The Iowa Nursing Board and the Department of Public Health promulgated administrative rules permitting advanced registered nurse practitioners (ARNP) to supervise radiologic technologists using fluoroscopy machines. Physician associations brought an action challenging the rules. Two nursing associations intervened to defend the rules. The district court, on cross-motions for summary judgment, invalidated the rules after concluding that ARNP supervision of fluoroscopy had not been recognized by the medical and nursing professions within the meaning of Iowa law. The court also concluded that the nursing board and the department of public health exceeded their authority in promulgating the rules. The nursing board and nursing associations appealed.
The Supreme Court of Iowa reversed the decision of the district court and remanded for further proceedings consistent with their opinion. The court held that supervision of fluoroscopy by ARNPs was recognized by medical and nursing professions, and supervision of fluoroscopy did not constitute impermissible operation of equipment. The court concluded that the nursing board's application of law to fact was not irrational, illogical, or wholly unjustifiable. The court also concluded that the rules fell within the authority of the nursing board and the department of public health. Accordingly, the rules at issue must be upheld.
The court found that supervision of fluoroscopy procedures by ARNPs was recognized by the medical and nursing professions, and therefore the nursing board and department of health's promulgation of regulatory rules permitting ARNPs to supervise radiologic technologists using fluoroscopy machines did not exceed the agencies' regulatory authority. Credentialing committees, which included physicians, at 16 or more Iowa hospitals had granted privileges to ARNPs to supervise fluoroscopy, 40 Iowa medical doctors wrote comments supporting the nursing board's proposed rule, and the board of medicine had never sought to enjoin any ARNP from supervising fluoroscopy as practicing medicine without a license, even though ARNPs had been doing so openly in Iowa for up to 20 years.
The court concluded that an ARNP who supervised the use radiologic technologists using fluoroscopy machines did not constitute an operator of the machine, and therefore the regulatory rule permitting such supervision did not violate the statute governing the use of radiation machines, including training requirements for operators; nothing in the plain language of the rules or statute required the ARNP supervising fluoroscopy to have the legal or technical ability to operate the equipment, and equipment was always operated by a licensed radiologic technician.
See: Iowa Medical Soc. v. Iowa Bd. of Nursing, 2013 WL 2361007 (Iowa, May 31, 2013) (not designated for publication).