Kansas And Missouri Professional Licensing Attorney Explains A Recent Decision Issued By The Kansas Board Of Healing Arts

Kansas and Missouri professional licensing attorney Danielle Sanger represents professional licensees facing discipline before their respective licensing authorities. She has appeared before the Kansas Board of Healing Arts (“the Board”) to defend clients facing potential suspension, revocation, or another form of supplemental discipline. As such, Attorney Sanger is a close observer of the decisions issued by the Board and believes that making her clients, other professionals licensed by the Board, and the public aware of the Board’s decisions helps them understand the disciplinary procedure. Furthermore, the decisions can be used as precedent for future disciplinary decisions.

In a March 2017 decision, the Board revoked the license of a Kansas physician’s assistant. The Board issued a default order against the physician’s assistant (“Respondent”) for failure to defend the case. A default order can enter if the Respondent fails to appear when summoned. In the case at issue, the Respondent refused to appear for a deposition after the prosecuting authority rescheduled the deposition at the Respondent’s request. Furthermore, the Respondent failed to appear at conferences as required by the Board during the pendency of the litigation. In an email exchange with the prosecutors, the Respondent acknowledged that he would not appear to be deposed and he understood that refusal to cooperate would likely result in revocation of his license.

Kansas’ Administrative Procedure Act permits a licensing authority to enter a default when, in the circumstances such as those described, a respondent fails to appear. Kansas’ Administrative Procedure Act permits the Board to make findings that by virtue of the Respondent’s default, the Respondent admits the factual allegations contained in the complaint and waives any defenses he might otherwise assert.

Notwithstanding the procedural posture of the present inquiry, the administrative law judge made findings of fact and rulings of law. There were three counts of alleged misconduct contained in the complaint. The first count alleged that the Respondent practiced as a Physician’s Assistant in violation of Kansas law. According to the findings by the administrative law judge, the Respondent treated four hundred, twenty-one patients without a supervising physician’s oversight. This conduct defrauded the public and endangered them as well. Accordingly, the judge found that this conduct by the Respondent was willful and intentional.

In count 2 of the complaint, the prosecuting authority alleged that the Respondent filed insurance claims for nineteen patients when he did not treat those patients. The administrative law judge ruled that this practice violated not only the physician’s assistants act, but also the pharmacy act, and the controlled substances act. Once again, the judge ruled that this conduct is fraudulent and endangers the public.

Count 3 alleged that the Respondent perpetrated a fraud by administering Botox that was not approved for use in the United States by the Food and Drug Administration (“FDA”). The Respondent received warnings not to administer this unapproved form of Botox to his patients. The Kansas Attorney General’s Office filed an ex parte request with a Court to enjoin the Respondent from treating his patients with the unapproved Botox. The Respondent willfully and intentionally ignored those warnings by continuing to treat patients with unapproved Botox. One hundred seventy-five patients received treatment by the Respondent with the unapproved drug.

In the end, the Board was left with no choice but to revoke the Respondent’s license to practice as a physician assistant in Kansas.

Contact Counsel Immediately If You Learn You Are Facing An Investigation

Do not try to tackle the government alone. You need experienced and effective representation from the beginning of any investigation into your conduct. Kansas and Missouri professional licensing attorney Danielle Sanger has the experience you need to protect your rights effectively. Call Attorney Danielle Sanger today at 785-979-4353 to schedule an appointment.

Kansas And Missouri Professional Licensing Attorney Discusses The Importance Of Effective Doctor-Patient Communication

Kansas and Missouri professional licensing attorney Danielle Sanger has vast experience representing medical professionals who are facing professional discipline. Through her experience, she has learned that effective communication between the healthcare provider and the patient is essential. Physicians and other medical professionals have an obligation to communicate with their patients. Patients need to know their diagnosis, prognosis, and treatment options.  Those concepts must be communicated to the patient to help them make an informed decision about their health.  Some doctors refuse to discuss those options with their patients. To be sure, some patients do not want to hear what the doctor has to say.

According to a recent story by CNN, many cancer patients do not know the options they have or their exact prognosis. Oncologists are not providing their patients with information to help them make an informed decision on their care. Cancer patients have more treatment options now than ever before, yet many do not know about them. Their doctors have refused, for whatever reason, to tell them about potential life-saving or life-prolonging treatment options.

Some experts have opined that doctors cannot effectively communicate with their patients. Doctors can say a lot; they can use copious amounts of words. But they do not actually say anything meaningful to the patient. Communicating effectively necessarily includes talking with a patient to help them understand the situation in words that they can understand. Communicating effectively also entails taking the appropriate amount of time for the patient to ask questions and digest and figure out what is happening. Emotions can run high. The doctor can use clinical terminology and precisely describe, as only a medical practitioner can understand, the patient’s predicament. Speaking in that manner is of little to no utility to the patient. Talking to someone about the disease that can kill them is not a time for the physician to demonstrate their intellect. It is about the patient, not them.

Many cancer patients do not know their prognosis and how much time they have to live or whether their condition is curable. One physician interviewed for CNN’s article describes that situation as utterly irresponsible on the doctor’s behalf. But, in the doctor’s defense, they might not know about the patient’s lack of information because they might have had the discussion with their patient. Their patient might not have had the capacity to understand because of their emotional state. Concomitantly, their patient might not have asked to clarify if they did not understand. Effective communication is a two-way street.

The failure of communication between patient and oncologist is more rampant than one would initially estimate. CNN cited a study that concluded only 5 percent of cancer patients with less than six months to live accurately knew their dire situation. According to that same study, an unbelievable Thirty-eight percent of patients could not recall talking with their doctors about how long they could live. A similar study from 2012 cited by CNN concluded that 81 percent of people who have advanced colon cancer and 69 percent of lung cancer patients whose cancer metastasized thought they could be cured. There is no excuse for that misunderstanding: both of those conditions are understood to be inexorably fatal.

Healthcare providers should take great pains to explain their patient’s situation thoroughly. Even if they have to be the bearer of bad news, a physician owes it to a patient to tell them so they can understand what is happening. Conversely, the failure to do so could result in a malpractice claim or an investigation into an ethical violation by the Board of Medical Arts.

Professional Discipline Attorney With Proven Results

Kansas and Missouri professional licensing attorney Danielle Sanger will vigorously defend your rights in a disciplinary investigation and proceeding. Call Attorney Danielle Sanger today at 785-979-4353 to schedule an appointment.

Kansas And Missouri Professional Licensing Attorney Asks Whether It is Ethical To Hasten One Death To Save Another Person?

Kansas and Missouri professional licensing attorney Danielle Sanger believes this is an important question to ask even if the answer at first blush might be repugnant. However, police are investigating an anesthesiologist in Los Angeles, CA for doing just that. The Los Angeles County coroner is conducting an investigation, in conjunction with local law enforcement authorities, into whether the physician gave a high dose of a powerful painkiller to kill an 8-year-old child faster so that the child’s organs could be harvested and sent to transplant patients.

According to Foxnews.com, in 2013, the 8-year-old child suffered cardiac arrest when the child was found hanging out of a washing machine. The child nearly drowned. Notwithstanding the heroic efforts of medical technicians, the child was saved; however, the child was placed on life support. The child’s family decided to remove the life support apparatus and subsequently the child passed away. The initial coroner’s report ruled the death an accident by near drowning. The child also suffered from “fragile x syndrome” which is a genetic abnormality causing developmental and intellectual deficiencies.

One of the L.A. County coroner’s investigators questioned the medical procedure that child received. The investigator wanted to delve into the reasons the anesthesiologist at Ronald Regan UCLA Medical Center administered a very high dose of fentanyl. The medical examiner at the time did not indicate a further investigation was necessary. A new chief medical examiner for the L.A. County coroner’s office subsequently added fentanyl overdose to the child’s cause of death but only after the investigator pushed for the change.

The issue came to light recently in a “whistleblower” lawsuit. The investigator sued L.A. County for damages claiming she was fired as retaliation for her persistent pursuit of what she believed was a contributing cause of death of the child. The lawsuit revealed the question asked by the coroner’s investigator.

The young boy was never going to regain consciousness or brain function after spending 25 minutes face down hanging out of a washing machine. The boy’s heart stopped, but paramedics were able to restart it. Unfortunately, the brain was irrevocably damaged. The child was not clinically brain dead, but his parents knew he would never awaken. They decided to remove him from life support and donate his organs.

Physicians could not harvest the boy’s organs until his heart stopped beating even though the ventilator was removed. Organs begin to decay only after 30 minutes of oxygen deprivation.  During that time, the anesthesiologist attending to the child gave a dosage of the powerful painkiller fentanyl. Physicians do not know whether people in the state in which the child lay feel pain. Consequently, physicians order painkilling medication just in case.

UCLA Medical Center policy approves using painkillers in a situation such as this. However, hospital policy expressly forbids hastening a death to preserve organs. Medical records produced in the lawsuit only indicate that the dying boy received comfort measures. No reference was made to the use of Fentanyl. However, the coroner’s office determined that the boy received 500 micrograms of the drug despite his tiny frame which carried merely 47 pounds.

Additional evidence leads one to question whether the anesthesiologist violated hospital policy and the ethics of her profession. According to the lawsuit, after doctors removed the ventilator, the boy gasped for air until the anesthesiologist administered the pain medication. Then, the boy peacefully slipped away.

Zealous Representation For Medical Professionals Facing Discipline

Kansas and Missouri professional licensing attorney Danielle Sanger is a zealous advocate for professional licensees. She has dedicated her practice to fighting for people to keep their livelihood and their careers when facing discipline. Contact Attorney Sanger today at 785-979-4353.

Missouri Nursing Discipline Explained

Kansas and Missouri professional licensing attorney Danielle Sanger has tremendous experience in her legal career representing nurses facing professional discipline. Attorney Sanger understands that nurses play an invaluable role in our healthcare.  Rather, they are the liaison between patient and physician. Not only do they assist doctors with monitoring patients, taking vital signs, and delivering medication, nurses also provide emotion support for patients. In that regard, nurses are more than assistants to physicians. A well-trained and caring nurse can help ease the emotional pain, uncertainty, and discomfort of a patient, and the patient’s family. Nurses seem to know innately when a smile can put a patient at ease or a reassuring touch will ultimately disarm a patient.

Despite all of the benefit nurses provide to their patients, it must be understood that nurses are fallible human beings like the rest of us. Nurses can become overwhelmed by stress. They are just as likely as anyone else to mistakes, oversights, misinterpretation, and other failures like substance abuse even if they are the most vigilant, scrupulous, attentive, and professional nurse. Simply put, things happen.

Nurses who fall on hard times should take care of not allowing a bad day spin or couple of days spin out of control. A lot can happen in a short time frame. It is important that you maintain perspective. Nurses owe a duty to their patients to give them the best care possible. Any failure to meet that standard could result in professional discipline. Consequently, if your personal or professional life is taking its toll on your performance, you must seek assistance. Talk with your nursing manager, human resources department, or head physician and discuss with those stakeholders the issues with which you face. Speak with resources provided by the nursing board. There is no need to go it alone.

The Missouri Board of Nursing (“the Board”) can take disciplinary action on your license if you violate the Missouri Nursing Act. The Act permits the Board to initiate disciplinary action if a nurse:

  • abuses substances, alcohol, or both to the extent that their ability to perform the tasks attendant to nursing is compromised;
  • perpetrates a fraud or deceit upon a patient or the public at large;
  • is convicted of a crime or pleads nolo contendre that calls into question the nurse’s ability to perform the job functions, is a crime of moral turpitude or is a crime of deceit; and
  • Is grossly incompetent or repeatedly negligent.

These are the most common infractions committed by nurses. The Act contains additional grounds for discipline.

The Board has the discretion to mete a punishment for a violation of the Act. The Board can consider the nature of the allegations, the nurse’s record of professional discipline, the severity of the infraction, and any other factor the Board deems to be relevant.

The Board has available to it four categories of disciplinary action. They are censure, probation, suspension, and revocation. Censure is the least severe punishment. Censure is a public reprimand that the Board retains in your personnel file as a record of discipline. Censure serves as a reminder to correct the action the Board ruled violated the Act. The Board may place a nurse on probation for a period. A nurse can practice but is subject to conditions on the license for a specified length of time. Suspension and revocation are the most serious punishments. A suspension cannot last longer than three years. However, revocation may be permanent. A nurse is permitted to reapply for reinstatement after one year after a nursing license was revoked.

Aggressive Representation To Protect Your Nursing License

Nursing is more than a job; it is a calling. Missouri Professional Licensing Attorney Danielle Sanger understands the sacrifices as a nurse makes. She will vigorously advocate for you if you face professional discipline or are under investigation. Call Attorney Danielle Sanger today at 785-979-4353 to schedule an appointment.