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Missouri medical association's challenge of law failed.

CASE ON POINT: Missouri State Medical Association v. State, 2008-MO-0625.007 S.W.3d -MO (2008)

CASE FACTS: This case involved a suit to invalidate a section of Missouri law, which legalized the practice of "tocology," or midwifery. The original bill was intended to amend and make additions to existing Missouri law regarding the Missouri Health Insurance and Portability Act. The bill underwent several amendments. Some amendments contained additional material and others repealed existing Missouri law. On April 12, 2007, the bill passed the full House and was read on the Senate floor that same day. As the bill worked its way through the Senate, more versions were submitted with more amendments, and the title of the bill was changed to state that the bill was repealing and enacting sections "relating to health insurance." On May 10, during the last week of the legislative session, the bill came up for debate on the floor of the Senate, and a substitute bill was offered, then withdrawn, and a second substitute bill was offered in which section 376.1753 was inserted for the first time. The second substitute bill then passed the Senate, and the final version of the bill's title stated that it was a bill: "To repeal [numerous sections of Missouri law were stated] ..., and to enact in lieu thereof, forty-nine new sections relating to health insurance, with an effective date for certain sections." The bill was signed into law the next day. The Missouri State Medical Association, joined by several other physician groups, filed suit seeking a determination as to the constitutionality of the new law. The plaintiffs' primary claim of 'standing' to challenge the constitutionality of the bill was premised on a concern that physicians' voluntary cooperation with nurse midwives who were not "licensed" might subject physicians to professional discipline by the Board of Registration for the Healing Arts (Board). The argument was based on the interplay of three statutes regulating the practice of medicine. The first, provided: "It shall be unlawful for any person not now a registered physician within the meaning of the law to practice medicine or surgery in any of its departments ... or engage in the practice of midwifery in this state ..." The second section provided: A physician is subject to professional discipline who "knowingly perform[s] any act which in any way aids, assists, procures, advises, or encourages any person to practice medicine who is not registered ..." The third section provided: "No physician or pharmacist licensed in this state shall be subjected to discipline for authorizing, assisting or cooperating with other health care professionals licensed by this state who are practicing ... within the scope of their license." The trial court found the law invalid. The defendants appealed

COURT'S OPINION: The Supreme Court of Missouri reversed the order of the trial court. The court held, inter alia, that first, and foremost, the plaintiffs lacked 'standing' to file suit seeking to have the courts rule on the validity of the new law. Further, the court determined that the new statute did not make it legal for a physician to assist anyone, other than a licensed midwife. The court concluded that the new statute failed to subject physicians to any more or less liability than they had before the enactment of the legislation.

LEGAL COMMENTARY: A vigorous dissenting opinion was filed, in which the dissenting judge noted that the suit was brought by four associations of physicians to contest a statute that legalized the practice of midwifery. The dissenting judge disagreed with the majority opinion which ruled that the plaintiffs had no 'standing' to challenge the constitutionality of the statute. The dissenting judge found that the plaintiff associations had standing since their members were physicians whom the judge contended, would bear the brunt of the burden the unconstitutionality of the statute in question would cause. Further, the dissenting judge found that the individual members of the association, as physicians, had standing as representatives of their patients. The judge pointed out that the very purpose of standing requirements is to ensure that an actual controversy exists and that the controversy is fairly litigated by adverse parties. There was no doubt in the dissenting Judge's mind that the purpose of the standing requirement was not to shield questionable legislation from legal challenge by denying standing to the only individuals or entities capable of fairly litigating the case. The judge went on to note that Missouri law provided that "no bill shall contain more than one subject which shall be clearly expressed in its title." The judge stressed that the statute in question clearly was in violation of that requirement. The judge was convinced that it was obvious that the statute failed to remotely describe the fact that within the contents of the statute was a provision for licensure of midwives and not necessarily provisions related to the broader topics of health care professional liability insurance. Moreover, he pointed out that ironically, the statute did not mandate professional liability insurance for midwives as might have been expected from the very title of the bill which became law. Again, he emphasized that the bill violated Missouri law, which mandates that each bill introduced must have a single purpose so that the proposed legislation, as well as its title are not misleading!

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for over 40 years, he concentrates in health care law with the Rhode Island firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's, Nursing Law's & Hospital Law's Regan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievements as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers, Marquis Who's Who in American Law, Who's Who in America and Who's Who in the World.
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Title Annotation:Medical Law Case on Point
Author:Tammelleo, A. David
Publication:Medical Law's Regan Report
Date:Nov 1, 2008
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