STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

FLORIDA STATE BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 78-777

) SHIRLEY A. WHITE COCKS, R.N., )

)

Respondent. )

)

RECOMMENDED ORDER

This hearing was heard in the Conference Room of the Hubert Rutland Hospital, St. Petersburg, Florida on July 12, 1978, by Stephen F. Dean, assigned Hearing Officer of the Division of Administrative Hearings. Formal notice of this hearing was given for June 22, 1978, but was continued by the Hearing Officer upon a motion of the Respondent to which the Petitioner had no objection. The hearing was rescheduled for July 12, 1978 and the parties waived notice of hearing.

APPEARANCES

For Petitioner: Julius Finegold, Esquire

1107 Blackstone Building

Jacksonville, Florida 32202

For Respondent: Michael B. Steeves, Esquire

1249 Rogers Street, Suite 1

Clearwater, Florida 33516

ISSUE

This case was presented upon an administrative complaint filed by the Florida State Board of Nursing against Shirley A. White Cocks, R.N. alleging that she was guilty of unprofessional conduct and was believed by the Board to be in such poor physical or mental health that an undue risk existed that she could cause harm to other persons contrary to the provisions of Section 464.21(1)(b) and (f), Florida Statutes.

1. Prior to commencing hearing the parties stipulated that prior to July, 1977, Ms. Cocks' performance of her professional duties was acceptable.

   
   

2. Between September, 1977 and November, 1977, Ms. Cocks was unable to perform her professional duties in a professional manner as outlined in subparagraphs a - i of paragraph one of the administrative complaint. Ms. Cocks' inability to perform these duties is substantiated by the testimony contained in the four depositions which were admitted into evidence. The parties further stipulated to the admission into evidence off the hospital discharge summaries dated July 18 - 22, 1977; July 24 - 27, 1977; and August 3 -

   17, 1977 and to the fact that after August 17th and treatment with lithium carbonate she was discharged as being in an improved state.

   
   

3. The primary issue presented is whether Ms. Cocks was responsible for her failure to perform her duties in a professional manner and whether at this time her physical and mental health are such that an undue risk is created that she would cause harm to another person.

FINDINGS OF FACT

1. Shirley Cocks is a registered nurse holding license no. 16354-4 issued by the Florida State Board of Nursing.

   
   

2. Shirley Cocks was employed at Hubert Rutland Hospital until November, 1977. Prior to July, 1977, Cocks' professional conduct as a nurse was acceptable or better. Persons familiar with her professional conduct described her as a meticulous nurse who performed her duties in a better than average manner.

   
   

3. July, 1977, Cocks suffered an attack of unknown origin that caused her to have blackout spells (Syncope). Cocks was hospitalized in July and August at Hubert Rutland Hospital during which time a complete physical work up was done. No physical abnormalities were discovered which would contribute to the blackout spells which Cocks suffered. During this period, Cocks was observed to have radical shifts in her moods. Because of her condition was tentatively diagnosed by her neurologist as manic depressive illness. She was prescribed lithium carbonate by her neurologist although a psychiatric work up had never been done on her. See discharge summaries.

   
   

4. Subsequent to her last hospitalization and while on lithium carbonate maintenance Cocks returned to work at Hubert Rutland Hospital. It was at this time that her coworkers observed that she was unable to perform her nursing duties in a professional manner and was unable to do the tasks required of her as enumerated A in subparagraphs A - I of paragraph one of the complaint.

   
   

5. During this period she was observed by the other R.N.s with whom she worked to have slurred speech, disjointed speech, stumbling gait, loss of muscular coordination, and loss of memory. According to Dio Regner, R.N. who was her direct supervisor, Cocks was mentally and physically incompetent after her discharge from the hospital on August 17, 1977. See Regner deposition, page

6. All of the nurses with whom she had worked indicated that Cocks' problems began after she had been hospitalized. Cocks was discharged from her employment at Hubert Rutland Hospital on November 11, 1977.

   
   

   1. After her discharge from Hubert Rutland Hospital she was employed at Oak Manor Nursing Center. At this time, she discontinued lithium carbonate maintenance and has not taken the drug since that time. The director of nursing and nursing supervisor with whom she works at Oak Manor Nursing Home both testified that Cooks' performance was better than average and that she was able to perform her duties in a professional manner. This is the same observational analysis of Cocks' work made by the nurses who worked with her prior to her illness.

      
      

      CONCLUSIONS OF LAW

      
      

   2. Shirley Cocks is charged with violation of Section 464.21(1)(b) and (f), Florida Statutes. The first charge stems from the allegations that Cocks

      performed her duties in an unprofessional manner. The second charge stems from the allegations that Cocks was unable to provide adequate nursing care because of poor mental or physical health.

      
      

   3. From the facts, it is clear that Cocks was unable to perform her nursing duties upon her return to work; however, it is also clear that she was not responsible for her conduct. Neither in terms of her being cognizant of her conduct or through misuse or abuse of medications. During the period upon which these charges were based, Cocks was on lithium carbonate maintenance as prescribed by her treating neurologist. It was the consensus of the observations of the nurses who worked with her, to include her supervisor, that she was not physically or mentally competent after her discharge from Hubert Rutland Hospital. After she discontinued taking lithium carbonate, the evidence indicates that she was able to return to work, perform her duties in a professional manner on a par with the manner she had performed her duties prior to her illness, and has been able to continue to perform her duties in a professional manner without any reoccurrence of the behavior described in the medical summaries. A legitimate question exists concerning the original diagnosis of manic depressive illness and the appropriateness of lithium carbonate treatment. The facts indicate that Cocks' inability to perform her duties in a professional manner were the direct result of lithium carbonate therapy. Cocks is not culpable for her failure to perform her duties in a professional manner while under the influence of this drug, and therefore is not guilty of a violation of Section 464.21(1)(b), Florida Statutes.

      
      

   4. Section 464.21(1)(f), Florida Statutes, does not require any culpability because the clear legislative intent was to permit the Board to remove from the active practice of nursing a licensee who, because of poor physical or mental health, would create an undue risk to members of the public if permitted to continue nursing. However, applicability of this section is limited to factual situations in which the licensee currently exhibits behavior indicating poor physical or mental health. The purpose of the provision obviously excludes its application to past con duct. In the instant case, the facts indicate that although Cocks did exhibit behavior within the purview of paragraph (f) of subsection one of Section 464.21, Florida statutes, she does not at this time exhibit such behavior and has not exhibited such behavior since lithium carbonate therapy was discontinued in November of 1977. Therefore, Cocks is not guilty of a violation of Section 464.21(1)(f), Florida Statutes.

RECOMMENDATION

Based on the foregoing findings of fact and conclusions of law the Hearing Officer recommends that the Florida State Board of Nursing take no action on the administrative complaint against Shirley A. White Cocks.

DONE AND ORDERED this 14th day of July, 1978, in Tallahassee, Florida.

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

(904) 488-9675

COPIES FURNISHED:

Julius Finegold, Esquire 1107 Blackstone Building

Jacksonville, Florida 32202

Michael B. Steeves, Esquire 1249 Rogers Street, Suite 1

Clearwater, Florida 33516

Geraldine B. Johnson, R.N. Investigation and Licensing Coordinator Board of Nursing

6501 Arlington Expressway, Bldg. B Jacksonville, Florida 32211

================================================================= AGENCY FINAL ORDER

=================================================================

BEFORE THE FLORIDA STATE BOARD OF NURSING

IN THE MATTER OF:

Shirley Ann Cocks

As a Registered Nurse Case No. 78-777

12311 105th Street North License Number 86804-2 Largo, Florida 33540

/

ORDER

This matter came on for final action by the Florida State Board of Nursing on the 16th day of October, 1978, at the Admiral Benbow Inn, 1200 N. Westshore Blvd., Tampa, Florida.

The Board, having reviewed the entire record, including all pleadings, exhibits admitted into evidence, the transcript of hearing proceedings, the Findings of Fact, Conclusions of Law and Recommended Order of the Hearing Officer, adopts the Findings of Fact of the Hearing Officer. Based upon the Findings of Fact, the Board concludes that the Respondent is guilty of unprofessional conduct in violation of Florida Statutes, Chapter 464.21(1)(b) and in violation of Florida Statutes, Section 464.21(f), exhibiting behavior which the Board has reason to believe is due to poor physical and mental health and which creates an undue risk that the person, as a nursing practitioner, would cause harm to other persons and IT IS THEREFORE:

ORDERED AND ADJUDGED that the registered nurse license number 16354-4 of the Respondent, Shirley Ann Cocks, be suspended for a period of one (1) year. However, it is ordered that said suspension be and the same is hereby stayed and the licensee be placed on probation for a period of one (1) year with the following terms and conditions:

1. That the Respondent refrain from violation of any law, Federal, State, or Local.

   
   

2. That the Respondent attend an Adult Mental Health Clinic or undergo treatment by a qualified Psychiatrist and provide this Board with a written report from the therapist, counsellor or physician every month for the first three months and every three (3) months thereafter.

   
   

3. That the Respondent inform, in writing, the Florida State Board of Nursing immediately of any change of address or change of employment.

   
   

4. That the Respondent request her employer to provide the Board with an evaluation of her nursing performance every three (3) months during the period of this probation.

The failure to comply with the terms of said probation shall be deemed a violation.

DONE AND ORDERED this 23rd day of October, 1973, at Jacksonville, Florida.

FLORIDA STATE BOARD OF NURSING

BY:

Dorothy C. Stratton, R.N. President

BOARD SEAL

ccs: Shirley Ann Cocks

12311 105th Street North Largo, Florida 33540

Michael B. Steeves, Esquire 1248 Rogers Street, Suite 1

Clearwater, Florida 33516

Julius Finegold, Esquire Attorney for the Board

Docket for Case No: 78-000777

Orders for Case No: 78-000777