Sermchief v. Gonzales

660 S.W.2d 683 (1983)

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Nature of the Case

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Facts

The Agency provides medical services to the general public in fields of family planning, obstetrics, and gynecology. The Agency is funded from federal grants, Medicaid reimbursements, and patient fees. The programs are directed toward the lower-income segment of the population. Similar programs exist both statewide and nationwide. Solari and Burgess (Ps) are duly licensed professional nurses and are employed by the Agency. They have had post-graduate special training in the field of obstetrics and gynecology. Physicians (Ps) are also employees of the Agency and duly licensed to practice medicine. Ds are the members and the executive secretary of the Missouri State Board of Registration for the Healing Arts (Board) and as such are charged with the enforcement, implementation, and administration of Chapter 334, the licensing laws. D is extremely upset that the nurses routinely take histories, do breast and pelvic examinations, laboratory testing of Papanicolaou (PAP) smears, gonorrhea cultures, and blood serology. They also provide and give information about oral contraceptives, condoms, and intrauterine devices (IUD) and dispense certain designated medications. They do counseling services and community education. If the nurses determine the possibility of a condition designated in the standing orders or protocols that would contraindicate the use of contraceptives until further examination and evaluation, they refer the patients to one of the Agency physicians. There are no claims of any injuries caused nor damages to any person. The nurses act pursuant to written standing orders and protocols signed by the physicians. D threatened to order Ps to show cause why the nurses should not be found guilty of the unauthorized practice of medicine and the physicians guilty of aiding and abetting such unauthorized practice. Ps sought declaratory relief. Ps called 4 expert witnesses who were prestigious and highly credentialed all of whom expressed the view that the acts of the nurses were proper. Ds called 3 witnesses all of whom were more prestigious and more highly credentialed than Ps’ witnesses were. Ds’ witnesses stated that Ps were outside the law. The Court specifically found that the more credible evidence was presented by Ds' witnesses.' It denied the relief Ps requested and Ps appealed. The appeal of this case attracted amici briefs resembling a letter-writing campaign directed at a legislative body.