On April 24, 2024, the Missouri Court of Appeals decided the case of Kayla Williams v. Missouri State Board of Nursing. This case is instructive to any nurse currently considering entering into a Non-Disciplinary Consent Agreement with the Missouri State Board of Nursing. Its facts show that review by the Courts of Board of Nursing matters are limited, that these matters are handled differently than a typical lawsuit, and why zealous representation is so important for any nurse facing allegations of wrongdoing, even after a “settlement” is signed.
The Nursing License Case
For background, the Missouri State Board of Nursing is empowered by statute to offer what it terms “early intervention” programs for nurses accused of positive drug tests or suspected substance abuse. Generally, these agreements require compliance with testing protocols for a predetermined period (usually a year) and successful completion after which the matter is settled. However, according to the statute, if a nurse or applicant violates any terms, the State Board is empowered to call a hearing and determine whether a violation occurred. Crucially, if a nurse concedes a violation, no hearing is even required by statute, and the Board can implement further discipline. See Mo. Rev. Stat. 335.067. It is this set of unique events that led to the decision in Williams.
Kayla Williams, a registered nurse, took a pre-employment drug screen as a travel nurse for Mercy South in St. Louis. Her drug test was positive for marijuana, which Williams explained was the result of her use of CBD oil for various medical issues. She entered into a Consent Agreement with the Board, which became effective on June 9, 2021. The main requirement was that she submit to random drug tests, which she would be notified of through a third-party site. Williams complied with the agreement for several months, but on August 19, 2021, she ultimately did not report to drug testing before a testing site closed. On August 23, 2021, the Board sent Williams a letter of violation. On August 26, 2021, Williams, through counsel, sent the Board a letter stating that she did in fact miss the drug screen due to a “misunderstanding” and requested that the probation not be rescinded. As a result, the Board saw this letter as an admission of a violation for which no hearing was necessary and suspended her nursing license without hearing for one year.
Williams filed suit in Butler County on September 23, 2021. She argued that the letter was an “objection” to the Board and warranted a hearing. She sought and received a temporary restraining order preventing the Board from suspending her license on the basis that doing so without a hearing was “arbitrary, capricious, and unreasonable.” The trial level court held for Williams and the Board appealed.
On appeal, the Missouri Court of Appeals held that the Board’s conduct was not unreasonable. Interpreting the statute as written, the Court held that an admission of a violation immediately triggers discipline, and a hearing is not necessary. It noted that a settlement agreement is essentially a contract between parties, and found that Williams’ letter was as good as admitting to a breach. It also held that the trial court erred when it overturned the Board decision because it considered evidence of “substantial compliance.” Under the Missouri Court of Appeals’ interpretation of the statute, there is no process to weigh mitigating factors or evidence of compliance with a consent agreement’s “spirit.” Because the trial court misapplied the law in determining otherwise, its judgment was reversed.
It is worth noting that this strict interpretation of a contract is a product of the unique circumstances surrounding the statutes regulating the practice of nursing. While substantial compliance with a contract is generally considered by courts, here, the Missouri Court of Appeals read the statute as requiring strict compliance with its terms.
Such legal issues are very complicated, and the lesson of this case is that time can be of the essence, and only so much can be done after the fact. That is why it is important to reach out to an attorney from The Crone Law Firm PLC as soon as issues with your nursing license arise. Our attorneys will be able to guide you through the entire process and get you back to fighting for your patients, and allow you to put issues with the Missouri State Board of Nursing behind you.