BEFORE THE

MISSOURI STATE BOARD OF REGISTRATION FOR

THE HEALING ARTS

MISSOURI STATE BOARD OF )

REGISTRATION FOR THE HEALING ARTS, )
)
Petitioner, )
)
Case Number: 19-0324
v. )
)
JOHN D. URE, DO, )
)
Respondent. )

FINDINGS OF FACT, CONCLUSIONS OF LAW

AND DISCIPLINARY ORDER

The Missouri State Board of Registration for the Healing Arts ("the Board"), in accordance with

law and pursuant to proper notice, took up this matter against John D. Ure, DO, ("Respondent") during

its regularly scheduled meeting on January 17, 2020, at the Missouri Council of School

Administrator's Building, 3550 Amazonas Drive, Jefferson City, Missouri, for the purpose of

determining the appropriate level of discipline to enter against his physician and surgeon's license.

The Board was represented by Adam Grayson, Contract Counsel for the Board. Katie

Brenneke, General Counsel, served as the Board's legal advisor during the hearing and in preparing

this Order. Respondent was present at the hearing, but was not represented by counsel. All

members of the Board participating in the decision were present throughout the disciplinary hearing.

In reaching the decision reflected in this Order, each member of the Board present at the hearing

read and considered the Administrative Hearing Commission’s Decision, Case No. 19-0324,

(“Decision”), entered on September 25, 2019.

At the commencement of the hearing, Petitioner asked the Board to invoke the rule of witnesses

and keep the witnesses outside the hearing until they are called, and the Board granted Petitioner’s

request. Exhibit 1, the Administrative Hearing Commission’s Certified Record of Proceedings, was offered

by Petitioner and admitted into evidence. Exhibit 2, an affidavit signed by the Board’s deputy custodian of

records regarding the status of Respondent’s osteopathic physician and surgeon’s license and his last
known address, was offered by Petitioner and admitted into evidence. Exhibit 3, an affidavit signed by

Jeffrey S. Ehmke, DO, regarding the expert’s review of the care Respondent provided to three (3) patients,

was offered by Petitioner and admitted into the evidence. Exhibit 4, a business record maintained by the

Board containing documents from Respondent’s investigative file, was offered by Petitioner and admitted

into evidence. Upon the motion of Petitioner, patients’ names were sealed pursuant to section 610.021(5),

RSMo, and in compliance with 42 CFR Part 2 (Hearing Tr. 59:4-13, January 17, 2020).

Testimony was adduced and the argument of parties was heard. Being fully advised, the Board now

enters its findings of fact, conclusions of law and disciplinary order as set forth below.

Findings of Fact

1. The Board is an agency of the state of Missouri, created and established pursuant to section

334.120, RSMo, for the purpose of executing and enforcing the provisions of Chapter 334, RSMo. 1

2. Respondent is licensed by the Board as a physician and surgeon, license number R4D38, which was

first issued on August 22, 1983. Respondent's license is current and active, and it was active at the

time of the underlying incidents which formed the basis of the Administrative Hearing Commission’s

Decision and the current Order.

3. Respondent's last known business address reported to the Board is 8768 NE 117Y Pvt Road,

Deepwater, MO 64740.

4. On March 18, 2019, the Board filed a properly pled Complaint against Respondent wherein it asked

the Administrative Hearing Commission to find there is cause to discipline his physician and

surgeon’s license. Respondent filed an Answer to the Complaint on May 6, 2019. On May 22,

2019, the Board filed a Request for Admissions pursuant to Mo. Sup. Ct. R. 59.01. Respondent did

not respond to the Request for Admissions, and the Administrative Hearing Commission entered a

Decision in favor of the Board on September 25, 2019, finding that 1) Respondent’s failure to timely

respond to the Board’s Request for Admissions results in each matter being admitted; and 2) the

Board has cause to discipline Respondent’s license pursuant to sections 334.100.2(4),

334.100.2(4)(h), 334.100.2(4)(l), 334.100.2(5), 334.100.2(6) (for violating sections 334.097 and

                                                            
1
All statutory references are to the Revised Statutes of Missouri Cumulative Supplement (2018), unless otherwise stated.
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 334.107) and 334.100.2(19), RSMo. The Board incorporates by reference and adopts the facts set

forth in the Decision.

5. On December 2, 2019, the Board sent a Notice of Disciplinary Hearing and a copy of the

Administrative Hearing Commission’s Decision to Respondent’s last known address via registered

mail. The mail return receipt was signed by Respondent on December 4, 2019.

6. Respondent was given proper notice of this proceeding by the Board.

7. Respondent saw patients for care and treatment at his personal office located in Deepwater,

Missouri. The office also served as a machine shed and lacked running water, restrooms, and an

examination table.

8. Patient 1, Patient 2, and Patient 3 were Respondent’s patients.

9. On May 22, 2016, Respondent amputated the fifth digit of Patient 1’s right foot due to gangrene.

The amputation was performed on the back porch/deck of Respondent’s office, a non-sterile

environment. Respondent admitted the procedure “was not done optimally” and in doing so, he “had

a lapse of judgment.” (Hearing Tr. 51:22-52:4).Respondent did not document the amputation in

Patient 1’s medical records until January 27, 2017. Nor did he report the unsanitary condition of his

back deck/porch to the Board within thirty days of the amputation. The medical records do not show

any antibiotics were administered to Patient 1 either pre-operatively or post-operatively and records

fail to show whether the surrounding bone remaining after the resection of the digit was properly cut

away and smoothed out with appropriate medical devices. Respondent prescribed Patient 1

medications without sufficient examination or adequate record-keeping. After amputating Patient 1’s

toe, Respondent did not document how Patient 1’s gangrenous toe was being treated or the effects

it had on Patient’s body over a period of eight months.

10. From 2015 to 2016, Respondent prescribed controlled substances to Patient 2 on a regular basis.

Patient 2 and Respondent entered into a Pain Management Contract on or about August 4, 2015,

in which Patient 2 agreed to random drug testing. There are no drug screens in Patient 2’s records.

When Patient 2 reported to Respondent the prescribed medications were stolen, Respondent wrote

Patient 2 new prescriptions to replace the allegedly stolen medication without receipt of any police

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 report. Respondent repeatedly prescribed Pheneragan with codeine (schedule II) to Patient 2 with

no documented complaint of cough and no lung exam on chart. When Patient 2 was tested positive

for illicit drugs and medications incongruent with Respondent’s prescriptions, Respondent did not

follow up with further drug screens or other treatment of controlled substance abuse. Respondent

prescribed Patient 2 excessive controlled substances without conducting sufficient physical

examination or maintaining adequate records.

11. In 2015, Respondent treated Patient 3 for chronic pain. On or about September 22, 2015, Patient 3

and Respondent entered a Pain Management Contract, in which Patient 3 agreed to random drug

testing. There are no drug screens in Patient 3’s records. Respondent also documented Patient 3

had 90 degree flexion with little difficulty, but rated Patient 3’s forth lumbar vertebra as 8/10, which

is incongruent. In the course of prescribing controlled substances to Patient 3, Respondent did not

order sufficient objective testing or imaging to verify or treat Patient 3’s complaints. Respondent

prescribed Patient 3 excessive controlled substances without conducting sufficient physical

examination or maintaining adequate records.

12. In the course of treating all three (3) patients, Respondent was repeatedly negligent, grossly

negligent and incompetent.

13. Respondent prescribed drugs to all three (3) patients without conducting sufficient examination.

14. Respondent prescribed controlled substances to Patient 2 and Patient 3 that were nontherapeutic

in nature or non-therapeutic in the manner in which the controlled substances were prescribed.

15. Respondent failed to keep complete and accurate records throughout the course of treating all three

(3) patients.

16. In amputating Patient 1’s toe on the back porch/deck of Respondent’s office, Respondent failed to

properly guard against contagious, infectious or communicable diseases.

17. Respondent maintained an unsanitary office and performed medical procedures under unsanitary

conditions. He also did not report the existence of an unsanitary condition in his office to the board,

in writing, within thirty days of performing the procedures.

18. At the hearing, Respondent offered oral testimony regarding his personal and educational

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 background, additional continuing medical education efforts and the corrective actions he planned

to take. He also offered testimony of a witness regarding his character.

19. The Board finds the discipline imposed herein is necessary to protect to the public.

Conclusions of Law

20. Pursuant to section 621.110, RSMo:

Upon a finding in any cause charged by the complaint for which the license may be
suspended or revoked as provided in the statutes and regulations relating to the profession
or vocation of the licensee and within one hundred twenty days of the date the case became
ready for decision, the commission shall deliver or transmit by mail to the agency which
issued the license the record and a transcript of the proceedings before the commission
together with the commission's findings of fact and conclusions of law. The commission may
make recommendations as to appropriate disciplinary action but any such recommendations
shall not be binding upon the agency. A copy of the findings of fact, conclusions of law and
the commission's recommendations, if any, shall be delivered or transmitted by mail to the
licensee if the licensee's whereabouts are known, and to any attorney who represented the
licensee. Within thirty days after receipt of the record of the proceedings before the
commission and the findings of fact, conclusions of law, and recommendations, if any, of the
commission, the agency shall set the matter for hearing upon the issue of appropriate
disciplinary action and shall notify the licensee of the time and place of the hearing, provided
that such hearing may be waived by consent of the agency and licensee where the
commission has made recommendations as to appropriate disciplinary action. In case of
such waiver by the agency and licensee, the recommendations of the commission shall
become the order of the agency. The licensee may appear at said hearing and be
represented by counsel. The agency may receive evidence relevant to said issue from the
licensee or any other source. After such hearing the agency may order any disciplinary
measure it deems appropriate and which is authorized by law. In any case where the
commission fails to find any cause charged by the complaint for which the license may be
suspended or revoked, the commission shall dismiss the complaint, and so notify all parties.

21. The Board has cause to discipline Respondent pursuant to sections 334.100.2(4), 334.100.2(4)(h),

334.100.2(4)(l), 334.100.2(5), 334.100.2(6) (for violating sections 334.097 and 334.107) and

334.100.2(19), RSMo, which state:

334.100.2. The board may cause a complaint to be filed with the administrative hearing
commission as provided by chapter 621 against any holder of any certificate of registration or
authority, permit or license required by this chapter or any person who has failed to renew or
has surrendered the person's certificate of registration or authority, permit or license for any
one or any combination of the following causes:

*******

(4) Misconduct, fraud, misrepresentation, dishonesty, unethical conduct or

unprofessional conduct in the performance of the functions or duties of any
profession licensed or regulated by this chapter, including, but not limited to,
the following:

*******
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 (h) Signing a blank prescription form; or dispensing,
prescribing, administering or otherwise distributing any drug,
controlled substance or other treatment without sufficient
examination including failing to establish a valid physician-
patient relationship pursuant to section 334.108, or for other
than medically accepted therapeutic or experimental or
investigative purposes duly authorized by a state or federal
agency, or not in the course of professional practice, or not in
good faith to relieve pain and suffering, or not to cure an
ailment, physical infirmity or disease, except as authorized in
section 334.104;

*******

(l) Failing to furnish details of a patient's medical records to

other treating physicians or hospitals upon proper request; or
failing to comply with any other law relating to medical records;

*******

(5) Any conduct or practice which is or might be harmful or dangerous to the

mental or physical health of a patient or the public; or incompetency, gross
negligence or repeated negligence in the performance of the functions or
duties of any profession licensed or regulated by this chapter. For the purposes
of this subdivision, "repeated negligence" means the failure, on more than one
occasion, to use that degree of skill and learning ordinarily used under the
same or similar circumstances by the member of the applicant's or licensee's
profession;

*******

(6) Violation of, or attempting to violate, directly or indirectly, or assisting or

enabling any person to violate, any provision of this chapter or chapter 324, or
of any lawful rule or regulation adopted pursuant to this chapter or chapter 324;

*******

(19) Failure or refusal to properly guard against contagious, infectious or

communicable diseases or the spread thereof; maintaining an unsanitary office
or performing professional services under unsanitary conditions; or failure to
report the existence of an unsanitary condition in the office of a physician or in
any health care facility to the board, in writing, within thirty days after the
discovery thereof;

22. Additionally, sections 334.097, RSMo, in pertinent part, provides that:

334.097.1. Physicians shall maintain an adequate and complete patient record for each patient
and may maintain electronic records provided the record-keeping format is capable of being
printed for review by the state board of registration for the healing arts. An adequate and
complete patient record shall include documentation of the following information:

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 (1) Identification of the patient, including name, birthdate, address and
telephone number;

(2) The date or dates the patient was seen;

(3) The current status of the patient, including the reason for the visit;

(4) Observation of pertinent physical findings;

(5) Assessment and clinical impression of diagnosis;

(6) Plan for care and treatment, or additional consultations or diagnostic
testing, if necessary. If treatment includes medication, the physician shall
include in the patient record the medication and dosage of any medication
prescribed, dispensed or administered;

(7) Any informed consent for office procedures.

2. Patient records remaining under the care, custody and control of the licensee shall be
maintained by the licensee of the board, or the licensee's designee, for a minimum of seven
years from the date of when the last professional service was provided.

3. Any correction, addition or change in any patient record made more than forty-eight hours
after the final entry is entered in the record and signed by the physician shall be clearly marked
and identified as such, and the date, time and name of the person making the correction, addition
or change shall be included, as well as the reason for the correction, addition or change.

23. Section 334.107, RSMo, in pertinent part, provides that:

334.107 Nothing in section 334.106 and this section shall deny the right of the board to deny,
revoke or suspend the license of any physician or otherwise discipline any physician who:

(1) Prescribes, administers or dispenses a controlled substance that is

nontherapeutic in nature or nontherapeutic in the manner in which it is
prescribed, administered or dispensed, or fails to keep complete and
accurate ongoing records of the diagnosis and treatment plan;

(2) Fails to keep complete and accurate records of controlled substances

received, prescribed, dispensed and administered, and disposal of drugs
listed in the Missouri comprehensive drug control act contained in chapter
195 or of controlled substances scheduled in the Federal Comprehensive
Drug Abuse Prevention and Control Act of 1970, 21 U.S.C. 801, et seq. A
physician shall keep records of controlled substances received, prescribed,
dispensed and administered, and disposal of these drugs shall include the
date of receipt of the drugs, the sale or disposal of the drugs by the
physician, the name and address of the person receiving the drugs, and
the reason for the disposal or the dispensing of the drugs to the person;

24. Pursuant to section 334.100.4, RSMo, finding that there is cause to discipline, the Board may, singly

or in combination, warn, censure, reprimand or place Respondent on probation for up to ten (10)

years; it may suspend Respondent’s license for up to three (3) years; it may restrict Respondent’s

license for an indefinite period of time; it may revoke Respondent’s license or permanently withhold

  7 
 issuance of his license; it may require Respondent to submit to the care, counseling or treatment of

physicians designated by the Board at the expense of the individual to be examined; and it may

require Respondent to attend such continuing educational courses and pass such examinations as

the Board may direct.

25. Pursuant to section 334.100.5, RSMo, when revoking a licensee’s license, the Board may state in

the order that the licensee may not apply for reinstatement for a period of time ranging from two (2)

to seven (7) years following the date of the order of revocation.

Decision and Disciplinary Order

26. Upon the foregoing findings of fact and conclusions of law, it is the ORDER of the Missouri State

Board of Registration for the Healing Arts that the physician and surgeon's license issued to

Respondent, John D. Ure, DO, number R4D38, is hereby REVOKED.

27. Respondent shall not apply for reinstatement of his license for a period of two (2) years and one (1)

day from the effective date of this Order.

28. Respondent shall immediately cease practicing in the state of Missouri; and within fifteen (15) days

of the effective date of this Order, he shall return his pocket card and license to the Board

29. If Respondent is licensed in other jurisdictions, he shall forward written notice of this disciplinary

action to the licensing authorities of those jurisdictions within thirty (30) days of the effective date of

this Order. Respondent shall submit a copy of the written notice to the Board contemporaneously

with sending it to the relevant licensing authority. If Respondent is not licensed in other jurisdictions,

he shall notify the Board of that fact, in writing, within thirty (30) days of the date of this Order.

30. Respondent shall, within thirty (30) days of the effective date of this Order, forward written notice of

this disciplinary action to all employers, hospitals, nursing homes, out-patient centers, clinics and any

other facility where Respondent practices or has privileges. Respondent shall, contemporaneously

with the giving of such notice, submit a copy of the notice to the Board for verification by the Board

or its designated representative. If Respondent does not have an employer, staff privileges or

practice at any facility, he shall notify the Board of that fact, in writing, within thirty (30) days of the

date of this Order.

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31. Respondent shall, within thirty (30) days of the effective date of this Order, forward written notice of

this disciplinary action to any allied health care professionals that are supervised by Respondent.

Respondent shall, contemporaneously with the giving of such notice, submit a copy of the notice to

the Board for verification by the Board or its designated representative. If Respondent does not

supervise any allied health professionals, he shall notify the Board of that fact, in writing, within thirty

(30) days of the date of this Order.

32. For purposes of this Order and unless otherwise specified herein, all reports, documentation,

evaluations, notices or other materials that Respondent is required to submit to the Board shall be

forwarded to the State Board of Registration for the Healing Arts, Attention: Enforcement, P.O. Box

4, Jefferson City, Missouri 65102.

33. Respondent is advised that his compliance with the terms of this Order and the discharge of his

professional obligation to transfer his patients' care and records to other physicians will be assessed

by the Board should he submit an application for licensure in the future.

34. This document shall be maintained by the Board as an open and public record as provided in

Chapters 324, 334 and 610, RSMo, and it will report this action to the National Practitioner Data Bank

and the Federation of State Medical Boards.

16th DAY OF __________________,

SO ORDERED, EFFECTIVE THIS _____ June 2020.

_____________________________________
Connie Clarkston, Executive Director
Missouri State Board of Registration for the Healing Arts

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