Stetina v. State, ex rel. Medical Licensing Bd. of Indiana

• Citation: 513 N.E.2d 1234
• Decision Date: 06 October 1987
• Docket Number: No. 49A02-8605-CV-169,49A02-8605-CV-169
• Parties: Janice R. STETINA, Appellant (Defendant Below), v. STATE of Indiana, ex rel. MEDICAL LICENSING BOARD OF INDIANA, Appellee.
• Court: Indiana Appellate Court

Page 1234

513 N.E.2d 1234

Janice R. STETINA, Appellant (Defendant Below), v. STATE of Indiana, ex rel. MEDICAL LICENSING BOARD OF

INDIANA, Appellee.

No. 49A02-8605-CV-169.

Court of Appeals of Indiana,

Second District.

Oct. 6, 1987.

Rehearing Denied Nov. 9, 1987.

Janice R. Stetina, pro se.

Linley E. Pearson, Atty. Gen., John Emry, Deputy Atty. Gen., Indianapolis, for appellee.

SULLIVAN, Judge.

In State ex rel. Medical Licensing Board v. Stetina (1985) 1st Dist.Ind.App., 477 N.E.2d 322, trans. denied, the First District of this Court concluded that the State had successfully presented a prima facie case in its suit to permanently enjoin Janice Stetina from unlicensed medical practice. Consequently, the decision reversed the trial court, which had dismissed the action at the close of the State's case-in-chief. The cause was remanded "to allow appellee [Stetina] an opportunity to present her evidence." Id. at 329.

Upon remand, the trial court heard Stetina's evidence. The court entered a judgment granting permanent injunctive relief. The judgment, in relevant part, reads as follows:

"[I]t is ORDERED, ADJUDGED AND DECREED:

1. The Defendant, Janice R. Stetina, is hereby permanently enjoined from practicing medicine in Indiana until she is issued a license by the State of Indiana.

2. The Defendant, Janice R. Stetina, is not enjoined from lecturing to or educating members of the public on her view of the value of nutrition or from selling products to members of the public so long as the Defendant does not examine the member, diagnose or treat the member, sell the member health products based on the Defendant's assessment of the members' needs or problems or otherwise engage in the practice of medicine or violate any other statute regulating her actions and representations." Record at 728.

Stetina now appeals.

The operative facts of the State's case are set forth in Stetina, supra, 477 N.E.2d at 324-25. We summarize them here. An investigation into Stetina's activities took the form of having an investigator pose as a person seeking advice on her physical condition. Stetina elicited information from the investigator using questionnaires and examining of the investigator's eyes. Based upon the information obtained, Stetina determined that the investigator had, inter alia, nutritional problems, abdominal problems, a slow electrical turnover, and poor circulation. To remedy these problems, Stetina suggested a colonic irrigation (an enema), mineral water, kelp, amelade, progestine and more raw food.

Stetina's evidence, presented on remand, focused primarily upon the basis for, and nature of, her beliefs and practices. Stetina testified that the Essene Gospels mandated the colonic irrigation process and that her activities are also based upon scientific, nutritional principles. These include prevention of disease through proper diet. Stetina also opined that traditional medical doctors are not adequately trained in the areas in which she works.

Dr. David Darbro, a practicing physician, agreed with Stetina's assessment that traditional medical training has not in the past been sufficiently grounded in natural and dietetic processes. He also stated that a colonic irrigation, if judiciously ordered, could be a helpful treatment. He noted that one person had responded well when receiving that treatment from Stetina. Stetina's other two witnesses were persons who had conferred with her. Both testified to an overall physical and mental improvement after their consultations with Stetina.

Stetina pursues the following issues, which have been restated and reordered:

1. Does application of the Medical Practice Act ¹ to persons such as Stetina violate the legislatively intended scope of the Act;

2. Did the trial court err by interpreting the Medical Practice Act in an overly broad and vague manner, thus creating the possibility of absurd results in defining "medical practice";

3. Does Stetina's conduct fall within the religious conduct exception of I.C. 25-22.5-1-2(f) (Burns Code Ed.Supp.1987);

4. Does the injunction granted in this case violate Stetina's right to free exercise of religion;

5. Does Stetina's conduct fall within the physician's assistant exception of I.C. 25-22.5-1-2(r) (Burns Code Ed.Supp.1987);

6. Does Stetina's conduct fall within the family-domestic remedy exception of I.C. 25-22.5-1-2(e) (Burns Code Ed.Supp.1987);

7. Is there a less intrusive manner of upholding the intended goal of the statute while preserving the patient's right to choose the type of medical care preferred;

8. Does the injunction violate Stetina's free speech rights by preventing her from carrying on personal discussions;

9. Does the judgment in this case deny Stetina equal protection of the law because of a different enforcement of the Medical Practice Act in an unrelated case; and

10. Did changes in the investigator's testimony invalidate that testimony and thus render the judgment contrary to law?

The State contends that review of Stetina's case is totally precluded because she failed to present cogent argument ² and citation to persuasive authority. ³

Stetina appears pro se. Her brief is not a paradigm of clarity nor does it contain abundant citation to persuasive authority. It does, however, provide some basis for intelligent review. Stetina cites some pertinent statutory provisions, I.C. 25-22.5-1-1.1 to 25-22.5-8-4 (Burns Code Ed.Repl.1982 and Supp.1987), and cites correctly to a case interpreting the predecessor to the current statutory provisions, Dean v. State ex rel. Board of Medical Registration & Examination (1954) 233 Ind. 25, 116 N.E.2d 503. Moreover, Stetina's arguments, though not using legal terminology and the analysis one might expect in an appellate brief, do provide a minimally acceptable framework within which to review the case. Stetina argues, in part, that the trial court's injunction was outside the legislatively intended scope of the statute; that her acts fell within some exceptions to the prohibition of unlicensed practice; that the trial court misinterpreted the statutes; and that her constitutional rights were violated.

In Terpstra v. Farmers & Merchants Bank (1985) 3d Dist.Ind.App., 483 N.E.2d 749, trans. denied, the Third District confronted a similar situation--an appellant, proceeding without counsel, filed a brief which was allegedly deficient. Here, as in Terpstra, we reach the merits vel non of Stetina's appeal, ⁴ concluding that her arguments have been presented clearly enough to be understood. We do not mean to suggest, however, that litigants, whether with or without counsel, have carte blanche to present cases in any manner they might choose. Litigants are ill-served by briefs which fail to follow the Rules of Appellate Procedure and fail to articulate the precise legal grounds upon which a claim for appellate relief is predicated. As noted in Terpstra:

"The purpose of AP. 8.3 is to aid and expedite review and relieve the appellate court of the burden of searching the record and briefing the case. We will not become an advocate for a party, nor will we address arguments which are either inappropriate, too poorly developed or improperly expressed to be understood.... [W]e conclude that ... we are not substantially impeded from reaching to the merits of this appeal." Id. at 754 (Emphasis supplied).

Stetina first argues that the intent of the Medical Practice Act is to protect people from their own credulity, citing Dean, supra, 116 N.E.2d 503. She then contends that application of the Act to her in the capacity as a nutritionist does nothing to further that purpose. She claims that it has a negative effect in that it perpetuates physician incompetence in the nutrition field, prevents public awareness of nutrition education and care, and drives medical care costs upward.

The question presented in Dean was whether the predecessor statute was criminal or civil in nature. Criminal statutes, the court observed, are those designed to prevent and punish criminal activity. The Act was designed to regulate the practice of medicine and was therefore not a criminal statute. Dean, supra, 116 N.E.2d at 505. The Dean court's statement about credulity had its genesis in a prior case, Crum v. State Board of Medical Registration (1941) 219 Ind. 191, 37 N.E.2d 65. Crum involved a person claiming, inter alia, the ability to cure myriad conditions including cancer and blindness, by use of a mechanical contrivance into which a saliva-moistened slip of paper was inserted. The Crum court concluded:

"[I]t is not uncommon for persons who are afflicted with dreadful diseases to be misled and beguiled into believing that they have been helped by quacks or charlatans. It is reasonable to suppose that by the enactment of the Medical Practice Acts, it was the deliberate purpose and intention of the General Assembly to protect such unfortunate people from their own credulity." Id. at 198-99, 37 N.E.2d at 68.

Dean differs significantly from Crum, and the statements in Dean, taken from Crum, must be viewed in the factual context before the Dean court. Jay Dean was a practicing chiropractor. Nothing in the case indicates that Dean's actions or inducements in any manner played upon his clients' gullibility. Dean may thus stand for the proposition that one need not be engaged in fraudulent or misleading activity to come within the prohibition against unlicensed practice.

In this light, the Dean rationale becomes more clear--the purpose of the Medical Practice Act is to protect people. It is not, however, solely designed to protect people in a vulnerable position from gullibility in medical matters. The Act's scope is broader--it protects people generally in their relationships with professionals to whom they entrust medical judgments. That protection does include protection against charlatans, quacks and frauds. Yet the regulatory scheme also protects against the well-intentioned but unskilled...