252 P.3d 141
Kan. Ct. App.2011Background
- Stinemetz, a Kansas resident and Jehovah's Witness, needs a liver transplant but will not accept blood transfusions.
- No Kansas facility offers a bloodless liver transplant; Nebraska Medical Center in Omaha can perform it.
- KHPA denied out-of-state prior-authorization for the bloodless transplant on the basis that religious preference does not meet medical necessity.
- KHPA would authorize a liver transplant in Kansas (including a bloodless one) if available locally; out-of-state is otherwise denied by rule.
- Administrative proceedings: KHPA summary stated religious preference did not meet medical necessity; presiding officer affirmed; Appeals Committee adopted; district court affirmed; appeal followed challenging First Amendment and Kansas Constitution §7 claims.
- Record shows evidence supporting a burden on religious exercise and lack of a demonstrated compelling state interest; court reverses and remands to grant the out-of-state bloodless transplant
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does KHPA's denial violate the First Amendment Free Exercise Clause? | Stinemetz; denial burdens sincere religious practice | KHPA; regulation neutral and generally applicable | Yes; violation found; remand for authorization |
| Does KHPA's denial violate § 7 of the Kansas Constitution Bill of Rights? | Stinemetz; Kansas §7 requires strict scrutiny and compelling interest | KHPA; Employment v. Smith framework governs; no heightened scrutiny | Yes; violation found; four-step test applied; remand for authorization |
| Was the constitutional issue properly preserved for review? | Stinemetz preserved at admin level; KHPA did not appeal district ruling | KHPA argues preservation failure | Properly preserved; court exercises unlimited review for constitutionality; issues proceed |
Key Cases Cited
- Sherbert v. Verner, 374 U.S. 398 (U.S. 1963) (burden on free exercise and compelling interest test (Sherbert))
- Employment Div., Ore. Dept. of Human Res. v. Smith, 494 U.S. 872 (U.S. 1990) (neutral, generally applicable law does not violate Free Exercise unless targeted)
- Grace United Methodist v. City of Cheyenne, 451 F.3d 643 (10th Cir. 2006) (system of exemptions may trigger heightened scrutiny; look for neutrality and purpose)
- State v. Evans, 14 Kan. App. 2d 591 (Kan. App. 1990) ( Kansas constitutional free exercise analysis with compelling interest standard)
- Shagalow v. State, Dept. of Human Services, 725 N.W.2d 380 (Minn. App. 2006) (Minnesota Constitution free exercise four-step test; influential guidance)
- Pringle v. Heritage Baptist Temple, Inc., 236 Kan. 544 (Kan. 1985) (three-factor framework for religious liberty challenges; compelling interest inquiry)