Supreme Court of Iowa Finds Portions of Administrative Code Dealing With Nursing Were Improperly Admitted at Criminal Trial

March 3, 2021

Similar to its federal counterpart, Iowa Rule of Evidence 5.403 states that

Although relevant, evidence may be excluded if its probative value is substantially outweighed by the danger of unfair prejudice, confusion of the issues, or misleading the jury, or by considerations of undue delay, waste of time, or needless presentation of cumulative evidence.

It’s exceedingly rare for an appellate court to find that a trial abused its discretion by admitting evidence under Rule 403, but the recent opinion of the Supreme Court of Iowa in State v. Buman, 2021 WL 646469 (Iowa 2021), is the exception.

In Buman, Michael Buman, a registered nurse, was charged with wanton neglect of a resident of a heath care facility. At trial, the State introduced, over Buman’s objection, a portion of the Iowa Administrative Code related to the practice of nursing as Exhibit 15, which stated, inter alia,

The registered nurse shall recognize and understand the legal implications of accountability. Accountability includes but need not be limited to the following:….

e. Executing the regimen prescribed by a physician. In executing the medical regimen as prescribed by the physician, the registered nurse shall exercise professional judgment in accordance with minimum standards of nursing practice as defined in these rules. If the medical regimen prescribed by the physician is not carried out, based on the registered nurse’s professional judgment, accountability shall include but need not be limited to the following:

(1) Timely notification of the physician who prescribed the medical regimen that the order(s) was not executed and reason(s) for same.

(2) Documentation on the medical record that the physician was notified and reason(s) for not executing the order(s).

The court also gave an instruction — Instruction No. 17 — related to Exhibit 15, which stated:

In accordance with the standards in the Iowa Administrative Code, a registered nurse is required to follow a medical regimen prescribed by a physician. If a medical regimen prescribed by a physician is not carried out by a registered nurse, the registered nurse is required to timely notify the physician who prescribed the medical regimen and also document on the medical record that the physician was notified and the reason for not executing the physician’s order. A violation of this standard, in and of itself, is not a criminal act. You may consider this standard only in determining whether the State has proven beyond a reasonable doubt the elements of the charge set forth in Instruction 15.

After he was convicted, Buman appealed, claiming that Exhibit 15 and Instruction 17 were improper. The Supreme Court of Iowa agreed (but found the error harmless), ruling as follows:

We think Buman is correct when he states that the admission of Exhibit 15, when coupled with Instruction No. 17, posed a serious risk of misleading or confusing the jury. The language of “accountability” in Exhibit 15 is ominous and creates a danger that the jury gave undue emphasis to potential violation of professional standards in determining his liability under the criminal statute. It is true, of course, that Instruction No. 17 stated that proving a violation of the professional standards in Exhibit 15 did not amount to a crime, but if this is true, what was the jury to make of the accountability language? And, by combining the accountability language with substantive professional standards in the exhibit, the danger exists that the jury would regard this case primarily as one based on violation of professional standards rather than on the higher level of proof required by the criminal offense. Prejudice occurs when evidence prompts a jury to make a decision on an improper basis….

In context, then, we find that the introduction of the totality of Exhibit 15, particularly its language regarding accountability as well as its irrelevant passages, created substantial confusion of issues and should have been excluded under Iowa Rule of Evidence 5.403. Under this rule, relevant evidence may be excluded if any probative value of the evidence is “substantially outweighed by a danger of…confusing the issues, [or] misleading the jury.”

-CM