Kansas and Missouri Professional Licensing Attorney Danielle Sanger Discusses Trends in Medical Board Licensing Cases—“Health Coaching”

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People often ask me what sort of trends I see in medical license defense. One of the most common areas revolves around medical professionals acting as “health coaches” in areas that are beyond their licensure. What usually happens is that a person begins to advise beyond their licensed specialty, and they tell themselves that this advice is allowable because it is merely “coaching” and not actually the practice of medicine. As you can imagine, the line between acting within a license and “coaching” patients illegally is blurry, at best, and crossing it can lead to the revocation of your hard-earned license. I routinely see clients accused of practicing medicine without a license and false advertising.

If you are licensed medical professional in Kansas or Missouri facing an investigation, call attorney Sanger today at 785-979-4353 to schedule a free consultation. Your career is at risk, and you cannot work your way through this alone.

What is the Problem with Health Coaching?

Health coaching is a relatively new and amorphous field that encourages healthy and sustainable living through changes in diet, exercise, outlook, and lifestyle.  It is a field that lives in the margins between other already established professions. It is similar to medicine, nutrition, psychology, and other fields such as massage therapy and physical therapy. The problem is that each of those fields already has a body of knowledge, training, and expertise that is required of its practitioners, and each field requires a license. While health coaching is not illegal, in practice it often drifts into one of these other professions’ areas of control. When that boundary is transgressed, licensure issues arise.

As a medical professional, you know that at the core of the practice of medicine are two actions—diagnosis and treatment. A medical professional can diagnosis or determine a problem and prescribe treatment for that problem, whether it is a medication or a therapy.

As a hypothetical, imagine you have a chiropractic license but are well read about nutrition and have a passion for helping people through their diets. There may be an impulse to start advertising yourself as a “health coach” to begin working with patients who have issues that you cannot treat through chiropractic care alone. While it may be alright to encourage people to eat a balanced diet and to encourage them to avoid unhealthy foods, but when you start telling them what sort of food they should eat to treat a particular physical ailment, you are going beyond coaching and are actually working as a medical doctor or nutritionist. When you begin diagnosing and treating a condition outside of your chiropractic licensure, you are setting yourself up for a complaint that puts your entire license at risk.

How will you know if you are crossing that line? If you are treating a condition, you will likely be reviewing lab tests, looking at genetic data, or prescribing specific treatment based on medical questionnaires or family health history. That sort of review suggests that you are trying to diagnose and treat a problem. If that treatment or diagnosis is in an area outside of your area of licensure, you are risking your license. Similarly, if you are advertising for this sort of treatment and lack the licensure to provide it, you are risking a false or misleading advertising claim.

While a patient may be happy with the “coaching” you have given them, those practicing in the field you have drifted into have a serious incentive to file a claim about you to the applicable Kansas or Missouri licensing board. Those boards are also keenly interested in protecting the sanctity of their fields and are unlikely to give you the benefit of the doubt when you cross into their regulatory area.

Contact an Experienced Kansas and Missouri Licensing Attorney Now

Any medical provider or clinic in Kansas or Missouri contacted by a state licensing board should contact experienced counsel immediately. Your business and license to practice are in jeopardy, and these initial moments are crucial. Trying to be helpful or “playing along” may seem like the easy way to go, but it may not be in your best interest. You have no obligation to speak to anyone without counsel present, and talking to an investigator without counsel may be a fatal error. Contacting an experienced licensing attorney to help you through this process and can mean the difference between getting back to helping your patients and a license suspension or revocation.

If you are a medical professional in Kansas or Missouri and are worried about your license, call attorney Sanger now.

Kansas and Missouri professional licensing attorney Danielle Sanger is prepared to advocate for your best interests and defend you. Call Attorney Sanger at 785-979-4353 to schedule a free consultation with an attorney experienced dealing with licensing issues.

 

 

Kansas and Missouri Professional Licensing Attorney Danielle Sanger Discusses Trends in Veterinary Licensing—Telemedicine

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Like all professions, veterinary medicine is now online. Just ten years ago, there was insufficient broadband and infrastructure to support a genuinely on-line veterinary practice. Now both of those problems have been solved, and veterinarians have almost boundless ability to interact with patients. But while the technological boundaries have fallen, the legal and licensure boundaries remain.

Where is the line between illegally practicing veterinary medicine in a state without a license and helping a long-time patient who is on vacation in another state? The line between legal and illegal practice is not as bright as it was before the internet, as patients can now reach out to you for advice from around the world. With this significant advantage comes extra regulatory scrutiny. Crossing an already blurry regulatory line can lead to the revocation of your hard-earned veterinary license, especially when the allegation involves the illegal or improper prescription of medications. I routinely see clients accused of practicing veterinary medicine without a license, and they usually come to me devastated.

If you are licensed veterinarian in Kansas or Missouri facing an investigation, call attorney Sanger today at 785-979-4353 to schedule a free consultation. Your career is at risk, and you cannot work your way through this alone.

What is the Challenge with Tele-Veterinary Medicine?

The critical thing to remember is that as a Kansas or Missouri veterinarian, your veterinary medicine license is tied to a specific state. While your clients may travel and rely on you wherever they go, your license is constricted by the boundaries of its issuing state.

Second, as a veterinarian, you should look to the guidelines set by American Veterinary Medicine Association, or AVMA, for whether your behavior is reasonable. In this area, the AVMA focusses on the veterinary-client-patient-relationship or VCPR. The VCPR is significant, as it provides a reasonable picture of what will be viewed as legitimate telemedicine.

Under the AVMA’s model, the VCPR establishes when the veterinarian has an ongoing relationship with the patient animal that is sufficient to allow for diagnosis and treatment planning. Given this guideline, it is reasonable to provide long-distance advice to a client about their pet while they are out of state, as the veterinarian in question has an ongoing treatment relationship with the patient animal.

That said, the opposite facts may lead to an allegation of malpractice. If a prospective client calls a veterinarian from out of state about a patient animal that the veterinarian has never treated, it is unlikely that any VCPR exists. Accordingly, that sort of treatment should be avoided.

Even if the there is a VCPR, distance creates another challenge. While a veterinarian may be able to make a general diagnosis based on some “tell-tale” symptoms and the patient animal’s health history, that diagnosis still suffers from not having the patient animal present for an examination. Claims of malpractice can arise when a veterinarian does not meet the standard of care for a given situation, and the standard of care does not differentiate between a long-distance diagnosis and one done in-person in a clinic. While not a silver bullet, having tele-veterinary medicine patients sign a disclosure acknowledging the limits of a distance diagnosis may prove useful.

Contact an Experienced Kansas and Missouri Licensing Attorney Now

Any veterinarian in Kansas or Missouri contacted by a state licensing board should contact experienced counsel immediately. Contacting an experienced licensing attorney to help you through this process and can mean the difference between getting back to helping your patients and a license suspension or revocation.

If you are a veterinarian in Kansas or Missouri and are worried about your license, call attorney Sanger now.

Kansas and Missouri professional licensing attorney Danielle Sanger is prepared to advocate for your best interests and defend you. Call Attorney Sanger at 785-979-4353 to schedule a free consultation with an attorney experienced dealing with licensing issues.

Kansas and Missouri Professional Licensing Attorney Danielle Sanger Explains Licensing Threats for Chiropractors

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Chiropractors are a highly-trained and highly-respected members of the medical community. The key to practicing as a chiropractor is your state-issued chiropractic license. For a variety of reasons, patients sometimes make false claims of misconduct against chiropractors; other times, unfortunately, chiropractors engage in misconduct themselves. Either way, aggressive, experienced licensing counsel is critical to defending your license and livelihood from a suspension or revocation. I wrote the following post to outline why discipline could occur and what you should do if an allegation arises.

If you are licensed medical professional in Kansas or Missouri facing an investigation, call attorney Sanger today at 785-979-4353 to schedule a free consultation. Your career is at risk, and you cannot work your way through this alone.

The Most Common Accusations Against Chiropractors in Kansas and Missouri

I have years of experience in front of both the Kansas State Board of Healing Arts and the Missouri Board of Chiropractic Examiners. These two agencies see many different allegations, but they commonly fall into the following categories:

Sexual misconduct—sexually abusing a patient or having a consensual relationship with a patient are both common misconduct claims against chiropractors. This is particularly a problem in this field, as the work involves touching patients, often in a private or mostly-private setting.

Fraud—insurance fraud, over-billing, and charging for procedures that were not performed are all frequent allegations. Given the complexity of medical billing and the difficulty in finding qualified and trained staff, recurring mistakes made by staff can too easily be construed as an act of fraud by a chiropractor.

Prescription Medications—Over-prescribing medications and providing prescription medication to those who do not medically require them are both increasingly prevalent complaints against chiropractors.  There is increased scrutiny on all medical professionals with prescription privileges due to the opioid epidemic in both Kansas and Missouri.

Negligence—Negligence is defined as a failure to meet the standard of care reasonably expected under the circumstances. Not all patients’ conditions improve after receiving chiropractic care, and patients sometimes wrongly blame their chiropractors for any decline.

Criminal Convictions—Convictions for some crimes may result in a collateral license action, especially if the offense suggests that the chiropractor may have a drug or alcohol problem, cannot safely interact with the public, or cannot be trusted with money or confidential information.

Can the State of Missouri or Kansas Just Take Your License?

No. Your chiropractic license is your property. The United States Constitution’s Fifth Amendment guarantees that the government cannot deprive you of life, liberty, or property without due process. But what does “due process” mean? While in a criminal trial you have a right to a jury and other elaborate processes, a license action only requires a hearing before an administrative hearing officer or board. In this context, due process means that the state must afford you notice of all the allegations against you, an opportunity to prevent your defense to a hearing officer or board, and consideration of your position. But make no mistake, an administrative hearing is just as contentious as a criminal trial, and your career hangs in the balance.

Contact an Experienced Kansas and Missouri Licensing Attorney Now

Any medical provider or clinic in Kansas or Missouri contacted by a state investigator or licensing board should contact experienced counsel immediately. Your business and license to practice are in jeopardy, and these initial moments are crucial. You have no obligation to speak to anyone without counsel present, and talking to an investigator without counsel may be a fatal error. Contacting an experienced licensing attorney to help you through this process and can mean the difference between getting back to helping your patients and a license suspension or revocation.

Kansas and Missouri professional licensing attorney Danielle Sanger is prepared to advocate for your best interests and defend you. Call Attorney Sanger at 785-979-4353 to schedule a free consultation with an attorney experienced dealing with licensing issues.

Kansas and Missouri Professional Licensing Attorney Danielle Sanger Discusses Medical Board Licensing Cases—Negligence Allegations

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While there are many types of allegations against medical professionals, what I most commonly see are negligence claims. I think that society’s high expectations for the medical profession make this type of allegation especially prevalent.  Patients begin treatment with lofty hopes of being completely healed in a short period of time, even when that result is clearly unrealistic. Because there is a natural desire to find blame when things do not go as people hope, negligence claims often ensue when a patient’s health does not improve to the expected level. As we all know, however, many factors influence a patients’ ability to heal, and a failure to heal does not necessarily imply that the doctor was negligent. Many times, the patient’s poor health beforehand or a failure to follow up with prescribed therapies is the real reason the patient did not recover.  In the end, society’s expectations for medical professionals far exceed the degree of accountability we show for our own health.

Medical professionals must understand the theory of negligence to avoid career-ending complaints. Because I receive so many questions about this sort of claim, I have written the following blog post to explain the basics.     

How Can a Negligence Accusation Cost Me My South Carolina Medical License?

What is negligence?  To be found negligent, a medical professional must fail to meet the standard of care for a patient that would reasonably apply under the circumstances, resulting in some harm. As a medical professional appearing before a medical board or hearing officer, you will have to show that you were not negligent. For the state to prove negligence at a hearing, it will have to demonstrate that you had a duty to care for the patient bringing the allegation, you failed to meet the standard of care for treating the patient under the circumstances, and your failure caused them harm.

As I am sure you have gathered, the negligence standard is not a well-defined “bright line.” Instead, it is a subjective standard, meaning what is “reasonable” will depend upon the person judging reasonableness and the circumstances in which the conduct occurred. For example, a battlefield medic operating under hours of withering enemy fire will be held to a lower standard of care than a well-rested physician working in a well-staffed, cutting-edge medical facility.

Because there is so much room for interpretation in the negligence standard, it is vital that you have a skilled licensing attorney help you through the hearing to make sure facts are portrayed in a light most favorable to you and that witnesses are skillfully cross-examined.

Contact an Experienced Kansas and Missouri Licensing Attorney Now

Any medical provider in Kansas or Missouri contacted by a state licensing board should contact experienced counsel immediately. Your license to practice is in jeopardy, and these initial moments are crucial. Trying to be helpful or “playing along” may seem like the easy way to go, but it may not be in your best interest. You have no obligation to speak to anyone without counsel present, and talking to an investigator without counsel may be a fatal error. Contacting an experienced licensing attorney to help you through this process and can mean the difference between getting back to helping your patients and a license suspension or revocation.

If you are a medical professional in Kansas or Missouri and are worried about your license, call attorney Sanger now.

Kansas and Missouri professional licensing attorney Danielle Sanger is prepared to advocate for your best interests and defend you. Call Attorney Sanger at 785-979-4353 to schedule a free consultation with an attorney experienced dealing with licensing issues.