v.
Teladoc, Inc.
FILED
15-0092 8/4/2015 3:59:31 PM tex-6352761 SUPREME COURT OF TEXAS BLAKE A. HAWTHORNE, CLERK
NO. 15-0092
________________________________________________________________________
IN THE SUPREME COURT OF TEXAS
________________________________________________________________________
TEXAS MEDICAL BOARD AND SCOTT FRESHOUR, IN HIS OFFICIAL CAPACITY AS GENERAL COUNSEL OF THE TEXAS MEDICAL BOARD, Petitioners, v. TELADOC, INC.
Respondent.
________________________________________________________________________
ON PETITION FOR REVIEW FROM THE COURT OF APPEALS
FOR THE THIRD JUDICIAL DISTRICT OF TEXAS
CASE NO. 03-13-00211-CV
________________________________________________________________________
TELADOC’S RESPONSE TO TMB’S PETITION FOR REVIEW
________________________________________________________________________ JACKSON WALKER L.L.P. BAKER BOTTS, L.L.P. Matt Dow Thomas R. Phillips State Bar No. 06066500 State Bar No. 00000102 Dudley D. McCalla 98 San Jacinto Blvd., Suite 1500 State Bar No. 13354000 Austin, Texas 78701 100 Congress St., Suite 1100 Tel: 512.322.2610 Austin, Texas 78701 Fax: 512.322.3608 Tel: 512.236.2000 [email protected] Fax: 512.236.2002 [email protected] Benjamin A. Geslison [email protected] State Bar No. 24074269 One Shell Plaza 910 Louisiana St.
Houston, Texas 77002 Tel: 713.229.1241 Fax: 713.229.2841 [email protected]
ATTORNEYS FOR RESPONDENT TELADOC, INC.
TABLE OF CONTENTS
FACTS..........................................................................................................................1 ARGUMENT .................................................................................................................1
I. This Court’s review is unwarranted because the Court of Appeals correctly held that the TMB letter articulated a new rule under the APA, which was invalid under Section 2001.035 of that Act.........................2 A. The TMB letter satisfies the elements of Section 2001.003(6). ...........2
B. The petition for review fails to identify flaws in the appellate court’s Section 2001.003(6) analysis. ...................................................5
II. This Court’s review is unwarranted because the court of appeals opinion will have none of the disruptive effects that TMB predicts. ..............9 A. The opinion below will not excessively burden agencies. ....................9
B. The opinion below will neither “drastically expand” Texas court dockets nor arrogate power to the judiciary at agency expense. ...............................................................................................12
C. Regulated entities will not be left without guidance. ..........................14
III. This Court’s review is unwarranted under Government Code Section 22.001(a). .......................................................................................................15 CONCLUSION .............................................................................................................16 CERTIFICATE OF COMPLIANCE ..................................................................................18 CERTIFICATE OF SERVICE ..........................................................................................18 INDEX TO APPENDIX ..................................................................................................19 ii
TABLE OF AUTHORITIES
Page(s) CASES Bd. of Adjustment v. Levinson, 244 S.W.2d 281 (Tex. Civ. App.—San Antonio 1951, no writ)............................ 3 Combs v. Entertainment Publications, Inc., 292 S.W.3d 712 (Tex. App.—Austin 2009, no pet.) .....................................10, 13 Dewhurst v. Hendee, 253 S.W.3d 320 (Tex. App.—Austin 2008, pet. dism’d) ....................................11 El Paso Hosp. Dist. v. Tex. Health & Human Serv., 247 S.W.3d 709 (Tex. 2008) ..............................................................8, 13, 14, 16 Martinez v. Harris Cnty., 808 S.W.2d 257 (Tex. App.—Houston [1st Dist.] 1991, writ denied) .................. 3 R.R. Comm’n. v. WBD Oil & Gas Co., 104 S.W.3d 69 (Tex. 2003) ...................................................................................6 Teladoc, Inc. v. Tex. Med. Bd., 453 S.W.3d 606 (Tex. App—Austin 2014, pet. filed) ................................passim Teladoc v. Tex. Med. Bd., No. 1:15-cv-00343-RP, slip op. (W.D. Tex. May 29, 2015) ...............................11 Tex. Dept. of Transp. v. Sunset Transp., 357 S.W.3d 691 (Tex. App.—Austin 2011, no pet.) .........................10, 13, 14, 16 Tex. Logos, L.P. v. Tex. Dep’t of Transp., 241 S.W.3d 105 (Tex. App.—Austin 2007, no pet.) ...........................................11 Tex. Mut. Ins. Co. v. Vista Cmty. Med. Ctr., L.L.P., 275 S.W.3d 538 (Tex. App.—Austin 2008, no pet.) ...........................................13 Tex. State Bd. of Pharmacy v. Witcher, 447 S.W.3d 520 (Tex. App.—Austin 2014, pet filed) .................................12, 14 Trinity Settlement Servs., LLC v. Tex. State Sec. Bd., 417 S.W.3d 494 (Tex. App.—Austin 2013, pet. denied)....................................... 6 iii STATUTES 22 Tex. Admin. Code § 174.4.....................................................................................4
22 Tex. Admin. Code § 174.8.....................................................................................4 22 Tex. Admin. Code § 190.8(1)(L) .................................................................passim Tex. Gov’t. Code § 2001.003(6) .......................................................................passim Tex. Gov’t. Code § 2001.035 .....................................................................................9 Tex. Gov’t. Code § 2001.038 ...............................................................4, 5, 13, 14, 16 OTHER AUTHORITIES 29 Tex. Reg. 3896 (Apr. [23], 2004) .............................................................................4 29 Tex. Reg. 6088-89 (2004)......................................................................................4 35 Tex. Reg. 3392 (Apr. 30, 2010) .............................................................................4
35 Tex. Reg. 9085 (2010) ...........................................................................................4
40 Tex. Reg. 1019 ....................................................................................................11 iv
FACTS
The “Background” section of the court of appeals opinion states the relevant facts sufficiently for purposes of this response. See Teladoc, Inc. v. Tex. Med. Bd., 453 S.W.3d 606, 608-13 (Tex. App—Austin 2014, pet. filed). TMB’s facts section contains some inaccuracies, including its having “used Rule 190.8 to discipline license holders who prescribed drugs over the telephone or internet without first conducting a face-to-face examination.” Pet. at 4. In reality, the record shows that it was not merely the lack of face-to-face examinations that led to TMB historically disciplining physicians, but the complete failure to establish any professional relationship with patients before prescribing dangerous drugs and controlled substances—something that has never been true of Teladoc physicians. See CR 41. TMB also states that its June 2011 letter was in response to “a company misrepresenting [Rule 190.8(1)(L)’s] restrictions.” Pet. 5. Teladoc maintains, and the appeals court agreed, that TMB—not Teladoc—has misrepresented Rule 190.8(1)(L)’s restrictions.
ARGUMENT
TMB’s petition for review never discusses the dispositive fact in the court of appeals’ analysis—namely that TMB’s June 2011 letter clearly departed from the plain text of the rule that TMB invoked against Teladoc: 22 Tex. Admin. Code § 190.8(1)(L). That omission presents a distorted picture not only of the Third Court’s analysis, but also of this case’s importance to the State’s jurisprudence. Because the letter was a clear departure from the plain text of a published rule, the Third Court’s analysis was correct, the parade of horribles predicted by TMB will never occur, and review of this case would be a waste of this Court’s resources.
I. This Court’s review is unwarranted because the Court of Appeals correctly held that the TMB letter articulated a new rule under the APA, which was invalid under Section 2001.035 of that Act.
A. The TMB letter satisfies the elements of Section 2001.003(6).
Under the APA, an agency statement is a “rule” if it is one “of general applicability that: (A) implements, interprets, or prescribes law or policy;” “(B) includes the amendment or repeal of a prior rule; and (C) does not include a statement regarding only the internal management or organization of a state agency and not affecting private rights or procedures.” Tex. Gov’t. Code § 2001.003(6). The court below had “little difficulty concluding that the substance and nature of” TMB’s June 2011 letter “distinguishes it as a rule.” 453 S.W.3d at 608. The pronouncements in TMB’s letter were statements of general applicability that implemented, interpreted, or prescribed policy; they included an amendment to a prior rule—Section 190.8(1)(L)(i)(II) of Title 22 of the Texas Administrative Code—and they affected private rights rather than internal TMB management.
TMB does not dispute that the letter is an agency statement or that its pronouncements implement, interpret, or prescribe policy. See Pet. 20-22. It does dispute that the letter’s pronouncements are statements of general applicability that affect private rights. See Id. at 21. But it simply ignores that the letter amended a prior rule. Tex. Gov’t. Code § 2001.003(6)(B). That was the principal contested element in the courts below, and the court of appeals found the letter’s departure from Rule 190.8(1)(L)’s plain text to be the most compelling factor in determining that the letter constituted an invalid rule. 453 S.W.3d at 608, 620.
Rule 190.8(1)(L) outlines what a doctor must do to establish a proper professional relationship with a patient. That relationship is a prerequisite for the doctor prescribing dangerous drugs or controlled substances to a person. Among the rule’s requirements is “establishing a diagnosis through the use of acceptable medical practices such as patient history, mental status examination, physical examination, and appropriate diagnostic and laboratory testing.” 22 Tex. Admin. Code § 190.8(1)(L)(i)(II) (emphasis added). Despite the term “such as” being universally understood to denote a non-compulsory, illustrative list of examples, 1 TMB’s letter threatened “disciplinary action against the participating doctors” in Texas unless they performed all four practices in that illustrative list, including (most importantly) a “face-to-face” physical examination. CR 17-18.
1 See, e.g., Teladoc, 453 S.W.3d at 617; Martinez v. Harris Cnty., 808 S.W.2d 257, 259 (Tex. App.—Houston [1st Dist.] 1991, writ denied) (holding that list of activities after “such as” was illustrative only and not exclusive); Bd. of Adjustment v. Levinson, 244 S.W.2d 281, 282-283 (Tex. Civ. App.—San Antonio 1951, no writ) (“The synonyms of ‘such as,’ are alike, similar, of the like kind; ‘such’ representing the object as already particularized in terms which are not mentioned, being a descriptive and relative word, referring to the specific articles mentioned.”).
An analogous rule, Rule 174.8, contains a similar list of practices for the separate telemedicine context. 22 Tex. Admin. Code § 174.8. There, TMB used notice-and-comment rulemaking to change the “such as” qualifier to “including,” thereby making all of the designated practices required in the telemedicine context.[2] TMB did not follow that practice for Rule 190.8(1)(L), however. Instead, TMB simply made pronouncements in its June 2011 letter to Teladoc, copying the Texas Medical Association. CR 17-19. The court of appeals correctly held that “TMB’s pronouncements in its June 2011 letter are tantamount to amendments to the existing text of Rule 190.8(1)(L)(i)(II), effectively substituting ‘including’ for ‘such as,’ thereby conforming it to the 2010 telemedicine rules.” 453 S.W.3d at 621.
As it did below, TMB frames this as a jurisdictional issue, arguing that “[t]he decision of the APA’s drafters to limit Section 2001.038’s immunity waiver to suits challenging the ‘validity of a rule’ was a deliberate one,” which limits jurisdiction to only those statements determined to be a “rule” under the APA. Pet. 10-11, 19-21. Teladoc agrees. But as the court of appeals properly noted, because the pronouncements in the June 2011 letter did constitute a rule, “Teladoc both properly 2 Specifically, in 2010, when promulgating the current version of Rule 174.8 identifying “acceptable medical practices, including patient history, mental status examination, physical examination . . . and appropriate diagnostic and laboratory testing,” TMB replaced the prior Rule 174.4, which had contained language parallel to Rule 190.8(1)(L)(i)(II), identifying “acceptable medical practices such as patient history, mental status examination, and appropriate diagnostic and laboratory testing.” Compare 35 Tex. Reg. 3392 (Apr. 30, 2010) (proposing the “including” language adopted as 22 Tex. Admin Code § 174.8, see 35 Tex. Reg. 9085 (2010)), with 29 Tex. Reg. 3896 (Apr. [23], 2004) (detailing the previous “such as” language, adopted as 22 Tex. Admin Code § 174.4, see 29 Tex. Reg. 6088-89 (2004)).
invoked the district court’s jurisdiction through section 2001.038 and established its entitlement to summary judgment on its declaratory claim under that statute, as it is undisputed that TMB did not promulgate the letter in accordance with the APA’s notice-and-comment rulemaking requirements.” 453 S.W.3d at 613-14.
B. The petition for review fails to identify flaws in the appellate court’s Section 2001.003(6) analysis.
TMB claims that the court of appeals made several errors in determining that the letter satisfied Section 2001.003(6)’s elements of a “rule.” Specifically, TMB contends that the letter was not a statement of general applicability, Pet. ix, 10, 20- 21, that it did not affect private rights, id. at 10, 21, and that the opinion applied with no limiting principle. Id. at 19, 23. Each contention is easily rejected.
First, while TMB argues repeatedly that the letter’s responsive nature— addressed to Teladoc in response to Teladoc’s advertising materials—somehow renders it a statement of limited, not general, applicability, Pet. 7, 10, 18, 20, it cites no authority for the underlying premise that a statement of general applicability cannot be made in direct response to a specific perceived problem. Indeed, using TMB’s logic, an agency’s statements would have general applicability only when the agency clairvoyantly foresees future problems and proactively elects to resolve them, not when it responds to an observed problem with a solution applicable to all.
TMB apparently is trying to invoke the distinct principle that agency statements made in the course of adjudicatory or similar proceedings, which are limited to the rights and interests of the parties subject to those proceedings, are not statements of general applicability. See, e.g., R.R. Comm’n. v. WBD Oil & Gas Co., 104 S.W.3d 69, 79 (Tex. 2003); Trinity Settlement Servs., LLC v. Tex. State Sec. Bd., 417 S.W.3d 494, 502 (Tex. App.—Austin 2013, pet. denied). The June 2011 letter was not, however, “an agency adjudicat[ion of] individual rights of parties through trial-type proceedings.” Trinity, 417 S.W.3d at 502. Rather, it was a statement of warning applicable to all Texas physicians. The letter opened by expressing “concern on the part of the Board for its licensed Texas physicians,” CR 17 (emphasis added), then proceeded to observe that TMB “does not believe that physicians in Texas can reply on your representations as to compliance with Texas board rules should they opt to participate in your program.” Id. (emphasis added). The letter warned that if a model like Teladoc’s is “followed by licensed Texas physicians, [it] will lead to disciplinary action against the participating doctors in the program.” CR 19 (emphasis added). Such language is plainly not directed solely at Teladoc, but at every licensed physician in Texas.
Indeed, TMB admits (as it must) that it sent the letter not just to Teladoc, but also to the Texas Medical Association, “the chief statewide association representing the Texas medical profession, with over 48,000 physician and medical student members.” 453 S.W.3d at 611. TMB argues that it “was merely doing its best to notify doctors who might be detrimentally relying on Teladoc’s mischaracterization of Rule 190.8(1)(L)(i)(II).” Pet. [21] n.5. But that explanation sounds a whole lot like what a statement of general applicability is intended to do—put everyone subject to agency oversight on notice.
TMB’s next argument, that the letter did not affect private rights, is even less persuasive. It consists solely of conclusory statements, bereft of argument or authority, id. at 10, 21, and should be summarily rejected.
TMB then charges that the Third Court’s opinion is “premised on semantics” and “merely promotes form over substance” because “[t]he court of appeals purportedly would not have asserted jurisdiction over this lawsuit had the Letter been phrased ‘tentatively.’” Pet. [9], 10, 13, 15, 19, 23. To support this conclusion, TMB refers repeatedly to the Third Court’s reassurance that TMB’s perceived parade of horribles (discussed in Part II below) is unlikely because the APA “defines ‘rule’ in a way that will exclude a considerable range of unofficial, individually directed, tentative or other non-proscriptive agency or staff issuances concerning law or policy.” 453 S.W.3d at 621-22 (emphasis added).
That simple clarification by the court of appeals—that the APA excludes a considerable range of statements from its definition of a rule, including tentative statements—is a far cry from TMB’s misleading characterization, that the opinion below welcomes “a slate of new APA claims any time an agency makes a statement that isn’t phrased in ‘tentative’ terms.” Pet. 10. Of course a statement phrased in tentative terms will avoid an APA challenge (because, for example, it would not affect private rights). But so will any agency statement that does not satisfy all of the Section 2001.003(6) elements. The inquiry is not simply whether a statement is tentative, but whether it is a generally applicable statement that implements policy, affects private rights, and amends a prior rule. Hence the “considerable range” of statements that the court below assured TMB it could make without fear of APA challenge.
TMB doubles down on this argument, claiming that it “is difficult to find a meaningful limiting principle to the court of appeals’ holding.” Pet. 19; see also id. at 23. But the “limiting principle” is the very principle that TMB assiduously ignores throughout its petition: when the other Section 2001.003(6) factors are present, and the disputed agency statement “departs from [a prior] rule’s unambiguous text to an extent as to effectively rewrite it,” the statement is a rule under the APA and must be passed with formal rulemaking. 453 S.W.3d at 618; see also El Paso Hosp. Dist. v. Tex. Health & Human Serv., 247 S.W.3d 709, 714-
15 (Tex. 2008) (finding that the commission’s “interpretation” actually “amends another rule . . . thus meeting the second criteria of a rule”).
It is that simple. The June 2011 letter is an agency statement of general applicability that implements, interprets, or prescribes policy, departs from the plain text of a prior rule it purports to interpret, and affects the private rights of all doctors regulated by TMB. The court of appeals properly held that the letter was a rule under the APA that bypassed notice-and-comment rulemaking, and is thus invalid under Section 2001.035 of the APA. 453 S.W.3d at 620.
II. This Court’s review is unwarranted because the court of appeals opinion will have none of the disruptive effects that TMB predicts.
TMB urges review based on its repeated predictions of dire consequences that await Texas courts, administrative agencies, and all regulated entities if the appeals court’s holding is allowed to stand. Pet. viii, 2, 9, 11-15. Specifically, TMB predicts that the “ruling will flood the courts with rule-validity challenges,” will “incentivize agencies to do nothing to explain their actions beyond putting their own rules in block quotations,” and will leave regulated entities “without an explanation, [such that] the entity would have to merely guess at the basis for the alleged violation.” Pet. [9], 13-14. None of these alarming consequences will occur.
A. The opinion below will not excessively burden agencies.
TMB contends that the “Third Court’s approach hamstrings agencies by effectively requiring them to pursue lengthy, formal rulemaking procedures any time they need to alert regulated entities that those entities are violating a statute or administrative rule.” Pet. viii, 9, 11-12. But that is not what the court below held. The court held that the letter was an improperly promulgated rule not because it “alert[ed] regulated entities” to the law, but because it changed it by departing from Rule 190.8(1)(L)’s plain text.[3] Had the letter merely “alerted” Teladoc to Rule 190.8(1)(L), it would not have been a rule under Section 2001.003(6); hence formal rulemaking would have been unnecessary. See, e.g., Tex. Dept. of Transp. v. Sunset Transp., 357 S.W.3d 691, 703-04 (Tex. App.—Austin 2011, no pet.). But it did not merely “alert.” It attempted to “effectively rewrite” Rule 190.8(1)(L)(i)(II) by “substituting ‘including’ for ‘such as.’” 453 S.W.3d at 618, 620.
As noted above, TMB actually used notice-and-comment rulemaking in 2010 to change “such as” to “including” in the analogous context of telemedicine rules. See Part I.A. supra. This history “betrays not only TMB’s understanding of the significant difference in meaning of ‘including’ versus ‘such as,’ but its awareness that a change between the two must properly be achieved through the APA’s notice-and-comment rulemaking processes and not by the naked fiat it relies on here.” 453 S.W.3d at 619-20.
Indeed, after the opinion below was issued, TMB actually undertook notice- and-comment rulemaking to change the very language at issue in Rule 190.8(1)(L) itself. On February 23, 2015, TMB proposed changes to Rule 190.8(1)(L), which would remove “such as” and replace it with “which includes documenting and performing,” the existing list of four practices. [40] Tex. Reg. 1019. The proposed change also adds a clarification that the physical examination “must be performed by either a face-to-face visit or in person evaluation . . . .” Id. 4 TMB has thus—by its own actions—accepted that the change to Rule 190.8(1)(L) that it tried to make with the June 2011 letter is properly made through formal rulemaking. 5
The opinion below neither incentivizes agencies to be opaque, Pet. [9], 13, nor limits them to TMB’s “three options” of instituting proceedings without warning,
4 The new rule has not yet gone into effect. On May 29, 2015, the U.S. District Court for the Western District of Texas granted a preliminary injunction, temporarily halting the rule, based on its anticompetitive effects, which include increased prices, reduced patient choice and access, reduced innovation, and reduced availability of physician services. See Teladoc v. Tex. Med. Bd., No. 1:15-cv-00343-RP, slip op. at 8-9 (W.D. Tex. May 29, 2015), attached as Appendix Tab A. 5 Moreover, it is difficult to see how TMB’s having already undertaken formal rulemaking to amend Rule 190.8(1)(L) does not render this appeal moot, or in any event, unworthy of this Court’s review. See, e.g., Tex. Logos, L.P. v. Tex. Dep’t of Transp., 241 S.W.3d 105, 114 (Tex. App.—Austin 2007, no pet.) (noting the requirements of “(1) a justiciable controversy as to the rights and status of parties actually before the court for adjudication; and (2) that will be actually resolved by the declaration sought”); Dewhurst v. Hendee, 253 S.W.3d 320, 332–33 (Tex. App.— Austin 2008, pet. dism’d) (expiration of biennium rendered moot claims challenging legality of legislative appropriations for that biennium). After all, if Teladoc prevails on the merits of its federal antitrust suit, neither the June 2011 letter nor the formal rule that was subsequently passed will be effective, and this case will resolve nothing. If Teladoc loses in its federal action, then the new rule will presumably take effect (subject to any challenges that may be brought on substantive or procedural grounds) and this case will still resolve nothing.
engaging in notice-and-comment rulemaking, or simply doing nothing. Id. at 2. In truth, the opinion below encourages agency transparency by reiterating the requirement that informal agency guidance be consistent with the language of the rule it purports to interpret. See, e.g., Tex. State Bd. of Pharmacy v. Witcher, 447 S.W.3d 520, 533, 536 (Tex. App.—Austin 2014, pet filed) (finding “a quintessential example” of impermissible ad hoc rulemaking where the existing rule listed many factors that “may be considered” for determining disciplinary action for pharmacists, but the Pharmacy Board elevated one “as an outcome-determinative factor”).
B. The opinion below will neither “drastically expand” Texas court dockets nor arrogate power to the judiciary at agency expense.
TMB further contends that the appeals court’s “interpretation will drastically expand” the dockets of Texas courts, Pet viii, and “flood the courts with rule-validity challenges.” Id. at 9. Continuing the hyperbole, TMB insists that the decision below has “elevat[ed] judicial power at the expense of specialized administrative agencies,” id., and has set courts up to “second-guess every interpretive utterance an agency makes,” id. at 12. In reality, nothing of the sort has occurred or will occur.[6]
6 In fact, if the opinion below prompted any attempted arrogation of power, it was by TMB, not the courts. Two weeks after the opinion issued, TMB held an emergency meeting and adopted a purported “emergency” amendment to Rule 190.8, mandating a “face-to-face visit or in-person evaluation” before a physician can issue a drug prescription—a move that was in direct response to, and inconsistent with, the lower court’s opinion. The professed “purpose of the emergency amendment is to protect the public health and welfare.” Appendix Tab B (Memo from Scott Freshour, TMB General Counsel (Jan. [16], 2015)). The Travis County District Court enjoined the purported emergency rule after a February 6, 2015 temporary injunction hearing, holding that “[n]o imminent peril to public health, safety or welfare existed on January 16, 2015, or exists at the present time to justify adoption of the emergency rule and it is invalid.” Appendix Tab C As explained above, the court of appeals correctly determined that the letter was an improper rule because it satisfied all the elements of Section 2001.003(6). Had it not done so, it would not be a rule subject to challenge under Section 2001.038.
In other words, courts will see no increase in rule-validity challenges because the court of appeals merely followed its and this Court’s recent precedent that when an agency statement of general applicability affects private rights, prescribes policy, and “amends another rule,” its failure to go through formal rulemaking is subject to judicial review under Section 2001.038. El Paso Hosp. Dist., 247 S.W.3d at 714- 15; Entm’t Publ’ns, 292 S.W.3d at 718-19. When, on the other hand, the agency has not departed from its earlier administrative policy, is otherwise consistent in its administrative guidance, or merely restates a published rule, there is no need (or, for that matter, jurisdiction) for judicial review.7 Had TMB’s June 2011 letter not purported to interpret Rule 190.8(1)(L) to require all four practices in the illustrative “such as” list, the letter would not have satisfied APA Section 2001.003(6)(B)’s definition of “rule.” This action would never have been brought, and courts would have lacked jurisdiction under Section 2001.038 if the suit had been attempted.
(Temporary Injunction Order, Teladoc v. Tex. Med. Bd., et al, No. D-1-GN-15-00238). It was only after having this second attempted end-run quashed that TMB finally began formal rulemaking. 7 See, e.g. Tex. Dept. of Transp. v. Sunset Transp., 357 S.W.3d 691, 703-04 (Tex. App.— Austin 2011, no pet.) (“[A]n informal agency statement that does no more than restate its own formally promulgated rules would not in itself be a ‘rule.’”); Tex. Mut. Ins. Co. v. Vista Cmty. Med. Ctr., L.L.P., 275 S.W.3d 538, 556 (Tex. App.—Austin 2008, no pet.) (“The 2005 Staff Report did not affect private rights because it did not change or amend” a formally promulgated rule).
C. Regulated entities will not be left without guidance.
For the same reasons agencies will not be hamstrung by the lower court’s opinion, regulated entities will not be starved for guidance, as TMB predicts. See Pet. [9], 13-14. The opinion below does not preclude informal agency guidance. It merely reiterates the rule, consistently applied by this Court and the Third Court of Appeals, that informal guidance may not consist of statements that reasonably appear to “amend[] or repeal . . . a prior rule.” Tex. Gov’t Code § 2001.003(6)(B); see El Paso Hosp. Dist., 247 S.W.3d at 714-15; Witcher, 447 S.W.3d at 534; Sunset Transp., 357 S.W.3d at 703.
TMB urges that “where a statute or formally promulgated rule permits reasonable, alternative constructions, the agency’s guidance to the public is most valuable.” Pet. [16]. Teladoc agrees. But this is not such a case. TMB’s letter did not, as TMB claims, merely make a “permissible resolution of an ambiguity.” Id. It took an unambiguous phrase from a published rule that had a single, reasonable construction—“such as,” and substituted for it a word with an inconsistent meaning—“including.” Making mandatory every item in a list of illustrative examples is not a “reasonable, alternative construction” of Rule 190.8(1)(L)’s “such as” qualifier any more than making dispositive a single factor in a list of many alternative factors that “may be considered” in determining disciplinary sanctions for pharmacists was reasonable in Witcher. See 447 S.W.3d 533.
III. This Court’s review is unwarranted under Government Code Section 22.001(a).
Review is also unwarranted here because this case meets none of the six jurisdictional criteria identified in Government Code Section 22.001(a). The justices below were unanimous in their opinion; the opinion was consistent with prior case law from this Court and the courts of appeals; the case does not involve the validity of a statute or state revenue; the Railroad Commission is not a party; and, while the subject matter of this case is important to Teladoc, to its affiliated physicians, and to the millions whose insurers give them access to Teladoc services, there is no legal error in the opinion below of such importance to Texas jurisprudence to warrant this Court’s review.
TMB presents a purported inconsistency in the case law, which supposedly requires this Court to “step in to provide clear guidance to agencies and the public.” Pet. 16-17. How, TMB muses, can the statements in Witcher and TABC v. Amusement & Music Operators of Texas be “rules,” while those in Brinkley v. Texas Lottery Commission and Beacon National Insurance Co. v. Montemayor are not? Id. TMB then invokes Professor Beal’s “miry bog” epithet to charge that the Third Court is hopelessly confused and needs this Court’s guidance.
While the court below conceded that this is a “notoriously muddled corner of the law,” 453 S.W.3d at 616, it also correctly observed that the dispositive factor in this case “is perhaps one of the few that can be discerned with ‘relative certainty.”
Id. (quoting Sunset Transp., 357 S.W.3d at 703). Whether the statements in Witcher, Brinkley, TABC, and Beacon were rules or not turned on the facts of those cases and judicial interpretation of various Section 2001.003(6) factors where lingering confusion may persist. But one thing is abundantly clear: “an agency’s ‘interpretations’ or ‘applications’ of existing formally promulgated rules will themselves be held to be ‘rules’ where they have the effect of amending the existing rules, or of creating new rules, and the other requirements of the APA’s ‘rule’ definition are met.” 453 S.W.3d at 616 (citing El Paso Hosp. Dist., 247 S.W.3d at 714-15 (holding agency statement to be a “rule” despite the agency’s insistence that it “is not a rule itself, but rather its interpretation of the [existing] rule”)). Because the June 2011 letter departed so plainly from the text of the rule it purported to interpret, the court of appeals found this to be an easy case and had “little difficulty concluding that [it was] a rule under the APA.” 453 S.W.3d at 608.
As such, even if this Court were otherwise inclined to wade into what may or may not be a “miry bog” of Section 2001.038 jurisprudence, this case is not the appropriate vehicle to provide further guidance because it was decided on clear and settled principles that are neither “miry” nor “muddled.”
CONCLUSION
For all of these reasons, Teladoc respectfully requests that the Court deny TMB’s petition for review.
Respectfully submitted, BAKER BOTTS L.L.P.
By: /s/ Benjamin A. Geslison Thomas R. Phillips State Bar No. 00000102 98 San Jacinto Blvd, Ste 1500 Austin, Texas 78701 T: 512-322-2565 F: 512-322-8363 [email protected] Benjamin A. Geslison State Bar No. 24074269 One Shell Plaza 910 Louisiana Street Houston, Texas 77002-4995 T: 713.229.1234 F: 713.229.2841 [email protected] JACKSON WALKER L.L.P.
Matt Dow State Bar No. 06066500 Dudley McCalla State Bar No. 13354000 100 Congress Ave, Suite 1100 Austin, TX 78701 [email protected] [email protected] Attorneys for Respondent Teladoc, Inc.
INDEX TO APPENDIX
Tab A Teladoc v. Texas Medical Board, No. 1:15-cv-00343-RP (W.D. Tex. May 29, 2015) order granting preliminary injunction. Tab B Memorandum from Scott Freshour, TMB General Counsel, announcing the emergency amendment to rule 190.8 (Jan. [16], 2015). Tab C Temporary Injunction Order, Teladoc v. Tex. Med. Bd., et al, No. D- 1-GN-15-00238 (Feb. [6], 2015).
TAB A
STATEMENT OF FACTS
The court of appeals correctly stated the nature of the case.
Regulatory background. The Board is an executive agency empowered “to regulate the practice of medicine” through rulemaking and adjudications. TEX. OCC. CODE § 152.001(a). The Legislature granted it the broad authority to “adopt rules and bylaws as necessary to . . . regulate the practice of medicine[] and enforce this subtitle.” Id. § 153.001(3)(4). The Board’s specific duties include disciplining license holders “on determining a violation of this subtitle or a board rule.” Id. § 164.001(a). The initiation of disciplinary proceedings typically results from complaints by members of the public. See id. § 154.051. Disciplinary hearings are conducted via formal or informal contested-case procedures and are subject to judicial review. Id. §§ 164.003, 164.007, 164.009.
One ground for a disciplinary action is the “fail[ure] to practice medicine in an acceptable professional manner consistent with public health and welfare.” Id. § 164.051(a)(6). Under its statutory delegation of authority, the Board formally promulgated a rule—unchallenged by Teladoc here—to elaborate on this ground: “Failure to practice in an acceptable professional manner consistent with public health and welfare within the meaning of the Act includes, but is not limited to . . . prescription of any dangerous drug or controlled substance without first establishing a proper professional relationship with the patient.” 22 TEX. ADMIN. CODE § 190.8(1)(L). The rule further defines this category with the language that is the subject of the instant dispute: “A proper relationship, at a minimum requires . . . establishing a diagnosis through the use of acceptable medical practices such as patient history, mental status examination, physical examination, and appropriate diagnostic and laboratory testing. An online or telephonic evaluation by questionnaire is inadequate . . . .” Id. § 190.8(1)(L)(i)(II) (emphasis added). Any license holder who violates section 190.8(1)(L)(i)(II) may be disciplined by the Board.
The Board has long interpreted that text to require all four practices to establish a professional relationship. Over the years— beginning well before the Board sent the Letter to Teladoc—the Board has used Rule 190.8 to discipline license holders who prescribed drugs over the telephone or internet without first conducting a face-to-face examination. See CR.40-46 (relevant adjudicatory proceedings).
Teladoc’s business and the instant dispute. Teladoc calls itself a “telehealth provider.” CR.171. It offers medical advice solely via telephone, not through in-person or even video consultations. See CR.212-14. Its physicians thus never see their patients. See, e.g., CR.174 (“Teladoc’s participating physicians do not conduct face-to-face consultations or physical examinations . . . .”).
Nevertheless, Teladoc advertised to the public—including Texas physicians that might participate with Teladoc—that Teladoc’s business model complied with the Board’s rules. See CR.197-98. Faced with a company misrepresenting the rules’ restrictions, the Board’s general counsel Nancy Leshikar responded by sending Teladoc a letter expressing concern that Teladoc’s physicians may be violating Rule 190.8(1)(L)(i)(II): “Tel[a]doc’s advertising material has multiple statements indicating that its process can be conducted over the telephone without any prior establishment of a physician/patient relationship via a ‘face-to-face’ examination.” CR.197. For instance, the Letter noted that Teladoc represented that its physicians treat patients “via remote telephone consultations.” Id. Leshikar concluded: “[A]ny representation that [Teladoc] make[s] regarding Tel[a]doc’s program being in conformance with the Board’s rules will be directly and firmly refuted by the Board.” CR.198. Because the Board didn’t know the identity of Teladoc’s doctors, cf. CR.72-73 (discussing Board’s discovery request for identity of Teladoc doctors), the Board sent a copy of the Letter to the vice president and general counsel of the Texas Medical Association, a medical society representing Texas physicians and medical students.
Teladoc filed its original petition shortly thereafter, claiming that the Letter was an invalid, unpublished “rule” under the APA. CR.5, 15. Teladoc deposed Leshikar and the Board’s Executive Director, Mari Robinson. Leshikar testified that the four practices listed in Rule 190.8(1)(L)(i)(II) are the “minimum” level of acceptable medical practices to establish a diagnosis. CR.237. Likewise, Robinson stated that the rule “require[s] a patient history, mental status exam, physical examination, and appropriate laboratory testing.” CR.231. Based on this testimony about what the Board’s rules require, Teladoc amended its petition to include claims that these deposition statements also constitute invalid, unpublished “rules.” CR.175-76, 179, 180-81.
The parties filed cross-motions for summary judgment, and the trial court held that the Letter is not a “rule” and issued judgment for the State. See CR.386-87. The court also entered a supersedeas order, purporting to rely on Texas Rule of Appellate Procedure 24.2(a)(5) to suspend enforcement of the judgment. CR.389.
The Third Court of Appeals reversed and rendered judgment “declaring that [the Board’s] pronouncements regarding Rule 190.8(1)(L)(i)(II)” in the Letter are an invalid “rule.” Teladoc, 2014 WL 7464833, at[*13] . The court held that the Letter is a “state agency statement” that “implements, interprets, or prescribes law or policy” by “implement[ing] a broader policy judgment by the Board . . . that the creation of a new physician-patient relationship should generally entail an in-person physical examination.” Id. at *6. The Letter thus also “impact[ed] private rights and not merely internal agency management or organization.” Id. Despite the fact that the Letter was a direct response to Teladoc’s misrepresentations, the court further held that the Letter constituted a “statement of general applicability” because it was also sent to the general counsel of the Texas Medical Association, thereby “plac[ing] the regulated public—Texas physicians—on notice.” Id. at *7.
The court also found that even resolving an ambiguity in Rule 190.8 “would have a legal effect on private parties beyond . . . the text of Rule 190.8[] alone.” Id. at 10.
REASONS TO GRANT THE PETITION
• The line between “rule” and policy statement limits courts’ ability to interfere with the executive’s constitutional discretion. The decision here epitomizes the Third Court’s elevation of judicial power at the expense of specialized administrative agencies.[3] This is all the more problematic given that, in evaluating the jurisdictional issue, the court refused to afford the Board deference regarding the interpretation of its own formally promulgated rule. The Board’s sensible attempt to refute Teladoc’s misstatement should not have opened the courthouse doors.
• The court of appeals purportedly would not have asserted jurisdiction over this lawsuit had the Letter been phrased “tentatively.” But a legal rule premised on semantics merely promotes form over substance. • The court of appeals’ ruling will flood the courts with rule-validity challenges: any agency statement, regardless of context or intent, might waive the State’s immunity so long as the statement isn’t “unofficial, individually directed, [or] tentative,” descriptors that set only vague and hollow limits on the court’s interpretation. Teladoc, 2014 WL 7464833, at[*11] .
• The court’s decision will also incentivize agencies to do nothing to explain their actions beyond putting their own rules in block quotations. The APA is not designed, however, to prevent administrative bodies from communicating with the public. A rational interpretation of the statute should encourage agencies to be more, not less, transparent.
SUMMARY OF THE ARGUMENT
The court of appeals’ decision throws open the courthouse doors to a broad range of APA challenges based on mere semantics, regardless of the intent or context of the agency’s statement. The upshot is a slate of new APA claims any time an agency makes a statement that isn’t phrased in “tentative” terms. Afraid that they might not meet this “tentative” standard, agencies will be less apt to issue any guidance, thereby depriving regulated entities of valuable information and harming the public.
Those are not the consequences of reasonable interpretations of the term “rule” and section 2001.038’s immunity waiver. To the contrary, that waiver must be strictly construed to preserve executive agencies’ immunity. Because the Board’s Letter merely responded to Teladoc’s own misstatements in an effort to allow Texas physicians to reform their conduct to avoid disciplinary proceedings under Rule 190.8, the Letter is not a statement of general applicability that itself affected private rights.
ARGUMENT
The decision of the APA’s drafters to limit section 2001.038’s immunity waiver to suits challenging the “validity or applicability of a rule” was a deliberate one. The Legislature could have empowered courts to adjudicate declaratory claims regarding any interpretive agency statement. But it instead restricted this jurisdiction to considering the validity of “statement[s] of general applicability” that “affect[] private rights or procedures.” TEX. GOV’T CODE § 2001.003(6); see id. § 2001.038(a). The Third Court’s interpretation removes any meaningful jurisdictional limit on that text and conflicts with Government Code section 2001.034’s requirement of strict construction of immunity waivers. And the result of that flawed legal analysis is predictably problematic for courts, agencies, and regulated entities hoping for more, not less, transparency from the government.
I. THE COURT OF APPEALS’ IMPERMISSIBLY BROAD INTERPRETATION OF THE TERM “RULE” CREATES AN UNTENABLE SITUATION FOR THE JUDICIARY AND STATE AGENCIES.
A. The Definition Of “Rule” Is Important To Texas Courts, Administrative Agencies, And The Public.
The Third Court’s interpretation of “rule” has pernicious consequences for the judiciary, the executive, and the public, as well as the relationships between the three.
As to the judiciary, the APA’s limited waiver protects the courts’ scarce resources. In a state as large as Texas, administrative agencies issue an untold number of pronouncements every month, as part of informal and formal requests, memoranda, and proceedings. Not every decision can (or should) be made through the APA’s formal processes. If a private party can challenge any statement that is phrased in definitive language—even if there is no grant of judicial review—section 2001.038 lawsuits may overwhelm the courts. Cf. Tex. State Bd. of Pharmacy v. Witcher, 447 S.W.3d 520, 529 (Tex. App.—Austin 2014, pet. filed) (allowing challenge to statement contained in contested-case ruling).
That limited waiver also preserves the appropriate functioning of both government departments. Properly construed, the APA allows agencies—which are subject to political pressure through the executive— to engage in policymaking without undue intrusion from the courts. The judiciary steps in only to determine the “validity or applicability” of agency action that concretely affects private parties. By contrast, courts do not stand ready to second-guess every interpretive utterance an agency makes, for that would impermissibly interject the courts into the details of executive functions. The Third Court’s decision here upsets that careful balance struck by the APA.
And as to that agency policymaking function itself, the court of appeals’ interpretation incentivizes agencies to provide less information to regulated entities or, at best, to provide information in a vague or ambiguous manner, lest it cross the line from “tentative” to definite. If the Letter here constitutes a “rule,” consider the alternatives left to an agency, like the Board, that wishes to alert a regulated entity that it is violating a statute or regulation. First, the agency could, without warning, simply initiate administrative proceedings. The agency’s interpretation of the regulation would be entitled to deference on judicial review. See, e.g., Gulf Coast Coal. of Cities v. Pub. Util. Comm’n, 161 S.W.3d 706, 712 (Tex. App.—Austin 2005, no pet.). This is plainly a poor option. Among other problems, it would increase costs for both the agency and the regulated entity, and would likely create needless friction between the parties.
Second, the agency could send correspondence stating that the entity is violating a rule but without providing any additional explanation because, under the court of appeals’ reading of the APA, any “non-tentative” explanation would subject the agency to an APA rule- validity challenge. But without an explanation, the entity would have to merely guess at the basis for the alleged violation. This option thus adds little value for a regulated entity that is not knowingly and willfully violating the Texas Administrative Code.
That leaves the two impractical options the court of appeals favors. One way for the agency to retain its independence from judicial interference is to initiate rulemaking proceedings under the APA each time it wants to notify a regulated entity of a possible violation. But that option is unworkable, inefficient, and overly restrictive, as the Third Court previously recognized:
Agencies would be reduced to impotence, however, if bound to express their views as to “law,” “policy,” and procedural “requirements” through contested-case decisions or formal rules exclusively; and they could not under such a theory exercise powers explicitly delegated to them by the legislature. . . . If every expression by the agency as to “law,” “policy,” and procedural “requirements” requires the promulgation of a formal rule, the agency could no longer exercise its “informed discretion” to choose adjudication as a means of making law and policy, rather than rulemaking, a choice we have repeatedly said an agency has when it possesses both adjudicatory and rulemaking powers. Brinkley v. Tex. Lottery Comm’n, 986 S.W.2d 764, 769 (Tex. App.—Austin 1999, no pet.); see also id. at 770 (noting “the straight-jacket of rulemaking”).
The other course is to avail itself of what the Third Court evidently (but erroneously) believed was a meaningful constraint on its decision: issue statements that are “unofficial, individually directed, tentative or other[wise] non-proscriptive.” Teladoc, 2014 WL 7464833, at[*11] . It’s difficult to see the sense of this approach. In the first place, the Letter itself was “unofficial” and “individually directed.” More importantly, there is no rational reason for the result here to differ had the Letter said that Texas physicians’ reliance on Teladoc’s misstatements about Rule 190.8 “may lead to disciplinary action,” instead of writing that such reliance “will lead to disciplinary action.” CR.198 (emphasis added). The law—especially an immunity waiver—should not turn on such semantics and formulaic niceties.
In sum, the only sensible option is precisely what the Board did here (and precisely what the Third Court approved in other cases, see infra Part I.B), namely, alert Teladoc and others who may have relied on Teladoc’s misstatements that the Board disagrees with Teladoc’s views.
The APA should be interpreted to encourage an agency to warn regulated entities, not to penalize it for doing so. See Brinkley, 986 S.W.2d at 770 (“The definition in section 2001.003(6) is sufficiently flexible to allow agencies to perform their functions without unnecessary procedural obstacles.”). This situation is exacerbated by the court’s treatment of interpretive deference owed to agencies. The court held that even a permissible resolution of an ambiguity offends section 2001.038. Teladoc, 2014 WL 7464833, at[*10] . But where a statute or formally promulgated rule permits reasonable, alternative constructions, the agency’s guidance to the public is most valuable. This important matter warrants the Court’s involvement.
B. The Third Court Of Appeals’ Decisions On This Issue Conflict With Each Other.
Adding uncertainty to a bad situation, the Third Court’s decisions interpreting the term “rule” reach conflicting results without any principled explanation for the differing outcomes.[4]
For instance, the court has held not to be “rules”: • Lottery Commission letters purporting “to make licensees aware of the agency’s position and to afford an opportunity to licensees for voluntary compliance,” Brinkley, 986 S.W.2d at 771 n.10 (emphases removed); see id. (noting that agency explained “that the ‘Eight-liner’ is a gambling device . . . and is therefore illegal,” and promised to
4 Cf. Ron Beal, Substantive and Interpretive Rules: The Judiciary Continues to Struggle to Define Them and to Determine Their Legal Validity and Effect, 12 TEX. TECH ADMIN. L.J. 55, 64 (2010) (calling two Third Court decisions “directly inconsistent” with each other and describing that court’s jurisprudence as a “miry bog”).
“initiate an appropriate administrative disciplinary action” for illegal operations); and • A letter sent to the plaintiff in which the agency allegedly “reversed [the agency’s] position” interpreting a form promulgated by the agency and promised to “institute an administrative enforcement action,” Beacon Nat’l Ins. Co. v. Montemayor, 86 S.W.3d 260, 264-65 (Tex. App.—Austin 2002, no pet.).
By contrast, the court has held to be rules, in addition to the Letter here:
• TABC memoranda setting out the “elements that make a[n] [eight-liner gambling] machine illegal,” TABC v. Amusement & Music Operators of Tex., Inc., 997 S.W.2d 651, 654 (Tex. App.—Austin 1999, pet. dism’d w.o.j.); and • An explanation of longstanding agency policy stated in a contested-case order, Witcher, 447 S.W.3d at 529.
This Court should step in to provide clear guidance to agencies and the public regarding what kinds of agency statements must proceed through formal rulemaking.
II. THE THIRD COURT OF APPEALS ERRONEOUSLY INTERPRETED THE TERM “RULE” TO INCLUDE THE BOARD’S LETTER.
“Not every statement by an administrative agency is a rule for which the APA prescribes procedures for adoption and for judicial review.” Tex. Educ. Agency v. Leeper, 893 S.W.2d 432, 443 (Tex. 1994). Indeed, as the Third Court previously explained, “[a]gencies would be reduced to impotence . . . if bound to express their views as to ‘law,’ ‘policy,’ and procedural ‘requirements’ through contested-case decisions or formal rules exclusively.” Brinkley, 986 S.W.2d at 769. That sensible interpretation also is required by the Code Construction Act’s mandate that immunity waivers be strictly construed. This Court should therefore reject the Third Court’s flawed, overbroad interpretation of “rule.”
A. Sections 2001.038 And 2001.003(6) Must Be Strictly
Construed To Preserve The State’s Sovereign Immunity.
Waivers of immunity must be strictly construed. See, e.g., Prairie View A & M Univ. v. Chatha, 381 S.W.3d 500, 513 (Tex. 2012); TEX. GOV’T CODE § 311.034. That principle “applies to both the existence and the extent of the waiver.” City of LaPorte v. Barfield, 898 S.W.2d 288, 297 (Tex. 1995), superseded by statute on other grounds. Accordingly, ambiguities must be resolved in favor of retaining immunity. Wichita Falls State Hosp. v. Taylor, 106 S.W.3d 692, 697 (Tex. 2003).
The decision here does just the opposite. Any agency statement— regardless of context or intent—might subject the State to a lawsuit. Here it was a letter responding to Teladoc’s misstatement. But this isn’t the Third Court’s only recent overreach. In Witcher, for example, another case pending in this Court, the court of appeals held that a contested- case decision’s explanation of the agency’s longstanding position could be challenged under section 2001.038. See 447 S.W.3d at 529.
It is difficult to find a meaningful limiting principle to the court of appeals’ holdings. As noted above, the court purported to carve out “unofficial, individually directed, tentative or other[wise] non- proscriptive” statements. Teladoc, 2014 WL 7464833, at[*11] . But how the Board was supposed to squeeze through that opening remains unclear. Simply couching communications with words like “might” is hardly a principled rule of law.
B. The Third Court Of Appeals’ Interpretation Of “Rule” Misinterprets The Limited Judicial Review Afforded By The APA.
The background presumption of Texas law is that, apart from constitutional claims, there is no basis for judicial review of executive action. See, e.g., Gen. Servs. Comm’n v. Little-Tex Insulation Co., 39 S.W.3d 591, 599 (Tex. 2001). The APA thus allows suits “only in certain, narrowly defined circumstances.” TDCJ v. Miller, 51 S.W.3d 583, 587 (Tex. 2001) (interpreting Tort Claims Act). The Court therefore “must look to the terms of the [statute] to determine the scope of its waiver” in light of “the particular facts of the case.” Id. (citation and internal quotation marks omitted).
Section 2001.038 limits jurisdiction to claims contesting the “validity or applicability” of a “rule.” TEX. GOV’T CODE § 2001.038(a). In turn, a “rule”
(A) means a state agency statement of general applicability that:
(i) implements, interprets, or prescribes law or policy; or (ii) describes the procedure or practice requirements of a state agency;
(B) includes the amendment or repeal of a prior rule; and (C) does not include a statement regarding only the internal management or organization of a state agency and not affecting private rights or procedures.
Id. § 2001.003(6). The Third Court’s interpretation of “rule,” taken in context of the APA as a whole and essential principles of sovereign immunity, is flawed in several respects.
First, the Letter does not fit a reasonable construction of the plain text. The Board responded to Teladoc’s misstatements so that Teladoc’s doctors have the opportunity to reform their conduct. And the Board directed the Letter at a single entity and merely warned that the entity was violating an administrative regulation.5 This is not a “statement of general applicability” that “affect[s] private rights.” Id. § 2001.003(6)(A), (C).
The context of the statement and the agency’s intent should matter. See Combs v. Entm’t Publ’ns, 292 S.W.3d 712, 722 (Tex. App.—Austin 2009, no pet.) (stating that courts must “consider the intent of the agency . . . and the context in which the agency statement was made” (citing Leeper, 893 S.W.2d at 443)). The Letter described policy, but did not create it. It is absurd to think that if the Board initiated a disciplinary proceeding against a Teladoc physician, it would cite the Letter as a basis for its action. Rather, the Board would rely on—and enforce—the statute and formally promulgated rules, as indeed it has done for years. Cf. CR.40-46.6 The Third Court’s approach also cannot be squared with the purpose of a rule-validity challenge. That type of claim prevents an agency from achieving the same result as formal rulemaking without actually engaging the rulemaking process. But any such characterization of the Letter is unavailing. The Board has been enforcing the Letter’s “interpretation” of Rule 190.8 for years; the Letter needed to make that understanding explicit now only because Teladoc itself made statements to the contrary.
The federal APA provides a stark but useful contrast. Whereas Texas law requires strict construction of immunity waivers and doesn’t contain a background right to judicial review of executive action, see, e.g., Little-Tex, 39 S.W.3d at 599, federal administrative law presumes the availability of review of administrative action. See, e.g., Block v. Cmty. Nutrition Inst., 467 U.S. 340, 348-49 (1984); see Prof’ls & Patients for Customized Care v. Shalala, 56 F.3d 592, 595 (5th Cir. 1995) (“The APA’s notice and comment exemptions must be narrowly construed.” (citation and internal quotation marks omitted)). Federal courts thus review a distinctly broader class of cases, including those involving interpretive rules. See, e.g., Prof’ls & Patients, 56 F.3d at 595-96; see also 5 U.S.C. §§ 551(4), 553(b)(A), 553(d)(2), 704; Am. Tort Reform Ass’n v. Occupational Safety & Health Admin., 738 F.3d 387, 395-96 (D.C. Cir. 2013). The drafters of Texas’s APA, however, deliberately selected a narrower immunity waiver, a choice that is consistent with general Texas administrative-law principles.
Second, the court of appeals’ construction has no limiting principle. Indeed, it comes close to allowing jurisdiction merely to consider interpretations of agency statements, even though section 2001.038 contemplates challenges only to the “validity or applicability” of the purported rule.
Third, the perverse results of the court’s interpretation reflect its interpretive defects. As discussed supra Part I.A, the court of appeals’ view hamstrings agencies, encouraging them to offer less information and explanation (or none at all) or to couch every statement in vague or tentative language. Neither the public nor the executive is served by such an incentive. A reasonable interpretation of the APA should promote communications like the Letter, not penalize them.
PRAYER
The Court should grant the petition for review, reverse the court of appeals’ judgment, and render judgment dismissing the case for want of jurisdiction.
Respectfully submitted.
KEN PAXTON SCOTT A. KELLER
Attorney General of Texas Solicitor General CHARLES E. ROY /s/ Douglas D. Geyser First Assistant Attorney DOUGLAS D. GEYSER General Assistant Solicitor General State Bar No. 24059817 TED A. ROSS Assistant Attorney General OFFICE OF THE ATTORNEY GENERAL P.O. Box 12548 (MC 059) Austin, Texas 78711-2548 Tel.: (512) 936-2540 Fax: (512) 474-2697 [email protected] COUNSEL FOR PETITIONERS
CERTIFICATE OF SERVICE
On April 2, 2015, the foregoing Petition for Review was served via File & ServeXpress on:
Matt Dow Thomas R. Phillips Carla Cox BAKER BOTTS L.L.P. Dudley D. McCalla 98 San Jacinto Blvd., Ste 1500 JACKSON WALKER L.L.P. Austin, Texas 78701 100 Congress Ave., Suite 1100 Tel.: (512) 322-2565 Austin, Texas 78701 Fax: (512) 322-8363 Tel.: (512) 236-2230 [email protected] Fax: (512) 391-2113 [email protected] Benjamin A. Geslison BAKER BOTTS L.L.P.
One Shell Plaza 910 Louisiana St.
Houston, TX 77002 Tel.: (713) 229-1241 Fax: (713) 229-2841 [email protected] Counsel for Respondent
/s/ Douglas D. Geyser Douglas D. Geyser
CERTIFICATE OF COMPLIANCE
In compliance with Texas Rule of Appellate Procedure 9.4(i)(2), this brief contains 4,277 words, excluding the portions of the brief exempted by Rule 9.4(i)(1).
/s/ Douglas D. Geyser Douglas D. Geyser Beacon Nat. Ins. Co. v. Montemayor, 86 S.W.3d 260 (2002) Mr. Paul Squire, Esq.
June 16} 2011 Page No.3
• ".... diagnose routine, non-emergency medical problems, recommend treatment, and can even call in a prescription to your pharmacy of choice, when necessary:"
These statements are but a few of the statements made by Teledoc, that if followed by licensed Texas physicians, will lead to disciplinary action against the participating doctors in the program. Such knowing and deliberate misrepresentation is unconscionable given the active participation of Teledoc in the discussions and rulemaking procedures leading up to the adoption of the telemedicine rules in Board Rule 174 this last year. Teledoc has been told by Board members, the Executive Director and myself, as General Counsel, that the structure proposed by Teledoc is contrary to the Board's rules and that opinion has not changed due to the adoption of Board Rule 174. The adoption of that rule did not in any manner amend, modify, or delete the requirements of Board Rule 190.8(1)(L).
Accordingly, the Board is hereby notifying you that any representation that you make regarding Teledoc's program being in conformance with the Board's rules will be directly and firmly refuted by the Board. By copy hereof, the Board is sending this correspondence to the Texas Medical Association.
The Board will take all legal steps as are necessary should it see continued advertisements containing the material referenced above.
WEB: SOAH DOCKET NO. 503-01·2134
LICENSE NO. E-7013
IN THE MAITER OF § BEFORE THE § THE COMPLAINT AGAINST § TEXAS STATE BOARD § DAVID LYMAN BRYSON, M.D. § OF MEDICAL EXAMINERS
FINAL ORDER
During open meeting at Austin, Texas, the Texas State Board of Medical Examiners finds that after proper and timely notice was given, the above~styled case was heard by an Administrative Law JUdge of the Texas State Office of Administrative Hearings ("SOAH") who made and filed a proposal for decision containing the Administrative Law Judge's proposed findings of fact and conclusions of law. The proposal for decision was properly served on all parties and all parties were given an opportunity to file exceptions and replies as part of the record herein. The Texas State Board of Medical Examiners, after review and due consideration of the proposal for decision, and exceptions and replies filed, if any, adopts the following proposed findings of fact and conclusions of law of the Administrative Law Judge ("ALJ"). All proposed findings of fact and conclusions of law not specifically adopted herein are hereby denied.
FINDINGS OF FACT
1. David L. Bryson, M.D., holds Texas Medical License E-7013.
2. The Texas State Board of Medical Examiners (Board) issued License E-7013 to Dr. Bryson on December 8, 1976.
3. Dr. Bryson's license has been temporarily suspended by the Board since January 22,2001. At all other times relevant to this case, Dr. Bryson'S license was in full force and effect.
4. In January 1999, Dr. Bryson entered into a business and financial relationship with Mr. William Stallknecht and the Pill Box Pharmacy. of San Antonio, Texas. Mr. William StaUknecht is a licensed Texas pharmacist.
G;\Physlclans\Bryson\Flnal Order of Revocation PAGE 1 OF 6 5. Dr. Bryson's business and financial relationship with Mr. Stallknecht and the Pill Box Pharmacy (Pill Box) continued until March 1, 2001.
6. During 1999, Dr. Bryson consulted with over 10,000 patients through either internet questionnaires or telephone conversations. As the year progressed, Dr. Bryson consulted with fewer patients by internet questionnaire and consulted with more patients by telephone. Dr. Bryson prescribed only unscheduled drugs based on the internet questionnaire. He also prescribed scheduled drugs and controlled substances based on the telephone conversations.
7. After December 24, 1999, Dr. Bryson ceased consulting with any patients solely through internet questionnaires. After that date, he conducted all of his consultations by telephone.
8. From January 2000 through March 1, 2001, Dr. Bryson consulted with over 10,000 patients through telephone conversations. Dr. Bryson prescribed scheduled drugs and controlled substances to these patients based on the telephone conversations.
9. Between January 1999 and March 1,2001, more than 50% of the prescriptions written by Dr. Bryson were for the pain medication hydrocodone.
10. Between January 1999 and March 1, 2001 J more than 25% of the prescriptions written by Dr. Bryson were for anti-anxiety drugs, such as Xsnax and Valium.
11. Between January 1999 and March 1, 2001, Dr. Bryson had no medical office or other facilities to examine patients.
12. Between January 1999 and March 1,2001, Dr. Bryson never saw his patients or pertonned physical examinations, nor did he order urinalyses, cecs, blood chemistries, X-rays, CT scans, MRls, or any other type of diagnostic testing for any of the more than 20,000 patients that he ," consulted with by telephone or internet questionnaire.
13. Between January 1999 and March 1, 2001, Dr. Bryson did not consult with the treating physicians for any of his 20,000 patients.
14. Between January 1999 and March 1,2001, Dr. Bryson failed to establish a proper medical diagnosis on his patients by not obtaining complete medical histories, not performing mental status exams, not performing physical examinations, and not ordering appropriate diagnostic testing.
15. Between January 1999 and March 1, 2001, Dr. Bryson prescribed scheduled substances and dangerous drugs without establishing a proper physician I patient relationship.
16. Between January 1999 and March 1, 2001, Dr. Bryson ordered three refills for approximately 90% of the prescriptions he issued.
17. Between January 1999 and March 1, 2001 , Dr. Bryson never requested or obtained any of his patients' relevant medical records directly from their prior or current treating physicians.
18. Between January 1999 and March 1,2001, Dr. Bryson never provided a report or a medical or clinical record to any of his patients' then current or subsequent treating physicians.
19. Between January 1999 and March 1, 2001, Dr. Bryson prescribed dangerous drugs or controlled substances for pain without conducting any physical examinations of patients that included an assessment and consideration of the pain, physical and psychological function, history of substance abuse, coexisting diseases and conditions, or the presence of a recognized medical indication for the use of a dangerous drug or controlled substance.
20. Between January 1999 and March 1,2001, Dr. Bryson failed to make any arrangements for clinical follow-up or assessment of treatment for any of his patients.
21. Between January 1999 and March 1,2001, Dr. Bryson received two or three calls per month from patient family members stating that the patient was abusing drugs.
22. Between January 1999 and March 1, 2001, Dr. Bryson failed to exercise sound medical judgment in treating pain and related symptoms with scheduled drugs and controlled substances.
23. Between January 1999 and March 1, 2001, Dr. Bryson prescribed scheduled drugs and controlled substances in a manner that created a SUbstantial risk of harm to his patients.
24. Between January 1999 and March 1, 2001, Dr. Bryson prescribed scheduled drugs and controlled substances in a manner inconsistent with public health and welfare.
25. Dr. Bryson's prescription of Tussionex (with hydrocodone) to patient JA on November 4, 1999, caused harm to JA in that it supported JA's addiction to pain medications.
26. During 1999, an $85.00 physician consultation fee was charged to each patient who received a prescription from Dr. Bryson. For internet-questionnaire patients, Dr. Bryson received $25.00 of the consultation fee and the Pill Box Pharmacy received $60.00 of the fee. For telephone consultation patients, Dr. Bryson received $35.00 and the Pill Box Pharmacy received $50.00.
27. Between January 2000 and March 1. 2001. a $100.00 physician consultation fee was charged to each telephone-consultation patient who received a prescription from Dr. Bryson. Dr. Bryson received $50.00 of the consultation fee and the Pill Box Pharmacy received $50.00 of the fee. After January 1,2000. Dr. Bryson consulted with all patients by telephone.
28. All patients paid their fees by credit card to the Pill Box Pharmacy, which then paid Dr. Bryson his share.
29. If Dr. Bryson did not write a prescription for a patient, the patient did not pay the consultation fee and Dr. Bryson received no compensation.
30. Dr. Bryson'S patient records lacked adequate information to document a diagnosis or to formulate a treatment plan for the following patients: JB, LB, VB, RC, OF, EH, PH, WH, CK, and DL.
31. Dr. Bryson's medical practice between January 1999 and March 1, 2001, was unprofessional and likely deceived, defrauded, and injured the public.
32. Dr. Bryson's continuation In the practice of medicine creates a danger or threat to the general pUblic.
CONCLUSIONS OF LAW
1. The Board of Medical Examiners (Board) has jurisdiction over this matter pursuant to TEX. Dcc. CODE ANN. §164.151.
2. The State Office of Administrative Hearings has jurisdiction to conduct the administrative hearing in this matter and to issue a proposal for decision pursuant to TEX. OCC. CODE ANN. § 164.007 and TEX. Gov1r CODe ANN., Ch. 2003.
3. Notice of hearing was provided as required by the Administrative Procedure Act, TEX. GOV'T CODE ANN.§ 2001,051 and 2001.052.
4, The hearing was conducted according to the requirements of the Administrative Procedure Act, the Aules of the State Office of Administrative Hearings, and the rules of the Texas State Board of Medical Examiners.
5. Based on Findings of Fact No. 30, Dr. Bryson violated 22 TEX. ADMIN. CODE (TAC)§ 165.1 by failing to maintain adequate medical records.
6. Based on Findings of Fact Nos. 6-24, Dr. Bryson violated TEX. Dcc. CODE § 164.051 (a)(6) by falling to practice medicine in an acceptable manner consistent with the public health and welfare.
7, Based on Findings of Fact Nos. 6-24, Dr. Bryson violated TEX. OCC. CODe § 164.051 (a}(l) and 164.052(a)(5) by engaging In unprofessional conduct that is Iikely"to deceive or defraud the public or injure the public.
8. Based on Findings of Fact Nos. 6-24, Dr. Bryson violated TEX. Occ. CODE § 164.053(a)(6) by prescribing dangerous drugs and controlled substances in a manner inconsistent with the public health and welfare.
9. Based on Findings of Fact Nos. 6-24, Dr. Bryson violated the BME Internet Prescribing Policy by prescrit;>ing dangerous drugs and controlled substances without establishing a proper physician-patient relationship.
10. Based on Findings of Fact Nos. 6~24, Dr. Bryson violated 22 TAC § 170.3 by failing to follow Board guidelines for treatment of intractable pain.
11. Based on Conclusions of Law Nos. 5-10, the Texas State Board of Medical Examiners should revoke Dr. Bryson's medical license No. E-7013.
ORDER
Based on the above Findings of Fact and Conclusions of Law, the Board ORDERS that Respondent's Texas license is hereby REVOKED. Respondent shall immediately cease the practice of medicine in the state of Texas.
In accordance with TEX. ace. CODE ANN § 2001.177 and 22 TEX. ADMIN. CODE§ 187.39(C), should Respondent appeal this Final Order, the Respondent shall be responsible for payment of all costs of preparation of the original or certified copy of the record of the agency proceedings.