Opinion ID: 1495900
Heading Depth: 2
Heading Rank: 1

Heading: Necessity of Expert Testimony on Standard of Care for Repeated Negligence Under Section 334.100.2(5).

Text: The Board alternatively argues that, even were the testimony of Dr. McDonagh's experts otherwise admissible under the relevant evidentiary standard, it was insufficient to counter the Board's allegations in various counts, and through expert and other evidence, that Dr. McDonagh's use of chelation therapy constituted repeated negligence as that term is used in section 334.100.2(5). [15] That section defines repeated negligence as the failure, on more than one occasion, to use that degree of skill and learning ordinarily used under the same or similar circumstances by the member[s] of the applicant's or licensee's profession. Sec. 334.100.2(5). The Board submits that, in order to counter the Board's experts, Dr. McDonagh's experts needed to testify as to whether he used the degree of skill and learning ordinarily used by members of his profession. But, while his experts testified that his treatment of his patients met the standard of care, they never identified that standard of care. The Board argues that the standard of care he met must be the standard of care generally accepted in the profession, and this means that Dr. McDonagh is negligent if he treats his patients in a way other than the treatment generally offered by doctors in the field. And, given Dr. McDonagh's experts' admission that mainstream doctors generally do not use chelation therapy to treat vascular disease, the Board suggests, Dr. McDonagh's experts cannot have used the correct standard of care in giving their opinion that his treatment met the required standard. Dr. McDonagh admits that his experts did not state by what standard of care they were evaluating his treatment of his patients, but argues, to the extent testimony as to the standard of care was necessary, [16] the standard is that used by doctors who apply chelation therapy. In effect, he argues that, because he used the protocol approved by ACAM, he could not be found to be negligent and necessarily met the requisite standard of care. Neither party's argument is correct. The relevant standard of care is neither a reformulation of the Frye general acceptance test, nor blind acceptance of the views of a subgroup of treaters. The relevant standard of care for discipline for repeated negligence is necessarily that set out in the statute addressing that conduct, section 334.100.2(5). That standard, similar to Missouri's standard for proof of negligence in civil cases, [17] requires a showing whether the doctor showed the skill and learning ordinarily used under the same or similar circumstances by the member[s] of [the doctor's] profession. Sec. 334.100.2(5) (emphasis added). As the issue here is the treatment of persons with vascular disease, the appropriate standard of care is that used by doctors treating persons with vascular disease. Application of this standard does not merely require a determination of what treatment is most popular. Were that the only determinant of skill and learning, any physician who used a medicine for off-label purposes, or who pursued unconventional courses of treatment, could be found to have engaged in repeated negligence and be subject to discipline. This would not be consistent with section 490.065. Rather the statute requires only what it saysthat Dr. McDonagh use that degree of skill and learning used by members of the profession in similar circumstances. By analogy, one doctor may use medicine to treat heart problems while another might chose to perform a by-pass and a third to perform angioplasty, yet all three may be applying the requisite degree of skill and learning. That they came to differing conclusions by applying that skill and learning does not make one negligent and one non-negligent. So too, here, if Dr. McDonagh's treatment, including his use of a diet and exercise regimen, and the lack of evidence of harm from his approach, demonstrates the application of the degree of skill and learning ordinarily used by members of his profession, then it is not a basis for discipline under the statute, even if other doctors would apply these facts to reach a different result. Because, in concluding that Dr. McDonagh did not violate section 334.100.2(5), the AHC relied on Dr. McDonagh's experts' testimony and because this testimony failed to establish whether the experts were using the legal standard of care for repeated negligence set out in section 334.100.2(5), this Court must reverse and remand. The circuit court should remand to the AHC for reconsideration under section 490.065 and in light of the standard of care contained in section 334.100.2(5).