Opinion ID: 2334466
Heading Depth: 2
Heading Rank: 2

Heading: Statutory and Regulatory Scheme

Text: 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. [1] 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; [2] 19 C.S.R. 10-1.010(1), (4). [3] These local centers are organized by collaborative practice arrangements, which delegate to ... registered professional nurse[s] 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). [4] The state boards of nursing and of the healing arts promulgate the rules regarding collaborative practice arrangements. Sec. 334.104(3). [5] The relevant rules are contained in 4 C.S.R. 200-4.200(1), (5). [6] 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 contrast to services ... includ [ing] diagnosis and initiation of treatment of disease or injury not related to population-based health services when the provisions of sections (2), (3), and (4) above shall apply. Id. at (5)(A). A collaborative practice arrangement is simply the operating agreement between physicians and nurses to provide treatment. Id. at (1)(B). There are several collaborative arrangements for various purposes at the Boone County clinic, but the one that specifically pertains to the delivery of population-based services is contained in the Columbia/Boone County Health Department Policies and Protocols Manual. It provides, The Medical Director of Columbia/Boone County Health Department delegates ... to registered nurses ... the authority to deliver population based health care services, including ... tuberculosis control. Written protocols related to these services are reviewed and signed annually by the Medical Director and nursing staff. [7] Collaborative Practice Arrangement, Policies and Protocols 2001, Columbia/Boone County Health Department Manual 3.