Missouri Ass'n of Nurse Anesthetists v. State Board of Registration
2011 Mo. LEXIS 169
| Mo. | 2011Background
- Missouri Board of Registration for the Healing Arts issued a February 2008 letter stating APNs do not have appropriate training to perform fluoroscopic injections, without following public rulemaking procedures.
- Appellants (MANA, Kunkel, Snyders) challenged the letter, asserting it was an invalid rule and exceeded the Board’s authority to define scope of practice for nurses.
- Plaintiffs sought declaratory relief, injunction prohibiting enforcement of the letter as a rule, a declaration the letter was void, and a retraction of the letter.
- Board admitted the letter was not a formally promulgated rule; it described the Board’s position rather than imposing legal requirements.
- Trial court granted summary judgment for the Board, concluding the letter was not a rule; this Court granted transfer.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Is the Board's letter a rule requiring rulemaking | Kunkel contends the letter is a rule. | Board argues the letter is merely a non-binding position. | Letter void as rule; not law. |
| Are declaratory and injunctive relief appropriate | Declaratory relief is proper to resolve threatened enforcement. | Relief unavailable pending rulemaking or remedies. | Declaratory judgment and injunction appropriate to invalidate the letter. |
| Does the Board have authority to define APN scope of practice | Board exceeded authority by defining nursing scope; Sermchief concerns apply. | Board may regulate physician delegation and collaborative practices; authority is ambiguous. | Record insufficient to decide; summary judgment improper; remand. |
| Is there an adequate remedy at law or exhaustion issue | Administrative remedies ineffective for APNs and delayed action against Kunkel prejudices declaratory relief. | Exhaustion of remedies is typical; administrative process could resolve disputes. | Declaratory relief appropriate given agency delay and threatened enforcement. |
Key Cases Cited
- United Pharmacal Co. of Missouri, Inc. v. Missouri Bd. of Pharmacy, 159 S.W.3d 361 (Mo. banc 2005) (promulgation required for rules; void otherwise)
- Kansas City Power & Light Co. v. McBeth, 322 S.W.3d 525 (Mo. banc 2010) (standing and declaratory relief standards)
- Group Health Plan, Inc. v. State Bd. of Registration for the Healing Arts, 787 S.W.2d 745 (Mo.App.1990) (standing and declaratory relief in agency context)
- Sermchief v. Gonzales, 660 S.W.2d 683 (Mo. banc 1983) (thin line between medicine and nursing; preemption by Chapter 335)
- NME Hospitals, Inc. v. Dep't of Soc. Services, Div. of Med. Services, 850 S.W.2d 71 (Mo. banc 1993) (rulemaking requires public procedures; changes with policy require APA compliance)
- Little Hills Healthcare, L.L.C. v. Dep't of Social Services, 236 S.W.3d 637 (Mo. banc 2007) (agency policy with future effect that is rulemaking)
- Glendinning Companies of Connecticut, Inc. v. Letz, 591 S.W.2d 92 (Mo. App. 1979) (ripeness and declaratory relief in agency context)
- Farm Bureau Town & Country Ins. Co. of Missouri v. Angoff, 909 S.W.2d 348 (Mo. banc 1995) (exhaustion of administrative remedies exception)
- Alternate Fuels, Inc. v. Dir. of Illinois E.P.A., 215 Ill. 2d 219, 294 Ill. Dec. 32, 830 N.E.2d 444 (Ill. 2004) (ripeness and threatened agency action considerations)
- Lorillard Tobacco Co. v. Roth, 99 N.Y.2d 316, 756 N.Y.S.2d 108, 786 N.E.2d 7 (N.Y. 2003) (hardship considerations in agency action)