On January 11, 2016, amendments to the regulations governing physician assistants in Kansas became effective. Generally speaking, the new regulations permit greater flexibility to physician assistants in some aspects while placing greater responsibility on the attending physician. The goal of the amendments is better patient care. Being aware of the changes is vitally important to both the physician and the physician’s assistant. Failing to follow the new changes may jeopardize your physician assistant’s license. Kansas professional licensing attorney Danielle Sanger stakes her reputation on fighting for licensees who are facing the specter of discipline.

The new amendments to the regulations governing physician assistants introduce a series of definitions for terms of art currently used in the profession to describe the relationship between a physician’s assistant and the supervising physician. For instance, the amendments define “supervision” as overseeing delegated medical care to the physician’s assistant. A substitute supervising physician is defined as the physician who agrees to take a supervisory role of the physician’s assistant when the primary supervising physician is unavailable. The phrase “different practice location” is a place where medical treatment is dispensed to patients where the supervising physician or substitute supervising physician practices less than 20% of the time. A medical care facility is exempted from this definition. “Direct supervision” is defined in the amendments as the supervising or substitute supervising physician being physically present and able to take over immediate care of the patient if so required. This is in contrast to the situation when the supervising physician is communicating with the physician’s assistant telephonically or via electronic communication.  That method of supervision is defined as “off-site supervision.” However, “indirect supervision” means that the supervising physician or substitute supervising physician can be on site to take over care of the patient in 15 minutes or less.

The amendments to the regulations define the limits on the scope of a physician assistant’s practice. The regulations allow a physician assistant to administer medical treatment to a patient when the supervising physician or substitute supervising physician authorizes and coordinates such treatment when the supervisor is physically present.  The physician assistant is also allowed to treat a patient when authorized and coordinated with the supervisor through “verbal or electronic communication.” The physician assistant may also render care to a patient consistent with the active practice request form which is required to be filed with the Kansas Board of Healing Arts. Lastly, the physician assistant may medically treat a patient in an emergency situation.

The physician assistant must file an active practice request form with the Kansas Board of Healing Arts. The physician assistant must disclose a significant amount of information on the active practice request form. Information such as identifying supervising and substitute supervising physicians, a disclosure of the nature of the medical services to be provided, and whether the supervising physicians will be present at the same location as the physician assistant. If not, the physician assistant must state that they have practiced at least 80 hours under the direct supervision of the supervising physician. The physician assistant and the supervising physician must also file a written agreement with the active practice request form. The agreement must contain a list of services the physician assistant may and may not perform. A list of prescription drugs the physician assistant is authorized to dispense must also be included in the agreement.  The practice request form must also memorialize the physician’s and substitute physician’s consent to be available for communication with the physician assistant during business hours.  It is important to note that the active request form must be filed with the Kansas Board of Healing Arts on or before July 1, 2016.

For More Information, Contact the Sanger Law Office Now

Keeping current in your field of practice is vital to satisfying the ethical standards of a physician assistant. It is critical, therefore, that you read and understand your obligations as a physician assistant. Kansas Professional Licensing Attorney Danielle Sanger advises physician assistants and other medical arts practitioners. Call Attorney Sanger today at 785-979-4353 for your no-obligation consultation.

Adverse action against a professional license can be appealed to a higher court for review. In Kansas, an administrative law judge makes findings and rulings at a hearing. The administrative law judge’s findings of fact and rulings of law must be based upon the evidence produced by the licensing authority at a hearing.  The licensee may accept the findings of the administrative law judge or appeal. The case is not heard all over again. Rather, the reviewing judge, usually a district court judge, will review the record generated by the investigation and hearing before the administrative law judge to ensure that the administrative law judge’s decision complied with Kansas law.  Kansas professional licensing attorney Danielle Sanger has vast experience in representing professional licensees in adversarial actions at the administrative level and on appeal.

In Kansas, the licensing authority has the burden of proving the allegations against the licensee. The administrative law judge must find the licensing authority has proved its case with substantial competent evidence to take adverse action against the licensee.  On appeal, the party with the burden of proof changes. The party asserting the error must prove that the ruling was wrong and its decision was “arbitrary and capricious.” The reviewing court will not hear new evidence. The reviewing court must accept the findings of fact found by the administrative law judge if the facts are “supported by substantial competent evidence.” “Substantial competent evidence” has been defined by Kansas courts as evidence that is relevant and provides a “substantial basis” to resolve the contested issues. The prevailing party is entitled to deference on the facts if the facts of the case are disputed on appeal to determine if the facts are supported by substantial competent evidence.” The court does not re-evaluate the evidence. However, the issues of law as decided by the administrative law judge are reviewed de novo by the appellate judge.

With those guidelines the reviewing court will only reverse the administrative law judge’s decision in very limited circumstances. One such circumstance is that the underlying statute, regulation, or by-law which formed the basis for punishment is unconstitutional and invalid, either “on its face” or “as applied.”  A reviewing court may overrule the findings if the agency investigating the allegations of wrongdoing had no jurisdiction to do so. The court may also overturn the decision if the administrative law judge failed to decide every issue required for resolution of the entire matter. If the investigating agency follows an illegal investigatory procedure or fails to follow proper procedure, then the decision may be overturned. Likewise, if the persons investigating the wrongdoing were not properly authorized to do so then the decision may be overturned. Furthermore, if the agency action is based upon a “determination of fact” of which there is no evidence and the fact is “substantial” to the determination of the issue. Lastly, the reviewing court may overturn the administrative law judge’s decision if the decision is arbitrary or capricious.

The district court’s decision may also be appealed. An appellate court will review a lower court’s decision to ensure that the district court limited its review strictly to the issues permitted. In that sense, an appellate court will undertake a similar review of the record as the district court. The appellate court is limited to the same areas of inquiry as the district court.

Do Not Try To Navigate These Choppy Waters Alone

Kansas Professional Licensing Attorney Danielle Sanger has vast experience in representing numerous professional licensees who face disciplinary action. Attorney Sanger is keenly aware of the sacrifice and determination required in obtaining a professional license. Adversary proceedings against a professional license are complicated and confusing. Contact Kansas professional licensing attorney Danielle Sanger today at 785-979-4353 to schedule your free consultation.

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.

Physical therapists profess to treat a multitude of common ailments by increasing mobility and motion in lieu of medical intervention. Physical therapy as a healing art is premised on the principle that moving “pain-free” is essential to good health and is a cost-effective alternative to other medical modalities. Physical therapists work with patients to increase strength and flexibility thereby increasing, depending upon individual circumstances,  the quality of one’s daily life.  Because a physical therapist provides a vital medical service to the public, the physical therapist must be duly licensed to practice. In Kansas, the Kansas Board of the Healing Arts (“the Board”) oversees physical therapist licensing and ethical practices.  Kansas professional licensing attorney Danielle Sanger devotes her practice to the representation of licensed professionals, such as physical therapists, who face disciplinary proceedings in both Kansas and Missouri.

Physical therapy provides the opportunity for patients suffering from pain or lack of mobility to reverse those ailments without prescription drugs or surgery.  For example, the American Physical Therapy Association (“APTA”) explains that freedom of movement will help reduce obesity, reduce the risk of heart attack and stroke as well as fracture and arthritis risk. The APTA further explains that increased mobility—one of the primary benefits of physical therapy—decreases the risk of falling by encouraging consistent movement to benefit our sense of balance. In addition to increased mobility, decreased pain is another perceived benefit of physical therapy.  The APTA cites a Journal of the American Medical Association study that concluded that back-pain is “over-treated” by physicians ordering costly diagnostics and treatment, such as “imaging” and surgery.  According to the APTA, physical therapy is a “cost-effective” alternative to “surgery and injections” to treat back-pain and other ailments, such as torn rotator cuffs, meniscus tears, and degenerative disc disease.

To ensure that physical therapy is practiced ethically, the APTA promulgated the “Code of Ethics for the Physical Therapist.”  The Code of Ethics establishes an industry standard of the physical therapists’ role in treating a patient, minimum standards of care, while promoting a patient-centric approach to health care. The APTA delineated 10 principles of physical therapy to guide the practitioner in providing health care in the Code of Ethics. Accordingly, physical therapists are implored to respect their patients and communicate well with them; practice with integrity; avoid misrepresenting their credentials and potential outcomes of treatment; and use sound professional judgment that is in the best interest of the patient at all times. Specifically, the Code of Ethics obligates practitioners to obey federal and state laws and regulations.

In Kansas, the Board of Healing Arts is the licensing authority for physical therapists. The Board of Healing Arts (“the Board”), by authority conveyed by statute, may deny licensure, renewal, or may take adverse action against a physical therapist’s license for conduct including but not limited to alcohol or drug dependency, felony conviction, or unprofessional conduct as defined by the Board’s rules and regulations. The regulations are consistent with, although more specific than, the APTA’s Code of Ethics. In Kansas, unprofessional conduct is defined as, for instance, failing to practice skillfully due to alcoholism or drug dependency and/or mental illness; committing gross or ordinary negligence; demonstrative incompetence; “advertising a guarantee” relating to physical therapy; making false or misleading claims in advertisements, including misrepresenting one’s own credentials; continuing unwarranted treatment or ordering useless tests or procedures; and charging excessive fees.

What To Do If You Are A Physical Therapist Facing An Ethical Investigation

If you are a physical therapist facing an investigation or complaint for unethical practices, contact Kansas Professional Licensing Attorney Danielle Sanger immediately at 785-979-4353 to discuss your options and defenses. Attorney Sanger has vast experience defending professional licensees in Kansas and Missouri against alleged ethical violations. Attorney Sanger is a zealous and tireless advocate who will pursue every available defense on your behalf. Call Attorney Sanger today for your free consultation.  

The Missouri Committee of Psychologists is the governing administrative agency for psychologists in Missouri. The Missouri Committee of Psychologists (“the Committee”) regulates the practice of psychology by ensuring proper licensing by people holding themselves out to the public as psychologists, and making certain that psychologists meet proper educational requirements, as well as continuing educational guidelines. The Committee is also charged with investigating psychologists who have allegedly violated the governing rules of ethics or for other forms of misconduct. Professional licensing attorney Danielle Sanger is a zealous advocate for licensees facing disciplinary actions in Missouri.

The authority to investigate psychologists is conferred by statute in Missouri. Missouri Revised Statutes section 337.035.1 et seq. delineates numerous grounds upon which the Committee may investigate for disciplinary reasons, including but not limited to ethics violations, criminal convictions, failure to pay taxes, and the like. If the Committee finds evidence of one or more grounds for discipline, then the Committee may file a complaint with the Missouri Administrative Hearings Commission. If the Hearings Commission rules that the Committee met its burden, the Hearings Commission may levy discipline.

The Hearings Commission is authorized by statute to hear the allegations brought by the Committee against the licensee. The Hearings Commission then refers the matter back to the Committee if the Committee has met its burden to prove the allegations at the hearing. The authority conferred by statute to the Committee permits discipline in the nature of censure, probation of a license with appropriate conditions not to exceed five years, suspension of a license for no longer than three years, or revocation of a license.

An examination of recent disciplinary rulings is instructive to practitioners to help assess the prevailing rationale of the Committee. In one case, the psychologist was unable to satisfy the continuing educational requirements. The Hearings Commission found that the licensee was subject to discipline as a result of that failure. The Committee placed the licensee on probation for three years with numerous conditions. The licensee indicated to the Commission that his own mental state was not stable, which caused him to fail to meet continuing educational requirements. Those conditions included submitting to an evaluation to assess the licensee’s own mental condition for fitness to practice as a psychologist.

In another decision, involving more egregious facts, the Committee and licensee entered into a stipulation for discipline. The licensee became romantically involved with a former patient. The patient had sought counseling for a period of time and then failed to keep an appointment.  The licensee failed to send a termination letter or conduct a termination session. Shortly thereafter, the licensee and patient became romantically involved. The Committee and licensee reached an agreement wherein the licensee would be suspended for three years from practice and be placed on probation for three years if the license was reinstated. The Committee ordered the psychologist to submit to a psychological assessment and attend counseling if necessary.

In a very recent decision, the Committee accepted a stipulation for a psychologist who self-reported an ethical violation. The psychologist reported that he failed to maintain appropriate notes, referrals, examination tests, and other documentation required to be maintained by Missouri law. The licensee informed the Committee that adverse working conditions prevented the necessary record keeping. The Committee and licensee entered into a stipulation that the licensee would voluntarily surrender his license, “in lieu of other discipline.”

Contact an Experienced Professional Licensing Attorney for Assistance

Even trained professionals make mistakes. Do not compound the problem by representing yourself if you face a disciplinary complaint.  Kansas Professional Licensing Attorney Danielle Sanger has helped many clients keep their licenses despite facing disciplinary action. Attorney Sanger will tirelessly advocate for you to keep your license to practice. Call Attorney Sanger today at 785-979-4353 for your free consultation, and learn what a difference experience makes.