STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

STATE OF FLORIDA, DEPARTMENT ) OF PROFESSIONAL REGULATION, ) BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 82-2488

)

SANDRA J. HOFFMAN a/k/a )

SANDRA J. PAULY, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, a hearing was held before Charles C. Adams, a Hearing Officer with the Division of Administrative Hearings. This final hearing was conducted in the Richard P. Daniel Building in Jacksonville, Duval County, Florida, on January 14, 1983. This Recommended Order follows the receipt and review of the transcript of proceedings which was filed with the Division of Administrative Hearings on February 14, 1983.

APPEARANCES

For Petitioner: W. Douglas Moody, Esquire

119 North Monroe Street, Suite 101 Tallahassee, Florida 32301

For Respondent: Sandra J. Pauly, pro se

11562 Tohopeka Lane

Jacksonville, Florida 32216 ISSUE

The issues presented here are based upon an Administrative Complaint brought by the Petitioner against the Respondent accusing her of various violations of chapter 464, Florida Statutes. In particular, Respondent is accused, over a period November 13, 1980, through February 9, 1982, of mishandling medications and controlled substances and, in a continuing fashion, negligently and/or incompetently, administering medications to patients under her care. In view of these alleged circumstances, Respondent is said to have violated Subsection 464.018(1)(f) , Florida Statutes, in that these actions are an indication of unprofessional conduct, by departing from minimal standards of acceptable and prevailing nursing practices. Further, Respondent is accused of a violation of Subsection 464.018(1)(d) , Florida Statutes, by making or filing a false report or record known by her to be false, intentionally or negligently failing to file a report or record required by state or federal law and willfully impeding or obstructing such filing or inducing another person to do so.

WITNESSES AND EXHIBITS

Petitioner presented as witnesses: Edna Sue Key, R.N., Nurse Supervisor, Beaches Hospital, Duval County, Florida; Joan Schalot, R.N., Staff Nurse, Beaches Hospital, Duval County, Florida; Carol Brown, R.N., Head Nurse, 300 Wing, Beaches Hospital, Duval County, Florida; and Connie Jean Dunbar, Director of Pharmacy Services, Beaches Hospital, Duval County, Florida. Petitioner offered four exhibits which were received.

Respondent testified and offered one exhibit which was admitted.

FINDINGS OF FACT

1. The State of Florida, Department of Professional Regulation, Board of Nursing, has regulatory authority over nurse practitioners in the State of Florida. One of those practitioners is Sandra Pauly, who has been issued license number 37332-1, Licensed Practical Nurse. She was formerly known as Sandra Hoffman. Respondent Pauly holds that license in good standing and was so licensed at all times relevant to this case.

   
   

2. From late 1980, through the beginning of February, 1982, Respondent worked as a shift nurse at Beaches Hospital, Duval County, Florida. When Respondent took the position, she was apprised of the hospital's procedures for transcribing doctors' medication orders and for the administration of those medications. These procedures are in keeping with the procedures manual, a copy of which is Petitioner's Exhibit No. 2, admitted into evidence. This manual was given to Pauly at the time of her employment. Additionally, she was assigned to work with an experienced nurse who assisted in familiarizing Pauly with the procedures set forth in that manual.

   
   

3. Respondent was also involved in an orientation session with the Director of Pharmacy Services in the hospital. In the course of that education session, Respondent was familiarized with pharmacy policies related to dispensing medication for patients and made aware of Florida laws on the subject of administration of medications. This orientation period considered physicians orders, labeling techniques utilized by the pharmacy in identifying the patient medications and other matters related to medications dispensed by the pharmacy. This discussion also included proper documentation of the administration of medications.

   
   

4. On January 7, 1981, Carol Brown, Head Nurse on the 300 Wing of Beaches Hospital, had an employee conference with Respondent on the topic of medication errors which had been committed by Respondent in the treatment of patients in Respondent's charge. While working at Beaches Hospital, Pauly had initialed patient medication records indicating the administration of medications, when in fact the medications had not been administered. This conduct by Respondent was contrary to hospital procedures and contrary to minimal acceptable and prevailing nursing practice in the community. Respondent denied failing to give the medications. Out of this circumstance, Respondent was given a warning and told that if the problem continued she would he terminated from her employment at Beaches Hospital.

   
   

5. Linda C. Melanson was a patient who was being treated in Beaches Hospital in February, 1981. Respondent was a shift nurse in charge of the care of Melanson on the 3:00 P.M. to 11:00 P.M. work cycle, February 9, 1981. The patient's medication administration record, a copy of which is Petitioner's Exhibit No. 1A, admitted into evidence, indicates that Respondent gave the

   patient Tussenex at 9:00 P.M., Bactrim DS at 9:00 P.M., Desophoral at 9:00 P.M. and Adapin 10 mg. at 9:00 P.M. However, the medications were not given to the patient by Respondent as documented. Respondent did not initial the entries related to the medications when she made the entries. On February 10, 1981, the medications were returned to the pharmacy and it was noted that the administration of those medications had not been initialed on the carbon utilized by the pharmacy, in addition to Pauly's failure to administer the medications. Respondent subsequently initialed the original patient medication administration record on February 11, 1981. By these acts and omissions, Respondent departed from minimal standards of acceptable and prevailing nursing practice in the community.

   
   

6. Anthony Scott was a patient being treated in Beaches Hospital on February 25, 1981, and he was under Respondent's care on that date. On that date, at 4:00 P.M. she administered Sphospho-Soda; at 5 P.M. to 9:00 P.M., Proctofoam-HC and at 7:00 P.M., Dulcolax in the amount of three tablets. Per physicians' instructions these items should have been administered to the patient on February 26, 1981. See patient's medication administration record, Petitioner's Exhibit 1B, admitted into evidence. In effect, a barium enema was given one day prior to the time ordered. This error required the patient to undergo the same preparation, i.e., the barium enema sequence, on the following day, a physical discomfort to the patient. The action by Respondent also caused additional financial expense. This mistake on the part of Respondent was a departure from minimal standards of acceptable and prevailing nursing practice in the community.

   
   

7. The medication administration record of the patient James Harrell, may be found as Petitioner's Exhibit 1H, admitted into evidence. This patient was under Respondent's care on September 28, 1981, while he was being treated in Beaches Hospital. On September 28, 1981, four Aluminum Hydroxide had been sent from the pharmacy for Harrell's benefit. In addition, four Maalox had been dispatched on that date. On the patient medication administration record, Respondent indicated that during her shift, from 3:00 P.M. to 11:00 P.M., on September 28, 1981 she administered one Aluminum Hydroxide out of the four and two Maalox out of the four. Four Aluminum Hydroxide were returned to the pharmacy on September 28, 1981. On that same date, three Maalox were returned. This establishes that Respondent did not administer the one Aluminum Hydroxide as she indicated and only administered one Maalox as opposed to the two Maalox which she claimed. By these acts and omissions Respondent departed from minimal standards of acceptable and prevailing nursing practices in the community.

   
   

8. On October 16, 1981, Jessy Jones was a patient at Beaches Hospital. He was attended by Respondent on that date and she indicated the administration of SSKI to the patient; however, she failed to initial the administration of that medication. (SSKI is a saturated solution of potassium iodine.) This failure was a departure from minimal standards of acceptable and prevailing nursing practice in the community. See Petitioner's Exhibit No. 1F, admitted into evidence, the patient's medication administration record.

   
   

9. Mary Sallas was a patient at Beaches Hospital on October 9, 1981. Forty milligrams of Prednisone had been dispensed from the pharmacy for the benefit of Sallas. This substance is a steriod to assist persons with asthmatic conditions. On that date, Respondent, who was caring for Sallas, made entry on the patient's medication administration record that 40 mg. of Prednisone was given Sallas. The entry was initialed by Respondent. See Petitioner's Exhibit 1G, admitted into evidence. In fact only 20 mg. had been administered to the patient by Respondent. These acts and omissions by Respondent are departures

   from minimal standards of acceptable and prevailing nursing practices in the community.

   
   

10. Mary Sallas was again a patient in Beaches Hospital on December 21, 1981. A copy of her medication administration record for that date may be found as Petitioner's Exhibit No. 1C, admitted into evidence. Sallas was in the care of Respondent on that date. Respondent indicated and initialed that she had administered 40 mg. of Prednisone to the patient Sallas at 9:00 A.M. on December 21, 1981. The 40 mg. of Prednisone Sallas supposedly received from Respondent was not administered by Respondent and was in fact returned to the pharmacy. These acts and omissions by Respondent were departures from minimal standards of acceptable and prevailing nursing practice in the community.

    
    

11. Monserrate Morales was a patient in Beaches Hospital on February 8, 1982. Respondent was the shift nurse on his ward from 7:00 A.M. to 3:00 P.M. on that date. She indicated the administration of Orinaze at 7:30 A.M.; Septra DS at 8:00 A.M.; Zyloprim at 9:00 A.M.; Clinoril at 9:00 A.M. and Pyridium at 9:00

    A.M. See Petitioner's Exhibit No. 1D, admitted into evidence. Pyridium is an urinary anesthetic. Clinoril is an antiarthritic or pain reliever. Zyloprim is an anti-gout medication. No other patient on the ward was receiving these medications on February 8, 1982. Amounts of Clinoril, Zyloprim and Pyridium which Respondent claimed to have administered to the patient Morales were found in a trash bag on the medication cart from which the medications had been extracted by Respondent. They were found by a nurse on the next work shift, the 3:00 P.M. to 11:00 P.M. shift. These medications are part of Petitioner's Composite Exhibit 3, admitted into evidence. Respondent had not administered the Clinoril, Zyloprim and Pyridium as she claimed on the medication administration record. These acts and omissions by Respondent were departures from minimal standards of acceptable and prevailing nursing practices in the community.

    
    

12. Catherine Fantom was also a patient at Beaches Hospital on February 8, 1982. She was being attended by Respondent on the 7:00 A.M. to 3:00 P.M. shift. A copy of her medication administration record may be found as Petitioner's Exhibit No. 1E, admitted into evidence. That record shows, by written entry made by Respondent, that she administered Slow K and Aristocort to the patient on February 8, 1982. Slow K is a potassium supplement to increase potassium or electrolytes in the patient's system. Fantom was the only patient on that ward receiving Slow K on the date in question. When Respondent indicated her administration of Slow K and Aristocort, she did not initial the medication administration record where the entries were being made. She subsequently initialed the record at a time later than February 8, 1982. These differences are shown in the pages of Exhibit 1E, in that copies of the Slow K and Aristocort entries at the time of the claimed administration are found on the second sheet and the initialed copies are found at page four of that exhibit. The Slow K was never administered to the patient and was subsequently found by the 3:00 P.M. to 11:00 P.M. shift nurse who came to work after Respondent on the date in question. That substance may be found as a part of Petitioner's Composite Exhibit No. 3. These acts and omissions by Respondent constitute departures from the minimal standards of acceptable and prevailing nursing practice in the community.

    
    

13. All individual mistakes, acts and omissions were also departures from hospital policy related to administration and charting of patient medications.

    CONCLUSIONS OF LAW

    
    

14. The Division of Administrative Hearings has jurisdiction over the subject matter and the parties to this action. See Subsection 120.57(1), Florida Statutes.

    
    

15. Based upon the facts found in this Recommended Order, Respondent is accused of violating Subsection 464.018 (1)(f), Florida Statutes, in that Respondent is guilty of unprofessional conduct by departing from minimal standards of acceptable and prevailing nursing practice, in which case actual injury need not be established. As related in the Findings of Fact, Respondent has departed from the minimal standards of acceptable and prevailing nursing practice and for that reason is guilty of unprofessional conduct, a violation of Subsection 464.018(1)(f), Florida Statutes. For these violations, in the aggregate, Respondent is subject to the penalties set forth in Subsection 464.018(2), Florida Statutes.

    
    

16. Based upon the facts reported in this Recommended Order, Respondent is also accused of a violation of Subsection 464.018(1)(d), Florida Statutes, for making or filing a false report or record, which she knew to be false, intentionally or negligently failing to file a report or record required by state or federal law, and willfully impeding or obstructing such filing or inducing another person to do so. The facts establish that Respondent made and filed false reports related to patients in her care and knew that those reports were false. Respondent has not otherwise violated that provision. Based upon the violations that have been shown, in the aggregate, Respondent is subject to disciplinary action in accordance with Subsection 464.018(2), Florida Statutes.

    
    

17. After full considering the facts in this case and the conclusions of law reached, it is

RECOMMENDED:

That a final order be entered which suspends Respondent's license to practice nursing for a period of sixty (60) days for violations of Subsection 464.018(1)(f) Florida Statutes, and suspends Respondent's license for a period of sixty (60) days, to run concurrently with the preceding suspension, for violations of Subsection 464.018(1)(d), Florida Statutes.

DONE and ENTERED this 18th day of March, 1983, in Tallahassee, Florida.

CHARLES C. ADAMS, Hearing Officer Division of Administrative Hearings The Oakland Building

2009 Apalachee Parkway

Tallahassee, Florida 32301

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 18th day of March, 1983.

COPIES FURNISHED:

W. Douglas Moody, Esquire Suite 101

119 North Monroe Street Tallahassee, Florida 32301

Sandra J. Pauly 11562 Tohopeka Lane

Jacksonville, Florida 32216

Fred Roche, Secretary Department of Professional

Regulation

130 North Monroe Street Tallahassee, Florida 32301

Helen P. Keefe, Executive Director Florida Board of Nursing

Room 504, 111 East Coastline Drive

Jacksonville, Florida 32202

Docket for Case No: 82-002488

Orders for Case No: 82-002488