State Board of Nursing v. Ruebke
1996 Kan. LEXIS 40, 259 Kan. 599, 913 P.2d 142 (1996)
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Rule of Law:
The practice of lay midwifery is not the practice of medicine or nursing under Kansas statutes because those professions are statutorily defined as treating pathologies such as disease, ailment, deformity, or injury, which do not include the natural processes of pregnancy and childbirth.
Facts:
- E. Michelle Ruebke was a practicing lay midwife who assisted pregnant women with prenatal care, delivery, and post-partum care.
- Ruebke considered her services a ministry and did not charge a fee, though she sometimes accepted money or goods from families she assisted.
- She followed the standards of the Kansas Midwives Association, which included risk screening and establishing prenatal care plans.
- Ruebke worked with supervising physicians who were aware of her practices, available for consultation, and performed medical tests incident to the pregnancies.
- She did not advertise her services but was available to members of her church, friends, and others who learned of her by word of mouth.
- Ruebke followed a 1984 consent decree from a different case which permitted midwifery as long as a licensed physician was available for consultation.
- Her services were involved in several pregnancies, including one where twins died (though evidence showed she had called the ambulance), and another where complications required a hospital delivery.
Procedural Posture:
- The State Board of Healing Arts and the State Board of Nursing (the Boards) filed a petition in trial court against E. Michelle Ruebke.
- The Boards sought a temporary injunction to prohibit Ruebke from practicing lay midwifery.
- The trial court issued a temporary restraining order pending a hearing on the injunction.
- After the hearing, the trial court denied the Boards' request for a temporary injunction.
- The trial court ruled that provisions of the Healing Arts Act and Nursing Act were unconstitutionally vague, that Ruebke's practices were outside the scope of the acts, and that she was covered by statutory exceptions.
- The Boards, as appellants, appealed the trial court's denial of the temporary injunction to the Kansas Supreme Court.
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Issue:
Does the practice of lay midwifery, which involves assisting in normal childbirth, constitute the unlicensed practice of medicine or nursing under the Kansas Healing Arts Act and the Kansas Nursing Act?
Opinions:
Majority - Larson, J.
No. The practice of lay midwifery does not constitute the unlicensed practice of medicine or nursing under the Kansas Healing Arts Act and the Kansas Nursing Act because the statutes were intended to regulate the treatment of sickness and abnormalities, not the natural process of childbirth. The Kansas Healing Arts Act defines 'healing arts' as the treatment of 'human disease, ailment, deformity, or injury.' The court reasoned that normal pregnancy and childbirth are physiological functions, not pathologies, and therefore fall outside this definition. A historical review of the statute showed its intent was to regulate 'empyrists' and quacks treating illness, not the long-standing, separate practice of midwifery. The court further rejected the argument that midwifery is 'incident to the practice of medicine' under K.S.A. 65-2869, holding that midwifery is a distinct practice. Similarly, the Kansas Nursing Act, which pertains to 'changes in the normal health processes,' does not apply because childbirth is a continuation of a normal process. Finally, even if some of Ruebke's acts did constitute the practice of healing arts, they were exempt under K.S.A. 65-2872(g) because she worked under the supervision of a licensed physician.
Analysis:
This decision legally validates the practice of lay midwifery in Kansas by narrowly interpreting the scope of existing medical and nursing licensing statutes. The court established that for a practice to be regulated as 'medicine,' it must involve the treatment of pathology, not normal physiological functions. This ruling places the burden on the state legislature to explicitly regulate or prohibit lay midwifery if it chooses, preventing administrative boards from expanding their jurisdiction through broad statutory interpretation. The court's emphasis on historical context and original legislative intent provides a strong precedent for future cases involving the scope of professional licensing acts.
