In Lyness v. State Board of Medicine, 529 Pa. 535, 605 A.2d 1204 (1992), the State Board of Medicine convened to hear evidence against a physician accused of sexual misconduct and determined that formal charges should be lodged and a formal hearing held. Subsequently, the State Board of Medicine, with many of the same members participating, reviewed the hearing examiner's recommendation and decided to permanently revoke the physician's license to practice medicine. Our supreme court held that, because the members of the State Board of Medicine made both the decision to initiate the professional licensing prosecution and then acted as the ultimate fact-finder in determining whether a violation had occurred, they impermissibly commingled their prosecutorial and adjudicatory functions and violated the physician's due process right to a fair and impartial tribunal. The Court stated: In determining what process is due Pennsylvania citizens, this Court has established a clear path when it comes to commingling prosecutorial and adjudicatory functions. There is a strong notion under Pennsylvania law that even an appearance of bias and partiality must be viewed with deep skepticism, in a system which guarantees due process to each citizen. Id., 529 Pa. at 542, 605 A.2d at 1207.