The state of Kansas violated a Jehovah's Witness' constitutional right to exercise her religious faith when it denied her request for an out-of-state liver transplant, a state appeals court ruled.

A three-judge appeals court panel overturned a lower-court ruling and ordered the Kansas Health Policy Authority to grant Mary Stinemetz's request to undergo a Medicaid-funded liver transplant in Nebraska.

Stinemetz, 64, had refused to undergo a liver transplant at the University of Kansas Hospital because she would need a blood transfusion - something she could not accept as a Jehovah's Witness.

She said Jehovah's Witnesses follow biblical directives to abstain from blood.

Church doctrine leaves it to the discretion of members to accept certain blood fractions and donor organs.

Stinemetz wanted the state to approve a liver transplant in Nebraska, where she could undergo a bloodless procedure, but her request was rejected because the procedure would be done out of state.

For 20 years, the Hill City, Kan. woman has suffered from primary biliary cirrhosis, a chronic disease that causes the liver to deteriorate and malfunction over time.

Stinemetz, who has known since last year she would need a new liver, isn't on a waiting list for an organ, and her eligibility for a transplant hasn't yet been evaluated.

Repeated efforts to reach the Kansas Health Policy Authority for comment on Wednesday's ruling were unsuccessful. It is not known whether the agency plans an appeal to a higher court.

While the Kansas Court of Appeals found that state Medicaid rules didn't focus on Stinemetz's faith, it did note that state regulations allow for exceptions to the general rule barring Medicaid funding for out-of-state services.

Because the rules allow for exceptions, the state under the First Amendment could not deny Stinemetz's request unless it had a compelling reason, something that judges had trouble pinpointing during oral arguments.

The state has failed to suggest any state interest, much less a compelling interest for denying Stinemetz's request for prior authorization for the out-of-state liver transplant, Judge Thomas E. Malone wrote for the appellate court.

The court noted that cost was not an issue in denying Stinemetz's claim, finding that the bloodless procedure costs less than one that requires a transfusion.

There is no question that the (state) would authorize a bloodless liver transplant if a medical facility was available in Kansas to perform the technique, Malone wrote in the 40-page opinion.

Given that the bloodless procedure is less costly, the state is unable to argue that the agency is being fiscally responsible as the steward of Kansas' tax dollars by rejecting Stinemetz's request.

Stinemetz's appeal was based partly on a 1963 U.S. Supreme Court case involving a Seventh-day Adventist who was let go from her job because she wouldn't work on Saturday, the Sabbath of her faith.

That woman was denied state unemployment benefits when she couldn't find a job because of her unwillingness to work on Saturdays.

The U.S. Supreme Court ruled in favor of the Seventh-day Adventist, finding that government needed a compelling state interest to justify infringing on someone's right to freely exercise religion.

The Kansas Health Policy Authority, meanwhile, contended the case involving the Seventh-day Adventist didn't apply any more. The agency instead, relied on a 1990 Supreme Court case involving two workers in Oregon who were fired for ingesting peyote for sacramental purposes and were denied unemployment compensation.

The Supreme Court eventually upheld the denial of benefits, ruling that the government can uniformly enforce laws that might impinge on someone's religion as long the law doesn't focus on one's faith.

But the Kansas appeals court distinguished between the two cases, noting that the Oregon case involved illegal activity and the case with the Seventh-day Adventist related to unemployment benefits.

The Supreme Court ruled in the Oregon case that in situations where the state might have a system of exemptions in place, it must have a compelling reason not to extend those exemptions in cases of religious hardship.

In the Stinemetz case, the appeals court found that because Kansas provided exceptions to its rules, it had to have a compelling reason to deny her request.

Court Unemployment Religion Supreme court