Background
Dr. David M. Hartman, a licensed Ohio physician since 2004, initially practiced ENT (ear, nose, and throat) medicine. In 2014, he opened a cosmetic surgical practice at his office performing procedures under local anesthesia without hospital or surgery center facilities. The State Medical Board brought proceedings against Hartman based on violations involving 13 patients, alleging improper office-based liposuction procedures, deviation from the minimal standard of care, and sexual misconduct.
The Board’s allegations centered on multiple problematic procedures. With Patients 1 through 10, Hartman performed liposuction in combination with other plastic surgery procedures (abdominoplasties, facelifts, arm lifts) in ways that violated administrative rules requiring liposuction to be a focused, local procedure performed as part of the main surgery. With Patient 4, who had pre-existing diabetes and hypertension, Hartman failed to perform a pre-operative assessment before performing a tummy tuck and liposuction; the patient’s blood pressure plummeted post-surgery, she fainted at home, and required ICU treatment with blood transfusion.
Most egregiously, with Patient 11, Hartman performed an arm lift (brachioplasty) and removed so much tissue that he could not close the incision. He used a 23-by-7 centimeter graft including skin and fat tissue to close the wound, but failed to remove the fat layer—a critical step for graft survival. He discharged the patient without proper post-operative instructions and restrictions. The graft failed, becoming necrotic; the patient endured multiple corrective surgeries over the following year with intense pain. With Patient 12, Hartman placed breast implants unevenly and assured the patient they were correct when they were not. With Patient 13, a former tenant and employee, Hartman opened her gown without consent and on another occasion exposed himself with an erection during a massage appointment.
The Court’s Holding
The Ohio Court of Appeals affirmed the permanent revocation of Hartman’s medical license. The court systematically rejected eight assignments of error that Hartman raised, holding that the trial court properly applied the standard of review under Ohio Revised Code § 119.12 and that the Board’s findings were supported by reliable, probative, and substantial evidence.
On the central question of whether expert testimony about Hartman’s qualifications and training was proper, the court held that the Board was not precluded from considering Hartman’s lack of specialized training when determining an appropriate sanction. The court distinguished between using inadequate training as the basis for a violation (which would require notice) and considering it as an aggravating factor in sentencing (which is permissible under prior precedent). The court found that Dr. Surfield’s testimony about the contents of Hartman’s CV—noting his lack of formal training in arm or breast surgery despite performing those procedures—was admissible and did not violate due process.
The court also upheld the Board’s rejection of the hearing examiner’s recommended indefinite suspension in favor of permanent revocation. The Board reasoned that permanent revocation was appropriate given the egregious nature of Hartman’s conduct, particularly his treatment of Patients 11 and 12, and his blatant disregard for proper medical record-keeping. The Board noted that physicians have a duty to understand that their lack of training would likely prevent them from complying with the standard of care in specialized areas.
Key Takeaways
- Medical boards have substantial discretion in determining appropriate sanctions and may consider a physician’s lack of specialized training as an aggravating factor when determining whether to revoke a license.
- Expert testimony regarding a physician’s qualifications, training, and CV contents is admissible in disciplinary proceedings even if not specifically detailed in the expert’s initial report.
- Permanent license revocation is appropriate when a physician demonstrates egregious conduct, ventures into specialties without adequate training, and shows a pattern of patient harm and carelessness with medical records.
- A physician who testifies as an expert on standard of care puts their own qualifications and training at issue, allowing opposing counsel to present evidence rebutting their claimed expertise.
- Appellate courts apply deferential review standards to administrative agencies’ factual findings and evidentiary rulings, reversing only for abuse of discretion.
Why It Matters
This decision reinforces that medical licensing boards possess broad authority to protect the public from physicians who operate beyond their competence. Even physicians with legitimate credentials in one specialty cannot venture into unrelated specialties without proper training and qualifications. The case emphasizes that severe patient injury, particularly in elective cosmetic procedures, combined with evidence of inadequate training and poor record-keeping, can justify permanent license revocation rather than suspension.
The ruling has practical implications for both medical professionals and patients. Physicians are on notice that performing specialized surgical procedures (particularly cosmetic surgery involving general anesthesia risks) without formal training or board certification in those specialties exposes them to significant disciplinary risk. For patients, the case demonstrates that state medical boards take seriously the combination of patient harm, sexual misconduct, and violations of practice rules when determining appropriate professional consequences.