Iowa Court Invalidates Rules Authorizing ARNPs to Provide Direct Supervision of Fluoroscopy

The Iowa District Court for Polk County has ruled in favor of the Iowa Society of Anesthesiologists’ (ISA) and Iowa Medical Society’s (IMS) lawsuit challenging regulations adopted by the nursing board and Iowa Department of Public Health (IDPH) that authorize advanced registered nurse practitioners (ARNPs) to provide “direct supervision” of fluoroscopy. The court finds the regulations to be invalid and of no effect because the nursing board and IDPH exceeded their statutory authority. 

ASA provided significant financial support to the ISA for the lawsuit. 

In its decision, the court notes that Iowa law does not provide the nursing board with “unfettered discretion” to authorize ARNPs to “engage in the practice of medicine and it specifically prohibits the expansion of nursing practice into areas of medicine absent recognition of the medical professions.”  Further, the nursing board “could not set forth or point to any recognized standards showing that the medical or nursing professions have recognized ARNP supervision of fluoroscopy either in national training, education or curriculum standards. In fact, the Iowa Association of Nurse Anesthetists admitted during the rulemaking process that CRNAs…do not receive sufficient training at the University of Iowa Nurse Anesthesia program to make CRNA’s [sic] competent to utilize fluoroscopy in practice.” 

Even if such expanded scope of practice had been valid, neither the nursing board nor IDPH rules establish a curriculum or minimum criteria and safety standards to provide direct supervision of fluoroscopy, as required by Iowa law. The rules are the product of the nursing board’s work that neither “reflect nor connect in any way to any curriculum, training and certification standards developed through the work and consensus of professional standard-setting bodies, whether in nursing or medicine, to assure nursing proficiency and public health safety in the field of radiology.”

Congratulations to ISA and IMS for their commitment to patient safety.

A copy of the full opinion is available here.