vs. ) CASE NO. 79-854
Respondent. )
Pursuant to notice an administrative hearing was held before Delphene C. Strickland, Hearing Officer of the Division of Administrative Hearings, in Room 821, Broward County Courthouse, in Fort Lauderdale, Florida, on July 31, 1979. The Transcript was received September 6, 1979, and final instruments in this cause were filed September 10, 1979.
For Respondent: Robert C. Kain, Jr., Esquire
Legal Aid Service of Broward County, Inc. 609 South Andrews Avenue
Whether License No. 71014-2, held by Respondent Gertrude Delman Levin, R. N., should be revoked or suspended, or whether Respondent should be placed on probation or otherwise disciplined.
The Respondent, Gertrude Delman Levin, R. N., holds License No. 71014-2 as a registered nurse in the State of Florida. She has practiced her profession as an employee of Bethesda Memorial Hospital in Boynton Beach, Florida, Cypress Community Hospital in Pompano Beach, Florida, and North Medical Center, Inc. in Fort Lauderdale, Florida, during the time pertinent to this hearing.
On January 9, 1979, an administrative complaint was issued by the Petitioner Board seeking to place on probation, suspend, or revoke the license of Respondent Levin for alleged unprofessional conduct during the course of her employment at the foregoing medical centers. Respondent requested an administrative hearing on April 9, 1979, and her request was forwarded by the Petitioner Board to the Division of Administrative Hearings on April 13, 1979.
An administrative hearing was scheduled for July 18, 1979, in Fort Lauderdale, Florida, by Notice of Hearing dated April 26, 1979. The hearing was continued upon Motion of the Respondent, and rescheduled and heard July 31, 1979. The Transcript of Proceedings was received September 6, 1979.
After the hearing was called to order, the Respondent admitted the following allegations of the Administrative Complaint:
On or about March 5, 1977, while on duty as a registered nurse at Bethesda Memorial Hospital, Boynton Beach, Florida, Respondent administered a controlled narcotic, to-wit: Morphine Sulphate, intravenously twice to a patient named Gladys Sargent, at approximately 1:15 a.m. and again at approximately 2:10 a.m., contrary to the physician's order which directed that the patient be given Demerol (Meperedine) 50 mg. and Vistaril 25 mg. I.M. every three hours, and failed to chart the administration of same on the medication administration record.
On or about March 29, 1977, while on duty at Bethesda Memorial Hospital, Respondent charted on the medication record as having omitted to administer a heart medication,
to-wit: Pronestyl Intramuscular to a patient, Phillip Bialer, at 12:00 midnight and 6:00 a.m., and charted in the Nurses Notes that the 6:00 a.m. dose was not given since the patient was unable to swallow, even though the medication was to be administered intramuscularly and not be mouth. The 12:00 midnight dose was charted in the Nurses Notes as having been given without difficulty.
On or about May 13, 1977, while on duty as above, Respondent signed out for a prescription drug, to-wit: Talwin for a patient, Mable Larkin, for whom there was no physician's order for said medication. Respondent failed to chart the disposition of said Talwin on either the medication administration record or Nurses Notes.
In view of the above medication errors, Respondent was terminated from her employment at Bethesda Memorial Hospital.
During the month of April, 1978, while on duty as a registered nurse at Cypress Community Hospital, Pompano Beach, Florida, Respondent committed numerous medication and charting errors with respect to the controlled substance, Demerol (Meperidine), including but not limited to:
(g) Signing out on the narcotic control record on April 1, 1978, at 12:30 p.m. for Meperidine 75 mg. for a patient, Lillian Sederquist, when the patient's physician's order called for only 50 mg. of Meperidine,
charting on the patient's medication administration record as having administered
50 mg. to the patient and failing to account for the excess.
Immediately after the foregoing admissions by Respondent, the Petitioner dropped Allegation 8 of the Administrative Complaint.
In reference to the foregoing admitted Allegations 1, 2, 3 and 4, Respondent submitted documentation to show mitigating circumstances. The documentation proported to show that during the period of time from March of 1977, through May of 1977, the Respondent had advised her supervisor at Bethesda Memorial Hospital that she was under medication for an injury and that she was under stress because of her divorce, care of a small child, and other personal problems.
Respondent admitted Allegation 5 (g) of the foregoing Administrative Complaint in reference to her work at Cypress Community Hospital. She did not admit "numerous" errors.
From evidence and testimony relating to physician's orders, I find that:
Respondent Levin signed out the narcotic, Demerol, for a patient, Benjamin Arber, at a time when the physician's order of March 23, 1978, had not been renewed.
On April 6, 1978, Respondent signed out the narcotic, Demerol, for a patient, Lillian Sederquist, on then narcotic control record without a physician's orders.
On April 25, 1978, Respondent signed out for 50 mg. of Demerol for a patient, Vivian Albapo. No time was indicated, and there were no physician's orders in affect at the time for 50 mg. The order was for 75 mg. of Demerol.
On April 6, 1978, there were no physician's orders in effect for Meperidine for patient Sederquist, but Respondent signed out 75 mg. of Meperidine for her at 2:00 o'clock p.m. The medication was not charted on the medication administration record of the patient, and no such entry was made in the nurses notes.
On April 7, 1978, Respondent signed out for 75 mg. of Meperidine at 7:00, 8:00 and 11:00 o'clock, but there were no physician's orders in effect. On the PRN record 7:00 o'clock a.m. was written over and 8:00 o'clock
a.m. and 3:00 o'clock p.m. noted, but there was no notation for 11:00 o'clock a.m. The nurses notes related to Sederquist do not mention 7:00 or 11:00 o'clock a.m.
On April 12, 1978, Respondent Levin signed out twice for narcotics for patient Sederquist without physician's orders and
without reflecting the administration of medication to the patient.
On April 13, 1978, there was a total of
75 mg. of Meperidine signed out for patient Sederquist, but there were no physician's orders. There was a medical record, but there was no notation in the nurses notes.
On April 15 and 17,1978, there was a sign-out at 9:00 o'clock for Meperidine 75 mg., but there were no physician's orders in effect. There was a medication record for April 15, but none for April 17, and there was no notation in the nurses notes. A discharge order for patient Sederquist was written for April 15, 1978, and the nurses notes showed discharge
via wheelchair to husband's care at 12:30 p.m. Respondent Levin had signed out for 75 mg. of Meperidine at 12:00 o'clock noon on April 15, 1978, without physician's orders.
From evidence relating to wasting, charting and nurses notes, I find that:
Respondent signed out for Demerol 75 mg. for a patient, Vivian Sederquist, on April 2, 1978, but it was not administered and was not shown to have been wasted.
Respondent signed out for 10 mg. of Morphine on April 7, 1978, and stated it was wasted on the record, but such wastage notation was not co-signed as required.
Respondent signed out for 75 mg. of Meperidine for a patient, Carmody, on April 15, 1978, and indicated that the narcotic had been wasted, but there was no indication of a co-signing witness.
On April 19, 1978, Respondent signed out for 100 mg. of Demerol for a patient, Bosch, and indicated wastage, but there was no
co-signature.
On April 20, 1978, Respondent signed out for 100 mg. of Demerol for a patient, Lowery, and indicated that 25 mg. had been wasted, but there was no co-signee. On the same date Respondent signed out 50 mg. of Demerol for patient Bosch and indicated a contaminated needle, but there was no cc-signature.
On April 21, 1978, Respondent Levin signed out for 75 mg. of Demerol and indicated a contamination, but there was no co-signature.
On April 24, 1978, 50 mg. of Demerol was signed out for a patient, Jones, and 25 mg. was indicated as wasted, but there was no
co-signature. On that same day and hour 50 mg. of Demerol was signed out by Respondent and
25 mg. indicated as wasted, but there was no co-signature.
On May 25, 1978, 2 mg. of Dilaudid was ordered for a patient, Hollinger, but was charted for 3 mg. by Respondent Levin, and there were no nurses notes.
On May 26, 1978, at 3:00 o'clock p.m. there was a sign-out for Dilaudid for patient Hollinger by the Respondent, but the nurses notes show the patient was medicated for pain at 2:45 p.m.
On May 29, 1978, there was a sign-out for medication for patient Hollinger at 10:30 a.m., but the medication administration record shows 9:30 a.m.
On May 30, 1978, Respondent signed out for Dilaudid for patient Hollinger at 9:00 o'clock a.m., but it was not charted on the medication administration record, and there was nothing in the nurses notes.
May 18, 1978, there was a sign-out by Respondent Levin for Leritene at 11:30 a.m. for a patient, Kraus, but there is nothing on the patient's medication record or in the nurses notes relative to such drug.
On May 19, 22, 24 and 25, 1978, there were sign-outs for Leritene by Respondent, but nothing was noted to this effect on the medication administration record or in the nurses notes kept by Respondent Levin.
Hospital policy and good nursing practice require that no narcotics be signed out by a nurse without a physician's order effective at that time. Medication given to a patient by a nurse must be charted by that same nurse. "Wasted" narcotics must be accounted for by the nurse who signs out the drug, and the record of wasted narcotics must be witnessed by another nurse. Nurses notes should be kept by the nurse.
There was testimony that at infrequent times the foregoing general hospital policy and good nursing practices were violated, but any such violations are at the peril of the nurse. From the testimony of employee witnesses at the hospitals in which Respondent was employed, it appeared that the hospitals were understaffed during the periods Respondent was employed.
Narcotic control and medical records from Bethesda Memorial Hospital, Cypress Community Hospital, North Beach Medical Center and Boca Raton Community Hospital were verified, and copies were placed in evidence. The Incident report from Boca Raton Community Hospital was satisfactorily explained.
Respondent Levin submitted a brief and entitled Sections 3 through 7 "Proposed Findings of Fact." There was no memorandum of law or proposed order from the Petitioner Board. The instrument from Respondent was considered in the writing of this Order. To the extent the proposed findings of fact have not been adopted in, or are inconsistent with, factual findings in this Order they have been specifically rejected as being irrelevant or not having been supported by the evidence.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction of this cause pursuant to Section 120.57, Florida Statutes.
Section 464.21 Disciplinary proceedings.--provides as follows:
(1) GROUNDS FOR DISCIPLINE.--the board shall have the authority to deny a license to any applicant or discipline the holder of a license or any other person temporarily authorized by the board to practice nursing in the state who has been found guilty by the board of: . . .
Unprofessional conduct, which shall include any departure from, or the failure to conform to, the minimal standards of acceptable and prevailing nursing practice, in which proceeding actual injury need not be established . . .
(3) REVOCATION, SUSPENSION, ANNULMENT, DENIAL OF LICENSE, ETC.--In disciplining any person convicted of a charge of violating the provisions of this chapter or any other statute or law of this state relating to the practice of nursing, the board may: . . .
Suspend or limit the right to practice in this state for a period to be determined by the board; . . .
The numerous incidents of the failure of Respondent Levin to chart the administration of narcotics to patients; her failure to keep nurses notes on a large number of patients; her many notations of "wasted" narcotics without the required Co-signature of a witness; and the numerous times she signed out narcotics without a physician's order in effect, are grounds for disciplinary proceedings and a violation of the foregoing statute.
Based upon the foregoing Findings of Fact and Conclusions of Law the Hearing Officer recommends that the license of Respondent Levin be suspended for a period of not more than two (2) years and until she can show rehabilitation to the satisfaction of the Petitioner Board.
DONE and ORDERED this 12th day of October, 1979, in Tallahassee, Leon County, Florida.
DELPHENE C. STRICKLAND
Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301
Robert C. Kain, Jr., Esquire
Legal Aid Service of Broward County, Inc. 609 South Andrews Avenue
Geraldine B. Johnson, R. N. State Board of Nursing
