State Board of Nursing and State Board of Healing Arts v. Ruebke

Brief Fact Summary. An injunction was sought against Ruebke (Defendant) by various nursing and medical groups alleging the practice of lay midwifery.

Synopsis of Rule of Law. For the purpose of professional regulation by statute, the practice of lay midwifery is not equal to the practice of nursing and medicine.

Facts. Ruebke (Defendant) worked as a lay midwife, helping pregnant women at length starting with prenatal care, and continuing through delivery and post-partum care.  She consulted with doctors regularly and followed a complete set of standards to ensure safe practice.  The State Board of Healing Arts (Plaintiff) and the State Board of Nursing (Plaintiff) sought a temporary injunction to stop Defendant’s alleged practice of medicine and nursing.  There was testimony from a gynecologist that many of Defendant’s assessments were obstetrical diagnoses, and there was testimony from a nurse that Defendant practiced nursing functions during deliveries.  The trial court found that the two acts the Plaintiffs cited were unconstitutionally vague.  Further, even if the acts were constitutional, Defendant’s acts fell within exceptions to them.  The injunction was denied by the trial court.  The Plaintiffs appealed.

Issue. For the purpose of professional regulation by statute, is the practice of lay midwifery equal to the practice of nursing and medicine?

Held. (Larson, J.)  No.  For the purpose of professional regulation by statute, the practice of lay midwifery is not equal to the practice of nursing and medicine.  It is always preferable to interpret a statute as constitutional where possible without undermining the intent of the legislature.  Here, it is unclear whether the state regulations are intended to cover midwifery.  The act defines the healing arts in terms of pathologies and abnormal conditions.  As long as there are no major complications, pregnancy and delivery are simply a continuation of normal human conditions.  It appears consistent with legislative intent to reason that midwifery was not prohibited by the regulation of the healing arts.  This interpretation does not make the acts unconstitutionally vague, or apply to restrict lay midwifery.  Affirmed in part and reversed in part.

Discussion. There is wide disagreement among the states regarding how to treat midwifery.  Nursing boards tried to carve out the field of midwifery from medicine by certifying nurses as nurse-midwives.  Various courts have separated the act of assisting during a delivery with the act of delivering a baby, a very minor distinction.  Nevertheless, for low-risk births, there will likely be increased favor for midwives as the trend toward low-cost alternatives in medicine grows.