State Board of Nursing v. Ruebke
259 Kan. 599, 913 P.2d 142, 1996 Kan. LEXIS 40 (1996)
Premium Feature
Subscribe to Lexplug to listen to the Case Podcast.
Rule of Law:
The traditional practice of lay midwifery is not the unlicensed practice of medicine or nursing under Kansas statutes because the legislature did not intend for laws regulating the treatment of pathologies like disease and injury to apply to the historically separate practice of assisting in the normal process of childbirth.
Facts:
- E. Michelle Ruebke, a practicing lay midwife, assisted pregnant women with prenatal care, delivery, and postpartum care.
- Ruebke served as president of the Kansas Midwives Association and followed its standards of care, which included prenatal risk screening and care plans.
- She worked with supervising physicians who were aware of her practices, available for consultation, and who performed related medical tests for the pregnant women.
- Ruebke did not advertise but made her services available to members of her church, friends, and others through word-of-mouth.
- She did not charge a fee for her services, which she considered a ministry, although some families gave her money or goods.
- Ruebke testified that she followed the terms of a 1984 consent decree from a separate case that permitted midwifery as long as a licensed physician was available for consultation and complications.
- The State Boards' action was prompted by incidents involving three pregnancies Ruebke was involved with, one of which resulted in the death of a twin.
Procedural Posture:
- The State Board of Healing Arts and the State Board of Nursing (the Boards) filed a petition in a Kansas trial court seeking a temporary injunction to stop E. Michelle Ruebke from practicing midwifery.
- The trial court issued a temporary restraining order against Ruebke pending a hearing.
- After a hearing, the trial court denied the Boards' request for a temporary injunction.
- The trial court found that provisions of the Kansas Healing Arts Act and the Kansas Nursing Act were unconstitutionally vague, that Ruebke's practices were not within the scope of either act, and that she was covered by statutory exceptions.
- The Boards, as appellants, appealed the trial court's denial of the injunction directly to the Kansas Supreme Court, with Ruebke as the appellee.
Premium Content
Subscribe to Lexplug to view the complete brief
You're viewing a preview with Rule of Law, Facts, and Procedural Posture
Issue:
Does the practice of lay midwifery, which involves assisting in the normal process of childbirth, constitute the unlicensed practice of medicine under the Kansas Healing Arts Act or the unlicensed practice of nursing under 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 relevant Kansas statutes. The Kansas Healing Arts Act defines the healing arts by focusing on the treatment of 'disease, ailment, deformity, or injury,' which are pathologies and abnormalities; normal pregnancy and childbirth are neither. A thorough historical review reveals that Kansas's medical practice regulations were originally aimed at 'empyrists' and quack healers, and the legislature never demonstrated an intent to regulate or prohibit the historically separate and distinct practice of midwifery. The court reasoned that just because obstetrics has become a medical specialty, it does not transform midwifery into the practice of medicine, a conclusion supported by the reasoning in cases like Acupuncture Society of Kansas v. Kansas State Bd. of Healing Arts. Similarly, the Kansas Nursing Act applies to 'changes in the normal health processes,' but pregnancy is a continuation of, not a change in, normal health. Finally, even if some of Ruebke’s actions could be considered practicing medicine, they were exempt under a statutory exception for services performed under the supervision of a licensed physician, a condition the court found she met.
Analysis:
This decision legally carves out a protected space for the practice of lay midwifery in Kansas, clarifying that it does not, by itself, constitute the unlicensed practice of medicine or nursing. The ruling emphasizes the importance of historical context and legislative intent in interpreting the scope of professional licensing statutes, establishing that a practice historically distinct from a regulated profession will not be absorbed into that profession's legal definition by judicial interpretation alone. Consequently, the decision places the burden on the Kansas Legislature to explicitly regulate or prohibit lay midwifery if it chooses to do so, as courts will not expand the scope of existing medical acts to cover it.
