Mo. Ass'n Of Nurse Anesthetists Inc v. State Bd. Of Registration For The Healing Arts
| Decision Date | 21 September 2010 |
| Docket Number | WD72412 |
| Parties | MISSOURI ASSOCIATION OF NURSE ANESTHETISTS, INC., GLENN KUNKEL, M.D., and KEVIN SNYDERS, CRNA, Appellants, v. STATE BOARD OF REGISTRATION FOR THE HEALING ARTS, Respondent. |
| Court | Missouri Court of Appeals |
Appeal from the Circuit Court of Cole County, Missouri The Honorable Jon E. Beetem, Judge
Before Division I: James M. Smart, Jr., Presiding Judge, and Mark D. Pfeiffer and Cynthia L. Martin, Judges
The Missouri Association of Nurse Anesthetists, Inc. ("MANA"), Glenn Kunkel, M.D., and Kevin Snyders, CRNA1 (Appellants collectively referred to as "Practitioners"), appeal the Circuit Court of Cole County's ("trial court") grant of summary judgment in favor of the State Board of Registration for the Healing Arts (the "Board"). Practitioners raise two points on appeal, claiming the trial court erred in granting summary judgment in favor of the Boardbecause (1) the Board's statements on the scope of practice for advanced practice nurses2 ("APNs") constitute a rule under section 536.010(6)3 and is subject to the rulemaking requirements of Chapter 536 and section 334.125 RSMo 2000 and, in the alternative, (2) even if the Board's statements are not a rule, Practitioners are still entitled to a declaratory judgment declaring that the Board is without jurisdiction or authority to make statements defining the scope of practice for APNs. We affirm.
On September 21, 2007, the Board received a letter from the Missouri State Medical Association ("MSMA") requesting the Board adopt a position prohibiting APNs from performing injections, under fluoroscopic control, of therapeutic agents around the spinal cord (the "procedure"). MSMA maintained that the procedure "constitutes the practice of medicine and the performance of such should be restricted to licensed physicians in the State of Missouri."
On October 23, 2007, the Board received a letter from Dr. Kunkel opposing MSMA's request. Dr. Kunkel stated that he employed APNs, currently Mr. Snyders, in the delivery of fluoroscopic procedures and that he "believed [APNs] should continue to be able to provide therapeutic fluoroscopic guided injections with direction of a physician." Two days after receiving Dr. Kunkel's letter, the Board received a letter from Dr. Donald James4 requesting the Board consider some additional factors relating to the issue submitted by MSMA.
MSMA's request was taken up by the Board at its October 25, 2007 meeting. However, the Board did not render a position; rather, it directed two members to investigate the request. Ultimately, on or around February 7, 2008, the Board directed its Executive Director to communicate via letter to the doctors and MSMA the following statement, in pertinent part:
After researching the current statute, rules, and regulations governing the practice of medicine and the practice of nursing it was the Board's decision to advise [MSMA and Dr. Kunkel] that Chapter 334 RSMo. authorizes a physician to delegate professional responsibilities to a person who is qualified by training, skill, competency, age, experience, or licensure to perform such responsibilities. Based on the information provided to the Board, it was their opinion that [APNs] currently do not have the appropriate training, skill or experience to perform these injections. If you disagree with the Board's interpretation please provide us with documentation that shows that [APNs] have the appropriate training, skill and experience to perform these injections.
(Emphasis added.) MSMA, thereafter, published this language in the February 2008 Progress Notes, a newsletter of the MSMA.
After receipt of the Board's letter and learning of the report's publication in Progress Notes, Dr. Kunkel sent a reply letter to the Board outlining the education and training of his CRNA, Mr. Snyders. Dr. Kunkel insisted Mr. Snyders was fully competent to continue injecting therapeutic agents under fluoroscopic guidance. Upon producing this additional information, the Board continued to disagree with Dr. Kunkel and advised him so.
Over a year later, on April 22, 2009, Practitioners filed a petition with the trial court alleging that the Board's letter to Dr. Kunkel constitutes a rule, and because it was not properly promulgated, it is "null, void and unenforceable." Practitioners sought an injunction and declaratory judgment prohibiting the enforcement of the "letter rule," declaring the rule void as it was not properly promulgated, and declaring that the rule is void as the making of such rule is outside the scope of authority of the Board.
On December 2, 2009, the Board filed a motion for summary judgment arguing that because the letter is not a rule, Practitioners are not entitled to the relief they seek. Practitioners filed a motion for partial summary judgment on December 31, 2009, arguing the opposite position. On March 22, 2010, after a hearing on the motions, the trial court entered judgment in favor of the Board. Practitioners timely appealed.
Our review of a grant of summary judgment is "essentially de novo." ITT Commercial Fin. Corp. v. Mid-Am. Marine Supply Corp., 854 S.W.2d 371, 376 (Mo. banc 1993). "The criteria on appeal for testing the propriety of summary judgment are no different from those which should be employed by the trial court to determine the propriety of sustaining the motion initially." Id. "The propriety of summary judgment is purely an issue of law." Id. "As the trial court's judgment is founded on the record submitted and the law, an appellate court need not defer to the trial court's order granting summary judgment." Id. When considering an appeal from summary judgment, we review the record in the light most favorable to the party against whom judgment was entered. Id. "We accord the non-movant the benefit of all reasonable inferences from the record." Id. Summary judgment will only be upheld on appeal if: "(1) there is no genuine dispute of material fact, and (2) the movant is entitled to judgment as a matter of law." Brock v. Blackwood, 143 S.W.3d 47, 61 (Mo. App. W.D. 2004); see also Rule 74.04(c).5 Because the material facts are undisputed, the focus of our analysis will be whether the Board is entitled to a judgment as a matter of law.
Practitioners seek a declaratory judgment that the Board violated the rulemaking requirements of Chapter 536 when, via letter, it communicated an opinion to Dr. Kunkel and MSMA in the form referenced above. Practitioners alternatively argue that, if the Board's statements do not constitute a rule, Practitioners are still entitled to a declaratory judgment stating that the Board lacks authority to render opinions that define the scope of practice for APNs.
The purpose of a declaratory judgment is to "dispel uncertainty as to legal rights." Doe v. Worsham, 290 S.W.3d 809, 811 (Mo. App. S.D. 2009). It is appropriate only "where a plaintiff can obtain relief against the defendant." Id. "The declaratory judgment act is not a general panacea for all legal ills nor is it a substitute for existing remedies." King Louis Bowling Corp. v. Mo. Ins. Guar. Ass'n, 735 S.W.2d 35, 38 (Mo. App. W.D. 1987). Thus, the circuit court may grant a declaratory judgment only if it is presented with:
(1) a justiciable controversy that presents a real, substantial, presently-existing controversy admitting of specific relief, as distinguished from an advisory decree upon a purely hypothetical situation; (2) a plaintiff with a legally protectable interest at stake, "consisting of a pecuniary or personal interest directly at issue and subject to immediate or prospective consequential relief," (3) a controversy ripe for judicial determination; and (4) an inadequate remedy at law.
Lane v. Lensmeyer, 158 S.W.3d 218, 222 (Mo. banc 2005) (citation omitted). Furthermore, the Missouri Administrative Procedure Act ("MAPA") establishes authority for courts of this state to render declaratory judgments that challenge the validity of a rule or the threatened application of such rule. § 536.050.1. Pursuant to MAPA, "a declaratory judgment under MAPA, therefore, is not available unless the administrative action in question constitutes a rule." Mo. Soybean Ass'n v. Mo. Clean Water Comm'n, 102 S.W.3d 10, 22 (Mo. banc 2003). Because Practitioners have not demonstrated a right to declaratory judgment, summary judgment in favor of the Board is proper.
The Board itself and its authority to act were created and limited by Chapter 334. Pursuant to sections 334.125 RSMo 2000 and 334.100, respectively, the Board may promulgate rules governing its actions and discipline a licensee subject to its authority. In pertinent part, section 334.100.2 provides:
The Board does not have the unilateral authority to interpret or apply these standards. The Board may not impose discipline without seeking and obtaining a determination of the Administrative Hearing Commission ("AHC") that there is cause for discipline upon a particular set of facts. § 334.100.4. Stated differently, the AHC shall conduct hearings and make independent findings of fact and conclusions of law regarding the Board's complaint. §...
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