bit.ly/MedBoard #PtSafety only matters when other doctors violate the law. The degree of hypocrisy is disgusting and significant. I have never received a speeding ticket, but the medical board thinks they have better moral character than me, despite the fact that they committed fraud six times versus a cardiologist who was helping patients. If the medical board is able to stop more good doctors whilst breaking the statutes and the laws themselves, they claim the quality of care will improve. There is growing evidence that the Medical Board Monopoly is not justified bassed on their failure to devilver quality and to ensure competency of the licensed physicians. If a chair does not know the difference between a sign and a symptom, then the board should be competent enough themsleves to identify such gross incompetence. A sign is something another persons sees or identifies by examination & testing. A symptom is something the patient complains about . A lack of energy is something a person complains about. Making such as serious assessment should be accompanied by appropriate communication of the meaning of such assessment. Finally, ... 1. The license of a physician shall be automatically revoked at such time as the final trial proceedings are concluded whereby a physician has been adjudicated and found guilty, or has entered a plea of guilty or nolo contendere, in a felony criminal prosecution under the laws of the state of Missouri, . . . for any offense reasonably related to the qualifications, functions or duties of a physician, or for any felony offense, an essential element of which is fraud, dishonesty or an act of violence, or for any felony offense involving moral turpitude, whether or not sentence is imposed . . . . The license of any such physician shall be automatically reinstated if the conviction or the revocation is ultimately set aside upon final appeal in any court of competent jurisdiction. So who is going to take up legal action against the licenses of the Medical Board Members for their six counts of #Fraud v. Dr. Antoine Adem? American Academy of Family Physicians (AAFP) American Medical Association (AMA) Interesting, their fraud when they could have looked up the guidelines in less than a single hour doesnt warrant reprimand, but they claim they are protecting the public, by revoking the license of this doctor for a drug conviction. Perhaps medical boards think that the judge on the criminal court didnt know what an appropriate type of punishment was? Is getting drunk related to the qualifications of a physician. These medical board members pick and choose who should follow the law and when. #MedEd #hcsm #PtSafety #NoJustice #NoEquity. Federal Trade Commission #SCOTUS #moleg #JCMO #KCMO #Springfield #stl #STLMO So what measure of discipline did the board take, is this left out of court. Furthermore, why should they reprimand doctors that are better than themselves such as Dr. Antoine Adem? #MedReg International Federation of Medical Students Associations JAMA, Journal of the American Medical Association American Medical Association Foundation American College of Cardiology How many cardiologists should be reprimanded for providing guideline-based care by the fraud-committing medical board members before people ask the AMA to defend their position claiming that fraud-committing medical board members deserve immunity for their felonious crimes, but they are never tried. Nonetheless, they reprimand others for less. Everything in life can be related to the practice of medicine, and the medical boards exhibit significant abuse of discretion on this topic. Furthermore, the medical boards are not protecting patients by repeatedly both committing fraud and reprimanding good care bit.ly/MedBoard, refusing to investigate patient harm, reprimanding the reporting of patient harm, and ignoring gross clinical incompetence. A sign versus a symptom, most doctors should know that lack of energy is a complaint, and if it was a misuse of words, then the Board should be alereted about the Chairs significant communication deficits. If I were going to tell someone that I thought they lacked energy, I would discuss why with them. Furthermore, the UMKC DIO gave false information to the #ACGME, and instead of investigating it, the medical board reprimanded me. In California physicians can commit a felony, and have their medical license, but in Missouri, a decision for the same crime has a markedly different effect in every state of the nation. Committing fraud against a cardiologist who was providing *good medical care* is reasonably related to the quantification of the duties of the physicians on the state medical board. #TheIOM #AAMC #ACGME #saveGME from fraud, from patient harm, from training residents to lie, and from training clinically incompetent program directors that do not know the difference between a sign and a symptom, and from enabling #UMKC #DIOs to lie to the #ACGME about the content of the surgical pathology reports.... Usually in formalin within 30 minutes per the DIOs letter to Amy Beane in 2011. In fact, the DIO went on to claim that they even often, document the ischemic time. Very easy to see if the DIO was describing the pathology departments custom and practice or whether they took the guidelines for the processing of breast cancer specimens and then merely transferred the words that describe the standard of care. Before the Administrative Hearing Commission State of Missouri STATE BOARD OF REGISTRATION FOR ) THE HEALING ARTS, ) ) Petitioner, ) ) vs. ) No. 08-1403 HA ) MARCELLUS R. LAWRENCE, ) ) Respondent. ) DECISION The State Board of Registration for the Healing Arts (“the Board”) may discipline the physician and surgeon license of Marcellus R. Lawrence (“license”) because Lawrence pled guilty to the crime of possession of a controlled substance. Procedure On July 31, 2008, the Board filed a complaint seeking cause to discipline Lawrence’s license. Lawrence answered. On October 20, 2008, the Board filed a motion for summary determination (“the Boards motion”). On November 25, 2008, Lawrence filed a response to the Board’s motion, his own motion for summary determination (“Lawrences motion”), and arguments supporting both his opposition to the Boards motion and his own motion. On December 11, 2008, the Board filed its arguments opposing Lawrences motion. On December 29, 2008, Lawrence filed a reply. The following facts are undisputed by the parties. Findings of Fact 1. The Board issued a license to Lawrence on July 26, 1989. The license is current and active and was so at all relevant times. 2. On December 21, 2007, in the Circuit Court of St. Louis County, Lawrence pled guilty to possession of a controlled substance, a Class C felony, committed on or about December 23, 2005. After examining Lawrence pursuant to Supreme Court Rule 24.02, the court found that Lawrence made his plea voluntarily with a full understanding of the nature of the charge and the range of punishment provided by statute. The court found that there was a factual basis for the plea. The court accepted Lawrences plea of guilty and referred the case to the drug court. Conclusions of Law We have jurisdiction of the complaint. The Board has the burden to prove facts for which the law allows discipline. I. Summary Determination Standard Our regulation 1 CSR 15-3.440(3)(B) provides: 3. Summary determination. Summary determination includes . . . relief in the nature of summary judgment. . . . A. The commission may grant a motion for summary determination if any party establishes facts that entitle any party to a favorable decision on all or any part of the complaint, and no party raises a genuine issue as to such facts. B. A party may establish a fact, or raise a genuine issue as to any fact, by stipulation, pleading of the adverse party, discovery response of the adverse party, affidavit, or other evidence admissible under the law. The Board cites § 334.100.2(2), which allows discipline if: [t]he person has been finally adjudicated and found guilty, or entered a plea of guilty or nolo contendere, in a criminal prosecution under the laws of any state or of the United States, for any offense reasonably related to the qualifications, functions or duties of any profession licensed or regulated pursuant to this chapter, for any offense an essential element of which is fraud, dishonesty or an act of violence, or for any offense involving moral turpitude, whether or not sentence is imposed[.] (Emphasis added.) There is no dispute about the facts that the parties rely upon in support of their respective motions. They dispute two legal issues. The first is whether a court’s referral of a case in which it has accepted a guilty plea to a drug court excepts or exempts the guilty plea from those designated in § 334.100.2(2). If Lawrences guilty plea is not excluded or exempted, the second issue is whether the offense of possession of a controlled substance is reasonably related to the qualification, functions or duties of a physician. II. Plea of Guilty The Board contends that the Board may discipline Lawrence for his guilty plea because it meets the criteria set forth in § 334.100.2(2). Lawrence contends that we must deny the Boards motion and grant his motion because: First, Lawrence has not been “finally adjudicated and found guilty”, nor has he “entered a plea of guilty or nolo contendere”, as contemplated by the laws of Missouri and the Drug Court of St. Louis County. Instead, Lawrence entered a conditional plea of guilty and was referred to Drug Court. . . . No sentence has been imposed or determined. Without a final guilty plea or conviction, the Board is without authority to take disciplinary action against Lawrences license.[ ] When interpreting a statute, our primary objective is “to ascertain the intent of the legislature from the language used, to give effect to that intent if possible, and to consider words used in their plain and ordinary meaning.” “[We] will not read into a statute a legislative intent contrary to the intent made evident by the plain language of the provision.” Recently, the Supreme Court has emphatically stated that we must interpret licensing statutes primarily to protect the public, not the licensee. Whatever else may be said of the attorneys comment, it seems to express the view that the purpose of regulating the professions of architecture and engineering is to provide financial protection for the members of those regulated professions. This view indicates a fundamental misunderstanding of the purpose behind professional regulation. While some financial protection of licensees may be an effect of professional regulation, the publics protection-not the licensees-is the purpose of professional regulation.[ ] The Court of Appeals has ruled specifically regarding statutes relating to the licensing of physicians: “The primary purpose of statutes authorizing the Board to discipline a physicians license is to safeguard the public health and welfare.” The Court of Appeals has interpreted a statute worded similarly to § 334.100.2(2) to authorize the denial of a permit to carry a concealed weapon because the applicant pled guilty with a suspended imposition of sentence: Section 571.090 provides in pertinent part: 1. A permit to acquire a concealable firearm shall be issued by the sheriff of the county in which the applicant resides, if all of the statements in the application are true, and the applicant: . . . . (2) Has not pled guilty to or been convicted of a crime punishable by imprisonment for a term exceeding one year under the laws of any state or of the United States other than a crime classified as a misdemeanor under the laws of any state and punishable by a term of imprisonment of two years or less that does not involve an explosive weapon, firearm, firearm silencer or gas gun[.] The plain language of Section 571.090.1(2) provides that the sheriff shall issue a permit to acquire a concealable firearm if the applicant “[h]as not pled guilty to or been convicted of” a crime punishable by imprisonment for a term greater than one year. Section 571.090.1(2) clearly creates two classes of applicants who are ineligible to receive permits to acquire a concealable firearm: (1) persons who have pled guilty to a specified class of crimes; and (2) persons who have been convicted of a specified class of crimes. Carrs argument that he should not be denied a permit because a suspended imposition of sentence is not a conviction would have merit if the plain language of Section 571.090.1(2) only prohibited persons convicted of crimes from receiving a permit. However, the plain meaning of the statute clearly includes both persons who have pled guilty to a specified class of crimes as well as persons convicted of such a crime. As the Sheriff observes, if the legislature intended to enable persons who plead guilty to a crime and receive a suspended imposition of sentence to be granted a permit to acquire a concealable firearm, the legislature would not have included the “pled guilty” language in Section 571.090.1(2). This court must give effect to the intent of the legislature as manifested by the plain meaning of the language that the legislature used. Section 571.090.1(2) unambiguously prohibits persons who have pled guilty to a crime punishable by incarceration for more than one year from receiving a permit to acquire a concealable firearm.[ ] In § 571.090, the legislature used the alternative “or” between “pled guilty” and “been convicted of” to indicate two separate categories. In § 334.100.2(2), the legislature used not only the alternative “or” between “finally adjudicated and found guilty” and “entered a plea of guilty,” but also a comma to indicate that the second alternative, “plea of guilty” was not one that resulted in a final conviction. A comma is a punctuation mark used to separate grammatically independent clauses. The plea of guilty in the second alternative stands alone with no modification regarding whether or not sentence is imposed. Accordingly, the plain meaning of § 334.100.2(2) is that a guilty plea alone may serve as grounds for discipline regardless of what other action the court has taken. Lawrence contends that § 334.100.2(2) does not apply to guilty pleas in those cases referred to drug court because those are “conditional” guilty pleas. The word “conditional” does not appear in § 334.100.2(2) or in the statute that Lawrence relies upon, § 478.001. Section 478.001 provides: Drug courts may be established by any circuit court pursuant to sections 478.001 to 478.006 to provide an alternative for the judicial system to dispose of cases which stem from drug use. A drug court shall combine judicial supervision, drug testing and treatment of drug court participants. . . . Upon successful completion of the treatment program, the charges, petition or penalty against a drug court participant may be dismissed, reduced or modified. Any fees received by a court from a defendant as payment for substance treatment programs shall not be considered court costs, charges or fines. (Emphasis added.) Lawrence offers the “Findings of St. Louis County Drug Court” as a “guide” to our interpretation of § 478.001. The drug court refers to Lawrences plea as a “conditional guilty plea” and states: “Upon graduation from Drug Court, the Respondents conditional plea of guilty will be set aside and the case dismissed (§ 478.001 RSMo.).” Although Lawrence does not mention the statutory construction principle by name, he argues that we should interpret § 334.100.2(2) as if it were “in pari materia” with § 478.001. “In pari materia” means “upon the same matter or subject.” Blacks Law Dictionary 791 (6th ed.1990). The doctrine requires that statutes relating to the same subject matter be construed together even though the statutes are found in different chapters and were enacted at different times. . . . However, “[w]here one statute deals with a subject in general terms and another deals with the same subject in a more minute way, the two should be harmonized if possible, but to the extent of any repugnancy between them the definite prevails over the general.” . . .[ ] Section 334.100.2(2) and § 478.001 do not concern the same subject matter. The former specifies what facts serve as cause to discipline a healing arts license, while the latter creates another avenue of rehabilitation for defendants with drug problems. Lawrence points out that the drug court may dismiss his charges after the Board may have already disciplined his license. Lawrence contends that this result is absurd and unfair and should be avoided by interpreting § 478.001 to eliminate the Board’s authority under § 334.100.2(2) to discipline the licenses of those who plead guilty to crimes that would otherwise qualify for discipline but who have been referred to drug court. Such a resolution requires us, in effect, to amend § 334.100.2(2). We have no authority to amend statutes. Even more to the point, such a narrowing interpretation of the Boards authority to discipline licensees under § 334.100.2(2) contravenes the principle, as set forth above, that we interpret professional licensing statutes broadly to protect the public, not the licensee. Finally, Lawrence contends that § 334.103 is similar enough to § 334.100.2(2) that we should find persuasive a circuit court’s decision that § 334.103 does not apply to guilty pleas referred to a drug court. Section 334.103 provides: 1. The license of a physician shall be automatically revoked at such time as the final trial proceedings are concluded whereby a physician has been adjudicated and found guilty, or has entered a plea of guilty or nolo contendere, in a felony criminal prosecution under the laws of the state of Missouri, . . . for any offense reasonably related to the qualifications, functions or duties of a physician, or for any felony offense, an essential element of which is fraud, dishonesty or an act of violence, or for any felony offense involving moral turpitude, whether or not sentence is imposed . . . . The license of any such physician shall be automatically reinstated if the conviction or the revocation is ultimately set aside upon final appeal in any court of competent jurisdiction. (Emphasis added.) The circuit court gave determinative status to the language the “final trial proceedings.” 6. In Section 334.103 RSMo, the General Assembly used the language “whether or not sentence is imposed”. When the language “whether or not sentence is imposed” is interpreted with “final trial proceedings”, Section 334.103 RSMo contemplates that the guilty plea results in either a conviction that becomes final or to an SIS or SES that have a disposition that has the elements of finality. While the General Assembly contemplated situations involving a guilty plea and a SIS, it could not be presumed to apply to this drug court situation under the later statutes, Sections 478.001 and 478.005 RSMo. Further, reading the statute as a whole, Section 334.103 RSMo also has the inherent problem to of [sic] failing to provide for reinstatement upon the withdrawal of the guilty plea and dismissal of the charges in Dr. Abbadessa’s case because the Board can only automatically reinstate “if the conviction or the revocation is ultimately set aside upon final appeal in any court of competent jurisdiction.”[ ] The circuit court’s reasoning does not apply to the instant case because the legislature did not include the “final trial proceedings” language in § 334.100.2(2). Section 334.103 and 334.100.2 have entirely different mechanisms for the protection of the public. Section 334.103 is drastic in that it severely restricts the Boards discretion by requiring it to impose only the most severe discipline. The boards only determination was whether Cantrell was convicted of a felony that reasonably related to the qualifications, functions or duties of a physician. The only defenses that Cantrell could have raised were that he was not convicted and that the felony did not reasonably relate to his practice of the healing arts.[ ] Appropriately, the legislature limited this statute to only those criminal proceedings that had been through all the procedures necessary before they became final. Section 334.100.2(2), on the other hand, allows discipline for criminal proceedings that have not become final judgments. Appropriately, the law allows more protections for the licensee. Before any discipline is imposed, the Board must (1) make a discretionary decision to file a complaint before us, (2) obtain a favorable decision based on our independent determination that there is cause to discipline, and (3) hold its own hearing so that, fully informed, it can exercise its discretion to impose the appropriate measure of discipline. Unlike § 334.103, the Board need not impose revocation, but may choose from a large number of lesser measures. The legislature could have changed the plain meaning of each statute, but has not done so. The legislature enacted § 334.100.2(2) in its present form in 1981. It enacted § 478.001 in 1998 without any amendment to the professional licensing statutes. It amended § 478.001 in 1999 by deleting a sentence regarding the legal characterization to be given to fees a defendant pays to a drug court but leaving untouched the provisions as they exist today and without referring to any effect that § 478.001 should have on statutes, such as § 334.100.2(2). Finally, the legislature amended § 334.100 in 2004 without any changes in § 334.100.2(2) or any references to § 478.001. That the legislature has made no provision for § 478.001 to except or exempt guilty pleas from discipline under licensing statutes, such as § 334.100.2(2), reinforces our conclusion that we should give the language of § 334.100.2(2) its plain and ordinary meaning. Lawrence pled guilty in a criminal prosecution under Missouri law, and sentence was not imposed. That meets § 334.100.2(2)’s criteria that a licensee “entered a plea of guilty . . . in a criminal prosecution under the laws of any state . . . whether or not sentence is imposed.” We conclude that Lawrences guilty plea may serve as grounds for discipline if the offense of possession of a controlled substance falls within one of the categories set forth in the statute. III. Relationship of Offense to Functions and Duties of a Physician A guilty plea may serve as cause for discipline if the underlying offense falls within one of the categories set out in § 334.100.2(2). The offense (1) must be reasonably related to the qualifications, functions or duties of a physician or (2) must have as an essential element fraud, dishonesty or an act of violence, or (3) must involve moral turpitude. While the Board’s complaint broadly contends that cause for discipline exists within § 334.100.2(2), the Board’s motion narrows its position by contending that Lawrences guilty plea was to an offense that falls into the first category, one related to a physician’s qualifications, functions or duties. The Court of Appeals has defined “function” and “duties” as: The ordinary meaning of “function” applicable here is: “1: professional or official position: OCCUPATION, 2: the action for which a person or thing is specially fitted or used or for which a thing exists.” The shared meaning elements of synonyms of “function” is “the acts or operations expected of a person or thing.” Webster’s New Collegiate Dictionary, 465 (1977). The ordinary meaning of “duty” applicable here is: “2a: obligatory tasks, conduct, service, or functions that arise from one’s position (as in life or in a group). 3a: a moral or legal obligation.” Webster’s New Collegiate Dictionary, 355 (1977). The Board relies upon § 195.070.1, which authorizes physicians either to prescribe or to cause another to prescribe controlled substances: 1. A physician, podiatrist, dentist, or a registered optometrist certified to administer pharmaceutical agents as provided in section 336.220, RSMo, in good faith and in the course of his or her professional practice only, may prescribe, administer, and dispense controlled substances or he or she may cause the same to be administered or dispensed by an individual as authorized by statute. The Board offers nothing in the record about the facts and circumstances of Lawrences particular offense. Therefore, the Boards motion presents the issue of whether illegal possession of a controlled substance, as a class of offenses, is reasonably related to the functions and duties of a physician and specifically to the physician’s legal entitlement to seek and use the authorization to prescribe controlled substances. As explained above, we may consider related statutes to interpret § 334.100.2(2). Physicians wanting to prescribe controlled substances must obtain a registration to do so from the Department of Health and Senior Services. By enacting the following provisions in § 195.040, the legislature has made clear that there is a relationship between any controlled substance offense and the physician’s qualifications, functions and duties relating to prescribing them: 2. No registration shall be granted to any person who has within two years been finally adjudicated and found guilty, or entered a plea of guilty or nolo contendere, in a criminal prosecution under the laws of any state or of the United States, for any misdemeanor offense or within seven years for any felony offense related to controlled substances. No registration shall be granted to any person who is abusing controlled substances. 3. The department of health shall register an applicant to manufacture, distribute or dispense controlled substances unless it determines that the issuance of that registration would be inconsistent with the public interest. In determining the public interest, the following factors shall be considered: (1) Maintenance of effective controls against diversion of controlled substances into other than legitimate medical, scientific, or industrial channels; (2) Compliance with applicable state and local law; (3) Any convictions of an applicant under any federal or state laws relating to any controlled substance; * * * 7. A registration to manufacture, distribute, or dispense a controlled substance may be suspended or revoked by the department of health upon a finding that the registrant: * * * (2) Has been convicted of a felony under any state or federal law relating to any controlled substance; * * * (4) Has violated any federal controlled substances statute or regulation, or any provision of sections 195.005 to 195.425 or regulation promulgated pursuant to sections 195.005 to 195.425[.] The qualifications for a registration and the related disciplinary standards include not just convictions for violations of controlled substance laws, but pleas of guilty to such offenses and “violation” of such laws. These disqualifications and disciplinary standards are broadly phrased in terms of classes of offenses and not in terms of the circumstances of any particular offense. We conclude that a physician’s plea of guilty to possession of a controlled substance is reasonably related to his functions and duties so as to authorize discipline under § 334.100.2(2). Lawrences guilty plea was to a Class C felony of possession of a controlled substance. This type of offense reasonably relates to his qualifications, functions and duties as a doctor. The law authorizes doctors to prescribe controlled substances. An offense of the type to which Lawrence pled guilty can disqualify him from obtaining a controlled substance registration or render such registration susceptible to discipline. Lawrence also contends that the offense does not reasonably relate to him because he does not prescribe controlled substances and because controlled substances are not unique to an anesthesiologist. Lawrence provided nothing to establish these facts. Even if he had, it would not matter. As just explained, Lawrences offense was of the type that is reasonably related to a doctor’s qualifications, functions, and duties, and this is all that the Board needs to show. We do not consider Lawrence’s rehabilitation in regard to whether there is cause for discipline. However, the Court of Appeals has held that once we find cause for discipline, the Board is required to consider any rehabilitation when it decides what measure of discipline to impose. Summary There is cause to discipline Lawrence under § 334.100.2(2). We cancel the hearing. SO ORDERED on January 8, 2008. ________________________________ JOHN J. KOPP Commissioner
Posted on: Sat, 02 Aug 2014 16:37:52 +0000
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