Court rules KHPA violated freedom of religion
The State Court of Appeals on Wednesday ruled that a Kansas Health Policy Authority decision denying a Hill City Jehovah’s Witness request for prior authorization for an out-of-state liver transplant violated her right to the free exercise of religion under the state and federal constitutions, officials said.
The decision came in a lawsuit filed by Mary D. Stinemetz against the KHPA after the agency denied Stinemetz' prior authorization for her surgery. Stinemetz, a practicing Jehovah's Witness, has been diagnosed with end-stage liver disease and needs a liver transplant, but her religious beliefs prohibit whole blood transfusions. Her religious beliefs also do not allow her own blood to be removed from her body and stored for later use in a surgical procedure.
Writing for a unanimous three-judge panel of the Court of Appeals, Judge Thomas E. Malone said the KHPA denial violated her right to the free exercise of religion guaranteed by the First Amendment to the United States Constitution and the Kansas Constitution Bill of Rights. Besides Malone, the Court of Appeals panel included Judges Steven D. Hill and Michael B. Buser.
The court held that the evidence showed there is a medically accepted technique, known as a bloodless liver transplant, in which liver transplant surgery can be performed without a blood transfusion, although many medical facilities do not consider this technique to be the safest procedure. There is no medical facility in Kansas that performs bloodless liver transplants, but theNebraska Medical Center in Omaha in is willing to perform the surgery.
“The available evidence indicates that the bloodless technique is less expensive than a procedure involving blood transfusions. The available evidence indicates that a bloodless liver transplant is a medically accepted technique offered by several medical facilities in other states, including the Nebraska Medical Center in Omaha and at the University of Oklahoma,” Judge Malone wrote.
Because Stinemetz is a Medicaid beneficiary, she requested prior authorization from the KHPA for an out-of-state liver transplant. There is no question that the KHPA would authorize a liver transplant for Stinemetz in Kansas, including a bloodless liver transplant, if a medical facility was available in to perform the technique. However, the KHPA denied Stinemetz' request for out-of-state services on the ground that her religious preference did not constitute a medical necessity. The district court affirmed the KHPA's decision.
On appeal, the judges found there is nothing in the language of the Kansas Medicaid regulations to indicate that the regulations either were enacted or are enforced in such a way as to target Jehovah's Witnesses.
However, the regulations allow for the KHPA to make exceptions to the general rule that out-of-state services are not covered by Medicaid. Because the regulations allow for exceptions, under the First Amendment the KHPA cannot refuse to grant an exception to cover Stinemetz' religious hardship without providing a compelling reason. "Here, the KHPA has failed to suggest any state interest, much less a compelling interest, for denying Stinemetz' request for prior authorization for the out-of-state liver transplant," Judge Malone wrote.
The Court of Appeals also determined, under existing Kansas precedent, that Stinemetz has even greater protections concerning the free exercise of religious beliefs under the Kansas Constitution Bill of Rights than under the federal constitution. Here, the district court had found that Stinemetz' religious beliefs were sincerely held, and the KHPA did not challenge that finding on appeal. Because the KHPA failed to offer any compelling reason for denying Stinemetz' request for the surgery, the Court of Appeals determined that the KHPA's decision violated Stinemetz' rights under the constitution.
The Court of Appeals reversed the Graham County District Court and remanded the case with directions that the KHPA grant Stinemetz' request for prior authorization for the out-of-state liver transplant.
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