ST. LOUIS — The Missouri Court of Appeals Western District has upheld the state health department’s decision to permanently place a St. Louis psychiatric nurse on its Employee Disqualification List, reversing a lower court’s effort to reduce the discipline and concluding the agency acted within its statutory authority after determining the nurse knowingly neglected a patient who later died.
The ruling centers on Bradley Hult, a registered nurse working the night shift on Jan. 9-10, 2021, at the Barnes-Jewish Hospital Psychiatric Support Center in St. Louis, according to the Nov. 18 decision in the Missouri Court of Appeals for the Western District.
The Missouri Department of Health and Senior Services (DHSS) found that Hult knowingly neglected a 28-year-old patient who had been transferred to the facility following severe intoxication and suicidal ideation.
The patient, who had arrived showing a positive fentanyl screen but appeared alert and in no acute distress, was required to receive regular alcohol withdrawal assessments and hourly nursing rounds under hospital policy and physician orders.
Evidence presented during a contested-case hearing showed that although Hult initially assessed the patient at 8:20 p.m. and noted he was calm and compliant shortly afterward, he did not conduct required assessments later in the night.
Chart entries made by Hult at 1:35 and 1:37 a.m. on Jan. 10 claimed that the patient refused further evaluation because he was sleeping.
A hallway video, however, showed Hult spent only about four minutes inside the patient’s room during that early-morning visit, a time the hearing officer determined was not sufficient to reasonably attempt to wake the patient for required monitoring.
The patient was later found unresponsive at approximately 6:30 a.m. and was pronounced dead around 7:05 a.m.
Following the discovery, Hult created new chart entries reporting nursing rounds at 1:00, 2:00, 3:00, 4:00, 5:00 and 6:00 a.m.
He also entered notes stating the patient had refused assessments at 5:00 a.m., yet video evidence showed Hult did not enter the patient’s room at any of those times, leading the department to conclude he had falsified medical records.
After receiving a hotline report from the psychiatric facility, DHSS investigated and determined Hult knowingly neglected the patient by failing to perform required care and then creating false documentation.
The department moved to place him on the Employee Disqualification List, which bars listed individuals from employment in numerous health-care settings under state law.
A hearing officer upheld the decision in July 2023 and ordered Hult’s permanent placement on the list.
Hult sought judicial review in Cole Circuit Court. While the court affirmed DHSS’s decision to list him, it found the agency acted arbitrarily and capriciously by ordering permanent placement without sufficiently weighing mitigating factors.
It reduced the disciplinary period to 18 months. Both Hult and the department appealed.
The appellate court ruled that DHSS acted within its statutory authority under §192.2490 to consider whether a worker’s continued employment in the health-care industry is appropriate after a finding of abuse or neglect.
The court rejected Hult’s argument that the department had usurped the Missouri State Board of Nursing’s licensing authority, noting that the statutory framework clearly requires DHSS to maintain the Employee Disqualification List and prohibits listed individuals from working in covered facilities.
The court further held that Hult’s arguments focused improperly on the testimony of the program manager who recommended his listing, rather than on the hearing officer who made the actual decision after the evidentiary hearing.
The hearing officer, the court noted, explicitly addressed each mitigating circumstance Hult raised—including his limited experience, absence of past discipline, fear of waking the patient and the fact that other staff had intermittently checked on the patient.
The officer found these factors did not reduce Hult’s responsibility as the patient’s primary nurse and did not outweigh the seriousness of the neglect or the false documentation.
The appellate decision emphasized that the hearing officer did not find Hult caused the patient’s death, but concluded his failure to perform required rounds and assessments created an “imminent danger” to the patient’s health, safety and welfare, which was one of the seven factors the department must consider when determining how long an individual remains on the disqualification list.
Finding no legal error and no abuse of discretion, the court affirmed the circuit court’s judgment in part and reversed in part, reinstating the department’s original determination that Hult should be permanently placed on the Employee Disqualification List.
Missouri Court of Appeals, Western District case number: WD87540