STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF PROFESSIONAL )

REGULATION, )

)

Petitioner, )

)

vs. ) CASE NO. 88-4411

)

GLORIA A. WILLIAMS, )

)

Respondent. )

)

For Respondent: Gloria A. Williams, pro se. For Petitioner: Michael A. Mone', Esquire,

Tallahassee

Before J. Lawrence Johnston, Hearing Officer, Division of Administrative Hearings.

RECOMMENDED ORDER

Final hearing was held in this case in Lakeland on December 9, 1988. The issue is whether the Board of Nursing should discipline the Respondent, Gloria

1. Williams, for alleged unprofessional conduct in violation of Section 464.018(1)(f) and alleged practice of nursing when unable to practice with reasonable skill and safety as a result of a mental condition in violation of Section 464.018(1)(h), Florida Statutes (1987).

   
   

   At the conclusion of the final hearing the Petitioner ordered the preparation of a transcript, which was filed on December 21,1988, making proposed recommended orders due on or before December 31, 1988. Explicit rulings on the Petitioner's Proposed Recommended Order may be found in the attached Appendix To Recommended Order, Case No. 88-4411. (The Respondent did not file a proposed recommended order.)

   
   

   FINDINGS OF FACT

   
   

   1. At all times material to this proceeding, the Respondent has been a licensed practical nurse in the State of Florida, having been issued license number PN 0695621. Before 1987, the Respondent practiced nursing for approximately 30 years, including some time for the United States Marine Corps, without any occasion for license discipline.

      
      

   2. During 1987, through August 2,1987, the Respondent was employed as a licensed practical nurse at Haines City Health Care Center.

      
      

   3. During 1987, the Respondent's performance at work at the nursing home was adversely affected by situational depression caused in part by the pain probably caused by an arthritic condition that involved the temporomandibular joint and in part by a reaction to the medication prescribed to alleviate the

      pain On many occasions while the Respondent was working at the Haines City Health Care Center in 1987, the Respondent experienced dramatic mood changes.. She would act normal, even very happy, one minute, and become very depressed, even crying, the next.

      
      

   4. In February, 1987, the Respondent signed the medication administration record indicating that she had performed a dressing change on a patient when she in fact had not performed the dressing change.

      
      

   5. On July 31, 1987, the Respondent charted in the medication administration record the administration of procardia to a patient when she in fact had not administered the medication.

      
      

   6. On August 2, 1987, the Respondent had the assignment, among other things, to clean out some medicine carts. She accumulated 14 assorted pills but could not dispose of them because another nurse was required to be there to verify the proper disposition of the pills. She put the pills in a souffle cup and covered them with a plastic cup, planning to dispose of them properly when another nurse was available to watch her. Time went by, and the Respondent got busy doing other things, and she forgot to dispose of the pills. She did not realize her error until she got home after her shift was over. She telephoned to ask the nurse on the next shift to dispose of the pills in the presence of another nurse. She also asked the nurse not to report her error to their supervisor.

      
      

   7. The incidents described in Findings 4 through 6, above, constitute unprofessional conduct which departs from, or fails to conform to , the minimal standards of acceptable and prevailing nursing practice.

      
      

   8. There was no evidence that any of the incidents described in Findings 3 through 6, above, resulted in any physical harm or injury to a patient (although failure to administer prescribed procardia could have endangered the health of the patient under some circumstances.)

      
      

   9. Thinking that the Respondent's performance deficiencies and mood changes may have been evidence of a chemical dependency of some kind, the staff at the Haines City Health Care Center recommended that the Respondent submit to an evaluation and treatment, if necessary, by the Intervention Project for Nurses (IPN). The Respondent agreed and enrolled on September 23, 1987. Testing convinced the professional working for the IPN that the Respondent had no chemical dependencies but indicated to them that she may benefit from psychiatric evaluation and treatment for depression. The Respondent considered some of the suggestion to be cost-prohibitive for her means, but she did see visit her medical doctor, who prescribed an antidepressant. Her doctor advised her to discontinue the medication when the Respondent noticed undesirable side- effects.

      
      

   10. By not completing the recommended psychiatric evaluation and treatment and not filing required status reports, the Respondent did not comply with the requirements of the IPN, and was dismissed from the program without having completed it.

       
       

   11. When the Respondent returned to the Haines City Health Care Center, she was not given back her job. She then sought and was given employment as an LPN at another facility, the Ridge Convalescent Center, Inc., and has been a satisfactory employee from February 15, 1988, through the date of the final hearing, December 9, 1988.

       CONCLUSIONS OF LAW

       
       

   12. Section 464.018(1)(f) , Florida Statutes (1987), provides that unprofessional conduct by a licensee which departs from, or fails to conform to the minimal standards of acceptable and prevailing nursing practice is a ground for discipline.

       
       

   13. Section 464.018(l) (h) , Florida Statutes (1987), provides a licensee can be disciplined for engaging in the practice of the profession of nursing when unable to practice

       with reasonable skill and safety as a result of any mental condition.

       
       

   14. The evidence did not prove a violation of paragraph (h) of Section 464.018(1). Dismissal from the IPN for failure to adhere to its requirements is not a per se violation of (h), especially where, as here, the licensee did not submit to the program in order to avoid disciplinary action by the Department of Professional Regulation. The facts in this case are that the Respondent has been satisfactorily employed as an LPN from February 15 through at least December 9. 1988.

       
       

   15. The evidence does establish three violations of paragraph (f) of Section 464.018(1).

       
       

   16. In the event of violations of the provisions of Section 464.018(1), Florida Statutes (1987), Section 464.018(2) authorizes the Board of Nursing to revoke or suspend a license, impose an administrative fine not to exceed $1,000 for each count or separate offense, issue a reprimand, or place a nurse on probation for a period of time and subject to such conditions as the board may specify, including requiring the nurse to submit to treatment, to attend continuing education courses, to take an examination, or to work under the supervision of another nurse.

       
       

   17. F. A. C. Rule 210-10.011(2) (j) sets out the following guidelines for establishing the penalty for violation of Section 464.018(1)(f): in the delivery of nursing services, from one year probation and appropriate CE courses to suspension until proof of safety to practice, followed by probation; in administrative duties (e.g., charting, supervision of others, etc.), from six months probation and CE courses to two years probation and CE courses. However,

F. A. C. Rule 210-10.011(l) specifies that multiple counts of violations charged in the same administrative complaint will be grounds for enhancement of penalties. F. A. C. Rule 210-10.011(3) (b) identifies other circumstances which may be considered for purposes of mitigation or aggravation of penalty, including but not limited to: the severity of the offense; the danger to the public; the number of repetitions of the offense; previous disciplinary action against the licensee in this or any other jurisdiction; the length of time the licensee has practiced; the actual damage, physical or otherwise, caused by the violation; the deterrent effect of the penalty; any efforts at rehabilitation; and attempts by the licensee to correct or stop violations. F. A. C. Rule 210- 10.011(1) also provides that all penalties at the upper range of the sanctions set forth in the guidelines include lesser penalties, which may be included in the final penalty at the board' s discretion.

RECOMMENDATION

Based on the foregoing Findings Of Fact and Conclusion Of Law, it is recommended that the Board of Nursing enter a final order finding the

Respondent, Gloria A. Williams, guilty of three separate violations of Section 464.018(1)(f), Florida Statutes (1987), and placing her on probation for one year conditioned on her submission for reevaluation of her mental and emotional stability by a psychiatrist or psychologist approved by the IPN, on her completion of any recommended follow-up treatment, and on her submission of quarterly progress reports while on probation.

RECOMMENDED this 13 day of January, Tallahassee, Florida.

J. LAWRENCE JOHNSTON Hearing Officer

Division of Administrative Hearings The Oakland Building

2009 Apalachee Parkway

Tallahassee, Florida 32399-1550

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 13 day of January, 1989.

APPENDIX TO RECOMMENDED ORDER CASE NO. 88-4411

To comply with the requirements of Section 120.59(2), Florida Statutes (1987), the following rulings are made on the Petitioner's proposed findings of fact:

1. Accepted and incorporated.

2. Rejected, but only because the Respondent's employment at Ridge Convalescent Center, In., between February 15 and at least December 9, 1988, is relevant to the alleged violation of Section 464.018(1)(h), Florida Statutes (1987); otherwise, accepted and incorporated.

3.-12. Accepted and incorporated to the extent necessary and not subordinate.

COPIES FURNISHED:

Michael A. Mone', Esquire

Department of Professional Regulation

130 North Monroe Street Tallahassee, Florida 32399-0750

Gloria A. Williams

2900 Powerline Road, Lot 88 Haines City, Florida 33844

Judie Ritter, Executive Director Board of Nursing

504 Daniel Building

111 East Coastline Drive Jacksonville, Florida 32201

Bruce D. Lamb, Esquire General Counsel

Department of Professional Regulation

130 North Monroe Street Tallahassee, Florida 32399-0750

Docket for Case No: 88-004411

Orders for Case No: 88-004411