vs. ) CASE NO. 76-246
Respondent. )
Pursuant to notice and in accordance with Chapter 120, F.S., the subject cause came on for hearing before the undersigned on April 12, 1976, in Fort Walton Beach, Florida. The parties to this hearing were afforded the opportunity to present witnesses and other evidence and to be represented by counsel, to present oral argument and to cross examine witnesses and opposing witnesses. The case was initiated by the Board of Nursing's (herein the petitioner) Administrative Complaint filed on or about February 10, 1976, seeking to revoke the Respondent's L.P.N. license No. 24641-1. The authority of the Respondent is derived from Florida Statutes, Section 464.
For Respondent: J. LaDon Dewrell, Esquire
Briefly, this case concerns itself, in the main, with the allegation that, Petitioner, on approximately 11 occasions signed out for a controlled narcotic drug while there was no doctor's order for such medication and that licensee failed to chart as having administered said medication to the patient for whom the medication was checked out.
The Administrative Complaint which is incorporated herein by reference was amended at the outset of the hearing to delete the allegations contained in paragraphs one, two, three, four, five, eight, nine and eleven to the effect that there was no doctor's orders and to specifically allege that there was a doctor's order in regard to the signing out of the medication referred to in the Administrative Complaint. The amendments were received without objection from Respondent's counsel. The net effect of this amendment is that the remaining allegation, as alleged in the complaint, is that the Petitioner failed to chart as having administered the narcotic drugs referred to in the complaint. Additionally, the complaint was alleged to change the date in paragraph eleven
from November 5, 1975, to January 5, 1975. The drug in each instance was Demerol and the dosage ranged from 50 mg. to 100 mg. on each occasion.
Paul Lawrence, a pharmacist and the Director of Pharmacy for Okaloosa Pharmacy Services for one year, testified that he is custodian of records for narcotics. He was shown copies of originals and when shown the records for the patients listed in the Administrative Complaint, they reflect that the charts do not contain notations that the medication was in fact administered to the patients.
Mrs. Collene French, a registered nurse for approximately 30 years, and the Director of Nursing since January, 1974, testified that she has known the Petitioner for approximately 5 years. She testified that charting is necessary in order to insure that medication requested has in fact been administered and to prevent double dosages which could have ill effects on patients. She evaluated the Petitioner annually and her evaluation in each instance was either average or above average. The personnel file revealed that there was no derogatory information contained in Petitioner's personnel folder. There was however, one incident of changing the dosage, however, testimony later revealed that the doctor in fact intended to prescribe the drug according to the dosage reflected by the change. She testified that for the dispensation of narcotic drugs, the policy at the hospital is one of immediately charting the narcotic drugs so as to avoid instances of double dosage of medications.
Joanne Salmons, a registered nurse, who was employed in 1975 served as hospital administrator through June, 1975. She had a conversation with the Petitioner and it came to her attention that she failed to chart Demerol during an investigation of the hospital's controlled drugs records by the Florida Department of Criminal Law Enforcement, (FDCLE). At the time, the FDCLE was conducting a probe of the hospital system and some discrepancies in the hospital controlled drug records. She testified that while the Petitioner failed to chart as having administered the narcotic Demerol, other medication such as aspirin was charted. She also testified that she charted other medications such as geocillin and keflex both of which are antibiotics. She testified that when these discrepancies were pointed out to her, she confronted the Petitioner and her explanation was simply that she had forgotten to chart the drugs. Following this, she terminated the Petitioner. In so doing, she advised the petitioner of the seriousness of the allegations of being negligent in her failure to chart drugs and that mistakes of that gravity could not be tolerated. In actuality, following the confrontation, Mrs. Little, the Petitioner, was granted approximately 2 weeks vacation time and upon the expiration of that period, she was terminated following an exit interview. Initially she was suspended which ultimately led to her termination. During the period in which Mrs. Little was questioned about the alleged failure to chart the narcotic drugs, officials of the Florida Department of Criminal Law Enforcement were present. She testified that some discussion was had with regard to the matter of suspension and the investigators indicated that it was up to the hospital as to what disciplinary action were to be meted out to Mrs. Little. According to notes made during the time of the interview the evidence reveals that the Florida Department of Criminal Law Enforcement suggested suspension rather than termination. In explaining the difference, Mrs. Salmons testified that she was going to terminate Mrs. Little for carelessness, because in her opinion, she could not tolerate a careless nurse. She explained that the charting procedure is to be carried out simultaneous with the actual administering of the drug or it should be done in any event prior to the termination of, the shift. As to narcotics, Mrs. Salmon states that it is done soon after the drug is dispensed. The Director of Nursing was called and was unable to produce the policy on charting
as it existed during the period in question. She was able to submit a policy as it existed in 1976, however, this policy was not introduced as much as testimony revealed that the 1976 policy was dissimilar in some instances from the 1975 policy and with regard to the dissimilarities, she was not specific.
Mrs. Beverly Little was called and testified that she had been employed with the Fort Walton Beach Hospital for approximately 5 years. She was employed as an L.P.N. working on the medical and surgical floors; she has been a licensed practical nurse in Florida for 5 years and has been an L.P.N. for approximately 15 years in both Alabama and Florida. During her employment with Okaloosa County Hospital, her normal work week was approximately 48 hours. She testified that the staffing on the normal floor would consist of one RN and two L.P.N.'s. One LPN would serve as team leader and the other used for dispensing medication and narcotics to various patients (referred to as the charge nurse). The charge nurse would draw the narcotics for the other two nurses and the charge nurse would in turn sign and chart the drug to turn over to that nurse for administration to that patient. She testified that on each occasion in question, she administered the narcotic that was drawn for the patient in question. She testified that she did not abscond with any of the drugs which she withdrew for patients. She received no guidance or counseling relative to the charts and how they were to be maintained or entries entered thereon. The procedure according to her, was to perform the charting when time permitted.
She further testified that the patient load around the hospital was heavy at times and that her primary concern was tending to patient needs. Charting was regarded by her as administrative work and secondary to that of tending to patients and their overall care. She testified that the narcotics ledger was located on opposite ends of the hospital and the drugs were maintained at another station at the other end of the hospital. She was aware that Demerol is a controlled narcotic drug and further that she recognized the importance of charting all drugs. Her explanation for the failure to chart drugs such as aspirin etc., was based on the fact that aspirin and other drugs are maintained in the same area that the ledger for charting those drugs were kept whereas with narcotics, the drugs are maintained in one area of the hospital while the charting ledger is maintained in an area at the extreme opposite end of the hallway. She testified further that during the rush of things, employees, that is she, sometimes failed to chart narcotic drugs.
ANALYSIS, CONCLUSIONS OF LAW AND RECOMMENDATIONS
The guiding statute controlling this case is Section 464, F.S. The Petitioner is charged with having violated Section 464.21(b), based on the above factors which according to the Board amounts to a pattern of unprofessional conduct and it therefore seeks to revoke the licensee's license to practice nursing. Section 464 states in part that the Board has the authority to discipline the holder of a license for engaging in unprofessional conduct, which shall include any departure from, or the failure to conform to, the minimal standards of acceptable and prevailing nursing practices, in which proceeding, actual injury need not be established. Section 464.21(1)(b), F.S.
The conduct complained of amounts essentially to circumstances wherein the Petitioner failed to charge several dosages of Demerol, a controlled substance as set forth in chapter 893, F.S., and the stated reasons advanced by her for not charting said drugs, is that during the rush of events at the hospital, she inadvertently failed to chart as having administered the drug. She further testified that at no time did she adscond with any of the drugs or use it for any other purpose illegal under the statutes. She recognized the importance of charting narcotic drugs and testified that she in fact charted,
drugs as close as practical and when time permitted, simultaneous with the withdrawal of the particular narcotic drugs. Petitioner's work record ate the hospital was good until her recent encounter with the Respondent Board and there had been no complaints of any patients or other nurses regarding her work or conduct at the hospital. These facts are substantiated by her evaluation reports.
The nursing director testified that the hospital has a policy of charting all narcotic drugs as soon as they are charged as having been charged- out on the narcotics ledger. She testified that this was a policy that had been in existence around the hospital for numerous years, however the written policy reflecting such could not be located as it existed during the period in question. She had no evidence that the Petitioner absconded with any of the drugs in question or that she otherwise engaged in any fraudulent or deceitful conduct in procuring or attempting to procure the drugs in question.
After due consideration of all the facts in this case including the documentary evidence, the undersigned is of the opinion that the Petitioner has engaged in a pattern of conduct which amounts to careless conduct, however, such conduct is not in the undersigned's opinion conduct amounting to unprofessional conduct. Petitioner testified without contradiction that she administered all of the drugs in question to the various patients but that her failure to chart as having administered the narcotic drugs was based on her busy schedule. There was no evidence that any one had complained about her failure to administer the drugs to patients until the investigation was made by the FDCLE. The undersigned is of the opinion that in order to insure proper patient care, it is necessary that nurses chart properly the administration of narcotic drugs. However, as far as the evidence revealed by this case discloses, the failure to chart was apparently based on the busy schedule in which the nurses operated under and it is foreseeable that circumstances may some time develop which prevents nurses from properly charting drugs. This seems to be the crux of the evidence in this case and while this is careless conduct, it does not, in the undersigned's opinion, rise to the level of "unprofessional" conduct. Based on the foregoing, I therefore conclude that the Petitioner is not guilty of unprofessional conduct within the meaning of Florida Statutes, Section 464.21(1)(b), however, I do find that the Petitioner has engaged in careless conduct and for which I shall recommend that she be issued a written reprimand.
CONCLUSIONS OF LAW
The Administrative Complaint filed herein was issued pursuant to Section 120.60, Florida Statutes, and Chapter 464, Florida Statutes.
The proceeding herein was conducted pursuant to Section 120.57, F.S., Chapter 221, and Chapter 28-5 and Chapter 38-6, Florida Administrative Code.
All parties were duly noticed pursuant to the notice provision of Section 120, Florida Statutes.
All parties were granted the right to be represented by counsel and to give testimony, to call and cross examine witnesses and to subpoena and present written evidence or argument on all of the issues raised by the Administrative Complaint.
The Petitioner has not engaged in unprofessional conduct within the meaning of Florida Statutes, Section 464.21(1)(b).
In view of my finding that the Petitioner has engaged in a pattern of careless conduct, I recommend that the Board issue a written reprimand to her for having engaged in the conduct as found herein. in all other respects I recommend that the complaint be dismissed in its entirety.
DONE and ORDERED this 29th day of July, 1976, in Tallahassee, Florida.
JAMES E. BRADWELL, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304
1/ As amended during the hearing, this allegation was deleted from the complaint.
J. LaDon Dewrell, Esquire Post Office Box 1503
