Kansas Professional License Defense Lawyer Asks: Homicide or Compassionate Care?

/in /by

In Kansas, a physician can be tried for murder for over-administering painkillers designed to relieve chronic and/or acute pain. From a pure ethical prospective, palliative care must not be denied to a suffering patient. Over-prescribing, with the intent to kill, however, may cross the line of sound medical ethics to murder. This intersection of medical ethics and criminal jurisprudence can result in a conflation of the healthcare professionals’ duties toward their patients. Accordingly, the highest attention and consideration must be given to the decision to administer higher doses of painkilling prescriptions that could cause an overdose, resulting in premature death. Such a decision can adversely affect licensing privileges as well as criminal responsibility. Attorney Danielle Sanger has years of experience defending medical professionals in licensing actions and promises to vigorously defend your license from adverse action by the State Board of Healing Arts.

Healthcare professionals are well versed in the six core values of medical ethics. Palliative care, according to the Indian Journal of Palliative Care, implicates the ethical mandates of patient autonomy, beneficence, or non-malfeasance, and justice.  Thus, healthcare professionals must counsel a patient facing end-of-life decisions resulting from terminal illness to guide them in making informed choices over their care to the extent possible.   This is especially true with regard to pain management.  The author of the article argues that pain management and relief is a basic “human right.”

No one truly wants to see their loved one suffer, especially when the patient is terminal. Since physicians are not trained to end a life, administering a high dose of narcotics to sedate, or even cause a fatal overdose, could lead to licensing sanctions as well as a criminal prosecution depending upon the physician’s intent.  This is a fine line. Kansas’s legislature passed a statute barring so-called “mercy killings” and prohibits any act or omission that ends a life in a manner inconsistent with the “natural process of dying.”

This fine line was tested in the case of State v. Naramore, wherein the Kansas Supreme Court reversed a physician’s conviction for attempted murder of a terminally ill cancer patient. Dr. Naramore administered high doses of pain killers. Dr. Naramore administered these high doses to combat the substantial pain from which his patient was suffering. The doctor, as well as the patient’s family, observed that the patient’s heart rate and respiration slowed subsequent to ingesting the pain medication. The administration of the medication resulted in a “double effect,” that is, the relief of excruciating pain through high doses of drugs, which, by virtue of the high doses, hastened death while primarily relieving pain.

The Kansas Supreme Court reversed the conviction. The Court recognized that the American Medical Association took the position that administering high doses of medication to combat pain was medically appropriate despite the effect of the drug “shortening life.” The Court noted that there is a fine line between a physician offering palliative care and euthanasia. Palliative care is designed to administer medication to relieve pain, which may then cause death. Conversely, euthanasia is the administering of medication to cause death and thereby eliminate suffering. More to the point, the Court cited the Kansas Association on Osteopathic Medicine’s opinion that failure to administer pain medication that causes a patient to suffer unbearable pain is “medical malpractice.” In the final analysis, the Court held that based upon all of the evidence heard at trial, much of which was from competing experts, Dr. Naramore was entitled to an acquittal.

Contact A Medical Licensing Attorney For Guidance

If you are a medical professional facing these difficult decisions, consulting Attorney Danielle Sanger, who has vast experience in licensing matters, can help. Kansas Professional Licensing Defense Lawyer Danielle Sanger has committed her career to vigorously fighting to protect the professional licenses of medical professionals in Kansas and Missouri. Call Attorney Danielle Sanger at 785-979-4353 today for a free, no-obligation consultation.

Professional Licensing Attorney Explains CPA Disciplinary Actions in Kansas

/in /by

The Kansas Board of Accountancy (“the Board”) enjoys superintendence power over all Certified Public Accounts (CPAs) in Kansas. The Board, created by Kansas statute, is charged with ensuring that CPAs ethically practice public accountancy according to the standards in the profession. The Board exercises its authority to investigate and discipline accountants who have allegedly violated their ethical obligations. Kansas professional licensing attorney Danielle Sanger, who has vast experience with occupational licensing defense, recommends contacting a highly skilled professional licensing attorney immediately if you are being investigated for or charged with disciplinary action relating to your work as a CPA in Kansas or Missouri.

A CPA’s professional standards are derived from core ethical principles of maintaining integrity in the profession, objectivity and independence, and due care.  These ethical principles are espoused by the American Institute of Certified Public Accountants (AICPA). The Kansas statute enunciating the Board’s duties specifically states that any state-issued standard must meet the standards promulgated by the AICPA.  That same statute authorizes the Board to investigate violations of ethical misconduct in the profession and take adverse action, if necessary, to regulate the profession in addition to issuing, denying, and revoking permits to practice public accountancy.

The statute enabling the Board’s seemingly broad powers enumerates specific grounds upon which the Board may base its decision to refuse to issue a permit or revoke a permit to practice accountancy in Kansas. The statute authorizes adverse action for multiple grounds of misconduct. Some of those include:

  • dishonesty, fraud, or gross negligence in the practice of accountancy;
  • willful violation of a rule of professional conduct; and
  • conviction of any felony or of any crime, an element of which is fraud or deceit.

In Kansas, willful is a term of art that has been defined by the Kansas Court of Appeals. In a case of first impression on the issue of defining a willful violation of an administrative statute, the Appeals Court held that willful should be defined as an intent to commit the act or an omission to act. Therefore, the Board, in issuing discipline, must find that the act was willful and not that the CPA willfully intended to violate a rule of professional conduct.

To further regulate practitioners, the Board has issued regulations that, in addition to the previously referenced statutes, govern CPAs’ ethical standards. Article 5 of Chapter 74 of K.A.R. specifically adopts the AICPA Code of Professional Conduct (“the Code”), its rules, definitions, interpretations, and guidance as the ethical standard of practice for CPAs in Kansas.

The Code defines the core principles of CPAs’ ethical responsibility. For example, the Code espouses the ideal that every CPA must conduct themselves in accordance with the public’s best interest and “serve the public trust.”  Serving the public trust means acting with the highest level of professionalism and demonstrating excellence in their profession and acting with the utmost personal and professional integrity. Performing CPA services with integrity requires the CPA to be honest and frank with clients while ensuring confidentiality. Performing with integrity also requires the CPA to observe the form and the spirit of the Code while remaining objective and independent. Objectivity and independence require the CPA to exercise independent judgment and be free from conflicts of interest.

Professional Licensing Attorney Vigorously Defends CPAs Against Claims of Ethical Violations

Kansas Professional Licensing Attorney Danielle Sanger understands the sacrifice and commitment required to obtain and maintain a permit to practice public accountancy.  Call Attorney Sanger if you are facing discipline before the Kansas Board of Accountancy. Attorney Sanger will zealously represent you and protect your livelihood. Call Attorney Sanger today at 785-979-4353 to schedule a free, no-obligation appointment.

Missouri and Kansas Law Differ Regarding Ex Parte Contact with Physicians

/in /by

Nearly every ex parte conversation about a patient’s health is prohibited in Kansas and Missouri. Notwithstanding, physicians who practice medicine in both states are faced with conflicting rules relating to ex parte conversations in the context of litigation involving a patient. Physicians must do their level best to educate themselves on their ethical responsibilities owed to their patients despite conflicting rules to avoid a HIPAA violation, which is a federal crime. Furthermore, a HIPAA violation can lead to sanctions on the physician’s license. Consequently, the careful physician must consult a professional licensing attorney to avoid HIPAA violations. Professional licensing attorney Danielle Sanger who is admitted to practice in Missouri and Kansas, possesses the knowledge and experience to advise you how to ethically resolve the issue.

The ethical conundrum for physicians licensed in both states is caused by conflicting treatment of HIPAA’s privacy rules in the context of third-party contact with physicians regarding a patient’s claims. In a recent decision from the United States District Court for the District of Kansas, a magistrate judge ordered a plaintiff to execute a HIPAA-compliant medical authorization granting permission to the defendant’s attorneys to conduct third-party conversations with the plaintiff’s treating physicians. The plaintiff objected to the defendant’s motion to endorse an authorization allowing the defendant’s attorneys to interview her treating physicians.  The plaintiff sought to quash the defendant’s motion by arguing that Missouri law, rather than Kansas law, must apply, and therefore under Missouri law, such a practice would be prohibited.

The magistrate judge disagreed with the plaintiff. The judge ruled that Kansas law applied rather than Missouri law. The judge further ruled that Kansas law, although recognizing a patient–physician privilege, specifically excluded patient–physician communications where the patient placed her condition in issue in litigation. This guided the court in ruling that HIPAA specifically allowed third-party conversations if the request otherwise complied with state requirements to obtain medical information from healthcare providers and the healthcare providers are given notice that they may decline to be interviewed. The magistrate judge, further construing Kansas law, noted that ex parte conversations with a physician are permitted by Kansas law and “may be regarded as ‘in the course of’ a judicial proceeding.”

The Supreme Court of Missouri, on the other hand, construes HIPAA, and therefore Missouri law, to prohibit ex parte contact. The Missouri Supreme Court, in an analogous situation to the case referenced above, analyzed whether HIPAA, a federal law, pre-empted state discovery rules in litigation.  The court held that HIPAA did pre-empt state law. Specifically, the Court found that HIPAA allowed disclosures of protected information through discovery or other “formal court procedures.”  In the context of discovery of protected medical information, a Missouri court has “authority and oversight” over proceedings in court and proceedings conducted under formal discovery rules. An ex parte conversation with a physician is not a formal discovery tool authorized by the Missouri Rules of Civil Procedure. Additionally, Missouri courts have no authority to compel a physician to engage in ex parte communications or to compel a plaintiff to specifically authorize such communication.

The Missouri Supreme Court ultimately decided that ex parte communications are specifically prohibited by HIPAA. The Court reasoned that ex parte communications are beyond judicial supervision and therefore, a trial court had no jurisdiction to rule on “informal ex parte communications” with the plaintiff’s physicians who are not parties to the litigation. The Court offered some guidance to Missouri physicians. The Court opined that physicians can comply with HIPAA by declining to an ex parte interview unless their patient gives appropriate authorization. Of course, the physician is free under Missouri common law to decline to be interviewed.

Consult With A Knowledgeable and Experienced Professional Licensing Attorney

Kansas Professional Licensing Attorney Danielle Sanger has the best interests of professional licensees in mind. Consult attorney Sanger if you or your staff has any questions or concerns regarding the scope of disclosures that you may lawfully make. Call professional licensing attorney Danielle Sanger at 785-979-4353 immediately to schedule your free consultation.

Kansas City Professional Responsibility Defense Attorney Discusses the Revocation of Hospital Privileges In Missouri

/in /by

Loss or revocation of hospital privileges can have a devastating effect on a physician’s career. The adverse impact of such a decision is felt beyond the physician and her reputation in the healing arts. Most importantly, patients suffer as well. Consequently, physicians whose privileges have been limited, suspended, or revoked by a private, non-profit hospital must vigorously fight to have their privileges reinstated. The State of Missouri now recognizes a cause of action for physicians to contest a hospital’s revocation of privileges. This cause of action is very limited in scope, as explained more thoroughly below. Professional licensing attorney Danielle Sanger zealously advocates for every professional licensee, including physicians, who have suffered an adverse action on their ability to practice their chosen profession.

The general rule in Missouri, as in most other states, is that courts will not interfere with a hospital’s decision to limit, suspend, or revoke a physician’s privileges.  The prevailing view at the time held that hospital privileges were a private matter that rested in the sole discretion of the hospital’s management. That absolute bar no longer exists and a limited exception is now recognized in Missouri. The first exception carved out of the general rule recognized a cause of action of civil conspiracy where two physicians acted in concert against a third physician to revoke privileges and steal that physician’s business. The aggrieved physician in that case was permitted to sue the hospital to be reinstated because the physician alleged something more than wrongful termination of privileges.

Subsequent to that case, Missouri adopted regulations that compel the hospital to draft and enact by-laws.  The by-laws are designed to guide the staff and promulgate the standards by which privileges are revoked, including a hearing and appellate review procedures. The state regulation created an obligation for the hospital to institute a comprehensive set of by-laws as well as a concomitant obligation to follow those by-laws. Consequently, the Missouri Supreme Court recognized the narrow exception to the general rule permitting a physician to sue a hospital for injunctive relief compelling the hospital to follow its own by-laws prior to revoking privileges. In that case, the Missouri Supreme Court indicated a trial court in a suit for injunctive relief would scrutinize the hospital’s actions to ensure “substantial compliance with the hospital’s by-laws.”  Substantial compliance, however, is not a re-evaluation of the hospital’s case. Rather, substantial compliance means that a reviewing court will analyze whether the hospital followed its own by-laws regarding the decision that adversely affects a physician’s privileges. A court will not order injunctive relief if the hospital has complied.

While Missouri courts recognize a suit for equitable relief against a hospital for failure to comply with its by-laws, they have thus far refused to permit a suit for money damages against the hospital.  In Missouri, the hospital’s by-laws are not considered a contractual obligation to a physician. Likewise, privileges to practice at a hospital are not absolute. Privileges may be revoked for reasons which are non-discriminatory and reasonable according to the hospital’s rules and regulations. The rationale supporting this rule relates back to the ultimate mission of a hospital: quality patient care. Missouri courts have reasoned that hospitals should not be forced to make financial decisions relating to restricting privileges at the risk of patient care.

The general rule does not appear to be expanding beyond those limited exceptions. In a recent Missouri case, a physician brought suit for tortious interfere with business expectations. The trial court dismissed and the appellate court upheld that decision, thereby refusing to extend relief beyond injunctive already recognized by Missouri courts.

Contact An Experienced Professional Licensing Attorney For Immediate Assistance

Contact Kansas City Professional Responsibility Defense Attorney Danielle Sanger immediately if you have received notice of a potential adverse action against your privileges. Getting an experienced professional licensing attorney involved early in your case may make the difference to you, your business, and most importantly, your patients. Call professional licensing attorney Danielle Sanger at 785-979-4353 today for a free, no-obligation consultation.