An Iowa physician who successfully challenged the state’s efforts to privately sanction him for incompetence is now suing the federal government.
In 2017, the Iowa Board of Medicine issued Dr. Mark B. Irland, a licensed physician who practiced primarily in Marengo, what it called a “confidential letter of warning.” Court records show the board sent Irland the letter after reviewing a complaint about the medical care he provided patients.
The board’s confidential letter, which Irland later made public through his own court filings, referenced “serious concerns” regarding his October 2015 treatment of a 29-year-old man, Nicholas Novak, who died after Irland allegedly “failed to recognize the seriousness of Mr. Novak’s medical condition and ignored the concerns of other health care professionals involved in his treatment.”
The court records show the Marengo Memorial Hospital had conducted an internal investigation of the death and had revoked Irland’s clinical privileges for emergency medicine due to what it called “serious concerns” regarding his clinical competency, “disruptive behavior and unprofessionalism and substandard care which may have contributed to a catastrophic patient outcome.”
People are also reading…
The board’s confidential letter indicates that in responding to the board’s inquiry, Irland told the board the hospital’s disciplinary process was unfair and that its actions resulted in “significant economic costs” and damage to his “reputation and social well-being.”
The board’s letter echoed the hospital’s concerns and advised Irland “to take appropriate steps to avoid similar concerns in the future.” The board also ordered Irland to submit a paper to the board describing what he had learned from the matter. Noting that Irland was not practicing medicine at the time, the board said it was opting not to pursue further action but warned Irland that if he opted to return to the practice of medicine, the board would take “appropriate action,” including issuing an order requiring him to complete a comprehensive clinical competency evaluation.
The board issued the confidential letter without publishing any public statement of charges against him or publishing a final order in the case.
Cloaking discipline within confidential warning letters undermines the public’s right to know when a physician’s competence has been called into question by a licensing board.
– Iowa Supreme Court
Irland then took the board to court, seeking judicial review of the matter and asserting the letter constituted illegal disciplinary action that should have been filed in conjunction with an investigation, a published statement of charges and an opportunity for a hearing on the matter.
The matter eventually resulted in an Iowa Supreme Court decision in which the justices sided with Irland.
“Cloaking discipline within confidential warning letters undermines the public’s right to know when a physician’s competence has been called into question by a licensing board,” the court ruled. “In our view, the (board’s) letter, by its plain language, presently restricts Dr. Irland’s ability to return to practicing his profession … The board cannot use a ‘confidential letter of warning’ to sidestep procedural requirements for imposing and reporting discipline … To protect the public from incompetent physicians, board-imposed discipline is a public record.”
Irland sues board, hospital and HHS
Separate from Irland’s litigation with the Board of Medicine, the physician also challenged Marengo Memorial Hospital over its actions, which led to a binding settlement agreement between the parties in 2021.
Despite that agreement, Irland sued the hospital in 2022 for defamation, noting that in 2016, long before the settlement agreement was in place, the hospital had submitted its report to the National Practitioner Data Bank, documenting its concerns about Irland’s ability to practice medicine safely.
As part of his lawsuit against the hospital, Irland argued that due to the settlement agreement the hospital should have retracted its 2016 report to the NPDB. The district court granted the hospital summary judgment in the case, which the Iowa Court of Appeals later upheld.
Now, more than 10 years after the patient death that sparked those lawsuits, Irland, 71, has initiated a new round of litigation, this time aimed at the U.S. Department of Health and Human Services.
In his current lawsuit, filed in federal court, Irland is representing himself and arguing that in 2023 the Iowa Board of Medicine issued a final order in his disciplinary case finding no medical incompetence, imposing no disciplinary action, and explicitly rescinding its prior administrative valuation order and leaving his state medical license “completely unblemished.”
The lawsuit asserts that on April 29, 2026, after Irland disputed the validity of the NPDB report that was based on the Marengo hospital’s concerns, Robert F. Kennedy Jr., the secretary of the U.S. Department of Health and Human Services, issued a final order indicating the NPDB report would remain in place.
