STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 83-1681

)

MARY AMBROZ, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, Sharyn L. Smith, held a formal hearing in this case on August 29, 1983, in Miami, Florida. 1/ The following appearances were entered:

APPEARANCES

For Petitioner: Charles F. Tunnicliff, Esquire

Department of Professional Regulation

130 North Monroe Street Tallahassee, Florida 32301

For Respondent: Mary Ambroz, Pro Se

3304 Southwest LeJeune Road Coral Gables, Florida 33134

The issue for determination at the final hearing was whether the license of the Respondent Ambroz should be suspended, revoked, or otherwise disciplined for allegedly performing nursing services in an unprofessional manner, which departed from, or failed to conform to, the minimal standards of acceptable and prevailing nursing practice.

At the final hearing, Cindy Shoard, a staff nurse at Mount Sinai Hospital, Cynthia Bunting Baltuch, a head nurse at Mount Sinai Hospital, Andrea Prentiss, a staff nurse at Miami Children's Hospital, Mary Mulcahy, a staff nurse of Miami Children's Hospital, Nancy Cox, a registered nurse and Critical Care Educator at Miami Children's Hospital, and Sandra J. Long-Attaran, Assistant Director of Nursing, Pediatrics and Neonatology at the University of Miami, Jackson Memorial Medical Center, testified for the Petitioner. The Respondent Mary Ambroz testified on her own behalf. Petitioner's Exhibit No. 1 was offered and admitted into evidence. Following the close of the hearing, the deposition of Dede Benarak was submitted as a late-filed exhibit and is admitted as Petitioner's Exhibit No. 2.

On October 13, 1983, the Petitioner Department of Professional Regulation filed a written closing argument which recommended that the Respondent Ambroz' license be suspended until she presents proof that she can competently provide

nursing services including, but not limited to, proof of her attendance at refresher courses in personal interaction and proof of an in-depth psychiatric study which would include the Minnesota multiphasic intelligence test.

FINDINGS OF FACT

1. The Respondent Mary Ambroz is a registered nurse having been issued license number 129 070-2. Her last known address is 3304 S.W. LeJeune Road, Coral Gables, Florida.

   
   

2. At all material times, the Respondent Ambroz was employed as a nurse at Variety Children's Hospital (now known as Miami Children's Hospital), and Mount Sinai Hospital, in Miami, Florida.

   
   

3. On or about June 14, 1981, the Respondent Ambroz was working at Mount Sinai Hospital under the supervision of Cindy Shoard, R.N. On that date, an emergency arose with a patient who suffered a lethal arrhythmia which required Shoard and another nurse to begin emergency procedures including starting an IV and placing vital sign monitors on the patient.

   
   

4. The Respondent Ambroz entered the room after Shoard had begun emergency treatment and pushed her aside stating that the patient was hers and she would take over. Shoard asked the Respondent to leave the room. The Respondent did not leave and instead picked up drugs which had been placed by Shoard on a table for administration to the patient after the IV procedure, and attempted to administer the drugs herself. Shoard informed the Respondent that the drugs were to be administered in a different manner from the way which she was attempting, and again asked her to leave the room. The Respondent then left the room and the patient was stabilized.

   
   

5. On or about July 7, 1981, while employed at Mount Sinai Hospital, the Respondent was absent without leave four days in a row. This incident resulted in her termination of employment from Mount Sinai. Additionally, while still employed at Mount Sinai, the Respondent failed to properly chart physicians' orders concerning medication on four separate occasions and reported to an oncoming nurse, that an IV bag of a patient in her care had been filled when the Respondent had in fact failed to fill the bag.

   
   

6. In August of 1982, while employed at Miami Children's Hospital, the Respondent Ambroz was caring for an extremely ill premature infant, K. Kuehnart, who was being treated by endotracheal tube. The Respondent was aware that the infant was classified as "limited touch" due to her serious condition and the risk that movement could kink or dislodge the tube and cause a life-threatening situation. The Respondent handled this infant without adequate justification and after being repeatedly told not to do so by her supervisor, Mary Mulcahy.

   
   

7. Moreover, in her care and treatment of baby Keuhnart, the Respondent Ambroz failed to observe basic aseptic techniques including insuring that the inside of the endotracheal tube remained sterile.

   
   

8. On August 17, 1982, the Respondent Ambroz, while under the supervision of Andrea Prentiss, R.N., was caring for a premature infant with a tracheal problem which required that the infant be placed on a ventilator. It was extremely important that this infant be handled minimally and carefully so the tube in the infant's throat would not become dislodged. Despite Prentiss' instructions, the Respondent moved the infant in a manner which caused the tube to become dislodged. A neonatologist was present to reinsert the tube and no

   permanent damage occurred. However, even following this incident, the Respondent handled the infant contrary to Prentiss' instructions.

   
   

9. Subsequently, the infant's mother arrived from out-of-town to visit her child. The mother was instructed to wash her hands and put on a surgical gown before entering her child's room. When the mother entered the room, the Respondent Ambroz refused to allow the mother to touch her baby, brushed her hand away from the child, and stated that the mother had an infected cuticle. Prentiss examined the mother's hands, saw no evidence of infection, and ordered the Respondent to allow the mother to touch her child. Also, during this visit, the Respondent requested that the mother change her child's socks since they were, in her opinion, an ugly shade of green.

   
   

10. These incidents upset the baby's mother and resulted in her requesting that Prentiss prohibit the Respondent Ambroz from caring for her baby.

    
    

11. The actions of the Respondent Ambroz, while employed at Mount Sinai and Miami Children's Hospital, departed from, or failed to conform to, acceptable and prevailing minimal standards of nursing practice.

    
    

    CONCLUSIONS OF LAW

    
    

12. The Division of Administrative Hearings has jurisdiction over the parties and subject matter of this proceeding. Section 120.57(1), Florida Statutes.

    
    

13. The Respondent Ambroz is charged with violating Section 464.018(1)(f), Florida Statutes, which empowers the Board of Nursing to take disciplinary action against a licensee found guilty of, inter alia:

    
    

    [u]nprofessional conduct, which shall include, but not be limited to, any de- parture from, or the failure to conform to the minimal standards of acceptable and prevailing nursing practice, in which case actual injury need not be established.

    
    

14. In proceedings of this type where a regulatory agency seeks to discipline a person in a manner substantially affecting the practice of a business or profession, the Petitioner must prove the allegations of the Administrative Complaint by clear and convincing evidence. Gans v. Department of Professional and Occupational Regulation, 390 So.2d 107 (Fla. 3d DCA 1980); Walker v. Board of Optometry, 322 So.2d 612 (Fla. 3d DCA 1975); Reid v. Florida Real Estate Commission, 188 So.2d 846, 851 (Fla. 2d DCA 1966). That evidence must be as substantial as its consequences. Bowling v. Department of Insurance, 394 So.2d 165, 172 (Fla. 1st DCA 1981).

    
    

15. In the instant case, the Petitioner proved by clear and convincing evidence that the Respondent's care and treatment of various patients while she was employed at Mount Sinai and Children's Hospital was unprofessional and departed from, or failed to conform to, minimal standards of acceptable nursing practice, in violation of Section 464.018(1)(f), Florida Statutes.

    
    

16. In determining an appropriate penalty, consideration has been given to Rule 210-10.05, Florida Administrative Code, which implements Section 464.018(4), Florida Statutes, and establishes disciplinary guidelines for violations of Chapters 455 or 464, Florida Statutes. Such factors as the

    severity of the offense, the danger to the public, the number of repetitions of offenses, the length of time since the violation occurred, the number of complaints received, the length of time the licensee has practiced, the actual damage to the patient, the deterrent effect of the penalty imposed, the effect of the penalty upon the licensee's livelihood, the efforts of the licensee toward rehabilitation, and any other mitigating or aggravating circumstances, must be considered in determining a penalty. See Rule 210-10.05(1)(a)-(k), Florida Administrative Code.

    
    

17. The Petitioner has shown that the Respondent's nursing practice over a period of time has failed to meet minimal acceptable standards, has endangered patients, and that revocation of the Respondent's license is, therefore, warranted.

RECOMMENDATION

Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED:

That the Board of Nursing enter a Final Order revoking the nursing license of the Respondent Mary Ambroz.

DONE and ENTERED this 17th day of October, 1983, in Tallahassee, Florida.

SHARYN L. SMITH, 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 17th day of October, 1983.

ENDNOTE

1/ The Respondent Ambroz appeared at the administrative hearing at 11:45 a.m., almost two hours after the scheduled hearing time, and after the conclusion of the direct examination of six of the Petitioner's witnesses. The Respondent was given the opportunity to listen to the recorded testimony of the Petitioner's witnesses which occurred during her absence, and she subsequently participated in the hearing and cross-examined each of these witnesses.

COPIES FURNISHED:

Mary Ambroz Helen P. Keefe, Executive 3304 S.W. LeJeune Road Director, Board of Nursing

Coral Gables, Florida 33134 111 E. Coastline Drive, Rm 504

Jacksonville, Florida 32202

Charles F. Tunnicliff, Esquire

Department of Professional Frederick Roche, Secretary Regulation Department of Professional

130 North Monroe Street Regulation Tallahassee, Florida 32301 130 North Monroe Street

Tallahassee, Florida 32301

Docket for Case No: 83-001681

Orders for Case No: 83-001681