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Roque v. Quern

OPINION FILED NOVEMBER 26, 1980.

FRANCISCO ROQUE, M.D., PLAINTIFF-APPELLANT,

v.

ARTHUR F. QUERN, DIRECTOR OF THE DEPARTMENT OF PUBLIC AID, ET AL., DEFENDANTS-APPELLEES.



APPEAL from the Circuit Court of Cook County; the Hon. RICHARD L. CURRY, Judge, presiding.

MR. JUSTICE WILSON DELIVERED THE OPINION OF THE COURT:

Plaintiff, Dr. Francisco Roque, appeals from an order of the circuit court under the Administrative Review Act (Ill. Rev. Stat. 1977, ch. 110, par. 264 et seq.) affirming an administrative agency's finding that he violated the licensing provision of the Illinois Dangerous Drug Abuse Act (Ill. Rev. Stat. 1977, ch. 91 1/2, par. 120.1 et seq.). On appeal, he contends that: (1) the decision of the administrative agency was contrary to the manifest weight of the evidence; (2) section 14 of the Act (Ill. Rev. Stat. 1977, ch. 120, par. 120.14) is an unconstitutional delegation of legislative authority; and (3) certain portions of section 14 do not bear a reasonable relation to the purpose of the Act. We affirm the trial court. The pertinent facts follow.

On March 8, 1978, plaintiff was served with a "Notice of Intent to Terminate and Right to Hearing" as to his participation as a vendor of goods and services under the Medical Assistance Program of the Illinois Department of Public Aid. The department alleged that plaintiff, while treating medical assistance program patients at the Mohawk Medical Center, furnished medical services and prescriptions in excess of his patients' needs and of grossly inferior quality. The charges were later amended to include an additional charge alleging that he had rendered care to drug abusers without a proper license as required by the Dangerous Drug Abuse Act. Ill. Rev. Stat. 1977, ch. 91 1/2, par. 120.14.

At the hearing the Department presented Dr. Elchanan Golan, who is employed as a consultant to review patient charts, interview Medical Assistance Program providers and help conduct on-site review of physicians and clinics when questions of quality of care arise. Dr. Golan testified that he conducted an on-site review of plaintiff's work at the Mohawk Medical Center. He stated that entries on the patients' charts reviewed showed similar continuing symptoms; sinus or nose problem, coupled with some sort of pain and anxiety. All patients on each visit were prescribed the same three drugs. On cross-examination, Dr. Golan admitted that he had not examined patients with long histories of drug abuse such as those seen by plaintiff, and further that his "experience" was not clinical experience but consisted of reviewing literature on other people's experiences, such as the Physician Desk Reference and medical books.

Plaintiff first testified as to his medical qualifications and honors. He then stated that he began work at the Mohawk Medical Center in September 1977 and that most of the patients he saw at Mohawk were of the lowest rank of the social economic system. He further indicated that approximately 95% of his patients at Mohawk were addicts and that they would "come only because of the triad of symptoms that is described as `abstinence syndrome': which is anxiety, pain and nose trouble * * * [caused by] the withdrawal of heroin, morphine, or what have you * * *."

The records indicated that these patients were treated for a number of other ailments (i.e., cough, skin problem, infection from needle marks, dandruff); however, his patients almost always had the same three symptoms of pain, nose trouble and anxiety. These patients were prescribed the same medication in the same dosages. Plaintiff stated that he was treating patients at Mohawk for the symptoms and discomfort they were having as a result of their drug addiction, but not for the addiction itself because he knew that there was no cure. He indicated he would refer certain patients to rehabilitation centers for their addiction problems. He said he chose the drug combination at issue here because other doctors at Mohawk used it and reference to standard medical textbooks did not contraindicate their use for addicts. He denied treating any patient at Mohawk specifically for his drug addiction and further denied prescribing or giving any patient any drugs in excess of his particular needs.

Dr. Otto Bettag testified on behalf of plaintiff as an expert witness. He indicated that the drugs prescribed by plaintiff were proper and indicated for the objective findings in the diagnosis of the particular patients involved. Dr. Bettag stated that facilities licensed to treat drug addiction were primarily interested in the drug-addiction problem. It was his opinion that other complaints, unrelated to but as a result of drug addiction, would get optimum treatment from private doctors. Dr. Bettag concluded that the drugs in question were properly prescribed for the symptoms of these particular patients.

Dr. Philippe Benoit, a professor of pharmacology at the University of Illinois Medical Center, next testified on behalf of plaintiff. He testified that the drug dosages were certainly not excessive and were perhaps a little less than is sometimes normally used. These drugs were proper treatment and commonly used for the complaints of sinusitis, backache and anxiety. The combination of these three drugs would not be any more harmful for people who are addicted to alcohol or narcotics and would not produce any adverse effects beyond the commonly known ones which a physician would warn a patient about: sleepiness, drowsiness, and a little lethargy.

The hearing officer concluded that plaintiff had violated the licensing provisions of the Dangerous Drug Abuse Act by providing services without a license to a clientele 95% of whom were drug abusers coming to Mohawk for treatment of abstinence syndrome, which established the basis for the termination of his participation as Medical Assistance Program vendor under section 4.61(i) of the Illinois Department of Public Aid rules. She further concluded that plaintiff's treatment of these patients cannot be judged to be "grossly inferior" or that he prescribed these drugs in excess of his patients' needs. She recommended that his participation as a vendor in the Medical Assistance Program be terminated.

Plaintiff filed a request for a rehearing, which was denied. He then commenced administrative review proceedings in the circuit court. The circuit court entered an order affirming the administrative decision finding that it was not contrary to the manifest weight of the evidence.

OPINION

Plaintiff asserts that the decision of the administrative agency was contrary to the manifest weight of the evidence. Additionally, he argues that the hearing officer interpreted section 14 of the Act to mean that no physician, when a significant portion of patients are drug addicts, can treat or service a drug addict for any ailment or affliction without a license from the Dangerous Drug Abuse Commission, even if such physician does not treat the patient for the addiction problem.

Section 14 of the Act provides in pertinent part that:

"(a) No person shall establish, open, conduct, operate or maintain a facility or provide services for the treatment, care, rehabilitation, training or education of addicts and abusers of dangerous drugs ...


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