## Facts

- The State Medical Board of Ohio initiated professional-discipline proceedings against Dr. Donald R. Williams, a Cincinnati physician, based on his prescribing practices for weight control.
- From roughly 1983 to 1986, Williams prescribed Schedule II stimulants (Biphetamine and Obetrol) to approximately 50 patients for weight loss, sometimes for months or years.
- On November 17, 1986, the Board adopted a rule prohibiting Schedule II stimulants for weight control; after learning of the rule, Williams stopped prescribing them for that purpose.
- The Board charged Williams under R.C. 4731.22(B) with failing to use reasonable care and departing from minimal standards of care.
- At the administrative hearing, the Board relied on documentary references (including drug-reference materials suggesting short-term use) and presented no expert testimony on the standard of care.
- Williams presented two expert witnesses who testified that there were two recognized medical views on stimulant use for obesity (majority short-term; minority long-term with monitoring) and that following the minority view did not fall below acceptable medical practice.
- The Board found Williams in violation and imposed a one-year suspension followed by five years of probation, including a prohibition on prescribing Schedule II substances.
- The court of common pleas reversed for lack of reliable, probative, and substantial evidence; the court of appeals affirmed; the Board appealed to the Ohio Supreme Court.

## Issues

1. Whether the Board’s discipline for substandard prescribing was supported by reliable, probative, and substantial evidence when the Board offered no expert testimony and the only expert testimony supported the physician.
2. Whether a medical board must present expert testimony in every case to establish a violation of minimal professional standards.

## Decision

- The Ohio Supreme Court affirmed the judgment in favor of Williams, leaving intact the reversal of the Board’s order.
- The court held that the Board is not required to present expert testimony in every case.
- The court nonetheless concluded that the Board’s order here lacked reliable, probative, and substantial evidence because the Board rejected uncontroverted expert testimony without countervailing evidence that Williams’s conduct fell below minimal standards.
- The court emphasized that where the medical community is divided and no controlling law governed the practice during the relevant period, the Board could not substitute its own unsworn views for evidentiary proof.
- The court noted that the later-adopted rule banning the practice could not supply a basis to discipline pre-rule conduct absent proof that the conduct was substandard at the time.

## Legal Principles

- A reviewing court must set aside an administrative discipline order that is not supported by reliable, probative, and substantial evidence.
- A medical board need not present expert testimony in every disciplinary case, but it must present sufficient evidence to establish the applicable standard of care and a departure from it.
- When professional opinion is divided and there is no controlling statute or rule governing the conduct at the time, an agency may not treat its own institutional preferences as evidence to overcome uncontroverted expert testimony.
- Deference to agency fact-finding does not permit affirmance where the record lacks substantial evidentiary support for the agency’s conclusions.

## Conclusion

The court upheld reversal of physician discipline because, although expert testimony is not always required, the Board could not sustain a finding of substandard care on documentary references and its own disagreement when the only expert evidence showed the physician’s conduct remained within acceptable medical practice and the conduct preceded the Board’s later prohibition.


In re Williams, 60 Ohio St. 3d 85, 573 N.E.2d 638 (Ohio 1991)