Kansas and Missouri Professional Licensing Attorney Danielle Sanger Explains: Is My Nursing Licensure Case Criminal or Civil?

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Nurses sometimes come to my office for a consultation regarding a licensing issue, and one of the first questions they ask is “can I go to jail for this?” The difference between jail-worthy offenses—criminal matters—and cases with “only” licensing consequences—civil matters—is not always clear, and depending on the conduct in question, the nurse’s case could end up being criminal, civil, or both. Because I so often get questions about the intricacies of these matters, I have written the following blog post to explain the difference.

If you are a nurse in Kansas or Missouri facing an allegation of misconduct or an investigation, call attorney Sanger today at 785-979-4353 to schedule a free consultation. Your career, reputation, and livelihood are at risk, and the challenge facing you is one you cannot work your way through alone. 

How Criminal Charges and Licensure Allegations Can Overlap

Criminal matters can result in the state putting you in jail, or taking your “liberty” in constitutional terms. In criminal cases, a district attorney files a criminal complaint against you in court, and you usually learn of the charges by being served by a police officer or by being arrested. A significant amount of “due process” is required in a criminal case.  Due process means an opportunity to know what the accusations are against you, a chance to review the evidence against you, and a hearing where you and your attorney can confront or attack those accusations and evidence with your evidence.  Similarly, the standard of proof—beyond a reasonable doubt—is high in a criminal case, a jury usually judges guilt or innocence, and the hearing or trial process is quite formal. Licensing cases typically are not criminal matters, although they can evolve into criminal cases later on, which I will discuss further.

In contrast, a civil matter is one where the state seeks to take some “property” from you, specifically, your property interest in your nursing license. Like in a criminal case, the state nursing board cannot take or suspend your professional license without “due process.” But in a  civil matter, the amount of process you receive is far less than in a criminal case.  A board usually makes licensing decisions after a much more informal hearing.

An Example

Take as an example: a nurse who is providing her relatives opioids for their pain without a prescription. If the state nursing board is alerted to this practice, the nurse will likely receive a notice of accusations in the mail, initiating her due process rights. That letter is a civil matter. If she is found to have violated the pharmacy regulations by a preponderance of the evidence—by a likelihood of at least 51%—she will have a civil penalty such as a fine, suspension, or license revocation. However, distributing opioids without a prescription is also a crime.

If the nurse in the above example admits in her civil hearing before the nursing board that she has been distributing opioids, that information can be used against her criminally. A statement made in a civil hearing, like any statement, can be used against you, even if it is not made under oath. The Assistant Attorney General who prosecuted the nurse’s licensing issue can hand the transcript of her admission to an Assistant District Attorney who can then charge the pharmacist with felony drug distribution.

As I stated above, the burden of proof in a criminal case is “beyond a reasonable doubt,” which is much higher than the civil hearing’s “preponderance of the evidence” standard. But if the nurse has admitted to distributing the opioids, that unequivocal admission will likely meet either standard. As a result, a civil matter can quickly turn into a criminal one if the conduct alleged violates both the state regulations that govern your medical field as well as the criminal statutes.

Contact an Experienced Kansas and Missouri Licensing Attorney Now

You have worked too hard to attain your nursing license.  Contacting an experienced licensing attorney to help you through the misconduct hearing process, explain the criminal implications of any allegations against you, and can mean the difference between getting back to helping your patients and losing your career forever.

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 nursing licensing issues.

 

 

 

 

Kansas and Missouri Professional Licensing Attorney Danielle Sanger Explains How Telemedicine Can Jeopardize Your Veterinary License

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Like so many fields, technology has made it possible for veterinarians to serve clients remotely.  Using computers, telephones, and Skype-type video links, many veterinarians in Missouri and Kansas can help patients well even when they are not physically present with the animal in need. But while these technological advances allow for quick consultations over vast distances, they also allow for several potential licensing issues. At direct issue is whether a “veterinarian-client-patient-relationship” is established between the person contacting the veterinarian and the veterinarian. This is an emerging area of law, so I wrote the following blog post to provide an overview.

If you are a veterinarian in Kansas or Missouri facing an allegation of misconduct or an investigation, call attorney Sanger today at 785-979-4353 to schedule a free consultation. Your career, reputation, and livelihood are at risk, and the challenge facing you is one you cannot work your way through alone.

The Veterinarian-Client-Patient-Relationship

Veterinarians want to help animals and put their owners at ease.  Telemedicine has made this more accessible but relies on diagnosis of problems without actual physical exams. Because these diagnoses lack that critical foundation, veterinarians often ask whether an incorrect diagnosis could result in an allegation of misconduct or malpractice.

As I mentioned above, the key element when looking at issues involving veterinarian conduct and allegations of misconduct is the veterinarian-client-patient-relationship.  Generally speaking, a veterinarian establishes a veterinarian-client-patient-relationship when she has sufficient knowledge of the animal in question to make a preliminary diagnosis of its medical condition, and that knowledge is either based on a past physical exam or a personal acquaintance with the animal.  That means that a call-in diagnosis that lacks the foundation of an actual, hands-on exam will usually not trigger a veterinarian-client-patient-relationship, which, in turn, means that a licensing board can not bring misconduct allegations based on these telemedicine interactions.

While the Missouri or Kansas licensing boards may not be able to bring a licensing action against a veterinarian who allegedly makes a misdiagnosis or acts negligently during a telemedicine session, that does not mean that the animal’s owner could not bring a civil negligence suit. Such a case would likely allege either that the diagnosis was negligently given or that the doctor’s use of telemedicine was itself negligent, meaning that the technology was insufficient to adequately asses the animal’s condition.

Negligence means that a person had a duty to protect another person—here, an animal—and failed to make reasonable efforts to meet that duty.  In telemedicine, the veterinarian must be able to demonstrate that the exchange of medical information using electronic communication, including audio telephones, text messages, or email allowed the veterinarian to meet or exceed the minimum competent standard of practice.  Veterinarians must follow the same rules for telemedicine as for in-person visits, including meeting requirements for recordkeeping and confidentiality. Veterinarians must always base diagnoses on extensive give and take communications across emails, telephone, or video conferencing and should never rely on an intake questionnaire.

Contact an Experienced Kansas and Missouri Licensing Attorney Now

You have worked too hard to attain your veterinary license.  Contacting an experienced licensing attorney to help you through the misconduct hearing process, explain the implications of any allegations against you, and can mean the difference between getting back to treating animals and losing your career forever.

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 veterinary licensing issues.

Kansas and Missouri Professional Licensing Attorney Danielle Sanger Explains Licensure Issues for Anesthesiologists

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Anesthesiologists are particularly finding themselves scrutinized in the frenzy to punish anyone connected to the opioid crisis. There are also many other reasons for an allegation to arise, including patient boundary issues, alcohol and drug abuse, and misappropriation of patient money.  When anesthesiologists come to my office, they often ask what they should do if they receive an administrative allegation that they have committed some form of misconduct.  Because this is an increasingly common question, I have written the following blog post to provide an overview.

If you are an anesthesiologist in Kansas or Missouri facing an allegation of misconduct or an investigation, call attorney Sanger today at 785-979-4353 to schedule a free consultation. Your career, reputation, and livelihood are at risk, and the challenge facing you is one you cannot work your way through alone.

When an Allegation Arises

Anesthesiologists in both Missouri and Kansas must possess a valid state medical licenses to practice medicine.  That license gives the states the ability to discipline physicians practicing in the state —such as demanding extra training or imposing license suspensions or terminations.  Misconduct allegations frequently arise from patients and their family members, co-workers, or through hospitals’ reports to a national data bank.  Some of these allegations are legitimate, while others arise from heartbroken patients and disgruntled colleagues.  Regardless of the allegation’s legitimacy, it must be dealt with aggressively.

The state cannot merely revoke an anesthesiologist’s license.  In severe cases, the license can be temporarily suspended if the physician is suspected of actively practicing in a manner that poses a risk to patient safety, such as practicing while under the influence of drugs or alcohol.  In all cases, an anesthesiologist must be provided due process before any disciplinary action can be taken against him or her.  Due process is a legal term stemming from the U.S. Constitution’s Fifth Amendment, which prevents the government from taking any “life, liberty, or property” from a person without due process.

In this context, due process means that a physician will have the opportunity to see all evidence supporting the allegations against him or her, have a chance to confront or challenge that evidence with witnesses and evidence, and will receive some form of a hearing or consideration from an administrative board.  The administrative board’s decision can then be appealed through the courts.

It is vital that you contact a licensing attorney if you receive any allegation of misconduct.  Like you are a specialist in anesthesia, you want an attorney that specializes in licensing cases.  Second, you should say nothing about your case, even if you think you are helping your case.  All of your statements can and will be used against you later, including comments you make on social media or to friends and family.  Only conversations with your attorney are “privileged,” meaning that they do not have to be produced at your administrative hearing later.  Finally, preserve all records related to the alleged misconduct, including computer files and emails. 

Contact an Experienced Kansas and Missouri Licensing Attorney Now

You have worked too hard to attain your medical license.  Contacting an experienced licensing attorney to help you through the misconduct hearing process, explain the implications of any allegations against you, and can mean the difference between getting back to helping your patients and losing your career forever. Anesthesiology is a rewarding career—don’t let allegations of misconduct end it prematurely.

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 the Opioid Crisis and Its Effect on Medical Professionals

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The New York Attorney General indicted the CEO and the Chief Compliance Officer of a major opioid manufacturer this week.  As you likely know, the United States is currently in the throes of an opioid crisis, and law enforcement’s frequent strategy has been to arrest those involved in distributing pain killers to the public. That means that CEO’s, manufacturers, pharmacists, and physicians are all finding themselves in law enforcement’s cross-hairs.  In my practice here in Missouri and Kansas, medical providers are frequently asking what the implications of the opioid crisis are for their practices. I have written the following blog post as an overview because this is an emerging issue of tremendous importance to those holding medical and pharmacy licenses.

If you are a medical professional in Kansas or Missouri facing an allegation of misconduct or an investigation, call attorney Sanger today at 785-979-4353 to schedule a free consultation. Your career, reputation, and livelihood are at risk, and the challenge facing you is one you cannot work your way through alone.

The Opioid Crisis and Medical Providers

Physicians and pharmacists that provide patients with illegal access to opioids can face a loss of their license to practice as well as potential criminal charges. As we have seen across the country, district attorneys are eager to go beyond a mere licensure action and put medical professional behind bars.

Allegations of misconduct involving opioids can arise from several areas. Unfortunately, drug-seeking patients often make unfounded or exaggerated claims to leverage more opioids from their providers.  Other times, however, legitimate claims have arisen from families of those addicted to these powerful painkillers, alleging that medical professionals were too quick to prescribe or distribute opioids or that they failed to stop providing them after the patient displayed obvious signs of addiction.  Finally, these allegations can also arise from co-workers and hospital staff as a result of petty-infighting or legitimate concerns.  Regardless of how the allegation arises, you need to address the allegations immediately with the help of an attorney that specializes in licensing issues.

Medical professionals that have over-prescribed opioids face a challenging problem when they receive a notice of misconduct from a licensing board.  This is because while a skilled licensing attorney may be able to help you through the administrative process and, hopefully, protect your license, statements regarding a pattern of over-prescription or improper-dispensing of opioids can be used by law enforcement as evidence of criminal activity. As a result, medical professionals facing legitimate allegations are caught in a Catch-22, and it may be better to accept a penalty from a licensing board without making any statement than to make a statement to diminish the licensing penalty, only to trigger criminal charges. In some serious cases, it may be better to endure a licensure suspension in an effort to spare yourself criminal charges.  In most cases, however, a licensing attorney can both protect your license and prevent those sorts of dire consequences.

Contact an Experienced Kansas and Missouri Licensing Attorney Now

The opioid crisis has resulted in numerous medical professionals facing licensing issues and even losing their careers permanently. You have worked too hard to attain your professional license to lose it due to an allegation of misconduct.  Contacting an experienced licensing attorney to help you through the misconduct hearing process, explain the implications of any claims against you, and can mean the difference between getting back to helping your patients and losing your career forever.

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.