Iowa Medical Society and Iowa Society of Anesthesiologists v. Iowa Board of Nursing
831 N.W.2d 826
Iowa2013Background
- The Iowa Board of Nursing and Iowa Department of Public Health enacted rules allowing advanced registered nurse practitioners (ARNPs) to supervise fluoroscopy by radiologic technologists; district court invalidated both rules for exceeding authority.
- Rule 655-7.2(2) and 641-41.1(5)(8) were adopted in 2009–2010; controversy centered on education, training, and supervision requirements for ARNPs.
- Rulemaking drew mixed public comments: supporters cited access, safety, and existing practice; opponents cited training gaps and safety concerns.
- Record showed ARNPs had long supervised fluoroscopy in practice across Iowa hospitals; physicians’ groups opposed the scope and training adequacy.
- District court held the rules exceeded authority because ARNP supervision was not “recognized by the medical and nursing professions” and deemed the delegation/operational framework improper.
- This appeal turns on whether the nursing board’s interpretive authority permits such recognition and upholds the rules under deferential review.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ARNP fluoroscopy supervision is recognized by the medical and nursing professions under §152.1(6)(d) | Medical groups deny recognition of ARNP supervision | Board relied on hospital credentialing and practice history; deference due under Renda | Yes; ARNP supervision is recognized; district court erred |
| Whether ARNPs may directly supervise fluoroscopy without operating the machine under §136C.3 | ARNP supervision requires operator status | Supervision can occur without ARNP operating the equipment | Yes; direct supervision by ARNP is permissible |
| Whether the board’s interpretive grant and deferential review require upholding the rules despite opposition | Deference should not override lack of recognition | Statutory interpretive authority permits this determination | Yes; district court erred in reversing and rules are within authority |
Key Cases Cited
- Renda v. Iowa Civil Rights Comm., 784 N.W.2d 8 (Iowa 2010) (agency interpretive authority requires deferential review of statutory interpretation)
- Iowa Dental Ass’n v. Iowa Insurance Div., 831 N.W.2d 138 (Iowa 2013) (de novo review absent express legislative interpretive grant)
- Auen v. Alcoholic Beverages Div., 679 N.W.2d 586 (Iowa 2004) (determine extent of agency interpretive authority under §17A.19(10))
- GME, City of Sioux City v. GME, 584 N.W.2d 322 (Iowa 1998) (district court acts in appellate capacity; burden on challenger; rationality standard for agency action)
- Sermchief v. Gonzales, 660 S.W.2d 683 (Mo. 1983) (illustrative on delineation between professional scopes of medicine and nursing)