Opinion ID: 2342794
Heading Depth: 1
Heading Rank: 4

Heading: sufficiency of the evidence

Text: Because the commission's conclusions that there was cause to discipline Dr. Tendai's license were not supported by substantial evidence, the Court need not reach his other claims. The commission concluded that Dr. Tendai violated the applicable standard of care in his treatment of S.G. and that this violation constituted gross negligence, repeated negligence, incompetence, and conduct harmful to a patient. Before examining each of these statutory grounds for discipline, the state of the medical record is considered. The medical record issue is whether Dr. Tendai's sticky notes are records that support his assertion that he referred S.G. to a perinatologist. The hearing commission gave no weight to Dr. Tendai's testimony and to his sticky notes that were provided after the healing arts board's initial investigation into his conduct. The commission indicated in a footnote that there was evidence that Dr. Tendai's sticky notes were falsified. In the words of the commission, the notes appear to have been written after the fact. Although falsification of records was not before the commission as a cause for discipline, the commission did resolve the credibility issue in the board's favor by refusing to believe Dr. Tendai's account of his treatment. This issue of credibility is for the commission. See Lagud v. Kansas City Bd. of Police Com'rs, 136 S.W.3d 786, 796 (Mo. banc 2004). Regardless of whether the commission believed that the sticky notes were subsequently produced falsifications, the commission was correct in excluding the notes from consideration because they are not proper medical records. Medical records relating to observations, treatment, and diagnoses are generally admissible as business records. Long v. St. John's Regional Health Ctr., Inc., 98 S.W.3d 601, 607 (Mo.App.2003); Caples v. Earthgrains Co., 43 S.W.3d 444, 452 (Mo.App.2001). The admissibility of business records in a professional licensing case before the commission is governed by section 536.070(10), RSMo 2000, which provides that a record is admissible if it shall appear that it was made in the regular course of any business, and that it was the regular course of such business to make such memorandum or record at the time of such act, transaction, occurrence, or event or within a reasonable time thereafter. Even if the notes, from the outset of the investigation, had been found with the regular medical record, the notes contained information that Dr. Tendai said he did not intend to transfer to another physician or hospital for use in S.G.'s care. Medical records are considered trustworthy because they are made for the purpose of documenting a patient's treatment and conditions for future reference. Although Dr. Tendai said that he made the sticky notes for his later reference, the fact that the notes were not intended to be included in S.G.'s regular records and relied upon by other health care providers undermines their credibility. Regular course of business is defined by considering the inherent nature of the business in question and ... the methods systematically employed for the conduct of the business as a business. Palmer v. Hoffman, 318 U.S. 109, 115, 63 S.Ct. 477, 87 L.Ed. 645 (U.S.1943). Since they do not qualify as business records, the sticky notes are hearsay. See Kitchen v. Wilson, 335 S.W.2d 38, 43 (Mo.1960). With the sticky notes properly excluded as medical record documentation, the factual issue was whether to believe Dr. Tendai or S.G. The hearing commission believed S.G., and her testimony is substantial and competent evidence to support the factual determination that Dr. Tendai did not refer S.G. to a perinatologist.