Gumbs v. Hhs , 620 F. App'x 945 ( 2015 )


Menu:
  •        NOTE: This disposition is nonprecedential.
    United States Court of Appeals
    for the Federal Circuit
    ______________________
    JAIME GUMBS,
    Petitioner
    v.
    DEPARTMENT OF HEALTH AND HUMAN
    SERVICES,
    Respondent
    ______________________
    2014-3194
    ______________________
    Petition for review of the Merit Systems Protection
    Board in No. DA-0752-13-0648-I-1.
    ______________________
    Decided: August 12, 2015
    ______________________
    JAMES MASON LOOTS, Law Office of James M. Loots,
    PC, Washington, DC, argued for petitioner.
    WILLIAM JAMES GRIMALDI, Commercial Litigation
    Branch, Civil Division, United States Department of
    Justice, Washington, DC, argued for respondent. Also
    represented by BENJAMIN C. MIZER, ROBERT E.
    KIRSCHMAN, JR., ALLISON KIDD-MILLER; NIGEL GANT,
    TONYA SAVAGE, Office of General Counsel, United States
    Department of Health and Human Services, Dallas, TX.
    2                                              GUMBS   v. HHS
    ______________________
    Before DYK, MOORE, and CHEN, Circuit Judges.
    Opinion for the court filed by Circuit Judge CHEN.
    Dissenting opinion filed by Circuit Judge DYK.
    CHEN, Circuit Judge.
    Dr. Jaime Gumbs appeals from a final order of the
    Merit Systems Protection Board (Board) which adopted
    the initial decision of an administrative judge and sus-
    tained Dr. Gumbs’ removal from the Indian Health Ser-
    vice, Pawnee Health Center (agency) based on the charges
    of failing to maintain a valid medical license and practic-
    ing medicine without a valid license. Gumbs v. Dep’t of
    Health and Human Servs., No. DA-0752-13-0648-I-1
    (MSPB July 10, 2014) (Final Order). Because substantial
    evidence supports the Board’s findings sustaining the
    agency’s charges against Dr. Gumbs, and the Board did
    not abuse its discretion in determining that the penalty
    for Dr. Gumbs’s misconduct was reasonable, we affirm.
    BACKGROUND
    Dr. Gumbs was employed with the Indian Health Ser-
    vice (IHS) as a General Practice Medical Officer in the
    Pawnee Service Unit in Pawnee, Oklahoma (clinic) for
    almost 22 years. The clinic operates with the permission
    of several Native American tribes in the area to provide
    medical care for members of those tribes. Joint Appendix
    (J.A.) 55. As a medical officer, Dr. Gumbs was subject to
    the Bylaws, Rules, and Regulations of the Medical Staff of
    the United States Public Health Service, Pawnee Service
    Unit, IHS (bylaws). Under these bylaws, Dr. Gumbs was
    required to have a current, full, and unrestricted medical
    license. J.A. 111. The bylaws also required Dr. Gumbs to
    be fully credentialed prior to seeing patients at the clinic.
    J.A. 116.
    GUMBS   v. HHS                                           3
    For most of his employment at the agency, Dr. Gumbs
    was licensed to practice medicine by the Commonwealth
    of Puerto Rico (Puerto Rico). He is not licensed by any
    other state or territory to practice medicine. At some
    point, Dr. Gumbs began to experience administrative
    difficulties and delays in renewing his medical license
    with the Puerto Rico Department of Health, Office of
    Regulation and Certification of Health Professionals
    (medical board). J.A. 93.
    According to Dr. Gumbs, when seeking to renew his
    medical license in 2007, the Puerto Rico medical board’s
    computer system failed to timely process his application,
    and as a result, his license lapsed. Dr. Gumbs informed
    his supervisor, Dr. Steven P. Sanders, director of the IHS
    clinic, that his license had inadvertently expired. Dr.
    Gumbs was without an active medical license for about a
    month as he waited for the Puerto Rico medical board to
    renew his license. During this period, Dr. Gumbs did not
    see patients or perform any of his job responsibilities. At
    this time, Dr. Sanders did not place Dr. Gumbs on leave
    without pay status or file a formal disciplinary action
    against him.
    The next renewal date for Dr. Gumbs’ license was in
    2010. According to Dr. Gumbs, the medical board’s web
    site again failed during the renewal application process,
    and thus the renewal of his license was again delayed. 
    Id. Despite these
    administrative difficulties, Dr. Gumbs
    received his renewed license three days before it was
    scheduled to expire. 
    Id. In 2013,
    Dr. Gumbs again allowed his medical license
    to lapse. Dr. Gumbs’ license was set to expire on May 8,
    2013, and he began the application process for renewal of
    his license in February of that year. According to Dr.
    Gumbs, the Puerto Rico medical board’s online portal was
    experiencing technical difficulties when he attempted to
    access the site during the month of February. Dr. Gumbs
    4                                             GUMBS   v. HHS
    next attempted to access the site three weeks later in
    March. According to Dr. Gumbs, the site was again
    experiencing difficulties. In April, Dr. Gumbs enlisted the
    help of a physician co-worker at the clinic who also had
    experience renewing his license with the Puerto Rico
    medical board. Nevertheless, even with his co-worker’s
    help, Dr. Gumbs was unable to complete his license
    renewal application online. During this period of time,
    Dr. Gumbs informed Dr. Sanders as well as Kristie Cho-
    ate, the clinic’s credentialing officer, that he had not yet
    renewed his medical license.
    Unable to complete his license renewal online, on
    April 22 Dr. Gumbs sent a paper copy of his license re-
    newal application to the medical board with a money
    order of $150 to cover what he believed to be the renewal
    fee. The application was received by the medical board on
    April 29. On May 7, Dr. Gumbs informed Dr. Sanders
    and Ms. Choate that his license had not been renewed,
    and that it would expire by the next day.
    Dr. Gumbs’ license expired at midnight on May 7.
    Although aware that his license had expired, Dr. Gumbs
    arrived at work on May 8 and began his normal rounds.
    He evaluated a patient, prescribing medication to treat
    that patient. J.A. 99–105. Dr. Gumbs was in the middle
    of examining a second patient when he was interrupted
    by Dr. Sanders, who ordered him to stop treating pa-
    tients. Dr. Sanders had just been informed by Ms. Choate
    that Dr. Gumbs’ license had not been renewed and thus
    had expired. Dr. Gumbs was thereafter reassigned to the
    medical records department, and was not permitted to see
    any other patients.
    Dr. Gumbs then learned he had not yet submitted a
    complete license application because he had not included
    the full required renewal fee with his application. J.A. 95.
    On May 9, Dr. Gumbs purchased a money order for an
    additional $100—the amount still owed to the Puerto Rico
    GUMBS   v. HHS                                            5
    medical board. The medical board received Dr. Gumbs’
    full renewal fee on May 15, which completed his license
    renewal application. 
    Id. The next
    day, on May 16, the
    medical board called Dr. Gumbs to inform him that his
    now-completed application had been accepted and that he
    would receive a renewal of his medical license by e-mail.
    
    Id. The renewal
    was dated May 16, the day the licensing
    authority received and cashed the money order submitted
    by Dr. Gumbs in order to complete his license renewal
    application. 
    Id. In a
    letter dated May 22, 2013, Dr. Sanders notified
    Dr. Gumbs that he was proposing to remove him based on
    his failure to maintain a valid medical license and his
    practice of medicine without a valid medical license. On
    June 18, 2013, Dr. Travis Scott, Chief Executive Officer of
    the clinic, notified Dr. Gumbs that he had decided to
    remove him from his position for “(1) Failure to maintain
    a valid medical license, and (2) Practice of medicine
    without a valid medical license.” J.A. 82.
    Dr. Scott explained that “[m]aintaining a valid medi-
    cal license [wa]s a condition of employment,” and alt-
    hough Dr. Gumbs was aware of the difficulties in
    renewing his medical license from the Puerto Rico medical
    board, he had not accepted responsibility for the untime-
    liness in obtaining that renewal. 
    Id. Dr. Scott
    noted that
    Dr. Gumbs treated a patient after expiration of his medi-
    cal license, and was in the middle of evaluating another
    patient when Dr. Sanders instructed him to stop. 
    Id. Dr. Scott
    explained that it was Dr. Gumbs’ “responsibility to
    recognize that [he] d[id] not have authorization to practice
    medicine without a medical license.” 
    Id. Dr. Scott
    con-
    tinued that “[t]hese requirements are clearly stated in the
    Medical Staff By-laws.” 
    Id. Dr. Scott
    explained that Dr.
    Gumbs’s misconduct exposed the clinic to liability. 
    Id. When selecting
    removal over a lesser penalty, Dr.
    Scott explained that Dr. Gumbs held a position that
    6                                             GUMBS   v. HHS
    required a medical license, and that his failure to main-
    tain such a license adversely impacted the clinic. Dr.
    Scott considered Dr. Gumbs’s lengthy service and aware-
    ness of the clinic’s bylaws, and also provided an analysis
    justifying Dr. Gumbs’s proposed removal under eleven of
    the twelve factors identified in Douglas v. Veterans Ad-
    min., 5 M.S.P.B. 313, 332 (1981).
    Dr. Gumbs timely appealed the agency’s action re-
    moving him from service. Gumbs v. Dep’t of Health and
    Human Servs., No. DA-0752-13-0648-I-1 (MSPB Nov. 7,
    2013) (Initial Decision). An administrative judge found
    the agency had proven both charges forming the basis of
    Dr. Gumbs’s removal by a preponderance of the evidence:
    that Dr. Gumbs failed to maintain a valid medical license
    and that Dr. Gumbs practiced medicine without a license.
    Initial Decision at 2–10. The judge determined that in
    view of the sustained charges, the agency’s penalty of
    removal was reasonable. 
    Id. at 10–12.
         Dr. Gumbs petitioned for review of the Board’s initial
    decision, arguing that it was contrary to evidence, that
    the clinic’s action did not promote the efficiency of the
    service, and that the penalty of removal was not reasona-
    ble. The Board denied this petition and affirmed the
    initial decision, finding that Dr. Gumbs had not shown
    error in the administrative judge’s findings, that the
    agency had established a nexus between Dr. Gumbs’
    misconduct and an adverse effect on the agency’s opera-
    tions, and that in view of the sustained charges, the
    penalty of removal was reasonable. Final Order at 2–6.
    Dr. Gumbs timely appealed the Board’s Final Order. We
    have jurisdiction over Dr. Gumbs’ appeal pursuant to 28
    U.S.C. § 1295(a)(9).
    DISCUSSION
    Our review of Board decisions is defined narrowly and
    limited by statute. E.g., Graybill v. United States Postal
    Serv., 
    782 F.2d 1567
    , 1570 (Fed. Cir. 1986); Maddox v.
    GUMBS   v. HHS                                           7
    Merit Sys. Prot. Bd., 
    759 F.2d 9
    , 10 (Fed. Cir. 1985). We
    must affirm a Board decision unless it is 1) arbitrary or
    capricious or not in accordance with law, 2) obtained
    without procedures required by law, rule, or regulation
    having been followed, or 3) unsupported by substantial
    evidence. 5 U.S.C. §§ 7703(c)(1)–(3); Hayes v. Dep’t of the
    Navy, 
    727 F.2d 1535
    , 1537 (Fed. Cir. 1984).
    I
    Dr. Gumbs does not challenge the Board’s finding that
    his medical license expired, which supported the agency’s
    charge that Dr. Gumbs failed to maintain a valid medical
    license. Appellant’s Br. 2 (“[T]here was a seven-day lapse
    between expiration of [Dr. Gumbs’s] existing license and
    issuance of a renewed one.”). Indeed, there is no dispute
    that Dr. Gumbs did not submit a complete license renewal
    application until May 15, 2013, when the medical board
    received Dr. Gumbs’ full license renewal application fee.
    J.A. 95; see also Letter from parties, Dkt. No. 72 (“[T]he
    parties agree the record shows that, as of the morning of
    May 8, 2013, Dr. Gumbs owed the Puerto Rico licensing
    authority an additional $100.”).
    Instead, Dr. Gumbs challenges the Board’s finding
    that he practiced medicine without a license. Dr. Gumbs
    argues that he only saw a single patient. He notes that
    Dr. Sanders eventually reviewed and completed the
    medical records associated with that patient. Dr. Gumbs
    also asserts there is no evidence he actually performed
    any services or engaged in any activities that morning for
    which a medical license was expressly required. However,
    the record shows that Dr. Gumbs reviewed a patient’s
    medical history, conducted a physical, and then pre-
    scribed and signed off on treatment and medication to
    that patient. J.A. 32–33; 99–105. There is no dispute he
    was purporting to act as a doctor, and not a paraprofes-
    sional or medical assistant. Second, while Dr. Sanders
    subsequently reviewed the medical records for the patient
    8                                             GUMBS   v. HHS
    evaluated by Dr. Gumbs, Dr. Sanders’ subsequent review
    does not erase the fact that it was Dr. Gumbs—and not
    Dr. Sanders—who actually saw, evaluated, and pre-
    scribed treatment for the patient. Thus, although Dr.
    Gumbs attempts to justify his conduct on the morning of
    May 8, his explanation does not negate the substantial
    evidence supporting the Board’s finding that he practiced
    medicine without a valid license.
    II
    Dr. Gumbs also challenges the Board’s finding that
    his removal promoted the efficiency of the agency’s ser-
    vice. A federal agency may discipline an employee “only
    for such cause as will promote the efficiency of the ser-
    vice.” 5 U.S.C. § 7513(a). The agency must demonstrate a
    “nexus” between the employee’s misconduct and “an
    adverse effect upon the agency’s functioning.” Mings v.
    Dep’t of Justice, 
    813 F.2d 384
    , 389–90 (Fed. Cir. 1987).
    We uphold a Board’s finding of a “nexus” if it is supported
    by substantial evidence. Brown v. Dep’t of Navy, 
    229 F.3d 1356
    , 1358 (Fed. Cir. 2000).
    Dr. Gumbs argues that because nothing in the record
    shows that he provided anything but routine, quality
    medical care at the clinic on May 8, there was no risk of
    negative repercussions from his action. Dr. Gumbs mini-
    mizes, however, the potential negative repercussions that
    could have resulted from his misconduct. As the Board
    found, Dr. Gumbs’ misconduct “not only threatened the
    trust of the Native American community, but also exposed
    the agency to liability.” Final Order at 5.
    The failure to maintain a valid medical license and
    the practice of medicine without such a license were “a
    violation of [the] Joint Commission Accreditation Stand-
    ard[s],” J.A. 36, and a violation of the clinic’s bylaws.
    Final Order at 4; J.A. 82. For example, the clinic’s bylaws
    require all medical professionals to “[h]old a current, full
    and unrestricted license to practice as a licensed inde-
    GUMBS   v. HHS                                              9
    pendent practitioner (i.e., Medical / Osteopathic Physician
    . . .) in the United States, or Territory of the United
    States.” J.A. 111. The bylaws also require medical prac-
    titioners to “be fully credentialed prior to seeing patients
    in the [clinic].” J.A. 116. Thus, even accepting that Dr.
    Gumbs provided “routine quality care” without his li-
    cense, it is the practice of medicine without a license itself
    that forms the basis of his misconduct.
    As Dr. Scott explained in his proposal to remove Dr.
    Gumbs from his position, the mission of the agency is to
    provide “the best health care possible at the highest level
    for the American Indian/Alaska Natives in the tribal
    community.” J.A. 85. Dr. Gumbs occupied a position with
    regular contact with the public and became well-known to
    the patients and to the population of the community at-
    large. 
    Id. Dr. Scott
    explained that Dr. Gumbs’ “lack of
    responsibility to ensure he maintained a valid license
    affect[ed] the mission of the [clinic] to provide clinical
    services” to those in this community. In particular, Dr.
    Scott asserted that if Dr. Gumbs’ unlicensed practice of
    medicine became known to the Native American commu-
    nity, it was “the experience of the [agency] that this
    becomes newsworthy and adversely impacts the reputa-
    tion of the agency.” J.A. 86.
    In addition, Dr. Scott noted that Dr. Gumbs was well
    aware of the requirements to maintain his medical li-
    cense, and even though he knew that his license had
    expired, chose to place the clinic at risk by providing
    unlicensed medical care. J.A. 85. This placed the clinic in
    violation of its own bylaws and exposed the agency to tort
    liability by creating a presumption that both Dr. Gumbs
    and the clinic were providing negligent care. J.A. 82–83.
    Dr. Gumbs’ characterization of the harm from his      un-
    licensed practice of medicine as “speculative” misses     the
    point because it does not account for the mission of      the
    agency. As explained by Dr. Scott, it is important to     the
    10                                           GUMBS   v. HHS
    clinic to maintain the trust of the Native American com-
    munity, and any lapse of responsibility to maintaining
    adequate standards—such as by violating its own by-
    laws—threatened to break that trust. See J.A. 36. Even
    if no harm to the agency specifically resulted from his
    treatment of the patient on May 8, on a more general
    level, Dr. Gumbs’ misconduct had the potential to cause
    significant harm to the agency if it caused the Native
    American community to perceive that the clinic was not
    adhering to its internal procedures and was not dedicated
    to providing responsible medical care. In short, substan-
    tial evidence supports the Board’s finding of a nexus
    between Dr. Gumbs’ misconduct and an adverse effect on
    the agency. 1
    III
    Dr. Gumbs also argues that the penalty of dismissal
    was disproportionate and unreasonable. He contends
    that his misconduct did not warrant removal from his
    position and that Dr. Scott should have given considera-
    tion to alternative penalties. Consideration of an appro-
    priate penalty is a matter committed primarily to the
    discretion of the employer and can be reversed only for an
    abuse of discretion. See Lachance v. Devall, 
    178 F.3d 1246
    , 1251 (Fed. Cir. 1999); Villella v. Dep’t of the Air
    Force, 
    727 F.2d 1574
    , 1576 (Fed. Cir. 1984). The penalty
    1  Dr. Gumbs also argues that his removal denigrat-
    ed the agency’s mission by delaying patient care and
    increasing the workload of the remaining care providers
    while IHS was hiring a new physician. But the focus of
    the efficiency inquiry is its impact of the employee’s
    misconduct on the agency, not the impact of the imposed
    penalty itself. See 
    Mings, 813 F.2d at 389
    –90. While Dr.
    Gumbs’ allegations may be true, they do not negate
    evidence of a nexus between Dr. Gumbs’ misconduct and
    an adverse effect on the agency.
    GUMBS   v. HHS                                           11
    must be reasonable in light of the sustained charges, and
    we have “effectively defined reasonable in this context to
    mean merely that the agency’s choice of penalty not be
    grossly disproportionate to the offense.” Webster v. Dep’t
    of Army, 
    911 F.2d 679
    , 685 (Fed. Cir. 1990) (internal
    quotations omitted).
    Here, the Board evaluated the reasonableness of the
    agency’s penalty after consideration of several relevant
    factors laid out in Douglas, 5 M.S.P.B. at 332. 2 In partic-
    2    The Douglas factors are: 1) the nature and seri-
    ousness of the offense, and its relation to the employee’s
    duties, position, and responsibilities, including whether
    the offense was intentional or technical or inadvertent, or
    was committed maliciously or for gain, or was frequently
    repeated; 2) the employee’s job level and type of employ-
    ment, including supervisory or fiduciary role, contacts
    with the public, and prominence of the position; 3) the
    employee’s past disciplinary record; 4) the employee’s past
    work record, including length of service, performance on
    the job, ability to get along with fellow workers, and
    dependability; 5) the effect of the offense upon the em-
    ployee's ability to perform at a satisfactory level and its
    effect upon supervisors’ confidence in the employee’s work
    ability to perform assigned duties; 6) consistency of the
    penalty with those imposed upon other employees for the
    same or similar offenses; 7) consistency of the penalty
    with any applicable agency table of penalties; 8) the
    notoriety of the offense or its impact upon the reputation
    of the agency; 9) the clarity with which the employee was
    on notice of any rules that were violated in committing
    the offense, or had been warned about the conduct in
    question; 10) the potential for the employee’s rehabilita-
    tion; 11) mitigating circumstances surrounding the of-
    fense such as unusual job tensions, personality problems,
    mental impairment, harassment, or bad faith, malice or
    12                                              GUMBS   v. HHS
    ular, because Dr. Gumbs failed to maintain a condition of
    his employment—holding a valid medical license—the
    Board determined the most relevant Douglas factors were
    1) the nature of the offense, 2) its effect on his job perfor-
    mance, and 3) the availability and effect of alternative
    sanctions. Final Order at 6. The Board found that the
    agency properly considered the seriousness of the charge
    of practicing medicine without a license, the fact that Dr.
    Gumbs, as a condition of his employment was required to
    maintain his license and be fully credentialed before
    treating patients, and the fact that Dr. Gumbs knew his
    license had expired yet still decided to practice medicine,
    which exposed the agency to liability and jeopardized the
    Native American community’s trust in the clinic. 
    Id. The Board
    explained that although Dr. Scott was aware that
    other options existed, based on the sustained charges,
    removal was not an unreasonable penalty due to the
    gravity of Dr. Gumbs’ misconduct. 
    Id. at 7.
        Dr. Gumbs argues that because the lapse of his medi-
    cal license was unintentional and inadvertent, and that
    his misconduct was not willful and did not appear to
    result in any actual harm, a lesser sanction would have
    been more appropriate. But our role is not to reweigh
    anew the evidence before the Board. Dr. Scott explained
    provocation on the part of others involved in the matter;
    and 12) the adequacy and effectiveness of alternative
    sanctions to deter such conduct in the future by the
    employee or others. Douglas, 5 M.S.P.B. at 332. We have
    approved the use of these factors for determining the
    reasonableness of a penalty. Zingg v. Dep’t of Treasury,
    IRS, 
    388 F.3d 839
    , 841 (Fed. Cir. 2004). However, the
    factors listed in Douglas are not exhaustive, and an
    agency is required only to consider those factors relevant
    to the action. Bryant v. Nat’l Sci. Found., 
    105 F.3d 1414
    ,
    1418 (Fed. Cir. 1997).
    GUMBS   v. HHS                                         13
    that although a lesser sanction was possible, he believed
    Dr. Gumbs need to be removed “to make sure that [Dr.
    Gumb’s misconduct] d[idn’t] happen again at [the clinic].”
    J.A. 48. We find no abuse of discretion in the Board’s
    determination that the agency’s penalty, in view of the
    sustained charges that Dr. Gumbs let his license expire
    and then practiced medicine without a license, is not
    unreasonable.
    AFFIRMED
    COSTS
    No costs.
    NOTE: This disposition is nonprecedential.
    United States Court of Appeals
    for the Federal Circuit
    ______________________
    JAIME GUMBS,
    Petitioner
    v.
    DEPARTMENT OF HEALTH AND HUMAN
    SERVICES,
    Respondent
    ______________________
    2014-3194
    ______________________
    Petition for review of the Merit Systems Protection
    Board in No. DA-0752-13-0648-I-1.
    ______________________
    DYK, Circuit Judge, dissenting.
    The majority affirms a decision of the Merit Systems
    Protection Board (“Board”) sustaining the Department of
    Health and Human Service’s (the “agency”) removal of Dr.
    Jaime Gumbs from his position as a medical officer at the
    Indian Health Service, Pawnee Health Center, in Okla-
    homa, for allowing his medical license to lapse and treat-
    ing one or two patients after the license had lapsed. I
    respectfully dissent.
    2                                             GUMBS   v. HHS
    I
    The agency and the Board viewed Dr. Gumbs’ allow-
    ing his medical license to lapse and treating one or two
    patients as a serious matter. The agency’s deciding
    official relied on a finding that “practicing medicine
    without a license is illegal in all states,” J.A. 82, and a
    “violation of laws regulating licensure requirements,” J.A.
    86. The deciding official further found that Dr. Gumbs’
    conduct exposed the agency to “potential liability issues,”
    J.A. 85. The Board’s initial decision relied on the agency’s
    finding that Dr. Gumbs’ conduct was “a violation of law.”
    J.A. 22. And the full Board affirmed, finding that removal
    was reasonable under the circumstances in part because
    of “the seriousness of the charge of practicing medicine
    without a license and the fact that the appellant’s actions
    exposed the agency to liability.” J.A. 6.
    It is far from clear that, as the Board assumed, Dr.
    Gumbs’ license had in fact lapsed. Dr. Gumbs applied to
    renew his medical license no later than April 22, 2013,
    prior to its expiration on May 7, 2013, and submitted a
    $150.00 fee. If the proper amount had been submitted, it
    appears that the license would have been extended auto-
    matically. Under both Oklahoma (where all of the con-
    duct at issue occurred) and Puerto Rico (where Dr. Gumbs
    was licensed to practice medicine) law, it appears that the
    filing of a timely renewal application extends the license
    term. Oklahoma Stat. tit. 75, § 314(B) provides:
    Except as otherwise prohibited by law, if a licen-
    see has made timely and sufficient application for
    renewal of a license or a new license with reference
    to any transfer of an activity of a continuing na-
    ture, the existing license does not expire until the
    application has been finally determined by the
    agency.
    GUMBS   v. HHS                                           3
    
    Id. (emphasis added).
    Under Puerto Rico law, the Medi-
    cal Discipline and Licensure Board “may suspend the
    license of any physician . . . who does not submit the
    information required for the register every three years,
    for the term it deems convenient, contingent upon the
    facts involved in each case.” P.R. Laws Ann. Tit. 20,
    § 134(c) (emphasis added). But “once the person meets
    the requirement of submitting such information, his/her
    license shall be activated by the Board.” 
    Id. Thus, it
    appears that under Puerto Rico law, even when a physi-
    cian fails to timely renew a medical license, it is likely
    that the license does not automatically terminate.
    According to Dr. Gumbs’ May 27, 2013, letter to the
    deciding official regarding the notice of proposed removal,
    he “sent the required application and documents with the
    money that was asked for on the web site well in advance
    of any deadline for renewal.” J.A. 95. Dr. Gumbs also
    acknowledged that he “later found out” that the licensing
    authority “wanted another $100.00,” so he sent the re-
    maining $100 on May 15th, 2013. 
    Id. The government
    argues on appeal, and the majority
    agrees, that the failure to make the additional $100
    payment resulted in the lapse of his license. But it is not
    clear under either Oklahoma or Puerto Rico law that the
    failure to make the full payment caused the license to
    lapse since the application was otherwise complete. This
    is a matter for the Board in the first instance, and the
    Board did not address the issue. In my view, the majority
    errs by deciding the issue without a remand.
    Even if we could properly assume that Dr. Gumbs’ li-
    cense lapsed because he failed to timely submit $100 of
    the license renewal fee, the Board’s action in sustaining
    the penalty of removal would have been arbitrary and
    capricious.
    4                                             GUMBS   v. HHS
    First, it is unclear whether either Oklahoma or Puerto
    Rico law would have regarded Dr. Gumbs’ continuing to
    practice as criminal, or even particularly serious. Here,
    neither the agency nor the Board cited any criminal
    statute or regulation that Dr. Gumbs violated. Instead,
    the agency relied on its conclusory assumption that Dr.
    Gumbs’ conduct was “illegal in all states,” J.A. 82, but did
    not even attempt to analyze his conduct under Oklahoma
    or Puerto Rico law, where his conduct may not have
    constituted a criminal violation. We have held that where
    an agency removes an employee based on a finding that
    conduct was criminal, but the conduct may or may not
    have been criminal, a remand is required. See Doe v.
    Dep’t of Justice, 
    565 F.3d 1375
    , 1383 (Fed. Cir. 2009)
    (reversing and remanding “[b]ecause it seems probable
    that Doe was disciplined at least in part because the
    deciding official mistakenly believed that his misconduct
    was in violation of the law”). Under Doe, therefore, since
    part of the basis for Dr. Gumbs’ removal was the agency’s
    potentially mistaken belief that his conduct was criminal,
    a remand for consideration of a lesser penalty is required.
    Second, even if the Board properly assumed that Dr.
    Gumbs’ actions were technically illegal, the penalty of
    removal was still arbitrary and capricious, particularly
    since Dr. Gumbs may have assumed that his license
    renewal was complete. 1 It is true that we “defer[] to the
    1   The majority asserts that Dr. Gumbs was “aware
    that his license had expired,” Maj. Op. 4, but the record is
    unclear on this point. According to Dr. Gumbs, he “was
    expecting that [he] would be receiving the renewal” on
    May 8, 2013, and did not realize until later that he still
    owed $100 for the license renewal. J.A. 95; see also Letter
    from parties at 2, Dkt. No. 72 (“As of [May 8, 2013],
    despite repeated inquiry Dr. Gumbs had no reason to
    GUMBS   v. HHS                                            5
    agency’s choice of penalty unless the penalty exceeds the
    range of permissible punishment specified by statute or
    regulation, or unless the penalty is so harsh and uncon-
    scionably disproportionate to the offense that it amounts
    to an abuse of discretion.” Archuleta v. Hopper, 
    786 F.3d 1340
    , 1352 (Fed. Cir. 2015) (internal quotation marks
    omitted). But even where all of the agency’s charges are
    sustained, that deference is not absolute. See, e.g.,
    O’Keefe v. U.S. Postal Serv., 
    318 F.3d 1310
    , 1313 (Fed.
    Cir. 2002) (“When all of the agency’s charges are sus-
    tained, the agency’s original penalty may nevertheless be
    mitigated to a maximum reasonable penalty when the
    agency’s penalty is too severe.” (citing Lachance v. Devall,
    
    178 F.3d 1246
    , 1260 (Fed. Cir. 1999)). In prior cases, we
    have reversed agency penalty determinations in similar
    circumstances where the punishment did not fit the
    crime, even where the employee’s conduct was unlawful.
    In Miguel v. Department of the Army, 
    727 F.2d 1081
    (Fed. Cir. 1984), a cashier was removed for “unauthorized
    possession of U.S. Government property” for admittedly
    stealing two bars of soap with a total value of $2.10. 
    Id. at 1082.
    We reversed: “We do not condone theft regard-
    less of the amount involved, but the relatively minor
    nature of the theft leads us to the conclusion that this
    harsh discharge of a 24-year employee with an otherwise
    unblemished record was a penalty grossly disproportion-
    ate to the offense and thus was an abuse of discretion.”
    
    Id. at 1084;
    see also Abrigo v. U.S. Postal Serv., No. 88-
    3390, 
    1989 WL 59271
    , at *1 (Fed. Cir. June 7, 1989)
    (unpublished) (vacating and remanding removal for
    misdemeanor unauthorized entry “where the penalty
    imposed [wa]s so disproportionate as to constitute an
    know that there was anything amiss with his application
    for renewal.”).
    6                                             GUMBS   v. HHS
    abuse of discretion” and “[t]he agency and the [B]oard
    gave absolutely no consideration to the . . . apparently
    technical nature of the violation”).
    Similarly, in VanFossen v. Department of Housing &
    Urban Development, 
    748 F.2d 1579
    (Fed. Cir. 1984), an
    appraiser (VanFossen) was removed “based on three
    charges of violating the standards of conduct: engaging in
    outside employment without authorization; engaging in
    improper outside employment; and failing to disclose
    financial interests.” 
    Id. at 1580.
    VanFossen had more
    than nineteen years of federal service with no prior disci-
    plinary record. 
    Id. He had
    previously requested and
    received approval for outside employment from an area
    manager, but under applicable regulations this approval
    was not legally sufficient because it needed to come from
    the agency’s regional counsel. 
    Id. We vacated
    and re-
    manded to determine an appropriate lesser penalty. 
    Id. at 1581.
        Here, Dr. Gumbs has had nearly twenty-two years of
    federal service, with no prior disciplinary record. At
    worst, his medical license lapsed for a period of nine days
    because he failed to pay $100 of the application fee, de-
    spite his “many attempts to get his medical license re-
    newed” prior to the deadline. J.A. 3. And on the morning
    after his license may have expired, Dr. Gumbs saw a
    patient or two, whose records were then reviewed by his
    supervisor.
    Our prior cases reflect an important responsibility to
    remand for determination of a more appropriate penalty
    in the rare case where the agency’s choice of penalty is
    grossly disproportionate to the offense. In my view, this is
    such a case, and I respectfully dissent.