ÿWPC  N„—öÌ/ÃÕaŒ§€?äæay¬\«K…pÌ%Ã×aíµ'žÒªùj)Ö–<ŠÞUò¶„=h®‹_²ÿ&Êr¢Èc3`¸ñö—±øWfM༠;¦þuH÷O'åÚ²þF‹oc2UšáæîÙ¬§¦oDyHßì f+\Y®ûæŽ\çã ë¸duˆ}²û¯j# Ú27†Þ†xW22µ1¶Í0ñTP1ãóQr´¯ÛÜYÄJ€!ieÀº´L6\þSjZIwfÿê*¡F'CÆ»Óðeïà*ب0.Ýõ¼êë@#@Ö‘ïÑ$Ÿìý: º¤ßSçþ&ijtR‰V÷½¡-…´¢z1õº;.ÊXCibe‡èçžãõžãI%ä’-ôEÞé'W‰óöx7Gaé]˜7®ˆÓÿäœó€ÿ¨í+‡ ÛJ4 §~„’‰„tñŠ"’¾¸Jå5]›–:†à¤±ÜœWL‹¥f:ù¢ÇÝЇQz“à`Ö\­]DÎñ(§´8sdBˆÎäeŸ  ]ÂW\ð/uð1k…Þ±}oR ñËlC™àg:@êß6çô *cq©¤C¸zC³ic”üÂ-E\&2K* u’ßÏsÖb#É\ %% UN+ 0ˆy UN 0 cO 0D² zö Òp 1uB 1‡· 72>^ pÆ|ÆBÆÆÎw”N˜( š4ÂEÖØç méééééééééééééééééééééb 0ë Bóó 0¤ D3´ D-ç 0K AS_Ʋ 0¤x 0D A«`˜\\IB01S01\CLERK1NASÈÈ,,,,ÈÈ0»(ÖÃ9 Z‹6Times New Roman Regular(`£ª$¡¡Ñ€.ÑÑ8€½­»»d»»d8ÑÑ ý ÑÓ  Ó(í€"  Z6Times New Roman Regular(;3£$´´Ô2#ÔÚ  Ú0Ú  Ú.Ô3  Ôà0  à(#Ã$òòÚ  Ú0Ú  Úóó ˜C:\PROGRA~1\COREL\WORDPE~1\TEMPLATE\CUSTOM~1\REVISE~1.WPTC:\Program Files\Corel\WordPerfect Office 2000\Template\Custom WP Templates\revised standard opinion.wpt3#37=CIQYag­­1.a.i.(1)(a)(i)1)a)(5hCEKQW]cioAutoList1I.I.I.I.I.I.I.I. i)û…l/Ï Level 1Level 2Level 3Level 4Level 5‚Level 1Level 2Level 3Level 4Level 5„Level 1Level 2Level 3Level 4Level 5…Level 1Level 2Level 3Level 4Level 5  Ý ƒRi$ÝÓ  Óà  àòòÚ  Ú1Ú  ÚóóÔ€ôâ ò»»ÔÝ  ÝÔ_Ôà ` àThe€regulations€at€issue,€General€Rules€and€Regulations€Governing€the€Practice€of€Medicine€RuleÐ ° Ð0880„2„.13(4)(p)€("Rule€0880„2„.13(4)(p)"€or€the€"directory€regulation")€and€Rule€0880„2„.13(4)(t)€("Rule€0880„2„Ð tÄ Ð.13(4)(t)"€or€the€"referral€regulation"),€state€the€following:Ð 8ˆ ÐÌÓ XÓà0  àà0` Ð Ð àThe€following€acts€or€omissions€in€the€context€of€advertisement€by€any€licensee€shallÐ À Ðconstitute€unethical€and€unprofessional€conduct,€and€subject€the€licensee€to€disciplinaryÐ „Ô Ðaction€pursuant€to€Ô_ÔT.C.A.Ô_Ô€ðð€63„6„214(b)(9).ÐH ˜` Ð ` Ð  ÐÌÓ  Ó***Ð Ð  ÐÓ  ÓÌÓ °XÓÓ  Óà0  àà0` xxàà0¸ ` x` xà(p)€Failure€to€include€the€corporation,€partnership€or€individual€licensee'sÐ X ¨  Ðname,€address,€and€telephone€number€in€any€advertisement.€€AnyÐ  l  Ðcorporation,€partnership€or€association€which€advertises€by€use€of€a€tradeÐ à 0  Ðname€or€otherwise€fails€to€list€all€licensees€practicing€at€a€particularÐ ¤ô  Ðlocation€shall:Ðh¸ ¸ x¸ x ÐÓ X°}ÓÓ‹ÓÌÓ  ÓÓ XÓà0  àà0`   àà0¸ ` ` àà0¸ ¸ à1.€Upon€request€provide€a€list€of€all€licensees€practicingÐ ð@  Ðat€that€location;€andд    ÐÌà0  àà0`   àà0¸ ` ` àà0¸ ¸ à2.€Maintain€and€conspicuously€display€at€the€licensee'sÐ <Œ Ðoffice,€a€directory€listing€all€licensees€practicing€at€thatÐ P Ðlocation.ÐÄ   ÐÓŒÓÓ X˜ÓÌÓ  Ó***Ð Lœ ÐÌÓ °XÓÓ  Óà0  àà0` xxàà0¸ ` x` xà(t)€Directly€or€indirectly€offering,€giving,€receiving,€or€agreeing€to€receiveÐ Ô$ Ðany€fee€or€other€consideration€to€or€from€a€third€party€for€the€referral€of€aÐ ˜è Ðpatient€in€connection€with€the€performance€of€professional€services.qdj/ê:i¢×+003|xÿU‹ÿÀÀÀ- ù-(|G2i$¤¤Ý ƒ£ª!ÝÑ€.ÑÑ8€Sõ»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  Ýà  àòòÚ  Ú0Ú  ÚóóÔ€ôâ ò»»Ô d(|3Él$££Ý ƒ£ª!ÝÑ€.ÑÑ8€Sõ»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  ÝVVVV'ÿÿdxd)!ÈÈÈÈdxdx( ±þ$’’ò òFigure€Ú  Ú1Ú  Úó ó^_X`YEþÿ<<CÿÿƒLevel 1Level 2Level 3Level 4Level 5(|3Él$¢¢Ý ƒ£ª!ÝÑ€.ÑÑ8€Sõ»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  Ý($$””ò òÚ  Ú1Ú  Úó óX[Z&OLE 2.0 Box <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKKÝ ƒ£ª!ÝÑ€.ÑÑ8€Sõ»»ddÈ8ÑÑ ý ÑÓ  ÓÝ  ÝÔ_ÔÔ_ÔÑ  ÑÔ€¼Sõ»»»ÔÑ8€XXdì»»d8ÑÑ  Ñà@ü ü ìàÔ‡îYÄSõÔIN€THE€COURT€OF€APPEALS€OF€TENNESSEEˆÐ ° Ðà@kk$ìàAT€NASHVILLEÔ#†¼Sõ»îîYÄ#ԈРÖ& ÐÓ  ÓJULY€9,€2003€SessionÐ üL ÐÔ‡XX»¼SõÔÌò òÔ#†¼Sõ»XX#ÔRICHARD€W.€FELDMAN,€M.D.òòóó€v.€TENNESSEE€BOARD€OF€MEDICALÐ úJ ÐEXAMINERSòòóóÔ‡XX»¼SõÔó óÐ  ^ ÐÌà@@½½ìàò òDirect€Appeal€from€the€Chancery€Court€for€Davidson€CountyÐ  ^ Ðà@@øøìàNo.€01„3680„1€€€€€€Irvin€H.€Ô_ÔKilcreaseÔ_Ô,€Jr.,€ChancellorÐ ú J ÐÌÌà@@ìì*ìàßA€V) °°` d€÷E<½` AßÐ ¾  ÐÌà@@TTìàNo.€M2002„02784„COA„R3„CV€„€Filed€November€12,€2003ó óÔ#†¼Sõ»XX§#ÔÔ‡XX»¼SõÔò òÐ ¹  ÐÌßA€V) °°` dE<` AßÐ ‘á  Ðó óÌÓ  ÓÔ‡XXXXÔThis€is€an€appeal€from€a€Chancery€Courtððs€review€of€an€administrative€hearing€concerning€violationsÐ ŒÜ Ðof€the€Tennessee€General€Rules€and€Regulations€Governing€the€Practice€of€Medicine€for€advertising.€Ð xÈ ÐFor€the€following€reasons,€we€affirm€the€decision€of€the€Tennessee€Board€of€Medical€Examiners.Ð d´ ÐÌÔ#†XXXX3#ÔÔ#†¼Sõ»XX•#ÔÔ‡XX»¼SõÔÌÓ'ÓÌò òTenn.€R.€App.€P.€3;€Appeal€as€of€Right;€Judgment€of€the€Chancery€Court€Affirmedó óÐ d ÐÌòòÓ  ÓÔ#†¼Sõ»àXÿ#ÔÔ‡XX.¼SõÔAlan€E.€Ô_ÔHighersÔ_Ô,€J.óó,€delivered€the€opinion€of€the€court,€in€which€òòDavid€R.€Farmer,€J.,óó€and€òòHollyÐ ì< ÐM.€Kirby,€J.óó,€joined.Ð Ø( ÐÌFrank€J.€Ô_ÔScanlonÔ_Ô,€William€R.€Ô_ÔOððBryanÔ_Ô,€Jr.,€Richard€C.€Rose,€Nashville,€TN,€Attorneys€for€AppellantÐ ° ÐÌPaul€G.€Summers,€Attorney€General€&€Reporter,€Sue€A.€Sheldon,€Senior€Counsel,€Nashville,€TN,Ð ˆØ Ðfor€AppelleeÐ t Ä ÐÓžÓÌò òOPINIONó óÔ#†¼Sõ»XXÍ#ÔÔ‡XX»¼SõÔÐ L"œ! ÐÌòòóóÔ#†¼Sõ»XXI #ÔÔ‡XX»¼SõÔÓ  Óò òÔ‡XXXXÔà@ÿÿìàFacts€and€Procedural€Historyó óˆÐ $$t# ÐÌà  àDr.€Richard€Feldman,€M.D.€("Feldman"€or€"Appellant")€is€the€president€and€an€owner€of€theÐ ü%L!% Ðcorporation,€Doctor's€Diet€Program,€Inc.€€As€a€physician,€Feldman€testified€he€was€the€first€inÐ è&8"& ÐTennessee€to€advertise€his€services€beginning€in€1979.€€He€has€four€offices€located€in€Nashville,Ð Ô'$#' ÐHendersonville,€Clarksville,€and€Murfreesboro.€€A€majority€of€Feldman's€patients€come€withÐ À($( Ðconcerns€of€obesity€and€he€utilizes€the€diet€suppressant,€Ô_ÔPhentermineÔ_Ô,€which€is€a€Class€IV€controlledÐ ¬)ü$) Ðsubstance.€Ð ˜*è%* ЀÌà  àIn€February€2000,€Feldman€mailed€approximately€eight€thousand€postcards€on€one€occasionÐ p,À', Ðto€past€and€present€patients€of€his€practice€offering€a€50%€discount€on€one€session€if€the€patientÐ \-¬(-ý ÐÔ_Ôbrought€with€them€a€new€patient€for€his€program.€€The€idea€of€offering€such€a€discount€originatedÐ ° Ðwith€Joe€Cook,€who€was€in€charge€of€marketing€for€Feldman's€corporation.€€Though€Feldman€isÐ œì Ðunsure€he€ever€actually€gave€the€discount,€he€stated€that€he€would€have€if€a€patient€referred€to€himÐ ˆØ Ða€new€patient€for€the€month€the€discount€was€offered.€Ð tÄ ÐÌà  àUpon€instructions€from€the€Department€of€Health,€Jackie€Henderson€("Henderson")€visitedÐ L œ ÐFeldman's€Nashville€office€in€July€2000€to€pick€up€an€original€of€the€postcard€that€Feldman€mailedÐ 8 ˆ Ðin€February€and€to€check€if€Feldman€had€a€directory€of€licensed€practitioners€posted€in€a€conspicuousÐ $ t Ðplace.€€Upon€inspection,€Henderson€noticed€that€no€such€directory€was€posted,€but€Feldman€had€hisÐ  ` Ðlicense€displayed€in€a€conspicuous€place€on€the€wall.€€In€addition,€Feldman€and€his€nurse€practitioner,Ð ü L  ÐCarolyn€Drake,€wore€name€tags.€Ð è 8  ÐÌà  àIn€May€2001,€the€Tennessee€Department€of€Health€sent€notice€of€charges€to€Feldman€allegingÐ À  Ðviolations€of€two€advertising€regulations׃×Ý ƒ#ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×€€promulgated€by€the€Board€of€Medical€ExaminersÐ ¬ü  Ð("Board")€and€Tenn.€Code€Ann.€ðð€63„6„214(b)(1)€for€"[u]nprofessional,€dishonorable€or€unethicalÐ ˜è  Ðconduct."€€At€a€hearing€before€Administrative€Law€Judge€Marion€P.€Wall,€the€Board,€after€the€partiesÐ „Ô  Ðrested,€found€Feldman€had€violated€Rule€0880„2„.13(4)(t)€prohibiting€the€offering€of€considerationÐ pÀ Ðin€return€for€referrals€but€had€not€violated€Rule€0880„2„.13(4)(p)€requiring€the€posting€of€a€directoryÐ \¬ Ðof€licensed€individuals€because€he€had€not€acted€willfully.€€Feldman€appealed€the€Board's€decisionÐ ° Ðto€the€Chancery€Court€of€Davidson€County,€which€affirmed€the€decision€of€the€Board,€and€then€toÐ œì Ðthis€Court€for€review€of€the€following€issues€as€we€perceive€them:Ð ˆØ ÐÌÓ€ (5h83 ÓÝ"‚3£"ÝÝ  Ýà  àÝ‚3£ëÝÔ25hÔÚ  ÚIÚ  Ú.Ô3  Ôà0 ` àÝ  ÝWhether€Feldman's€advertisement€constituted€commercial€speech€under€the€FirstÐ `° ÐAmendment€of€the€United€States€and€Tennessee€Constitutions,€which€is€entitled€toÐ L œ Ðintermediate€scrutiny;݃3£ë$ÝŒÐ8 ˆ` (#` (# ÐŒÝ  ÝÝ"‚3£"ÝÝ  Ýà  àÝ‚3£ÝÔ25hÔÚ  ÚIIÚ  Ú.Ô3  Ôà0 ` àÝ  Ý€Whether€the€Board€erred€when€it€interpreted€the€words€"third€party"€in€Rule€0880„2„Ð $ t Ð.13(4)(t)€to€include€Feldman's€past€and€present€patients;݃3£Ö݌Р`` (#` (# ÐŒÝ  ÝÝ"‚3£"ÝÝ  Ýà  àÝ‚3£ÝÔ25hÔÚ  ÚIIIÚ  Ú.Ô3  Ôà0 ` àÝ  ÝWhether€the€Board€must€find€that€Feldman€acted€dishonorably,€unprofessionally,€orÐ ü L  Ðunethically€to€be€in€violation€of€Rule€0880„2„.13(4)(t);€and݃3£NÝŒÐè 8 ` (#` (# ÐŒÝ  ÝÝ"‚3£"ÝÝ  Ýà  àÝ‚3£ŽÝÔ25hÔÚ  ÚIVÚ  Ú.Ô3  Ôà0 ` àÝ  ÝWhether€the€Board€erred€when€it€found€that€Feldman€had€willfully€violated€RuleÐ Ô$  Ð0880„2„.13(4)(t).݃3£ŽÇÝŒÐÀ ` (#` (# ÐŒÝ  Ýà  àÌFor€the€following€reasons,€we€affirm€the€decision€of€the€Board€of€Medical€Examiners.Ð ˜è  ÐÌÓ  Óò òStandard€of€Reviewó óÐ pÀ ÐÌÓ  Óà  àFor€review€of€an€administrative€hearing,€we€do€not€follow€a€òòde€novoóó€standard.€€Instead,Ð H˜ Ðwe€are€directed€by€the€Uniform€Administrative€Procedures€Act€which€states:Ð 4„ ÐÌÓ XÓÓ  Óà0  àThe€court€may€reverse€or€modify€the€decision€if€the€rights€of€the€petitioner€have€beenÐ  \ Ðprejudiced€because€the€administrative€findings,€inferences,€conclusions€or€decisionsÐ øH Ðare:Ðä4Ð Ð  ÐÌÓ XsÓÓ °Óà  àà ` à(1)€In€violation€of€constitutional€or€statutory€provisions;Ð ¼  Ðà  àà ` à(2)€In€excess€of€the€statutory€authority€of€the€agency;Ð ¨ø Ðà  àà ` à(3)€Made€upon€unlawful€procedure;Ð ”ä Ðà0  àà0` xxà(4)€Arbitrary€or€capricious€or€characterized€by€abuse€of€discretion€orÐ €Ð Ðclearly€unwarranted€exercise€of€discretion;€orÐl¼` x` x Ðà0  àà0` xxà(5)€Unsupported€by€evidence€which€is€both€substantial€and€materialÐ X ¨ Ðin€the€light€of€the€entire€record.ÐD!”` x` x ÐÓ °£ ÓÓ XßÓÌà0  àIn€determining€the€substantiality€of€the€evidence,€the€court€shall€take€into€accountÐ #l! Ðwhatever€in€the€record€fairly€detracts€from€its€weight,€but€the€court€shall€notÐ $X" Ðsubstitute€its€judgment€for€that€of€the€agency€as€to€the€weight€of€the€evidence€onÐ ô$D # Ðquestions€of€fact.Ðà%0!$Ð Ð  ÐÌÓ X]#ÓÓÓÓ  ÓTenn.€Code€Ann.€ðð€4„5„322(h)€(2003).€€Substantial€and€material€evidence€has€been€defined€as€"suchÐ ¸'#& Ðrelevant€evidence€as€a€reasonable€mind€might€accept€as€adequate€to€support€a€rational€conclusion€andÐ ¤(ô#' Ðsuch€as€to€furnish€a€reasonably€sound€basis€for€the€action€under€consideration."€€òòPace€v.€GarbageÐ )à$( ÐDisposal€Dist.€of€Washington€Countyóó,€390€S.W.2d€461,€463€(Tenn.€Ct.€App.€1965).€€Generally,Ð |*Ì%) Ðsubstantial€and€material€evidence€is€more€than€a€mere€scintilla€or€glimmer€but€less€than€aÐ h+¸&* Ðpreponderance.€€òòWayne€County€v.€Tenn.€Solid€Water€Disposal€Control€Bd.óó,€756€S.W.2d€274,€280Ð ° Ð(Tenn.€Ct.€App.€1988).€€In€addition,€an€agency's€decision€is€not€arbitrary€or€capricious€if€there€is€anyÐ œì Ðrational€basis€for€its€conclusions.€€òòMobileComm€of€Tenn.€v.€Tenn.€Pub.€Serv.€Commððnóó,€876€S.W.2dÐ ˆØ Ð101,€104€(Tenn.€Ct.€App.€1993)€(citing€òòPace€Co.,€Div.€of€AMBAC€I.,€Inc.€v.€Depððt€of€Armyóó,€344€F.Ð tÄ ÐSupp.€787,€790€(W.D.€Tenn.€1971)).€€€€Ð `° ÐÌÓ  Óò òCommercial€Speech€and€Constitutional€Protectionó óÐ 8 ˆ ÐÌÓ  Óà  àIn€a€pretrial€motion€hearing,€Feldman€argued€that,€because€his€postcards€constitutedÐ  ` Ðcommercial€speech,€the€State€should€have€the€burden€of€proving€the€basis€of€the€rule€regulating€thatÐ ü L  Ðspeech.€€However,€the€Administrative€Law€Judge€declined€to€instruct€the€Board€that€the€State€heldÐ è 8  Ðsuch€a€burden.€€Feldman€asserts€that€the€rule€should€be€subjected€to€the€four€part€test€articulated€inÐ Ô$  ÐòòCent.€Hudson€Gas€&€Elec.€Corp.€v.€Pub.€Serv.€Commððnóó,€447€U.S.€557€(1980).€€In€that€case,€theÐ À  ÐUnited€States€Supreme€Court€presented€the€test€as€follows:Ð ¬ü  ÐÌÓ XÓà0  àAt€the€outset,€we€must€determine€whether€the€expression€is€protected€by€the€FirstÐ „Ô  ÐAmendment.€€For€commercial€speech€to€come€within€that€provision,€it€at€least€mustÐ pÀ Ðconcern€lawful€activity€and€not€be€misleading.€€Next,€we€ask€whether€the€assertedÐ \¬ Ðgovernmental€interest€is€substantial.€€If€both€inquiries€yield€positive€answers,€we€mustÐ H˜ Ðdetermine€whether€the€regulation€directly€advances€the€governmental€interestÐ 4„ Ðasserted,€and€whether€it€is€not€more€extensive€than€is€necessary€to€serve€that€interest.€Ð pÐ Ð  ÐÌÓ X“,ÓòòCent.€Hudsonóó,€447€U.S.€at€566.€€The€State€argues,€at€the€outset,€that€because€the€content€of€theÐ øH Ðcommercial€speech€concerns€illegal€activity€it€should€be€afforded€no€protection€under€the€òòCentralÐ ä4 ÐHudsonóó€test.€€Specifically,€the€State€cites€Tenn.€Code€Ann.€ðð€63„6„225(b)€(1997)€which€states€thatÐ Ð  Ð"[p]ayments€by€physicians€in€return€for€referrals€are€prohibited"€and€gives€such€conduct€the€statusÐ ¼  Ðof€a€Class€B€misdemeanor.€€Even€though€there€is€no€evidence€that€Feldman€actually€gave€theÐ ¨ø Ðdiscount€to€a€current€or€former€patient€in€return€for€a€referral,€it€is€inconsequential€in€applying€theÐ ”ä ÐòòCentral€Hudsonóó€test.€€To€receive€protection,€the€commercial€speech€must€òòconcernóó€lawful€activity.€Ð €Ð ÐThe€postcard€mailing€at€issue€in€this€case€is€offering€consideration€in€the€form€of€a€discount€in€returnÐ l¼ Ðfor€a€referral€which,€this€Court€holds,€concerns€illegal€activity€and,€therefore,€warrants€no€protectionÐ X ¨ Ðunder€the€rigors€of€the€òòCentral€Hudsonóó€test.€€For€this€reason,€we€affirm€this€decision€by€theÐ D!” ÐAdministrative€Law€Judge.Ð 0"€  ÐÌÓ  Óò òInterpretation€of€Rule€0880„2„.13(4)(t)ó óÐ $X" ÐÌÓ  Óà  àNext,€Feldman€argues€the€Board€erred€when€it€found€that€his€current€or€former€patients€couldÐ à%0!$ Ðconstitute€a€"third€party"€under€Rule€0880„2„.13(4)(t).€€In€general,€"courts€must€give€great€deferenceÐ Ì&"% Ðand€controlling€weight€to€an€agency's€interpretation€of€its€own€rules."€€òòJackson€Express,€Inc.€v.€Tenn.Ð ¸'#& ÐPub.€Serv.€Commððnóó,€679€S.W.2d€942,€945€(Tenn.€1984)€(citing€òòEnvtl.€Def.€Fund,€Inc.€v.€Tenn.€WaterÐ ¤(ô#' ÐQuality€Control€Bd.óó,€660€S.W.2d€776,€781€(Tenn.€App.€1983);€òòPuerto€Rico€Mar.€Shipping€Auth.€v.Ð )à$( ÐFed.€Mar.€Commððnóó,€678€F.2d€327€(D.C.€Cir.€1982)).€€The€administrative€interpretation€controlsÐ |*Ì%) Ðunless€it€is€plainly€erroneous€or€inconsistent€with€the€regulation€itself.€€òòBowles€v.€Seminole€Rock€&Ð h+¸&* ÐSand€Co.óó,€325€U.S.€410,€414€(1945);€òòUdall€v.€Tallmanóó,€380€U.S.€1,€16„17€(1965);€òòJackson€Express,Ð ° ÐInc.óó,€679€S.W.2d€at€945.€€€€Ð œì ÐÌà  àAppellant€argues€that,€because€Rule€0880„2„.13(4)(t)€uses€the€word€"patient"€later€in€the€sameÐ tÄ Ðsection,€"third€party"€cannot€be€construed€to€include€a€patient.€€Therefore,€as€Appellant€asserts,€theÐ `° ÐBoard€erred€by€applying€the€regulation€to€him€since€he€sent€the€discount€postcards€only€to€currentÐ L œ Ðand€former€patients.€€We€find€Appellant's€argument€is€without€merit.Ð 8 ˆ ÐÌà  àIn€its€findings€of€fact,€the€Board€found€that€Feldman's€corporation€advertised€a€discount€ofÐ  ` Ð"fifty€percent€(50%)€off€to€òòthose€who€bringóó€a€'diet€buddy'€on€their€next€visit"€and€concluded€thatÐ ü L  ÐFeldman€had€violated€Rule€0880„2„.13(4)(t)€quoting€that€section€in€its€entirety€(emphasis€added).€Ð è 8  ÐClearly,€the€Board€interpreted€the€phrase€"third€party"€to€include€past€and€present€patients€ofÐ Ô$  ÐFeldman.€€Because€the€Board€interpreted€"third€party"€this€way,€that€interpretation€controls€unlessÐ À  Ðit€is€plainly€erroneous€or€inconsistent€with€Rule€0880„2„.13(4)(t).€€Upon€review,€there€appears€noÐ ¬ü  Ðsuch€plain€error€or€inconsistency€in€the€Boardððs€interpretation.€€Ð ˜è  ÐÌà  àFirst,€there€is€no€plain€error€given€the€traditional€definition€of€"third€party"€and€the€fact€thatÐ pÀ Ðthe€regulation€does€not€define€what€persons€are€included€in€or€excluded€from€this€term's€scope.€Ð \¬ ÐGenerally,€a€third€party€is€one€who€is€not€a€party€to€the€agreement€but€may€have€some€rights€in€thatÐ H˜ Ðagreement.€€òòBlackððs€Law€Dictionaryóó,€1327€(5th€ed.€1979).€€Rule€0880„2„.13(4)(t)€prohibits€aÐ 4„ Ðphysician€from€offering€any€fee€or€other€consideration€to€a€third€party€for€the€referral€of€a€patient.€Ð  p ÐIn€this€instance,€the€current€or€former€patient€is€being€offered€a€discount€for€the€referral€of€a€newÐ  \ Ðpatient€to€Feldman.€€Therefore,€there€is€no€plain€error€in€the€Board's€interpretation€that€a€current€orÐ øH Ðformer€patient€of€Feldman€falls€within€meaning€of€"third€party"€for€the€rule.Ð ä4 ÐÌà  àNext,€the€Board's€interpretation€that€a€current€or€former€patient€can€be€"third€party"€is€notÐ ¼  Ðinconsistent€with€Rule€0880„2„.13(4)(t)€and€its€purpose.€€In€the€policy€statement€for€the€Rule,€it€setsÐ ¨ø Ðforth€that,€in€order€to€avoid€misleading€the€public,€given€the€lack€of€sophistication€of€many€in€theÐ ”ä Ðpublic€concerning€medical€services€and€the€importance€of€the€interests€affected€by€the€choice€of€aÐ €Ð Ðphysician,€a€physician€is€prohibited€from€offering€some€form€of€payment€or€consideration€to€a€thirdÐ l¼ Ðparty€in€exchange€for€a€referral.€€Rule€0880„2„.13(1).€€Unlike€a€referral€earned€by€merit,€such€paidÐ X ¨ Ðreferrals€can€only€mislead€the€public€as€to€the€quality€of€medical€care€it€will€receive.€€Whether€suchÐ D!” Ðpaid€referrals€come€from€other€physicians,€those€outside€the€field€of€medicine,€or€current€or€formerÐ 0"€  Ðpatients€is€irrelevant.€€A€current€or€former€patient€who€is€paid€to€refer€his€or€her€physician€can€be€justÐ #l! Ðas€misleading€as€any€other€person€who€is€paid€to€refer€such€physician.€€Therefore,€the€Board'sÐ $X" Ðinterpretation€of€the€term€"third€party"€in€the€rule€is€not€inconsistent€with€the€rule's€purpose.€€ThisÐ ô$D # ÐCourt€affirms€the€Board's€interpretation€of€Rule€0880„2„.13(4)(t).Ð à%0!$ ÐÌÓ  Óò òUnprofessional,€Dishonorable,€or€Unethical€Conductó óÐ ¸'#& ÐÌÓ  Óà  àNext,€Appellant€argues€that,€because€the€Board€found€he€was€not€"unprofessional,Ð )à$( Ðâ âdishonorable,€and€unethical,"€it€was€error€for€the€Board€to€find€him€in€violation€of€Rule€0880„2„Ð |*Ì%) Ð.13(4)(t).€€Appellant€mistakenly€interprets€the€requirements€of€the€rule€and€fails€to€consider€theÐ ° Ðcontext€in€which€the€Board€set€forth€this€conclusion€of€law.€€Ð œì Ðâ âÌà  àRule€0880„2„.13(4)(t)€states€that€the€act€of€offering€consideration€to€a€third€party€in€return€forÐ tÄ Ða€referral€constitutes€"unethical€and€unprofessional€conduct."€€By€its€plain€language,€the€rule€doesÐ `° Ðnot€require€a€finding€that€Feldman€was€unprofessional€and€unethical€in€order€to€find€a€violation,€butÐ L œ Ðrather,€it€is€merely€characterizing€such€behavior€as€unprofessional€and€unethical.€€When€the€BoardÐ 8 ˆ Ðdeliberated€over€whether€Feldman's€conduct€was€unprofessional,€dishonorable€or€unethical,€it€hadÐ $ t Ðalready€found€Feldman€in€violation€of€Rule€0880„2„.13(4)(t)€and€moved€on€to€discuss€Tenn.€CodeÐ  ` ÐAnn.€ðð€63„6„214(b)(1)€(2003)€which€lists€these€three€terms€as€grounds€for€disciplinary€action.€€ThisÐ ü L  Ðsection€was€deliberated€upon€because€it€was€one€of€the€charges€filed€against€Feldman€by€theÐ è 8  ÐDepartment€of€Health.€€It€was€this€statute,€not€Rule€0880„2„.13(4)(t),€that€Feldman€had€not€violated.€Ð Ô$  ÐTherefore,€upon€examination€of€the€language€in€Rule€0880„2„.13(4)(t)€and€the€transcript€of€theÐ À  Ðadministrative€hearing,€we€hold€the€Board€committed€no€error€when€it€found€Feldman€was€inÐ ¬ü  Ðviolation€of€the€Board's€rule.Ð ˜è  ÐÌÓ  Óò òWillfulness€of€the€Violationó óÐ pÀ ÐÌÓ  Óà  àFinally,€Feldman€makes€two€arguments€concerning€the€Board's€conclusion€that€he€willfullyÐ H˜ Ðviolated€Rule€0880„2„.13(4)(t).€€Specifically,€Feldman€argues€the€Board's€application€of€theÐ 4„ Ðdefinition€of€willful€was€arbitrary€and€capricious,€and€the€evidence€of€willfulness€was€insufficientÐ  p Ðto€meet€the€substantial€and€material€evidence€standard.€€Both€of€Appellant's€arguments€areÐ  \ Ðunsupported.Ð øH ÐÌà  àAs€noted€above,€an€administrative€agency's€decision€is€not€arbitrary€and€capricious€as€longÐ Ð  Ðas€there€is€any€rational€basis€for€its€conclusions.€€òòMobileComm€of€Tenn.óó,€876€S.W.2d€at€104.€€InÐ ¼  Ðaddition,€a€Board's€findings€of€fact€and€conclusions€of€law€must€be€supported€by€substantial€andÐ ¨ø Ðmaterial€evidence,€which€has€been€defined€as€more€than€a€scintilla€but€less€than€a€preponderance.€Ð ”ä ÐTenn.€Code€Ann.€ðð€4„5„322(h)€(2003);€òòTenn.€Solid€Water€Disposal€Control€Bd.óó,€756€S.W.2d€at€280.€Ð €Ð ЀÌà  àIn€this€case,€the€Administrative€Law€Judge€instructed€the€Board€members€that€they€must€findÐ X ¨ ÐDr.€Feldman€acted€willfully€to€be€in€violation€of€the€regulations€and€defined€"willful"€to€mean€notÐ D!” Ðaccidental€or€inadvertent€but€voluntary€and€intentional.€€Appellant€argues€that,€since€he€defendedÐ 0"€  Ðagainst€both€the€directory€regulation€and€the€referral€regulation€by€stating€he€was€unaware€of€bothÐ #l! Ðregulations€and€the€Board€found€he€had€only€violated€the€referral€regulation,€the€Board€must€haveÐ $X" Ðapplied€a€specific€intent€standard€for€the€directory€regulation€and€a€general€intent€standard€for€theÐ ô$D # Ðreferral€regulation.€€Therefore,€Feldman€argues,€the€conclusion€of€the€Board€that€he€was€in€violationÐ à%0!$ Ðof€Rule€0880„2„.13(4)(t)€is€arbitrary€and€capricious.€€Upon€our€review€of€the€record,€we€find€noÐ Ì&"% Ðsupport€for€this€argument.€€The€evidence€for€the€directory€violation€under€Rule€0880„2„.13(4)(p)Ð ¸'#& Ðsupports€the€Board's€conclusion€that€the€violation€was€accidental€rather€than€willful.€€While€FeldmanÐ ¤(ô#' Ðdid€not€have€a€directory€posted,€he€did€have€his€license€posted€in€a€conspicuous€place.€€In€addition,Ð )à$( ÐFeldman€and€his€personnel€wore€name€tags€to€identify€themselves.€€On€the€other€hand,€for€the€referralÐ |*Ì%) Ðregulation,€the€Board's€conclusion€that€Feldman's€actions€were€willful€is€supported€by€a€different€setÐ h+¸&* Ðof€evidence.€€Feldman€testified€that€he€did,€in€fact,€send€the€postcards€at€issue,€that€he€sentÐ ° Ðapproximately€eight€thousand€postcards,€that€he€had€access€to€the€regulations€but€only€looked€at€themÐ œì Ðwhen€he€questioned€a€competitor's€advertisement,€and€that€he€was€the€first€physician€to€advertise€inÐ ˆØ ÐTennessee€in€1979.€€The€evidence€presented€affords€the€Board€a€rational€basis€for€concluding€that,Ð tÄ Ðwhile€Feldman€did€not€willfully€violate€Rule€0880„2„.13(4)(p)€requiring€the€posting€of€a€directory,Ð `° Ðhe€willfully€violated€Rule€0880„2„.13(4)(t)€prohibiting€the€offering€of€consideration€in€return€for€aÐ L œ Ðreferral.€€Therefore,€we€hold€the€Board€did€not€act€arbitrarily€or€capriciously€in€reaching€its€decisionÐ 8 ˆ Ðon€the€question€of€willfulness.Ð $ t ÐÌà  àIn€addition,€Appellant€argues€that€this€Court€should€reverse€the€decision€of€the€Board€becauseÐ ü L  Ðthere€is€no€substantial€and€material€evidence€to€support€the€conclusion€that€he€willfully€violated€RuleÐ è 8  Ð0880„2„.13(4)(t).€€After€reviewing€the€record€of€the€administrative€hearing€below,€this€argument€alsoÐ Ô$  Ðfails.€€In€this€case,€Feldman€testified€that€he€offered€a€discount€in€return€for€bringing€in€a€new€patient,Ð À  Ðthat,€even€though€he€does€not€remember€giving€the€discount,€he€would€have€if€one€of€his€patientsÐ ¬ü  Ðbrought€in€a€new€patient,€that€he€decided€to€consult€the€advertising€regulations€only€after€heÐ ˜è  Ðquestioned€a€competitor's€ad€but€not€before€sending€approximately€eight€thousand€postcards€of€hisÐ „Ô  Ðown,€and€that€he€had€been€advertising€as€a€physician€since€1979.€€We€hold€there€is€more€than€a€mereÐ pÀ Ðscintilla€of€evidence€to€support€the€Boardððs€conclusion€that€Feldman€willfully€violated€Rule€0880„2„Ð \¬ Ð.13(4)(t).€€Therefore,€we€affirm€the€Board's€conclusions€of€law€with€regard€to€willfulness.Ð H˜ ÐÌÓ  Óò òConclusionó óÐ  p ÐÌÓ  Óà  àFor€the€foregoing€reasons,€we€affirm€the€decision€of€the€Tennessee€Board€of€MedicalÐ øH ÐExaminers.€€Costs€are€judged€against€Appellant,€Dr.€Richard€Feldman,€and€his€surety,€for€whichÐ ä4 Ðexecution€may€issue€if€necessary.Ð Ð  Ѐ€€€Ô#†XXXXÕ #ÔÔ#†¼Sõ»XX§ #ÔÔ€XX»¼SõÔÐ ¼  ÐÌÌÌà  àà ` àà ¸ àà  àà h àà À àà  à___________________________________€Ð l¼ Ðà  àà ` àà ¸ àà  àà h àà À àà  àALAN€E.€HIGHERS,€JUDGE