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State ex rel Howenstine v. Roper2/15/2005
Opinion Vote: WRIT MADE ABSOLUTE.
All concur.
Opinion:
In the underlying medical malpractice case, Paul Muren claims that Dr. Debra Howenstine is responsible for negligent treatment he received from various nurses at a public health center. Dr. Howenstine moved for summary judgment on the bases of official immunity and public duty immunity. The trial court overruled Dr. Howenstine's motion. This Court issued a preliminary writ, which is now made absolute.
I. Legal Standard for Writ
"Prohibition is particularly appropriate when the trial court, in a case where the facts are uncontested, wrongly decides a matter of law thereby depriving a party of an absolute defense." State ex rel. Div. of Motor Carrier & R.R. Safety v. Russell, 91 S.W.3d 612, 616 (Mo. banc 2002). "Forcing upon a defendant the expense and burdens of trial when the claim is clearly barred is unjust and should be prevented." State ex rel. O'Blennis v. Adolf, 691 S.W.2d 498, 500 (Mo. App. 1985).
II. Background
A. Facts
Mr. Muren visited the City of Columbia/Boone County Health Department Clinic in April 2000. He was initially treated by four public health nurses and an advanced practice nurse. He tested positive for tuberculosis. The advanced practice nurse prescribed Isoniazid (INH) and he began the nine-month treatment. The treatment destroyed Mr. Muren's liver and he received a transplant in October 2000.
Dr. Howenstine was consulted and began treatment of Mr. Muren on September 19, 2000. There are no allegations that Dr. Howenstine negligently treated Mr. Muren herself, but instead Mr. Muren claims that she was responsible for the actions of the nurses at the clinic. In addition to her role as a consulting and treating physician at the clinic, Dr. Howenstine was the medical director for clinic. As medical director, she assisted in adopting protocols and participated in training, consulting and supervision at the clinic.
Mr. Muren brought suit against the nurses and Dr. Howenstine. He settled his claims against the nurses. Dr. Howenstine's liability is the only remaining issue. There is no genuine issue of material fact. There is no dispute that the clinic nurses provided negligent treatment to Mr. Muren. The dispute is legal. Within the context of the delivery of population-based health services, is Dr. Howenstine immune from the suit?
B. Statutory and Regulatory Scheme
The Department of Health for the State of Missouri has the charge to "safeguard the health of the people in the state and all its subdivisions." Sec. 192.020, RSMo. 2000. Part of this charge is carried out by local public health centers, which are intended to improve the health of all inhabitants of the county. Sec. 205.050; 19 C.S.R. 10-1.010(1), (4). These local centers are organized by collaborative practice arrangements, which "delegate to . . . registered professional nurse the authority to administer or dispense drugs and provide treatment . . . [and to] prescribe drugs if the registered nurse is an advanced practice nurse." Secs. 334.104(1), (2).
The state boards of nursing and of the healing arts promulgate the rules regarding collaborative practice arrangements. Sec. 334.104(3). The relevant rules are contained in 4 C.S.R. 200-4.200 (1), (5).
Subdivision (5) of the regulation states: "(A) In . . . public health clinics that provide population-based health services limited to . . . tuberculosis control . . . , the geographic areas, methods of treatment and review of services shall occur as set forth in the collaborative practice arrangement." Id. at (5)(A). This is in contras
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