientreasoningforherdecision.

[¶14]Wedisagree.

A. StandardofReview

[¶15] “When the Superior Court acts in an intermediate appellate

capacitypursuant toM.R.Civ.P.80C,wereviewtheadministrativeagency’s

decision directly for errors of law, abuse of discretion, or findings not

supportedbysubstantialevidenceintherecord.”Manirakizav.Dep’tofHealth

&Hum.Servs.,2018ME10,¶7,177A.3d1264(quotationmarksomitted).“We

reviewquestionsoflawdenovo,”Palian,2020ME131,¶10,242A.3d164,but

8

wewillnotsubstituteourjudgmentforthatoftheDepartment,AngleZBehav.

HealthServs.v.Dep’tofHealth&Hum.Servs.,2020ME26,¶12,226A.3d762.

B. VaguenessandExcessiveDelegation

[¶16] Dr. Doane first argues that the statutes authorizing the

Department’s action are insufficiently specific. This argument invokes two

constitutionaldoctrines—thatastatuteisvoidifitistoovagueorifitdelegates

toomuchauthoritytotheadministeringbody.Whiletheseconceptsoverlap,

see Uliano v. Bd. of Env’t Prot., 2009ME 89, ¶ 15, 977 A.2d 400, they have

differentsourcesofauthorityandemphases.

[¶17]Agoalofbothdoctrinesistoavoidarbitrarydecision-making.See

Lentinev.TownofSt.George,599A.2d76,78(Me.1991);SuperintendingSch.

Comm. v. Bangor Educ. Ass’n., 433 A.2d 383, 387 (Me. 1981). A “void for

vagueness”claimisbasedonthedueprocessprotectionssetforthintheUnited

StatesandMaineConstitutionsand focuseson theneed foradequatenotice.

SeeTownofBaldwinv.Carter,2002ME52,¶10,794A.2d62(“[T]hosesubject

to sanctionby law [must]begiven fairnoticeof the standardof conduct to

which they can be held accountable.” (quotation marks omitted)). An

“excessivedelegation”claimisbasedontheseparationofpowersclauseofthe

MaineConstitution,whichprecludesa statutorydelegation toaregulatorso

9

broadoramorphousthatitamountstoasurrenderoflegislativeauthorityto

theexecutivebranch.SeeMe.Const.art.III§2;Lewisv.Dep’tofHum.Servs.,

433 A.2d 743, 747 (Me. 1981) (“We have consistently endorsed the

fundamental constitutional requirement that legislation delegating

discretionary authority to administrative agencies must contain standards

sufficienttoguideadministrativeaction.”).

[¶18]Here,Dr.Doanedoesnotcomplainthathelackednoticeastothe

typeofconductthatwouldexposehimtosanctions,includingterminationfrom

participationinMaineCare.TheDepartmentregulationsandManualareclear.

Rather, he argues that the authorizing statutes are too broad, so that the

Department improperly acted in a legislative capacity when it issued its

regulations.Wethereforeanalyzehisclaimasassertingexcessivedelegation.

[¶19]Dr.Doaneiscorrectinnotingthatthelanguagecontainedinthe

authorizingstatutesisbroad.Title22M.R.S.§42(1)provides:

The department shall issue rules and regulations considerednecessaryandproperfortheprotectionoflife,healthandwelfare,andthesuccessfuloperationofthehealthandwelfarelaws.Therules and regulations shall be adopted pursuant to therequirementsoftheMaineAdministrativeProcedureAct.

Title22M.R.S.§3173provides,inrelevantpart:The department is authorized to administer programs of aid,medical or remedial care and services for medically indigent

10

persons[,][and]...[t]hedepartmentisauthorizedandempoweredto make all necessary rules and regulations consistent with thelaws of the State for the administration of these programsincluding,butnot limited to,establishingconditionsofeligibilityandtypesandamountsofaidtobeprovided,anddefiningtheterm“medicallyindigent,”andthetypeofmedicalcaretobeprovided.

[¶20] At first blush, these statutes seem to provide few limits on the

Department’sabilitytoenactwhateverregulationsitmightchoose,triggering

excessive-delegation concerns. But a more in-depth review shows that

sufficientlimitationsandsafeguardsareinplaceforthestatutoryframework

topassconstitutionalmuster.

[¶21] We start with the premise that when evaluating the

constitutionalityofastatutewe“will,ifpossible,construe[it]topreserveits

constitutionality.”FriendsofMe.’sMountains.v.Bd.ofEnv’tProt.,2013ME25,

¶21,61A.3d689(quotationmarksomitted).

[¶22] Greater flexibility is also allowedwith respect todelegationsof

authoritytostateagenciesbytheactsoftheLegislaturethantodelegationsof

authoritytoboardsandcommitteesbymunicipalities.SeeUliano,2009ME89,

¶26,977A.2d400.Thisisbecausethe“state’sdelegationofauthoritytoan

executiveagency...issubjecttotheMaineAdministrativeProcedureAct[APA]

and its procedural protections.” Id. In Uliano, we noted that because the

Department of Environmental Protection is required to promulgate rules

11

complyingwith theAPA that are “subject topublicnotice,modification, and

judicial review,” these regulatory processes provided significant protection

againstabuse.Id.¶28;seealsoBangorEduc.Ass’n,433A.2dat387(“Especially

whereitwouldnotbefeasiblefortheLegislaturetosupplyprecisestandards,

thepresenceofadequateproceduralsafeguardsmaybeproperlyconsideredin

resolvingtheconstitutionalityofthedelegationofpower.”);Statev.Boynton,

379 A.2d 994, 995 (Me. 1977) (“[T]he presence of adequate procedural

safeguards to protect against an abuse of discretion by those to whom the

power is delegated compensates substantially for the want of precise

guidelinesandmaybeproperlyconsideredinresolvingtheconstitutionalityof

the delegation of power.”). The possibility of arbitrary administrative

decision-makingcommontobothvoid-for-vaguenessandexcessive-delegation

concernsisassuagedbytheformalAPArulemakingprocess.

[¶23] Also, because the subjectmatterof the regulationat issuehere

concernspublichealthandsafety,awideamountofrulemakinglatitudemay

benecessary.SeeKovackv.LicensingBd.,157Me.411,418,173A.2d554,558

(1961) (“As compared to a delegation of authority to regulate businesses

generally, the [L]egislaturemay be less restrictedwhen it seeks to delegate

authority of a legislative nature to an administrative body created for a

12

particular purpose, such as the care of public health.” (quotation marks

omitted)). This point is driven home by two decisions rejecting an

excessive-delegationclaiminvolving22M.R.S.§42.SeeLewis,433A.2d743;

Ne.OccupationalExch.,Inc.v.State,540A.2d1115(Me.1988).

[¶24] In Lewis, the plaintiff contended that the absence of specific

standardswithintheenablinglegislation,section42,madetheDepartment’s

adoptionoftheMaineStatePlumbingCodeanunconstitutionaldelegationof

authority. 433 A.2d at 746. In rejecting that argument, we considered the

entire legislative scheme, noting “that theDepartment ofHuman Services is

chargedwiththegeneralresponsibilityofsupervisingtheinterestsofhealth

and life of the citizens of the State” and that “[s]uch responsibility quite

obviously includes the prevention and control of disease and irresponsible

human waste disposal.” Id. at 746-47 (quotation marks omitted). The

delegationofauthority topromulgateplumbingandsewageregulationswas

constitutionalbecauseitwascontainedwithinageneralstatutoryscheme,was

confinedtoaclearlydefinedarea,andresultedinregulationsthatwerelimited

to what was necessary and proper. Id. at 747-48. We concluded that a

legislativedelegationisnotexcessivewhen“thelegislationclearlyrevealsthe

purpose to be served by the regulations, explicitly defines what can be

13

regulatedforthatpurpose,andsuggeststheappropriatedegreeofregulation.”

Id.at748.

[¶25] InNortheast Occupational Exchange,we applied this three-part

testfromLewistodecidewhethertheCommunityMentalHealthServicesAct,

34-B M.R.S. §§ 3601-3606 (1988), was an unconstitutional delegation of

authority.540A.2dat1116-17.Werejectedtheclaimthatthedelegationwas

unconstitutional,reasoningthattheclearpurposeoftheActwas“toencourage

anincreasedavailabilityofandparticipationinlocalcommunitymentalhealth

services”;theActclearlydefinedtheservicesthatcouldberegulatedforthat

purpose;and,becausetherulespromulgatedundertheActweresubjecttothe

APA,therewasanappropriatedegreeofregulationtocompensateforthelack

ofpreciseguidelines.Id.

[¶26]Intheinstantcase,thelatitudethattheLegislaturehasbestowed

upontheDepartmentisfurtherinformedbyMaineCare’srolewithinthefederal

Medicaidframework.AstheManualnotes,“TheMaineDepartmentofHealth

and Human Services...is responsible for administering MaineCare in

compliance with Federal and State statutes[] and administrative policies.”

10-144C.M.R. ch. 101, ch. I, §1.02-1 (effectiveSept. 17,2018). The federal

government appropriatesmoney toMaine to furnishmedical, rehabilitation,

14

andotherassistance“onbehalfoffamilieswithdependentchildrenandofaged,

blind,ordisabledindividuals,whoseincomeresourcesareinsufficienttomeet

thecostsofnecessarymedicalservices.”42U.S.C.S.§1396-1(LEXISthrough

Pub.L.No.116-344).Mainemustadheretofederalrequirementsfortheuseof

the appropriated funds. See 42U.S.C.S. § 1396a (LEXIS through Pub. L. No.

116-344).Forinstance,federallawrequiresMaineto“complywithprovider

and supplier screening, oversight, and reporting requirements,”

id.§1396a(a)(77), (kk), and to notify the Secretary of Health and Human

Servicesandthestatelicensingboard“wheneveraproviderofservicesorany

otherpersonisterminated,suspended,orotherwisesanctionedorprohibited

fromparticipatingunder theStateplan,” id.§1396a(a)(41). Aswenoted in

DoaneI:

Some providers, pursuant to the federal Medicaidregulations,mustormaybeexcludedfromtheMedicaidprogramby the federal Office of Inspector General. See 42 C.F.R.§§1001.101,1001.201–1001.951(2016).TheInspectorGeneral’soffice must exclude from participating in the Medicaid programproviderswhohavebeenconvictedofcertaintypesofcrimes,seeid.§1001.101,andmayexcludefromparticipationproviderswhohavecommittedothermisconduct, includingproviderswhohavehadtheirstateprofessionallicensesrevokedorsuspended,seeid.§§1001.201-1001.951. The federal regulations are not to be“construedtolimitaState’sownauthoritytoexcludeanindividualor entity fromMedicaid for any reason or period authorized byStatelaw.”42C.F.R.§1002.2(b)(2016)(redesignatedas42C.F.R.§1002.3(b)by82Fed.Reg.4100§36(Jan.12,2017)).

15

2017ME193,¶22,170A.3d269(emphasisinoriginal).7

[¶27]Insum,whiletheamountofdiscretiontheLegislaturecanbestow

uponastateagencyisnotboundless,latitudemustbegiveninareaswherethe

statutoryenactmentofdetailedspecificstandardsisunworkable.Whenthe

subjectmatterispublichealth,agencyregulationsaresubjecttoAPAreview,

andthescopeoftheregulatoryauthorityislimitedbycontext,purpose,anda

comprehensive federal regulatory regime. Department regulations that call

for potential exclusion from a medical assistance program based on

incompetenceandfailuretocomportwithprofessionalstandardsshouldnot

surpriseaphysician-participantandfallsquarelywithinthegoalsarticulated

bytheLegislatureintheauthorizingstatutesfortheprotectionoflife,health,

andwelfare;thesuccessfuloperationofthehealthandwelfarelaws;andsafe

careforthemedicallyindigentpopulation.See22M.R.S.§42(1).

7Byfederallaw,generallyspeaking,individualseligibleformedicalassistanceunderMedicaid

maychooseany“qualified”provider.42U.S.C.S.§1396a(a)(23)(LEXISthroughPub.L.No.116-344).Thedefinitionof“qualified”isnotincludedinthefederalstatute.Federalregulationsprovidethatstates may set “reasonable standards relating to the qualifications of providers,” 42 C.F.R.§431.51(c)(2)(2019),and“qualified”isinterpretedtomeancapableofperformingneededmedicalservicesinaprofessionallycompetent,safe,legal,andethicalmanner,PlannedParenthoodofInd.Inc.v. Comm’r of the Ind. StateDep’t ofHealth, 699F.3d962, 978 (7thCir. 2012). Thus, stateshave“considerable discretion” in establishing qualifications based on professional competency andpatientcare.PlannedParenthoodofKan.&Mid-Missouriv.Andersen,882F.3d1205,1230(10thCir.2018);seealsoDubev.Dep’tofHealth&Hum.Servs.,97A.3d241,248(N.H.2014)(notingthatstateshave“considerableauthority”toestablishqualifications).

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C. IssuePreclusion

[¶28] Dr. Doane next contends that the Board made a factual

determination that he was competent and met minimum professional

standards;thattheDepartmentmustacceptthisfinding;andthatthefinding

requires the Department to continue his participation in MaineCare. This

argumentmisapprehendsthedistinctrolesplayedbythetwoagencies.

[¶29] We review de novo whether issue preclusion, also known as

collateralestoppel,appliestotheBoard’sdecision.PortlandWaterDist.v.Town

of Standish, 2008 ME 23, ¶ 7, 940 A.2d 1097. The doctrine “prevents the

relitigation of factual issues already decided if the identical issue was

determined by a prior final judgment, and the party estopped had a fair

opportunityandincentiveto litigatetheissueinapriorproceeding.” Id.¶9

(quotationmarksomitted).Thedoctrinecanapplytoadministrativeagencies.

See Fitanides v. Perry, 537 A.2d 1139, 1140 (Me. 1988) (“Absent a specific

contrarystatutoryprovision,anadjudicativedeterminationofalegalorfactual

issuebyanadministrativetribunalhasthesameeffectofissuepreclusionasa

courtjudgmentiftheadministrativeproceedingresultinginthatdetermination

entailed theessentialelementsofadjudication.” (quotationmarksomitted)).

TheRestatement(Second)ofJudgments§36cmt.f(Am.L.Inst.1982)notes,

17

however, that “a prior determination that is binding on one agency and its

officialsmaynotbebindingonanotheragencyanditsofficials...[i]fthesecond

actioninvolvesanagencyorofficialwhosefunctionsandresponsibilitiesareso

distinct from those of the agency or official in the first action that applying

preclusionwouldinterferewiththeproperallocationofauthoritybetween[the

twoagencies].”

[¶30]Applyingtheseprincipleshere,weconcludethattheDepartment

andtheBoardservedistinctfunctionsandthattheissuedecidedbytheBoard

wasnotidenticaltothatbeforetheDepartment.

1. DistinctFunctions

[¶31]WenotedthedifferencesbetweenthefunctionsoftheBoardand

theDepartmentinDoaneI,2017ME193,¶29,170A.3d269.TheBoardisa

licensingauthority.Itiscomposedprimarilyofphysicians,see32M.R.S.§3263

(2021),setsstandardsofpracticeforphysicians,andinvestigatescomplaints,

see 32 M.R.S. § 3269 (2021). Its investigations of complaints can result in

variousrestrictionsonaphysician’s licenseor inconsentagreements,which

aredesignedbothtoprotectthegeneralpublicandtorehabilitateoreducate

thelicensee.See32M.R.S.§3282-A(1)(2021).

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[¶32] In contrast, the Department is a procurer of services. It

administerstheMedicaidprogram,amongotheractivities,andis“authorized

to administer programs of aid, medical or remedial care and services for

medicallyindigentpersons.”22M.R.S.§3173.“ToimplementtheMaineCare

program, the Department contractswith health care providers,who bill the

Department for MaineCare-covered services pursuant to the terms of those

contracts, Department regulations, and federal law.” AngleZ Behav. Health

Servs.,2020ME26,¶2,226A.3d762;see42U.S.C.S.§1396a(LEXISthrough

Pub.L.No.116-344).

[¶33]AsweheldinDoaneI,theBoard’slicensingfunctionisnotthesame

astheDepartment’sprocurementfunction.2017ME193,¶16,170A.3d269.

Wenotedthat“thedispute[inDoaneI]focuse[d]notonDoane’smedicallicense

butonhis capacity toparticipate in and receive compensation fromMaine’s

Medicaid program,MaineCare.” Id. The state exercises its police power to

regulate themedical profession on behalf of the general public through the

Board’sprofessional licensing. Id. ¶ 29. TheDepartment’sdecision-making

relates only to those citizens receiving services through MaineCare, and in

keepingwith thatgoal,making thebestuseofstate fundsreceived fromthe

federalgovernment.Id.¶¶29-30.

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2. DifferentIssues

[¶34]Dr.Doanenextarguesthatinordertodeterminethathewasfitto

practicemedicine,“the[Board]necessarilyhadtoconcludethatin2015,hewas

a‘competentandhonestpractitioner’whosatisfiedthe‘minimumstandardsof

proficiencyinthe[medical]profession.’”Tosupportthisproposition,hecites

10M.R.S.§8008(2021),whichprovides:

The sole purpose of an occupational and professionalregulatory board is to protect the public health andwelfare. Aboardcarriesoutthispurposebyensuringthatthepublicisservedby competent and honest practitioners and by establishingminimumstandardsofproficiencyintheregulatedprofessionsbyexamining, licensing, regulating and disciplining practitioners ofthose regulated professions. Other goals or objectives may notsupersedethispurpose.

[¶35] Asa thresholdmatter, theBoard’scensuredecision includesno

affirmativeorexpressfindingthatDr.Doaneisfittoserveanypopulation,let

alonetheconstituencyservedunderMaineCare.TheBoardspecificallyfound

thatDr.Doanedemonstratedincompetenceinhisopioidprescriptionpractice

and imposed sanctions, although not the sanction of license revocation.

Although we can reasonably infer that the Board implicitly concluded that

Dr.Doane could meet minimum standards of proficiency with monitoring,

frequentreporting,andapracticelimitedtocertaindiscretepopulations,this

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implicit finding is not an issue identical to the Department’s determination

whethertocontinueaphysician’sparticipationinMaineCare.

[¶36] The Manual lists the grounds for sanctioning a MaineCare

provider. See 10-144 C.M.R. ch. 101, ch. I, §§ 1.19-1(A)–(Y) (effective

Feb.13,2011).8 Mostof thesegrounds forsanctiondonot involve failure to

meetminimumstandardsofproficiency. See,e.g., id.§1.19-1(A)(fraudulent

claims for services); id. § 1.19-1(D) (failing to retain or disclose records of

servicesprovidedtoMaineCaremembers).Thisisbecause,asnotedabove,the

Departmentisconcernedwithriskstotheprogramaswellasriskstothehealth

andsafetyofthespecificpopulationitserves.Groundsforterminationcitedin

the Department’s termination decision, section 1.19-1(M), and (R) of the

Manual, were met: Dr. Doane violated the standards of his profession and

sufferedformalcensure.ThesanctionsavailabletotheDepartmentarelisted

in its regulations, and in determining which sanctions to impose, the

Departmentmayconsider factorssuchas theseriousnessof theoffense, the

extent of violations, the history of prior violations, and consideration of

whetheralessersanctionwouldbesufficienttoremedytheproblem,among

8 This provision is currently located at 10-144 C.M.R. ch. 101, ch. I, § 1.20-1 (effective

Sept.17,2018).

21

otherfactors.10-144C.M.R.ch.101,ch.I,§1.19-3(A)(1)(a)–(c),(g)(effective

Feb.13,2011).9IrrespectiveofanyimplicitBoardfindingthat,withpractice

limitations,Dr.Doanemetminimumstandardsforservingcertainpopulations,

fromtheperspectiveof the interestsandregulations,bothstateand federal,

governingtheDepartment’sadministrationofMaineCare,Dr.Doanefellbelow

the Department’s standards such that it could choose to terminate him.

Althoughensuringprofessionalcompetencyisanimportantconsiderationin

thedecision-makingofboththeBoardandtheDepartment,theagenciesmay

makedifferentdeterminations in accordancewith theirown standards. See

Grant’sFarmAssocs.,Inc.v.TownofKittery,554A.2d799,803(Me.1989)(“Itis

thereforeoften thecase that anapplicant . . .mustsimultaneouslypersuade

differentagenciesthatthesameorsimilarstandardsaremet.”(citingLarrivee

v.Timmons,549A.2d744,747-48(Me.1988))).

D. SubstantialEvidence

[¶37] The Department terminated Dr. Doane’s participation in

MaineCarebasedon“undisputedseriousandmultipleincidentsofprofessional

incompetence by Dr. Doane over an extended period of time.” Dr.Doane

9 This provision is currently located at 10-144 C.M.R. ch. 101, ch. I, § 1.20-3 (effective

Sept.17,2018).

22

contends that thisdeterminationwasnotsupportedbysubstantialevidence

andconstitutedanabuseoftheDepartment’sdiscretionbecausetheevidence

presentedat theDepartment’shearingdidnotshowthathecurrentlyposes

anyrisktoMaineCarepatients.

[¶38]Wereviewan“administrativeagency’sdecisiondirectlyforlegal

errors, abuseofdiscretion, orunsupported factual findings.” ForestEcology

Networkv.LandUseRegul.Comm’n,2012ME36,¶28,39A.3d74(quotation

marks omitted). In conducting such a review,we “do[] not substitute [our]

judgment for that of an agency andmust affirm findings of fact if they are

supportedbysubstantialevidenceintherecord.”Int’lPaperCo.v.Bd.ofEnv’t

Prot.,1999ME135,¶29,737A.2d1047.“Substantialevidenceexistswhena

reasonable mind would rely on that evidence as sufficient support for a

conclusion.” Richard v. Sec’y of State, 2018 ME 122, ¶ 21, 192 A.3d 611

(quotationmarksomitted). “Upon reviewof anagency’s findingsof factwe

mustexaminetheentirerecordtodeterminewhether,onthebasisofall the

testimonyandexhibitsbeforeit,theagencycouldfairlyandreasonablyfindthe

factsasitdid.”FriendsofLincolnLakesv.Bd.ofEnv’tProt.,2010ME18,¶13,

989A.2d1128(quotationmarksomitted).

23

[¶39]TheDepartmentbaseditsdecisiontoexcludeDr.Doanefromthe

MaineCareprogramonitsdeterminationthatseriousincidentsofprofessional

incompetenceoccurredoveranextendedperiodoftime.Thisconductrelated

toDr.Doane’streatmentofapatientbetween2003-2012,withparticularfocus

oneventsin2012leadinguptohispatient’soverdose.Thepresidingofficer

found, as the Board had previously, that Dr. Doane had “committed

unprofessionalconduct,” “demonstrated incompetence inhis treatment”ofa

patient who “died of oxycodone and cyclobenzaprine intoxication,” and

“violatedBoardRuleChapter21, Section III, governing theuseof controlled

substancesforthetreatmentofpain”withregardtothesamepatientwhodied

ofanoverdose.Thepresidingofficer’sfindingsoffact,whichtheDepartment

adopted in its final decision, were supported by the testimony of the

Department’s audit program manager, who issued the initial April 2015

decisionexcludingDr.DoanefromMaineCare.

[¶40] The Department’s audit program manager testified about the

Board’sinvestigationintoDr.Doane’sprescriptionpracticesleadinguptothe

death of his patient. He testified that Dr. Doane’s patient had been to the

emergencyroomtwiceasaresultofopiateoverdosesandthatanemergency

roomdoctortreatingthepatienthadinformedoneofDr.Doane’spartnersthat

24

the patient was overmedicated and was taking opiates at dangerous levels.

Insteadofreducingthepatient’smedicationastheemergencyroomdoctorhad

recommended,Dr.Doaneincreasedthenumberofpillshewasprescribingto

hispatient.TheDepartment’switnesstestifiedthatDr.Doane’spatientdiedon

May19,2012,inanaccidentaldeathrelatingto“[o]xyand[cyclobenzaprine]

intoxication.” He further testified that the Board found that the opiate

treatmentDr.Doaneprovidedforhispatientdemonstratedpoorjudgmentand

“decision-makingregardingprescriptionsthatwerewelloutsidethestandard

ofcare.”

[¶41]Basedonthisevidence,theDepartmentwasnotcompelledtofind

thatitcouldnotterminateDr.Doane.SeeFriendsofLincolnLakes,2010ME18,

¶14,989A.2d1128(“The‘substantialevidence’standarddoesnotinvolveany

weighingofthemeritsofevidence.Insteaditrequiresustodeterminewhether

thereisanycompetentevidenceintherecordtosupportafinding.”).

[¶42]Intheend,Dr.DoaneisnotcontestingtheDepartment’sfindings—

heacknowledgesthathisconductfellbelowprofessionalstandardsanddoes

not dispute that the Board censured him—a basis for the Department’s

sanctioninitsownright.Instead,ashearguedwithrespecttoissuepreclusion,

he asserts that because the Board did not revoke his license based on his

25

conduct, the Department cannot terminate his participation in MaineCare

basedonthesameconduct.Butnotonlydothesetwoagencieshavedifferent

functions, just as we do not substitute our judgment for an administrative

decision-maker,oneagencyisentitledtoreachadifferentconclusionbasedon

the same or similar evidence presented to another agency, as long as both

conclusionsaresupportedbytherecordevidence.TheBoarddeterminedthat

theappropriateactiontotakeastoDr.Doane’s licensebasedonhisconduct

was toassignhimapracticemonitorand impose limitationsonhispractice.

The Department determined that the appropriate action regarding his

participation in MaineCare was termination. Each agency acted within the

boundsofitsdiscretion.

E. SufficientFindingsandConclusions

[¶43] Finally, Dr. Doane contends that the decision issued by the

DepartmentviolatestheAPAbecauseitdoesnotincludesufficientfindingsof

fact.See5M.R.S.§9061(2021)(“Everyagencydecisionmadeattheconclusion

ofanadjudicatoryproceedingshallbeinwritingorstatedintherecord,and

shallincludefindingsoffactsufficienttoapprisethepartiesandanyinterested

memberof thepublicof thebasis forthedecision.”). Thepresidingofficer’s

factual findingswere comprehensive, and the acting Commissioner adopted

26

themintoto.Dr.DoanearguesthattheactingCommissioner’sexplanationas

towhysheimposedthesanctionofterminationbasedonthosefindingswas

tooterse.

[¶44]TheactingCommissioner’sexplanationwasconcise,notdeficient.

She noted that she accepted the presiding officer’s fact-finding, which was

basedinturnonmuchoftheBoard’sfact-finding,andstatedthatherdecision

was due to “the undisputed serious and multiple incidents of professional

incompetencebyDr.Doaneoveranextendedperiodoftimeassetforthin”the

Board’s censure decision and consent agreement. Thegravity, number, and

length of time over which the violations occurred are relevant factors in

determining appropriate sanctions pursuant to the Manual. 10-144 C.M.R.

ch.101,ch.I,§1.19-3(A)(1)(a)–(c)(effectiveFeb.13,2011).10ThattheBoard

didnotrevokeDr.Doane’s licensebasedonthisconductdidnotrequirethe

Departmenttoprovidealengthyelaborationofitsconclusionthattheconduct

warrantedterminationunderitsregulations.

Theentryis:

Judgmentaffirmed.

10Currentlylocatedat10-144C.M.R.ch.101,ch.I,§1.20-3(A)(1)(a)–(c)(effectiveSept.17,2018).

27

ChristopherC.Taintor,Esq.(orally),Norman,Hanson&DeTroy,LLC,Portland,forappellantStephenDoaneAaron M. Frey, Attorney General, and Thomas C. Bradley, Asst. Atty. Gen.(orally),OfficeoftheAttorneyGeneral,Augusta,forappelleeMaineDepartmentofHealthandHumanServicesKennebecCountySuperiorCourtdocketnumberAP-2018-74FORCLERKREFERENCEONLY