Johnson County nurses sue to overturn KS midwife law after losing hospital privileges
Two Johnson County nurse midwives who lost the ability to deliver babies at an area hospital earlier this year are now suing to try and overturn a Kansas law that bars them from practicing without physician oversight.
The federal lawsuit filed by Kara Winkler and Julie Gorenc of Midwife Partners in Women’s Wellness in Lenexa could have implications not only for Kansas, but for the 18 other states that also require nurse midwives to sign formal collaborative practice agreements with physicians.
Their attorney, Blue Springs-based Keith Williston, said requiring nurse practitioners to practice under a physician is unfair because physicians have a financial interest.
“They’re what we call a market competitor,” Williston said. “They both want to treat the same patients.”
In addition to being a lawyer, Williston previously owned and operated “A Mother’s Love Birthing Center” in Independence. It is now closed.
In 2009 he filed a petition objecting to Missouri’s regulations requiring birthing centers to have a physician on staff and for their nurse midwives to have collaborative practice agreements.
The state health agency dismissed that petition, so he sued in Cole County Circuit Court. After that suit was dismissed, he appealed, but in October 2017 the Missouri Court of Appeals upheld the lower court’s dismissal.
Williston said the Missouri Supreme Court had declined a request to hear the case, but he’s exploring other options to keep it alive.
“It’s probably not really over, either,” Williston said.
Winkler and Gorenc’s suit says they lost 25 clients who were planning to give birth at Shawnee Mission Medical Center after Overland Park doctor Janetta Proverbs ended her collaborative practice agreement with them and none of the laborists employed by Shawnee Mission would take them on.
Laborists are hospital-employed physicians who deliver babies for women who don’t have a regular OBGYN, or whose OBGYNs can’t be at the hospital at the time of delivery.
In addition to suing the president of the Kansas State Board of Nursing over the nurse midwife regulations, Winkler and Gorenc are also suing Proverbs, Adventist Health Mid-America (Shawnee Mission Medical Center’s parent organization), and four laborists for lost income.
Shawnee Mission Medical Center spokeswoman Morgan Shandler said Tuesday that the organization had no comment because it had not yet seen the suit.
Before the suit was filed, hospital officials had said the laborists aren’t a good fit for a collaborative practice agreement because they don’t follow women throughout their pregnancy, as midwives generally do.
Proverbs, reached by phone Monday, said the claims in the suit against her “are completely unfounded.”
“I personally did nothing wrong,” Proverbs said. “I did nothing to infringe on anybody else’s liberties and it’s not my job to be in charge of the world. It’s not my job to provide for the world.”
Proverbs also took exception to Winkler and Gorenc’s claims that Adventist Health Mid-America placed overly onerous regulations on midwife collaborative practice agreements that made it less likely for physicians to sign them.
“If they didn’t like the rules and didn’t want to follow the rules they shouldn’t have joined the hospital,” Proverbs said. “The hospital did not treat them any differently than any other provider that has hospital privileges at Shawnee Mission.”
Proverbs declined to comment on why she ended her collaborative practice agreement with Winkler and Gorenc, citing the litigation.
Clashes between physicians and nurse midwives in Kansas are not new.
The state’s certified nurse midwives pressed for legislation that would allow them to practice independently of doctors in 2015 and 2016. A lobbying group for Kansas doctors opposed the bill and a compromise was struck to allow midwives to practice independently only if they get two medical licenses: one from the state’s nursing board and one from the board that regulates doctors.
Nurse midwives weren’t happy with the unusual arrangement, which has since gotten bogged down in the regulation-writing process that follows the enactment of new laws.
Williston said that leaves midwives at the mercy of physicians who can restrict them from practicing unless they give the doctors a cut of the revenue.
“In order to get a physician to sign a collaborative practice agreement, a lot of nurses have to accept conditions that they would not accept if they didn’t have to have this document from a physician,” Williston said. “They don’t really have a choice; they have to accept whatever terms are put in there.”
Mark Finkelston, a long-time OBGYN who practices in Johnson County, said the state has good reasons to require nurse midwives to work with doctors that have nothing to do with money.
“There’s almost always got to be some sort of backup,” Finkelston said. “They can’t do C-sections and they have to have someone that has that capability.”
Finkelston said that he’s not against nurse midwives and has worked with them in the past. But he said some give their clients a “distorted view” of labor and delivery by overselling the virtues of natural births.
“They can argue all they want about ‘low intervention, no intervention, this is what people want,’ but I guarantee what people don’t want is to have a problem,” Finkelston said. “Either themselves or their baby.”
This story was originally published August 15, 2018 at 5:30 AM.