Opinion ID: 1988913
Heading Depth: 1
Heading Rank: 10

Heading: Harmful Conduct

Text: Albanna argues that the commission erred in finding that he engaged in conduct that is or might be harmful to a patient because the statute is targeted at conduct akin to quackery and should not be evaluated through a post hoc review of patient outcomes or physician skill. [6] The commission found both potential harm and actual harm resulting from Albanna's conduct. These findings rely on section 334.100.2(5), which proscribes [a]ny conduct or practice which is or might be harmful or dangerous to the mental or physical health of a patient or the public. Albanna points this Court to section 334.100.2(4), which authorizes the board to bring a complaint for [m]isconduct, fraud, misrepresentation, dishonesty, unethical conduct or unprofessional conduct ... The statute then gives several examples of conduct that would fall under this provision, including [m]isrepresenting that any disease, ailment or infirmity can be cured by a method, procedure, treatment, medicine or device[,] section 334.100.2(4)(e), and [p]erforming or prescribing medical services which have been declared by board rule to be of no medical or osteopathic value[,] section 334.100.2(4)(f). Albanna states that this conduct, the quackery outlined in the examples, is the harmful or dangerous conduct to which section 334.100.2(5) refers. Albanna argues that the subsections (4) and (5) of section 334.100.2 must be connected to read something like the board is authorized to bring a complaint against a physician for quackery that might be or is harmful to a patient. Albanna argues that only this reading completes the statutory scheme by authorizing discipline for the practice of quackery. Because there was no evidence of quackery, Albanna suggests, there should not have been any findings of actual or potential harm. A simple reading of the statutory language demonstrates the logical deficit in Albanna's proposed interpretation. Section 334.100.2 describes all of the bases the board can use to bring a complaint against a physician. For example, section 334.100.2(3) authorizes the filing of a complaint for a physician's [u]se of fraud, deception, misrepresentation or bribery in securing any certificate of registration or authority, permit or license issued pursuant to this chapter or in obtaining permission to take any examination given or required pursuant to this chapter[.] Not all of the things outlined in section 334.100.2 necessarily cause harm. A physician who fraudulently obtained a license very well may practice competently. The board nonetheless is authorized to bring a complaint against that physician pursuant to section 334.100.2(3). Albanna was not charged under section 334.100.2(3), the so-called quackery statute. The board brought its complaints under sections 334.100.2(4) and 334.100.2(5). The commission interpreted the language of harm in section 334.100.2(5) as follows: We note that conduct or practice which is or might be harmful to the mental or physical health of a patient or the public is not only vague, by its terms it encompasses many beneficial practices in the medical field. An obvious example would be chemotherapy. Much of neurosurgery, properly practiced, might be harmful to a patient's physical health. In accordance with our decision in State Bd. of Regis'n for the Healing Arts v. Prince, No. 03-0384 HA (Admin. Hearing Comm'n Sept. 24, 2004), we conclude that a practice or other conduct is cause for discipline when its harm or danger (that is, its potential harm) outweighs its potential medical benefit. Such conduct or practice might amount to negligence, or it might fall short of that standard. Although the commission's definition of harm makes sense, one cannot ignore the other language in the same paragraph: incompetency, gross negligence or repeated negligence. This Court applies noscitur a sociis  that meaning can be derived from the context of the words in their immediate neighborhood. State v. Bratina, 73 S.W.3d 625, 627. In so doing, the Court reads the phrase conduct or practice which is or might be harmful to the mental or physical health of a patient or the public as including the concept of unreasonableness. In the context of the whole subparagraph, the Court simply finds implicit in the statutory language the word unreasonable. As so read, the statute permits the board to sanction any conduct or practice which is or might be unreasonably harmful or dangerous to the mental or physical health of a patient or the public If the word unreasonable is not inferred, a neurosurgeon could be disciplined for practicing neurosurgery, as the commission's quoted definition suggests. A certain number of spine surgery patients are worse off following surgery, even in the absence of negligence. Neurosurgery, whether practiced skillfully or negligently, by its very nature is conduct or practice that may be harmful to a patient. The purpose of the statute is not to discipline a neurosurgeon for practicing his or her profession. The harm that this provision of the statute seeks to avoid is harm that flows from incompetence, gross negligence or repeated negligence. In this case, the conduct or practice which is or might be harmful or dangerous to the mental or physical health of a patient or the public is the same harm that supports the finding of repeated negligence. The findings of the commission, as noted, support the conclusion that Albanna's conduct involved repeated negligence as that term is used in the statute. Accordingly, the commission's conclusion that Albanna's conduct involved harm or potential harm is supported by the evidence.