Sermchief v. Gonzales

Brief Fact Summary. Several nurses (Plaintiffs) claimed that when their employer allowed them to perform medical acts such as taking histories and conducting diagnostic procedures, this was not the unauthorized practice of medicine.

Synopsis of Rule of Law. Certain medical procedures may be performed by a nurse without the nurse having engaged in the unauthorized practice of medicine.

Facts. Medical services were provided by the Missouri Action Agency at several locations, mainly to low-income individuals.  Nurses were allowed by protocols of the Agency to perform procedures such as taking histories, conducting examinations, performing lab tests, dispensing certain medications, and providing family planning information.  The Missouri State Board of Registration for the Healing Arts (Defendant) threatened to cite the nurses for the unauthorized practice of medicine and the physicians at the clinic for aiding and abetting.  An action was filed by several of these nurses and doctors seeking a declaratory judgment that they were not in violation of the law.  Plaintiffs also sought an injunction against the Defendant prohibiting Defendant from prosecuting a case against them.  The trial court denied relief and held that the clinic allowed the unauthorized practice of medicine.  An appeal was taken.

Issue. May certain medical procedures be performed by a nurse without the nurse having engaged in the unauthorized practice of medicine?

Held. (Welliver, J.)  Yes.  Certain medical procedures may be performed by a nurse without the nurse having engaged in the unauthorized practice of medicine.  Missouri’s revised statutes § 334.010 prohibit unauthorized medical practice.  Section 334.155 exempts nurses who are performing their professional duties lawfully.  Where nursing ends and medical practice begins has never been clear.  However, in 1975 the Missouri legislature revised § 335.016.8, which defines the scope of legitimate nursing duties.  It is consistently agreed that these revisions broadened the scope of what a nurse can do.  The requirement that all nursing must be done under the direct supervision of a physician was gone.  Also, the statute uses the language “including, but not limited to” when examples are provided of what a nurse may do.  In light of this legal framework, it is clear that actions of the Plaintiffs in their clinic were well within the tolerable limits of nursing.  Reversed and Remanded.

Discussion. It was a rather narrow decision by the court in this case.  The decision did not try to define the outer scope of what a nurse may do; it only held that the tasks performed by the nurses in this case were acceptable.  The court felt that it was inappropriate in this case to try to make rigid rules regarding exactly what constitutes the practice of medicine.