Tonia N. Williams, Relator,

This opinion is nonprecedential except as provided by
Minn. R. Civ. App. P. 136.01, subd. 1(c).

STATE OF MINNESOTA
IN COURT OF APPEALS
A20-0969

Tonia N. Williams,
Relator,

vs.

Minnesota Board of Nursing,
Respondent.

Filed May 10, 2021
Affirmed
Gaïtas, Judge

Minnesota Board of Nursing
File No. R15565-1 L542940

Tonia N. Williams, Brooklyn Park, Minnesota (self-represented relator)

Keith Ellison, Attorney General, Alex Mountain, Nicholas Lienesch, Assistant Attorneys
General, St. Paul, Minnesota (for respondent)

Considered and decided by Gaïtas, Presiding Judge; La rkin, Judge; and Cochran,
Judge.
NONPRECEDENTIAL OPINION
GAÏTAS, Judge
In this certiorari appeal, relator To nia N. Williams challenges a decision by
respondent Minnesota Board of Nursing rescinding a stipul ation and consent order and
indefinitely suspending Williams’s licenses to practice professional and practical nursing.
Williams argues that (1) the board’s decision is not supported by substantial evidence,
2
(2) the board’s procedure violated her due-pro cess rights, and (3) the suspension of her
licenses violates her right to equal protection under the law. We affirm.
FACTS
For many years, Williams held licenses from the board to practice professional and
practical nursing. In 2018, following Willia ms’s convictions for three separate gross
misdemeanor driving offenses involving al cohol and controlled substances, the board
pursued disciplinary action against her. In February 2019, Williams and the board entered
into a stipulation and consent order (consent order) that resolved the disciplinary action.
In the consent order, signed by both parties, Williams acknowledged that her convictions
subjected her to board discipline because the criminal conduct was reasonably related to
the practice of nursing. Minn. Stat. § 148.261, subd. 1(3) (2020). She also agreed that her
conduct demonstrated “actual or potential inability to practice nursing with reasonable skill
and safety to patients by reas on of illness, use of alcohol, dr ugs, chemicals, or any other
material, or as a result of any mental or physical condition.” Id., subd. 1(9) (2020).
The consent order suspende d Williams’s nursing licenses but stayed the suspension
and allowed Williams to continue practicing nursing so long as she complied with certain
conditions. The conditions included that Williams participate in the Health Professionals
Services Program (HPSP), a statutor ily authorized mo nitoring agency, see Minn. Stat.
§ 214.31 (2020), and “successfu lly complete all terms of her HPSP Participation
Agreement.” It also require d her to abstain from mood-alte ring substances, among other
conditions. The parties agreed in the consent order that if Williams violated the conditions
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of the stay, the board’s review panel 1 could, upon probable caus e, order removal of the
stayed suspension and schedule a hearing before the board for a final determination. As to
the hearing, the parties specifically agreed:
Prior to the hearing before th e Board, the Review Panel and
[Williams] may submit affidavits and written argument in
support of their positions. At the hearing, the Review Panel
and [Williams] may present oral argument. Argument will not
refer to matters outside the record. The evidentiary record will
be limited to the affidavits su bmitted prior to the hearing and
this Stipulation and Consent Order. Unless stated otherwise in
this Stipulation and Consent Order,[
2] the Review Panel will
have the burden of proving by a preponderance of the evidence
that a violation has occurred. . . . [Williams] waives a hearing
before an administrative law judge, discovery, cross-
examination of adverse witne sses, and other procedures
governing hearings pursuant to Minnesota Statutes chapter 14.

About five months after the parties entered the consent order, the review panel
issued an order removing th e stayed suspension, thereb y suspending Williams’s nursing
licenses. In the order of removal, the review panel asserted that Williams had not complied
with the terms of her HPSP participation agreement, specifically citing problematic
toxicology screens, an arrest for felony DWI-test refusal in March 2019, failure to submit
worksite monitor reports, and terminatio n from employment. Williams met with the

1 The board explains in its briefing that the review panel consists of two members—a board
member and a nursing practice specialist em ployed by the board—and that the review
panel’s role is to “review, investigate, and prosecute disciplinary matters on behalf of the
Board.”

2 The consent order also provides that if the HPSP discharges Williams from the program
for any reason besides successful completi on, “there will be a presumption of a
preponderance of the evidence that [she] failed to comply” with the consent-order
conditions for staying the suspension.
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review panel shortly thereafter, and, following the meeting, the board rescinded the order
that removed the stayed susp ension. The board reinstated the consent order, again
providing Williams the chance to maintain her licensure so lo ng as she complied with its
terms, including monitoring by the HPSP.
Thereafter, from September 2019 to January 2020, the HPSP filed multiple reports
with the board. The reports relayed that W illiams had missed toxicology screenings on a
few occasions, tested positive for opiates, 3 and had another screening test positive for
amphetamine, methamphetamine, and cannabis. In February 2020, the HPSP obtained an
expert opinion from a toxicologist regard ing the screening that tested positive for
amphetamine, methamphetamine, and cannabis. Although Williams had a prescription for
medical cannabis, the toxicologist relayed that none of her prescribed medications
contained amphetamine or methamphetamine. He opined that a positive toxicology screen
could only have resulted from ingesti on or exposure to amphetamine and
methamphetamine. A few days after the to xicologist provided his opinion, the HPSP
reported to the board that Williams had been unsatisfactorily discharged from the program
due to positive toxicology screening.
In April 2020, the review pa nel served Williams with a new order of removal of stay
of suspension, again suspendi ng her licenses, and also se rved her with a notice of
suspension and of a hearing. The review panel alleged th ree grounds for discipline:
(1) Williams failed to comply with the terms of her HPSP participation agreement in

3 Williams presented information suggesting th at the positive opiates test resulted from a
prescribed medication.
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violation of the terms of the consent orde r and Minnesota Statut es section 148.261,
subdivision 1(18) (requiring compliance with board orders); (2) Williams failed to abstain
from all mood-altering substances in violati on of the terms of the consent order and
Minnesota Statutes secti on 148.261, subdivision 1( 18); and (3) Williams was
unsatisfactorily discharged from the HPSP pursuant to Minnesota Statutes section 214.355
(2020). To support its allegations, the review panel submitted an affidavit of the HPSP
case manager assigned to Williams, with attached exhibits that included Williams’s signed
HPSP participation agreement, reports deta iling Williams’s missed toxicology screens,
toxicology screening reports, and the letter from the toxicologist regarding the screen that
was positive for amphetamine and methamphetamine.
Prior to the hearing, Williams submitted a re sponse to the review panel’s allegations
and several of her own exhibits, including laboratory results indicating a negative April 10,
2019 Phosphatidylothanol (PEth) test, her prescription profile, information on medical
marijuana, and a May 2020 chemical-use assessment.
In June 2020, the board he ld a hearing and heard arguments from Williams and the
review panel. Williams asserted that she did not consume alcohol or use drugs other than
those prescribed to her, that the HPSP had been difficult to work with, and that the positive
toxicology screen must have been a “mix-up.”
After the hearing, the board issued findi ngs of fact, conclusions, and a final order
that suspended Williams’s licenses indefi nitely. The board concluded that the
preponderance of the evidence showed that Williams violat ed the terms of the consent
order, and thereby violated Mi nnesota Statutes section 148. 261, subdivision 1(18). The
6
final order suspends Williams’s licenses to practice practical and professional nursing for
a minimum of twelve months, at which time she may petition for reinstatement.
Williams appeals.
DECISION
Appellate courts will reverse agency decisi ons “only when they reflect an error of
law, the findings are arbitrary and capricious, or the findings are unsupported by substantial
evidence.” Cable Commc’ns Bd. v. Nor-W. Cable Commc’ns P’ship , 356 N.W.2d 658,
668 (Minn. 1984). Ordinarily, agency decisions receive a presumption of correctness, and
appellate courts defer to the agency’s expe rtise and special knowledge in its field. In re
Annandale NPDES/SDS Permit Issuance , 731 N.W.2d 502, 514 (Minn. 2007); N. States
Power Co. v. Minn. Pub. Utils. Comm’n, 344 N.W.2d 374, 377 (Minn. 1984). “The relator
has the burden of proof when challenging an agency decision . . . .” Minn. Ctr. for Envtl.
Advocacy v. Minn. Pollution Control Agency, 660 N.W.2d 427, 433 (Minn. 2003).
The agency in this matter, the Board of Nursing, is authorized under the Minnesota
Nurse Practice Act to license and regulate adva nced practice registered nurses, registered
nurses, and licensed practical nurses, and to take disciplinary action as appropriate. Minn.
Stat. §§ 148.171-.285 (2020). The standard of proof for professional licensing proceedings
is proof by a preponderance of the evidence. In re License of Friedenson , 574 N.W.2d
463, 466 (Minn. App. 1998), review denied (Minn. Apr. 30, 1998).
Williams argues that we should reverse the board’s order suspending her licenses
indefinitely for several reasons. She argues that the board’s decision was not supported by
substantial evidence, and she also asserts two constitutional challenges—that the board’s
7
procedure violated her substantive due-pro cess rights and that the suspension of her
licenses violates equal protection.4 We address each argument in turn.
I. The board’s final order suspending Williams’s li censes was supported by
substantial evidence.

Williams first argues that the board’s deci sion to indefinitely suspend her licenses
was not supported by substantial evidence.
“The substantial-evidence standard addre sses the reasonableness of what the agency
did on the basis of the evidence before it.” In re Expulsion of A.D., 883 N.W.2d 251, 259
(Minn. 2016) (quotation omitted). Substantial evidence is “such relevant evidence as a
reasonable mind might accept as adeq uate to support a conclusion.” Minneapolis Van &
Warehouse Co. v. St. Paul Terminal Warehouse Co., 180 N.W.2d 175, 178 (Minn. 1970)
(quotation omitted).

4 Williams also lists as separate issues at the beginning of her appellate brief that the board’s
decision to terminate her licenses was “excessive,” and that the board improperly relied on
her conviction for DWI-test refusal because, at the time of the board hearing, she was in
the process of appealing that conviction.

As to the excessiveness issue, Williams does not provide any argument or briefing on this
point. Her brief could be liberally construed to discuss excessive punishment only insofar
as she suggests within her equal-protection challenge that the board treated her more
harshly than other license holders. We ge nerally decline to reach issues that are
inadequately briefed, Broehm v. Mayo Clinic Rochester , 690 N.W.2d 721, 728 (Minn.
2005), as inadequately briefed issues are not properly before an appellate court, Melina v.
Chaplin, 327 N.W.2d 19, 20 (Minn. 1982). We accordingly decline to analyze excessive
punishment except to the extent that it is implicated in Williams’s equal-protection
argument, discussed below.

As to the board’s reliance on Williams’s criminal conviction, that issue appropriately falls
within Williams’s argument that the board’s decision was not supported by substantial
evidence. We accordingly address it within our decision.
8
In examining whethe r an agency’s decision is supported by substantial evidence, a
reviewing court evaluates all of the evidence relied on by the agency, examining the record
as a whole. Cable Commc’ns Bd. , 356 N.W.2d at 668. Appe llate courts “defer to an
agency’s conclusions regarding conflicts in testimony, the weight given to expert testimony
and the inferences to be drawn from testimony.” In re Excess Surplus Status of Blue Cross
& Blue Shield of Minn. , 624 N.W.2d 264, 278 (Minn. 2001). The reviewing court must
not substitute its judgment for that of the administrative body when its findings are properly
supported by evidence. See In re Denial of Eller Medi a Co.’s Applications for Outdoor
Device Advert. Permits , 664 N.W.2d 1, 7 (Minn. 2003). But a reviewing court will
intervene if “there is a combination of da nger signals which suggest the agency has not
taken a hard look at the salient problems and the decision lacks articulated standards and
reflective findings.” Cable Commc’ns Bd., 356 N.W.2d at 669 (quotations omitted).
Williams appears to argue that the board’s decision was not supported by substantial
evidence because she disputes the validity of the positive drug screens and the record does
not establish a pattern of alcohol or drug use. Specifically, she points to a toxicology screen
in January that was negative an d suggests that it negates th e screen that was positive for
amphetamine and methamphetamine. She also argues that a few problematic, or diluted,
toxicology screens do not show drug use.
5

5 As previously noted, Williams also assert s that the board impr operly relied on her
conviction for DWI-test refusa l because, at the time of her board hearing, she was
challenging that conviction on appeal. She makes this asse rtion without providing any
argument or authority as to how the board erred. An assignment of error in a brief based
on “mere assertion” and not supported by ar gument or authority is waived “unless
prejudicial error is obvious on mere inspection.” Schoepke v. Alexander Smith & Sons
9
The board responds that it considered Williams’s arguments that she had not used
illicit drugs, but ultimately determined Williams “did not impugn th e evidence presented
by the [Review] Panel.” Additionally, the bo ard asserts that Williams’s argument about
the diluted toxicology screenings misses the mark because her licenses were actually
suspended because she violated the consent order by missing toxicology screens, having a
positive toxicology screen, and being discharged from the HPSP.
The review panel presented a significant amount of evidence to the board. It
submitted a toxicology screening report showing that Williams’s sample tested positive for
amphetamine and methamphetamine. It also presented a toxicologist’s opinion that the
positive screening resulted from ingesti on or exposure to amphetamine and
methamphetamine. And it presented evidence that Williams failed to comply with HPSP
requirements by missing screenings, and that she was unsatisfactorily discharged from the
HPSP.
Williams, for her part, did not present ev idence that effectively refuted these
allegations; her explanation for the positive toxicology screen, for example, was that there
must have been a “mix-up” w ith the samples. And while sh e presented evidence of one

Carpet Co., 187 N.W.2d 133, 135 (Minn. 1971). He re, we discern no error, let alone
prejudicial error, by the board regarding the criminal conviction. Indeed, the board’s order
does not reflect that the DWI-test refusal conviction was an important factor in its decision
to suspend Williams’s licenses. Its decision to suspend Williams’s licenses is specifically
based on her failure to comply with the consent order by faili ng to successfully complete
the HPSP and by failing to abstain from mood-altering substances. Accordingly, Williams
has not demonstrated that she is entitled to relief in regards to any consideration of the
DWI-test refusal conviction.
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negative PEth test, she did not explain how it negated the positive toxicology screen for
amphetamine and methamphetamine.
Ultimately, the board determined, after receiving evidence and hearing arguments
from both sides, that Williams violated the consent order, which required her to abstain
from mood-altering chemicals and successfully complete the HPSP. The board was in the
superior position to weigh conflicting testimony and make credibility determinations; this
court does not substitute its judgment for the board’s when its findings are properly
supported by the totality of the evidence. In re Excess Surplus Status of Blue Cross & Blue
Shield of Minn. , 624 N.W.2d at 278; In re Denial of Eller Me dia Co.’s Applications for
Outdoor Device Advert. Permits, 664 N.W.2d at 7; Cable Commc’ns Bd., 356 N.W.2d at
668. The board’s conclusion is well-supported by the r ecord, and by “such relevant
evidence as a reasonable mind might accept as adequate.” Minneapolis Van & Warehouse
Co., 180 N.W.2d at 178. Accordingly, giving proper deference to the board’s findings, we
conclude the decision to suspend Williams’s licenses is supported by substantial evidence.
II. The board’s hearing process and fina l order did not violate Williams’s
constitutional rights.

Williams next raises two c onstitutional challenges, arguing first, that the board’s
procedure violated her substantive due-process rights, and second, that the suspension of
her licenses violates equal protection. We address each challenge in turn.
A. The board did not violate Williams’s right to procedural due process.

The United States and Minnesota Constitu tions prohibit the state from depriving
any person of liberty or property without due process of law. See U.S. Const. amend. XIV;
11
Minn. Const. art. I, § 7. In examining a procedural-due-process challenge, courts first ask
whether a protected liberty or property interest is at issue. Bd. of Regents of State Colls. v.
Roth, 408 U.S. 564, 569-70, 92 S. Ct. 2701, 2705 (1972); see also Humenansky v. Minn.
Bd. of Med. Exam’rs , 525 N.W.2d 559, 565 (Minn. App. 1994), review denied (Minn.
Feb. 14, 1995) . If such an interest is at issue, we then examine what process is
constitutionally due. See Mertins v. Comm’r of Nat. Res. , 755 N.W.2d 329, 337 (Minn.
App. 2008).
A license to practice nursing is a property right entitled to due-process protections.
See Greene v. McElroy, 360 U.S. 474, 492, 79 S. Ct. 1400, 1411 (1959) (holding that the
Due Process Clause protects the right to private employment in a chosen profession from
unreasonable government interference); Humenansky, 525 N.W.2d at 566 (explaining that
“[a] license to practice medicine is a prope rty right deserving co nstitutional protection,
including due process”). Health professionals are regulated pursuant to the state’s police
power and do not have an “absolute” right to practice their profession. Humenansky, 525
N.W.2d at 566. Under Minnesota law, the Board of Nursing is authorized to deny, revoke,
suspend, or otherwise limit a license for professional or practical nursing under enumerated
circumstances. Minn. Stat. § 148.261.
Williams argues that she was denied proc edural due process because she should
have had an opportunity to cross-examine adverse witnesses and to call her own witnesses
before the board indefinitely suspended her licenses. The board responds that Williams
had no right to these due-process protections because she specifically waived them when
she signed the consent order. We agree with the board.
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Williams acknowledged when she signed th e consent order that she had committed
conduct that justified license suspension. She also agreed that the board could revoke the
stay of suspension if she vi olated the consent-order cond itions, and she agreed to the
specific procedure outlined in the consent order for revoking the stay. The procedure
identified in the consent order specifically excludes the opportun ity to call her own
witnesses and cross-examine adverse witnesses, which is the procedure that she now argues
she should have been afforded.
Parties can waive due-process rights in civil proceedings. Overmyer Co. v. Frick
Co., 405 U.S. 174, 185, 92 S. Ct. 775, 782 (1972). Such a waiver, though, “must be
voluntary, knowing, and intelligently made.” Majestic Inc. v. Berry, 593 N.W.2d 251, 255
(Minn. App. 1999), review denied (Minn. Aug. 18, 1999). Here, Williams waived her right
to specific procedural safeguards by signing the consent order. She does not point to any
evidence suggesting that her waiver was not voluntary, knowing, and intelligent. And the
record reflects that, when she entered the consent order, she was represented by counsel.
Moreover, we note that the board affo rded Williams a significant amount of
procedural protection after her alleged violations of the cons ent order. After the review
panel issued its first order removing the stay of suspension, it met with Williams to discuss
the alleged violations. Following the meeti ng, the review panel rescinded the order and
gave Williams another opportuni ty to maintain her licensure if she complied with the
consent order. The second time that the review panel issued an order removing the stay of
suspension, Williams received notice of hearing about two months before the hearing date.
She also received details about the allegations, including the affidavit from the HPSP case
13
manager and the attached documents. Additi onally, she had a meeting with the review
panel about a month before the hearing. These were the procedures that she agreed to in
the consent order.
Because Williams waived the procedural -due-process protections that she now
argues should have been afforded and she has not shown that the waiver was invalid—and
because the board followed the procedure that the parties agreed to in the consent order—
we conclude that the board did not viol ate Williams’s constituti onal procedural-due-
process rights.
B. Williams has not shown that the b oard violated her right to equal
protection.

The United States Constitution provides that “[n]o State shall . . . deny to any person
within its jurisdiction the equal protection of the laws.” U.S. Const. amend. XIV, § 1; see
also Minn. Const. art. I, § 2. The federal and state equal-protection clauses are “analyzed
under the same principles.” State v. Johnson, 813 N.W.2d 1, 11 (Minn. 2012) (quotation
omitted). Equal protection does not “‘forb id classifications,’” but instead “‘keeps
governmental decisionmakers from treating diffe rently persons who are in all relevant
aspects alike.’” Id. at 12 (quoting Nordlinger v. Hahn , 505 U.S. 1, 10, 112 S. Ct. 2326,
2331 (1992)). Accordingly, “the threshold question in an equal protection claim is whether
the claimant is treated differently from others to whom the claimant is similarly situated in
all relevant respects.” Id.
14
Here, Williams claims that she was treat ed differently than similarly situated
individuals when the board suspended her licenses for a minimum of twelve months. She
asserts that she submitted a “data form request” and received the following response:
You requested ‘all public data for all nurses beginning
January 1, 1999 – July 21, 2020 sanctioned for being removed
from HPSP by suspension for 1 year or more for being accused
of having a single positive drug screen for scheduled III due to
exposure.’ The Board’s search has resulted in a null response.

The referenced form and response are not part of the appellate record, though. Appellate
courts will not consider questio ns when the record is insufficient to support review. See
Noltimier v. Noltimier, 157 N.W.2d 530, 531 (Minn. 1968); see also Thorp Loan & Thrift
Co. v. Morse , 451 N.W.2d 361, 363 (Minn. App. 1990), review denied (Minn. Apr. 13,
1990) (“When an appellant acts as attorney pro se, appella te courts are disposed to
disregard defects in the brief, but that does not relieve appellants of the necessity of
providing an adequate record and preserving it in a way that will permit review.”) Because
it appears that Williams’s equal-protection ch allenge is based solely on the data-request
response that is not in the record, the record is insufficient for our review of that challenge.
See Minn. R. Civ. App. P. 110.01 (“The documents filed in the trial court, the exhibits, and
the transcript of the proceedings, if any, shall constitute the record on appeal in all cases”);
Minn. R. Civ. App. P. 115.04, subd. 1 (stating that, on review by certiorari, the record is
defined by Minn. R. Civ. App. P. 110 and “[e]ach reference in Rule[] 110 . . . to the trial
court . . . shall be read, where appropriate, as a reference to the body whose decision is to
be reviewed”).
15
Even if we were to consider the alleged data-request response, though, we note that
the quote does not advance Williams’s position. It appears that she requested data on
nurses who were “sanctioned for being remove d from [the] HPSP,” but Williams herself
was subjected to discipline for her failure to abide by the conditions of the consent order,
despite repeated opportunities to comply. A “null” response to her request, without more,
simply cannot establish dissimilar treatment of individuals who were “similarly situated in
all relevant respects.” Johnson, 813 N.W.2d at 11. Willia ms accordingly has not shown
the board violated her equal-protection rights.
Affirmed.