The bootstrap style for active is based on selection. So it looks like the button is still focused, and that's why it looks like its still active. Try making it like so:
<button type="button" data-bind="click: function () { SMSAppointment(!SMSAppointment());}, css: { active: SMSAppointment() == true }, hasFocus: SMSAppointment()" class="btn btn-default btn-xs">Appointment</button>
Now the bootstrap style for focus is working correctly as well.
Edit:
This is an example of how to deal with the bootsrap focus issue. Though I don't think it's actually what you want. So you can probably do things like clear focus after its been clicked and things like that. Or override the css altogether.