Certified Registered Nurse Anesthetists (CRNAs) are nurses licensed to deliver anesthesia for procedures and surgeries. In Missouri, the National Board of Certification and Recertification for Nurse Anesthetics (NBCRNA) certifies CRNAs, while the licensing authority for CRNAs is the Missouri State Board of Nursing (MO Nursing Board). Under Missouri's Nursing Practice Act (NPA), published in the Revised Statutes of Missouri, Chapter 335, the Board may take disciplinary action against a licensee for violating the NPA, including public reprimand and suspension or revocation of your nursing license. Call the Lento Law Firm at 888-535-3686 or contact us online to discuss your options with our Professional License Defense Team if you believe your license is in jeopardy.
Disciplinary Records Can Follow CRNAs to Multiple States
Pursuant to the NPA, Missouri is a member of the Nurse Licensure Compact (NLC). Missouri nurses are licensed in one state and can practice in other states that are members of the compact without having to obtain another license in that state. Conversely, if a nurse loses their license to practice in one member state, they can also lose their ability to practice in other NLC-compliant states. Currently, forty-one jurisdictions across the U.S. are part of the NLC, underscoring the importance of adequately defending against license investigations or actions on your CRNA license.
Even if you don't plan on using your nursing license to practice in an NLC-compliant state, it's likely that the Board will find out about your disciplinary record. The Missouri Code of State Regulations imposes a mandatory reporting requirement on employers (i.e., hospitals, ambulatory surgical centers, and temporary nursing staffing agencies), who must inform the Board if a CNRA receives disciplinary action or voluntarily resigns.
Disciplinary Actions the Missouri Nursing Board May Impose
To maintain a Missouri CRNA license in good standing, the nurse must follow the Nurse Practice Act, MO Nursing Board rules, and Nurse Licensure Compact rules. If a licensee nurse violates any of the applicable rules and regulations, the Board may impose any of the following compliance actions singularly or in combination:
- Censure: A public reprimand kept permanently in the licensee's file.
- Probation: The imposition of restrictive terms and conditions on a license that a licensee must follow for up to five years.
- Suspension: The imposition of a requirement that the licensee stops practicing nursing for up to three years.
- Revocation: The imposition of a mandate that the licensee immediately loses their license and may no longer practice nursing in Missouri. A nurse with a revoked license cannot reapply for a license for at least one year from the date of revocation.
- Additional Conditions, Intervention Programs, or Alternative Programs: The imposition of supervision, continuing education, drug screening, counseling, or other conditions pursuant to NPA section 335.067.
Given the severity of these disciplinary consequences, which can last several years or permanently, the stakes are high for Missouri CRNAs facing professional misconduct allegations. Even a censure, the least restrictive action, is a permanent part of a nurse's record and can negatively impact their current and future job prospects throughout the United States.
Grounds for Sanctioning Missouri CRNAs
NPA Section 335.066, subsection 2 sets forth the grounds for taking disciplinary action against a CRNA. These include:
- Violating, assisting, or enabling any person to violate the NPA
- Using or unlawfully possessing any alcoholic beverage or controlled substance in a manner that impairs the CRNA's job performance
- Any offense related to the duties or qualifications of the CRNA or any conduct that seriously endangers the health or safety of a client or the public
- Fraud, deception, misrepresentation, bribery, dishonesty, unethical conduct, intimidation, coercion, or unprofessional conduct
- Violating a client's confidentiality or privacy rights or causing physical or emotional harm
- Violating drug laws or rules and regulations of Missouri, any other state, or the federal government
- False, misleading, or deceptive advertisement or solicitation
- Incompetently or negligently performing job duties
- Improperly delegating professional responsibilities or failing to provide other nurses with appropriate details of a client's nursing needs
- Performing services beyond the CRNA's authorized scope of practice
- Failing to conform to nursing standards
- Placement on a sex offender registry or employee disqualification list
- Disciplinary action against the CRNA by any other state, territory, federal agency or country on the same grounds a license would be revoked or suspended in Missouri
- Failing to comply with a Board-issued subpoena, order, probation agreement, or settlement agreement, or failing to cooperate with the Board during any investigation (i.e., failing to complete a drug or alcohol screening, substance use disorder program, or aftercare program)
- A final judgment that the CRNA is insane or incompetent by a court with proper jurisdiction
- Physical or mental illness that impairs the CRNA's ability to practice nursing with reasonable judgment, skill, or safety
- Failing to pay license renewal fees or update the Board with the CRNA's current residence in a timely manner
- Failure to answer or fully provide all information requested when applying for a license or renewal
Missouri State Board of Nursing Disciplinary Process for CRNAs
The Missouri Code of State Regulations governs the procedure for handling complaints against nurses, which can take many months or even years to resolve.
Filing and Review of Complaints Alleging Nursing Violations
Anyone with knowledge of the alleged violation can file a complaint, including any member of the public or profession, the MO Nursing Board executive director or any Board staff member, or any federal, state, or local officials. Once the Board receives a complaint, the Director of Enforcement reviews the information submitted and determines if the Board has jurisdiction, if the complaint contains sufficient information to investigate, and if a violation of the Nursing Practice Act potentially occurred. If the Board determines all three factors are present, a Board investigator is assigned to the case.
Board Investigation and Report
The Board investigator interviews the complainant and the nurse licensee, collects information from relevant sources, including patient records and personnel records, and prepares an investigative report for the Board. The complaint investigation phase alone takes an average of three months to complete.
Board Preliminary Action or Settlement Agreement
The Board of Nursing reviews the investigative report and decides what action to take based on the case's merits and potential danger to the public. If the Board finds sufficient evidence of an NPA violation, it may choose to issue a letter of concern (which is not considered a disciplinary action) or seek disciplinary action against the nurse by referring the case to legal counsel to file a formal complaint with the Administrative Hearing Commission. Alternatively, the Board and the nurse may enter into a settlement agreement stipulating to the facts of the case and resulting disciplinary action.
Administrative Hearing Commission Action
If the Board decides to pursue disciplinary action against the CRNA through the Administrative Hearing Commission, it must submit a complaint and supporting documentation to the Commission along with the nurse's last address on file. Within one business day of the complaint filing, the Commission must send the Board a service packet that includes the Board's complaint and any supporting documents. Within twenty-four hours of receiving the packet, the Board must provide the CRNA with a copy of the service packet, either by personal service or by leaving it at all of the nurse's current addresses on file with the Board. Prior to the hearing, the nurse may file documents for the Administrative Hearing Commission's consideration.
Proceedings before the Administrative Hearing Commission must follow a deadline-driven process set forth in the Missouri Revised Statutes, Chapter 621. Within five days of the Board's filing of the complaint, the Commission must review the information submitted by the Board and the licensee and determine whether probable cause exists to issue an emergency suspension or restriction against the nurse based on violation of the NPA. If the Commission doesn't find probable cause to issue an emergency suspension or restriction, the Board must remove all references to such emergency suspension or restriction from its public records. If the Commission finds probable cause, it will enter the order requested by the Board. The order becomes effective upon personal service or by leaving a copy at all of the nurse's current addresses on file with the Board.
Within forty-five days of the date the Board filed the complaint, the Commission must hold a hearing to determine if cause for discipline exists. In administrative hearings, the burden of proof is based on a preponderance of evidence, so if the Commission decides there is over a 50% chance the allegations against the CRNA are true, it will likely resolve the case in favor of the Board. The Commission may grant a request for a continuance but must hold the hearing within 120 days of the Board's initial filing. If no cause for discipline exists, the Commission must issue factual findings, legal conclusions, and an order to terminate the emergency suspension or restriction. If cause for discipline exists, the Commission must issue factual findings, legal conclusions, and an order that the emergency suspension or restriction will remain in place pending a disciplinary hearing before the Board.
Board Hearing, Adjudication, and Final Disposition
Once the Administrative Hearing Commission certifies the record, the Board must hold a hearing and may impose disciplinary action against the nurse. The MO Nursing Board has broad powers to investigate and adjudicate complaints against CRNAs. The NPA gives the Board significant authority over such complaints, including the power to administer oaths, issue subpoenas duces tecum (a court order requiring the nurse to attend court and bring relevant documents), and require production of documents and records. The NPA also provides a process for the Board to apply for judicial enforcement of the subpoena duces tecum. Failure to comply with a Board-issued order or subpoena is a violation of the NPA.
In all cases, the Board will send the complainant and the nurse written notice of the final disposition of the complaint. The final decision is a public record, accessible online at NURSYS.com and by request to the MO Nursing Board.
Delays Are Common for Final Disposition of the Complaint
Unfortunately for nurses awaiting a final decision, the Board meets only four times per year. Missouri CRNAs can expect a delay between the initial contact from the Board investigator and the notice from the Board regarding the result of the case. CRNAs will also encounter significant delays during the legal process of prosecuting the case through the Administrative Hearing Commission.
Appealing an Unfavorable Ruling
Under the Missouri Revised Statutes, Chapter 621, the Administrative Hearing Commission's final decision is subject to judicial review by an appellate court based on a petition for review filed within thirty days after the mailing or delivery of a final decision. Typically, the appellate court will uphold the Administrative Hearing Commission's decision so long as the decision is authorized by law and supported by evidence. Depending on your case, there may be several grounds for filing an appeal, including procedural errors and lack of substantial evidence. Even if you lose an appeal, you may still have options for getting your license reinstated.
Professional License Defense Throughout the United States
You work hard to earn and maintain your license and livelihood, and you deserve legal counsel to defend yourself against complainants seeking to jeopardize your nursing practice. The Lento Law Firm Professional License Defense Team has experience dealing with nursing boards, Administrative Hearing Commissions, and courts nationwide. We assist nurse anesthetists by evaluating complaints and corroborating evidence, gathering helpful evidence and witnesses, advising on defense strategies, responding to allegations, negotiating for case dismissal or reduced sanctions, and serving as the legal point of contact in all correspondence, meetings, and formal hearings. The Lento Law Firm can also represent you throughout the appeals process if needed. Contact the Lento Law Firm at 888-535-3686 to discuss your case with our dedicated Team of Professional License Defense attorneys.