STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

FLORIDA STATE BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 76-1549

) SYLVIA PORTER DEBRUIN, R.N., )

)

Respondent. )

)

RECOMMENDED ORDER

A hearing was held pursuant to notice in the library of the offices of Doctors Freed and Farris, 1040 South West 2nd Avenue, Ocala at 8:30 a.m. on January 14, 1977 before Stephen F. Dean, assigned Hearing Officer of the Division of Administrative Hearings, Department of Administration.

This case came on to be heard upon the Administrative Complaint filed by the Board against Sylvia DeBruin, R.N. The Administrative Complaint was amended prior to hearing as follows:

1. The last sentence of paragraph 3 of the Administrative Complaint was stricken by the Board.

   
   

2. Paragraph 4 of the Administrative Complaint was stricken by the Board.

The Administrative Complaint charged that DeBruin gave inadequate oral reports to her relief at the change of shift by confusing patients one with another, and used loud, abusive, and profane language towards Delores Gillum, LPN, said conduct being unprofessional and in violation of Section 464.21(1)(b), Florida Statutes.

APPEARANCES

For Petitioner: Julius Finegold, Esquire

1130 American Heritage Building Jacksonville, Florida 32202

For Respondent: E. G. Musleh, Esquire

415 North West First Avenue Post Office Box 924

Ocala, Florida 32670

FINDING OF FACT

1. The parties stipulated to the following facts:

   
   

   1. Sylvia DeBruin is a registered nurse holding License Number RN10723-4 issued by the State of Florida.

      
      

   2. Sylvia DeBruin is a captain, retired from the United States Air Force, Service Number FV3075515. She was placed on TDRL Status, which is temporary duty retirement leave, at Lackland Air Force Base, San Antonio, Texas,

      23 August 1975.

      
      

   3. Temporary duty retirement leave is a five year retirement plan which requires reevaluation of the retiree every eighteen (18) months.

      
      

   4. Sylvia DeBruin's last evaluation was 11 January 1977.

      
      

   5. That on the dates stated in the Administrative Complaint she was employed as a registered nurse at Surgical Medical Hospital, Ocala, Florida.

      
      

   6. Sylvia DeBruin has received all notices in this cause and all rules and statutes have been complied with in this proceeding.

      
      

   7. Sylvia DeBruin's almost twenty years of service, both active and reserve, with the United States Air Force was honorable and her performance was exceptional and she was recommended for more responsibility and promotion ahead of her contemporaries.

      
      

   8. After 2 November 1975, Sylvia DeBruin was in the care of Enrique Araneta, M.D., psychiatrist at Veteran's Administration Hospital in Gainesville, Florida. Dr. Araneta is also an Associate Professor of Psychiatry at Shands Teaching Hospital, University of Florida.

      
      

   9. The deposition of Dr. Araneta will be received into evidence as Exhibit 2.

      
      

   10. The facts relating to Mrs. DeBruin's condition as stated in Dr. Araneta's deposition are accepted as true.

       
       

   11. The actions complained of as received by the Florida State Board of Nursing and upon which the Administrative complaint were based, were consistent with the symptomatology of Mrs. DeBruin's condition as described by Dr. Araneta.

       
       

   12. Mrs. DeBruin did exhibit confusion while on duty at the Surgical- Medical Hospital; to wit; her oral shift reports were confusing in that they confused patients, one with another, but all her charting was correct and accurate. Further, Mrs. DeBruin repeated orders to subordinates, having forgotten giving the initial orders.

       
       

   13. No injury or harm resulted to any patient at Surgical-Medical Hospital as a result of Mrs. DeBruin's conduct as described above.

       
       

   14. The efficiency reports of Mrs. DeBruin from 1966 until 1968 were introduced into the record as Exhibit 1 by the Board.

2. Sylvia DeBruin exhibited confusion in November 1975 while on duty at Surgical-Medical Hospital in that in her oral shift reports she confused patients one with another, and repeated orders to her subordinates.

   
   

3. This conduct was consistent with the symptomatology of a partial relapse of the condition for which she had been placed on TDRL status. Her physician felt the relapse resulted from the changes in her daily schedule and her medication schedule, and from taking a position on the 11 to 7 shift.

   
   

4. By late December, Sylvia DeBruin's condition was cleared up by alteration of her medication schedule. Had Dr. Araneta been aware that she was working, he would not have recommended her stopping because of her immediate improvement when her medication schedule was altered.

   
   

5. No injury or harm resulted to any patients and DeBruin's charging was accurate and correct.

   
   

6. DeBruin has an excellent prior record as a nurse in the United States Air Force with approximately twenty (20) years service. She is presently on temporary retirement leave because of the condition for which Dr. Araneta is treating her which was diagnosed as schizophrenic reaction which is in remission.

   
   

7. According to Dr. Araneta, her prognosis is good based upon her past record of performing under stress, and the substantial nature of stress which caused her condition which included in rapid succession; service as an operating room nurse in Viet Nam, several transfers in the military, and a divorce. Based on her doctor's medical opinion, DeBruin would be able to practice nursing at this time if she were followed up medically to check on her condition and she were able to choose her assignment to alleviate overly stressful positions.

   
   

8. DeBruin would like to return to work but only with her physician's prior approval and in a non-supervisory position as a floor nurse, not a nursing supervisor. DeBruin is also willing to provide the Board with information concerning her health and any plans for employment prior to seeking employment.

   
   

9. There were words between DeBruin and Delores Gillum, LPN, but this resulted from DeBruin's insistence that Gillum maintain personal possession of the narcotic keys which Gillum refused to do. Gillum's refusal resulted in an argument in which DeBruin sought to impress upon Gillum the necessity of carrying the keys. There is no evidence that any profane language was used by DeBruin in the conversation. DeBruin, as Gillum's supervisor, was justified in using harsh or abusive and possibly derogatory language in light of Gillum's refusal to comply with the directions given.

   
   

10. DeBruin has not worked since November 1975, lives with her mother, and is able to meet her basic living expenses from her retirement pay.

    
    

    CONCLUSIONS OF LAW

    
    

11. Section 464.21(1)(b), Florida Statutes, would permit the Board to discipline a licensee guilty of unprofessional conduct.

    
    

12. The allegations relating to DeBruin's conduct toward Gillam were not proven.

13. The facts are not in dispute, however, whether the conduct of DeBruin was unprofessional is also a question of law. While DeBruin may be said to have exercised bad judgment in taking the position in the first place, it was apparently the alteration of her schedule which contributed to the conduct which is the basis of the complaint. This, of course, would have been difficult to anticipate. When it was realized, the change in medication schedule again stabilized her condition. As to her conduct on the job, it was limited to forgetfulness. This type of conduct, while disconcerting to the other members of the nursing staff, can hardly be deemed "unprofessional" when the chartings and care given patients are adequate. Clearly, Mrs. DeBruin's condition is such that she should have some restrictions placed upon her license at this time; however, this is based solely upon her medical condition not her conduct. Section 464.21(1)(f) specifically addresses this factual situation, and the Hearing Officer finds that Ms. DeBruin did exhibit behavior in November which was the result of her poor mental health which created an undue risk. However, that condition is no longer manifested by Ms. DeBruin according to her treating physician, and he would permit her to practice with minor limitations.

RECOMMENDATION

The Hearing Officer recommends that the Board require that DeBruin provide the Board, prior to seeking employment, a statement from her physician regarding her ability to practice and any restriction or recommendation he would place on her, and further that any restrictions be communicated to the potential employer so that she is not placed in a position or circumstances that would jeopardize her health, the care of any patient, or her employer.

STEPHEN F. DEAN, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304

(904) 488-9675

COPIES FURNISHED:

E. O. Musleh, Esquire

415 Northwest 1st Avenue Ocala, Florida 32670

Julius Finegold, Esquire

1130 American Heritage Building Jacksonville, Florida 32202

Geraldine B. Johnson, R.N. State Board of Nursing 6501 Arlington Expressway Building B

Jacksonville, Florida 32211

Docket for Case No: 76-001549

Orders for Case No: 76-001549