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Doane v. Maine Department of Health & Human Services

Superior Court of Maine, Kennebec

June 30, 2016

STEPHEN DOANE, M.D., Plaintiff,


          Michaela Murphy Justice

         I. Background

         Plaintiff Stephen Doane, M.D. is a licensed physician by the State of Maine Board of Licensure in Medicine (the "Board"). His primary practice is at PrimeCare Physicians in Biddeford, which is affiliated with Southern Maine Medical Center. His last employer, Webber Hospital, enrolled Dr. Doane in Maine's Medicaid program ("MaineCare"), allowing reimbursement by the Department of Health and Human Services ("DHHS") for care provided. The enrollment documentation between MaineCare and Webber Hospital ("Provider Agreement") incorporates 10-144 C.M.R. Ch. 101, sub-ch. I, that provides DHHS with the authority to terminate a rendering provider from the MaineCare program for: "1) violating regulations or ethical codes governing professional conduct, and 2) failing to meet State and federal standards for participation, and 3) being formally reprimanded or censured by a peer association for unethical practice." 10-144 C.M.R. ch. 101, sub-ch. I. The Provider Agreement provides that Webber Hospital will not employ individuals excluded from the MaineCare program.

         On March 10, 2015, Dr. Doane was issued a letter by the Board stating that Dr. Doane had demonstrated incompetence in the treatment of a patient who died of drug intoxication. The Board renewed Dr. Doane's license, but censured him, imposed terms of probation and required a practice monitor to review all cases in which Dr. Doane writes prescriptions for more than one week of controlled substances. (Mot. Dismiss Ex. B at 32-33.) As a result of the finding of the Board, on April 9, 2015, DHHS issued a letter to Dr. Doane at Webber Hospital stating that he was no longer eligible to participate in Maine's Medicaid program ("MaineCare").[1] The letter explains "The general practical effect of this restriction is to prohibit employment in any capacity by a provider that receives reimbursement, indirectly or directly, from MaineCare or other Medicaid programs." MaineCare Exclusion Ltr. April 9, 2015.

         Dr. Doane sought informal review of the determination. In its Final Informal Review Decision dated September 11, 2015, DHHS affirmed its earlier determination. Dr. Doane has since sought administrative appeal of the determination in addition to pursuing the current action. In this action, Dr. Doane seeks a declaration by the Superior Court that DHHS's exclusion of Dr. Doane from the MaineCare program constituted a revocation of a license that, pursuant to 4 M.R.S. § 152(a) and 5 M.R.S. § 10051(2), can only be revoked by the Maine District Court.

         This is the second time in recent years that this issue has come before the Kennebec County Superior Court. In Corrado v. DHHS, KENSC-CV-2015-084(Me. Super. Ct., Ken. Cty., 2015), plaintiff Corrado similarly seeks a determination that his approval for the MaineCare program be declared a license for purposes of revocation, thereby requiring DHHS to bring the matter before the District Court. In that case, the plaintiff is a pharmacist who was reprimanded by the Board. Following the reprimand, DHHS issued a letter excluding Corrado from the MaineCare program. Corrado brought an action for declaratory relief similar to the action brought in this case. Because Corrado filed the action for declaratory relief simultaneously to filing for administrative appeal, the Court stayed the case pending determination by DHHS.

         In the current matter, DHHS has moved the court for dismissal and Dr. Doane has moved the Court for summary judgment.

         II. Discussion

         Defendant DHHS moves to dismiss Plaintiff Doane's Complaint for declaratory relief. In his Complaint, Dr. Doane asserts that DHHS terminated his participation in the MaineCare program and disqualified him from receiving reimbursement for professional services rendered to any participant in a medical assistance program administered by DHHS. (Pl's Compl. ¶ 5.) Dr. Doane contends that this action constitutes a revocation of a license that, pursuant to 4 M.R.S. § 152(a) and 5 M.R.S. § 10051(2), can only be done by the Maine District Court. (Pl's Compl. ¶ 10.)

         DHHS argues that Dr. Doane's Complaint should be dismissed because DHHS did not revoke any "license" held by Dr. Doane or engage in any "licensing" action. Instead, DHHS contends that it simply terminated a contract it had entered into with Dr. Doane. Dr. Doane opposes this motion and simultaneously moves for summary judgment arguing that DHHS's revocation of Dr. Doane's ability to participate in, and receive reimbursement from, MaineCare constitutes a licensing action and has been recognized as such by federal courts.

         For the reasons discussed below, the Court denies DHHS's Motion to Dismiss and grants Dr. Doane's Motion for Summary Judgment.

         a. Standard of Review

         On review of a motion to dismiss for failure to state a claim, the Court accepts the facts alleged in the complaint as true. Saunders v. Tisher, 2006 ME 94, ¶ 8, 902 A.2d 830. The Court "examine[s] the complaint in the light most favorable to plaintiff to determine whether it sets forth elements of a cause of action or alleges facts that would entitle the plaintiff to relief pursuant to some legal theory." Doe v. Graham, 2009 ME 88, ¶ 2, 977 A.2d 391 (quoting Saunders, 2006 ME 94, ¶ 8, 902 A.2d 830). "For a court to properly dismiss a claim for failure to state a cause of action, it must appear 'beyond doubt that [the] plaintiff is entitled to no relief under any set of facts that might be proven in support of the claim.'" Dragomir v. Spring Harbor Hosp., 2009 ME 51, ¶ 15, 970 A.2d 310 (quoting Plimpton v. Gerrard, 668 A.2d 882, 885 (Me. 1995)).

         Summary judgment, on the other hand, "is appropriate if the record reflects that there is no genuine issue of material fact and the movant is entitled to judgment as a matter of law." Dussault v. RRE Coach Lantern Holdings, LLC,2014 ME 8, ¶ 12, 86 A.3d 52 (quoting F.R. Carroll, Inc. v. TD Bank, N.A.,2010 ME 115, ¶ 8, 8 A.3d 646). "A material fact is one that can affect the outcome of the case, and there is a genuine issue when there is sufficient evidence for a fact- finder to choose between competing versions of the fact." McIlroy v. ...

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