## Facts

- Edward W. McDonagh, D.O., a Missouri-licensed osteopathic physician since 1961, used EDTA chelation therapy for decades to treat geriatric patients with vascular disease.
- EDTA is FDA-approved to remove heavy metals from the body; some physicians have used it off-label since the 1950s for arteriosclerosis and related vascular conditions via intravenous infusion with other additives.
- The State Board of Registration for the Healing Arts filed a disciplinary complaint alleging violations of § 334.100, including endangering patients, misrepresenting chelation therapy’s effectiveness or scientific status, and related recordkeeping/testing deficiencies, framed in part as “repeated negligence.”
- The Administrative Hearing Commission (AHC) conducted an evidentiary hearing with competing expert testimony on chelation therapy’s efficacy/risks and the applicable standard of care, then found “no cause” to discipline.
- The circuit court affirmed the AHC; the court of appeals reversed and remanded; the Missouri Supreme Court granted review to address the governing standards for expert evidence and standard of care in the administrative proceeding.

## Issues

1. Whether Missouri administrative disciplinary proceedings apply the Frye “general acceptance” test to expert testimony, or instead apply § 490.065.
2. How to define the “relevant field” for determining whether an expert’s facts and data are of a type reasonably relied on by experts, under § 490.065.3, in a case concerning chelation therapy for vascular disease.
3. For a “repeated negligence” charge under § 334.100.2(5), whether the standard of care is measured by chelation practitioners or by physicians treating patients with vascular disease generally, and whether the AHC applied the correct standard.

## Decision

- The Missouri Supreme Court reversed the circuit court’s judgment affirming the AHC’s “no cause” determination.
- The Court held that § 490.065, not Frye, governs admission and evaluation of expert testimony in civil cases and also in administrative cases; post-Lasky civil decisions applying Frye were disapproved.
- The Court held that, for § 490.065.3, the “relevant field” in this matter is physicians treating persons with vascular disease.
- The Court concluded the AHC did not properly apply § 490.065’s requirements regarding the type of facts/data reasonably relied upon in the relevant field.
- The Court remanded for reconsideration of the “repeated negligence” allegation because the AHC appeared to assess conduct by reference to other chelation physicians and because supporting experts did not clearly identify the standard of care used.
- The Court remanded the entire disciplinary matter (including misrepresentation, recordkeeping, and testing allegations) for reconsideration under the corrected expert-evidence and standard-of-care framework.

## Legal Principles

- In Missouri civil and administrative proceedings, § 490.065 controls the admissibility and evaluation of expert testimony; Frye’s “general acceptance” test does not govern.
- Under § 490.065.3, expert opinions must rest on facts or data of a type reasonably relied upon by experts in the relevant field, and the relevant field must be defined by the condition and treatment context at issue.
- In discipline alleging “repeated negligence” under § 334.100.2(5), the physician’s conduct must be measured against the standard of care of physicians treating the condition at issue (here, vascular disease), not a narrower subgroup defined by a particular alternative technique.
- When an agency applies an incorrect expert-evidence standard or misidentifies the relevant field/standard of care, remand is required for reconsideration under the proper legal framework.

## Conclusion

The Missouri Supreme Court required that physician-disciplinary cases apply § 490.065 to expert testimony and evaluate alleged negligence against the standard of care of physicians treating the relevant condition; because the AHC used an improper framework, the case was reversed and remanded for reconsideration of all charges under the correct standards.


State Bd. of Registration for the Healing Arts v. McDonagh, 123 S.W.3d 146 (Mo. 2003)