North Dakota's Supreme Court began trying to sort out a dispute over an Elgin doctor's medical license, an argument that Justice Dale Sandstrom described as a "procedural quagmire."

Dozens of supporters of Dr. George Hsu filled the Supreme Court's courtroom Wednesday to hear his lawyer, Randolph Stefanson, argue the board ignored less severe disciplinary recommendations from an administrative law judge who was well versed in medical disputes.

Instead, the board decided that poor record-keeping was reason enough to revoke Hsu's license, Stefanson said.

"There is nothing about this record that reeks of fairness," Stefanson said. "There is nothing about this record, in many ways, that justified revoking Dr. Hsu's medical license under these circumstances."

The board's lawyer, John Olson, argued that Stefanson was minimizing Hsu's violations. His poor record-keeping could harm patients if they needed to seek treatment from another doctor, and the new physician could not get needed information, Olson said.

"These are serious, life-and-death issues. This is not just a medical record-keeping case," he said. "This is a (case of) appropriateness of what physicians must do to care for their patients."

The board has filed two complaints against Hsu.

Its first, in 2003, alleged he had provided inappropriate care and kept inadequate records for seven patients. An administrative law judge, Allen Hoberg, recommended that Hsu's license be revoked unless he agreed to outside monitoring of his practice.

The following year, the board issued a second complaint, which incorporated the allegations from its first and added new allegations about Hsu's care of three other patients. The board temporarily suspended his license, and put off a decision on its first complaint.

After a hearing on the second complaint, Hoberg again recommended revoking Hsu's license unless he agreed to outside oversight. The board rejected Hoberg's recommendation and revoked Hsu's license.

Hsu appealed, and South Central District Judge Sonna Anderson reversed the board's order. The board responded by giving more detail about its earlier decision, and revoked his license again. The judge then ordered the board to reinstate Hsu and draft a plan for supervising his practice.

Both the board and Hsu appealed. The board wants the Supreme Court to reinstate the revocation of Hsu's license, while Hsu is challenging Anderson's ruling that the board did not violate his right to due process and equal protection of the law.

Stefanson argued Wednesday that the board had brushed off Hoberg's disciplinary recommendation, and that it was arguing it could discipline doctors any way it pleased.

Hoberg is familiar with medical disputes, and "knows about as much medicine as most doctors," Stefanson said. If the board's argument holds, it will give "the board virtually unfettered, unqualified ability to do anything it wants," he said.

Olson said decisions to discipline physicians were the board's responsibility.

"It's the board that has to weigh the severity of the conduct by the physician in these cases," Olson said. "It's not for lawyers and judges to examine underneath the medical technicalities."

The Supreme Court took the case under advisement Wednesday, and will issue its decision later.

Justices Mary Muehlen Maring and Carol Ronning Kapsner recused themselves from hearing the case, and were replaced by Southwest District Judge Allan Schmalenberger and retired East Central District Judge Lawrence Leclerc.