Administrative – Board of Medicine’s discretionary decision isn’t subject to appeal

Where a man appealed the Virginia Board of Medicine’s decision not to initiate disciplinary proceedings against a doctor who was the subject of the man’s complaint, his appeal was dismissed. The Board’s advisory letter made no determination regarding the physician’s compliance with the law, regulations or licensure requirements. Accordingly, it was not a decision subject to judicial review under the Virginia Administrative Process Act.

Background

Hazem Garada’s mother, Laila Garada, was taken to a hospital in Fairfax County in July 2024. A physician recommended discharging Laila. Garada appealed to hospital administrators and arranged for Laila to stay at the hospital at his own expense. That night Laila “crashed,” “became unable to breath[e,] . . . had severe chest pain,” and required emergency intervention.

A response team resuscitated Laila, her discharge was cancelled and she was moved to an intensive unit for monitoring. She stayed in the hospital for almost an additional week, during which time she was seen by multiple specialists.

Garada complained to the Virginia Board of Medicine about the physician’s treatment of Laila. In January 2025, the Board sent Garada a letter that it had reviewed the investigative report about his complaint, and “[b]ased upon the information available for its thorough review, the Board ha[d] determined that it [would] not initiate disciplinary proceedings.” Garada appealed to the circuit court under the Virginia Administrative Process Act, or VAPA.

The Board demurred and filed a plea in bar. It argued that the letter was not a “case decision” subject to judicial review under the VAPA because it did not include a factual determination about the physician’s compliance with the law, regulations, or licensure requirements. Rather, it simply “memorialize[d] the Board’s decision not to initiate disciplinary proceedings against the physician,” and the Board asserted that such proceedings were “a prerequisite to the Board making a finding [of] whether a licensee violated a law or failed to comply with a licensure requirement.” The Board also argued that Garada lacked standing and that it was entitled to sovereign immunity.

After a hearing, the circuit court held that the Board’s letter was “not a case decision under Code §§ 2.2-4001[,] . . . -4026.” It also ruled that Garada lacked standing because he was not an aggrieved party under Code § 2.2-4026, the complaint failed to state a cause of action and the Board was entitled to sovereign immunity.

Analysis

Garada argues that the term “case decision” includes any determination by an agency, and the Board determined that the physician did not violate medical practice standards. He contends, therefore, that the circuit court erred in holding that the Board did not issue a case decision. This court disagrees.

The Board’s advisory letter made no determination regarding the physician’s compliance with the law, regulations or licensure requirements. Accordingly, the circuit court properly concluded that the Board’s letter was not a case decision subject to judicial review under the VAPA.

Affirmed.

Garada v. Virginia Board of Medicine, Case No. 1306-25-4, May 19, 2026. CAV (unpublished opinion) (per curiam). From the Circuit Court of Fairfax County (Capsalis). (Hazem Garada, on briefs), pro se. (Jason S. Miyares, Attorney General; Robert B. Bell, Deputy Attorney General; Allyson K. Tysinger, Senior Assistant Attorney General; M. Brent Saunders, Senior Assistant Attorney General, on brief), for appellee. VLW 026-7-209. 5 pp.

Full-Text Opinion
VLW 026-7-209