STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
AGENCY FOR HEALTH CARE ) ADMINISTRATION, BOARD OF NURSING, )
)
Petitioner, )
)
vs. ) CASE NO. 94-2793
) CATHERINE HARDISKY EVANOFF, )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuit to notice, a formal hearing was held in this case in Miami, Florida, on October 6, 1994, before Suzanne F. Hood, a Hearing Officer with the Division of Administrative Hearings.
APPEARANCES
For Petitioner: Donna L. Korora, Esquire
Agency for Health Care Administration 1940 North Monroe Street, Suite 60
Tallahassee, Florida 32399-0792
For Respondent: Barbara C. McCauley, Esquire
3445 North West 7th Street Miami, Florida 33125
STATEMENT OF THE ISSUES
The issue is whether Respondent committed the offenses set forth in the Administrative Complaint and, if so, what disciplinary action should be taken against her license to practice nursing in the state of Florida.
PRELIMINARY MATTERS
On July 23, 1993, the Department of Business and Professional Regulation, filed an Administrative complaint against the Respondent, Catherine Hardisky Evanoff (Respondent), alleging that disciplinary action should be taken against her license to practice nursing for violation of Section 464.018(1)(h), Florida Statutes. Said complaint specifically alleged that Respondent's nursing care of patient E. R. failed to conform to the minimal standards of acceptable and prevailing nursing practice.
Pursuant to Section 120.57(1), Florida Statutes, Respondent filed a timely request for a formal hearing. Prior to the hearing, the Agency for Health Care Administration, Board of Nursing, was substituted as Petitioner for the Department of Business and Professional Regulation, Board of Nursing. Said hearing was held on October 6, 1994, in Miami, Florida.
At the formal hearing, Petitioner presented the live testimony of: (1) Fran Miller, State Attorney Investigator; (2) Delores Pope, Assistant Director of Medical Records, North Shore Medical Center (NSMC); (3) Dr. Edward H. Cottler, Arch Creek Nursing Home Physician; (4) Virgil Peacock, State Attorney Investigator; and (5) Charlene McAlpin, R.N., Expert Witness. Petitioner offered ten (10) exhibits all of which were accepted into evidence. 1/ Respondent presented the live testimony of: (1) Dr. Frank Waxman, Expert Witness; (2) Jeanette D. Jaffe, R.N.; and (3) Dahna Schaublin, Investigator, Department of Business and Professional Regulation. Respondent offered three
exhibits only one (1) of which was accepted into evidence. 2/
The transcript of the formal hearing was filed with the Clerk of the Division of Administrative Hearings on November 2, 1994. Petitioner and Respondent filed proposed findings of fact and conclusions of law. A ruling on each proposed finding of fact has been made as reflected in an Appendix to this Recommended Order.
FINDINGS OF FACT
Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant findings of facts are made:
At all times material to this proceeding, Respondent was licensed by the State of Florida as a practical nurse, holding license number PN0876551.
At all times material to this proceeding, Respondent was employed by Arch Creek Nursing Home (Arch Creek) where she worked as a practical nurse on the 11 p.m. to 7 a.m. shift. Her direct supervisor, Ms. McDonald, R.N., worked the 7 a.m. to 3 p.m. shift. The Arch Creek Director of Nursing, Jeanette Jaffe, R.N., also worked the day shift.
At all times material to this proceeding, Respondent was assigned to provide nursing care to patient E. R., a seventy-seven (77) year old female.
After suffering a stroke, E. R. was admitted to North Shore Medical Center (NSMC) on November 16, 1990. She was transferred from NSMC to Arch Creek on December 7, 1990. At that time, E. R. suffered hypertension and was partially paralyzed and aphasic. Because she was incontinent of bowel and bladder, a foley catheter was used for urine drainage. A gastrostomy tube was required for nutritional feeding.
At the time of admission to Arch Creek, E. R. also had a stage II sacral decubitus ulcer on her buttocks which was one and one half (1 1/2) inches by one half (1/2) inches. The decubitus ulcer was not infected at that time.
On December 7, 1990, Dr. Cottler, E. R.'s physician at Arch Creek, ordered that the decubitus ulcer be treated with a DuoDerm dressing, an occlusive "sealed" treatment, which was to be changed every three (3) days. He also ordered that E. R. be turned every two (2) hours to alleviate pressure in the sacral area.
On December 9, 1990, a 3:00 p.m. nurse's note reflects that E. R. had two (2) open sores with a small necrotic area on her buttocks.
Dr. Cottler examined E. R. on December 11, 1990. He did not describe the ulcer in his notes or change the orders for treatment. At that time, the wound was approximately 4" by 6" inches.
On December 17, 1990, a 2:45 p.m. nurse's note reflects that E. R.'s decubitus ulcer was getting worse and needed to be evaluated.
Nurses' notes are inherently reliable. The presence of these notes in
E. R.'s chart should have alerted Respondent to the changes in E. R.'s condition.
Respondent had the opportunity to observe whether the DuoDerm dressing was intact and clean when she performed her rounds on the night shift. This was especially important after a bowel movement to ensure that fecal matter did not contaminate the wound.
On December 20 and 21 at 6:00 a.m., Respondent noted on E. R.'s chart that a treatment was done to the buttocks. On neither occasion did Respondent chart information relating to the size, color, odor, or drainage of the decubitus ulcer. All of these factors needed to be documented so that a record could be developed as to any changes in the patient's condition and to facilitate an ongoing assessment of the treatment.
Respondent did not contact Dr. Cottler during the night shift of December 20-21.
There is no persuasive record evidence that Respondent verbally reported E. R.'s condition to the registered nurse in charge on the mornings of December 20 and December 21.
On December 21 at 4:00 p.m., a nurse noted in the chart that the skin around E. R.'s sacral area was black with a fowl odor and appeared not to be responding to treatment. This same nurse noted that Dr. Cottler's new orders required E. R.'s wound to be treated with twenty-five percent (25 percent) acetic acid and wet to dry dressings every eight (8) hours.
A decubitus ulcer does not change to a fowl smelling necrotic ulcer in ten (10) hours. Therefore, it is likely that the signs of decay were present when the Respondent treated E. R.'s buttocks on the night shifts of December 19- 20 and 20-21.
Around noon on December 23, E. R.'s temperature was 100.8 degrees.
Respondent again provided nursing care to E. R. on the night shift of December 23-24. At 3:00 a.m., she observed that E. R. was slower to respond and short of breath. However, this assessment of E. R.'s condition was incomplete. Respondent did not record the patient's vital signs or note the condition of the decubitus ulcer. She also failed to alert Dr. Cottler of the change in E. R.'s condition. Evidence that Respondent made a verbal report regarding E. R.'s condition to the registered nurse at 7:00 a.m. on the morning of December 24 is not persuasive.
Because E. R. was slower to respond and short of breath at 3:00 a.m. on December 24, Respondent should have recorded the patient's vital signs and documented other relevant information, including the condition of the decubitus ulcer. Armed with all the information for a total assessment, Respondent should have immediately alerted the doctor about E. R.'s condition.
At 2:00 p.m. on December 24, a nurse's note reflects that E. R. was unresponsive and short of breath. The nurse informed Dr. Cottler, who ordered a
chest x-ray and oxygen for E. R. Dr. Cottler subsequently authorized transfer of E. R. to NSMC. At the time of transfer, Dr. Cottler was under the impression that E. R. had aspirated.
On admission to NSMC's emergency room, E. R. was unresponsive and acutely short of breath. Her vital signs were extremely beyond her normal range: temperature, 102.8; pulse, 130; respirations, 40; and blood pressure,
Additionally, E. R.'s white blood cell count of 31,000 indicated the presence of infection.
Dr. Kann took care of E. R. upon her admission to NSMC on December 24. Within twenty-four (24) hours, he observed that E. R.'s wound was roughly nine
(9) inches by six (6) inches by three (3) inches deep; it had greatly increased in size and had deteriorated in condition during the seventeen (17) days that E.
R. had been a resident at Arch Creek.
On January 8, 1991, fifteen (15) days after E. R. was discharged from Arch Creek, Respondent charted a late entry on E. R.'s Weekly Decubitus or Treatment Sheet. This entry was dated December 13, 1990, and states:
I, Catherine Evanoff, L.P.N., reviewed this patient on 12/13/90. Superficial decubitus area extends 6"-7" across both left & right buttocks (Coccycx area, necrotic tissue, is deeper in depth and surrounded by red soft, tender tissue. All decubitus area is soft, mushy w/strong foul odor & drainage present.)
Respondent made this late entry at the request of Jeanette Jaffe, R.N., the Director of Nursing at Arch Creek. Ms. Jaffe asked Respondent to make the record because Ms. McDonald, the registered nurse in charge of the day shift and Respondent direct supervisor, no longer worked at Arch Creek.
Respondent should not have made the late entry fifteen days after the care was provided. A late entry should be made only where such information continues to be relevant and pertinent to the care being provided to a patient.
After emergency room treatment, E. R. was admitted to NSMC's intensive care unit.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties and the subject matter in this case. Section 120.57(1), Florida Statutes; Section 455.225, Florida Statutes.
Pursuant to Section 464.018(2), Florida Statutes, the Board of Nursing may suspend, revoke, or otherwise discipline the license of a nurse who commits the acts set forth in Section 464.018(1), Florida Statutes, including:
(h) Unprofessional conduct, which shall include, but not be limited to, any departure 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.
Section 464.018(1)(h), Florida Statutes.
Petitioner has the burden of proving that Respondent violated Section 464.018(1)(h), Florida Statutes, by clear and convincing evidence. Ferris v. Turlington, 510 So. 2d 292 (Fla. 1st DCA 1987).
Petitioner has met its burden of proving that Respondent violated Section 464.018(1)(h), Florida Statutes, by failing to provide E. R. with adequate nursing care. Specifically, Respondent failed to properly assess E. R.'s sacral decubitus ulcer on the night shifts of December 19-20 and December 20-21. On both evenings, Respondent treated the wound but failed to make a written record of the size, color, odor, or condition of the ulcer. Evidence that she reported E. R.'s condition to the day shift charge nurse is not persuasive.
There is insufficient evidence in the record to determine that Respondent acted unprofessionally by failing to call Dr. Cottler during the nights of December 19-20 and December 20-21.
Petitioner also met its burden of proving that Respondent violated Section 464.018(1)(h), Florida Statutes, by failing to document E. R.'s vital signs or chart a description of the wound on the night shift of December 23-24. This was especially important because Respondent was aware that E. R. was slower to respond and short of breath that evening. Respondent's failure to make a complete assessment, document vital signs and the condition of the ulcer, and place a call to the doctor was unprofessional conduct.
Respondent admits that she had a duty to communicate any pertinent information, about E. R.'s condition, to the doctor. She argues that she met this obligation by reporting E. R.'s condition to the registered nurse who came on duty at 7:00 a.m. each morning. However, the only record evidence to support Respondent's argument is found in Respondent's response to one of Petitioner's request for admissions. The undersigned does not find such evidence, standing alone, to be persuasive.
Respondent also admitted that she made the late entry referenced above on January 8, 1991. The undersigned does not find that this entry is reliable and credible evidence of what Respondent observed on December 13, 1990. Regardless of the accuracy of the note, Respondent acted unprofessionally in making the late entry so many days after E. R. was discharged from Arch Creek.
Pursuant to Rule 210-10.011(2), Florida Administrative Code, the Board of Nursing may impose a range of penalties for violation of Section 464.018(1)(h), Florida Statutes (1989), including: (1) for unprofessional conduct in the delivery of nursing services, from one (1) year probation and continuing education courses to suspension until able to practice safely; (2) for unprofessional conduct in administrative duties (e.g. charting), from six
(6) months probation and continuing education courses to two years of probation and continuing education courses; and (3) for other instances of unprofessional conduct, from reprimand to suspension, probation and fine. Rule 210- 10.011(2)(j), Florida Administrative Code.
Pursuant to Rule 210-10.011(3), Florida Administrative Code, the undersigned has considered the following aggravating circumstances: (1) Respondent's conduct created a very real danger to the public; (2) Respondent's conduct caused her patient physical harm; and (3) Respondent's penalty should have a deterrent effect.
Pursuant to Rule 210-10.011(3), Florida Administrative Code, the undersigned has considered the following mitigating circumstances: (1) Respondent has been licensed since 1987; (2) Respondent has not been the subject of previous disciplinary action; (3) Respondent was not exclusively responsible for the inadequate nursing care that E. R. received at Arch Creek.
Based on the foregoing Findings of Fact and Conclusions of Law, it is, therefore recommended that the Board of Nursing enter a Final Order finding that Respondent violated Section 464.018(h), Florida Statutes (1989). Additionally, the Board of Nursing should: (1) reprimand Respondent's license; (2) place Respondent on probation for two (2) years with direct supervision; (3) require Respondent to take continuing education courses in decubitus care and charting in addition to her required continuing education credits; (4) require Respondent to pay an administrative fine in the amount of $1,000.
DONE AND ENTERED in Tallahassee, Leon County, Florida, this 28th day of November 1994.
SUZANNE F. HOOD, Hearing Officer Hearing Officer
Division of Administrative Hearings The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-1550
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 28th day of November 1994.
ENDNOTES
1/ Petitioner's Exhibits six (6) through ten (10) were pictures taken of patient E. R.'s decubitus ulcer. Respondent objected to the admission of these pictures because they were taken almost three weeks after E. R. left Arch Creek Nursing Home. Respondent's objection was overruled. However, the pictures have not been considered as evidence of the size of the wound on December 24,1990.
2/ Respondent offered the sworn statements of Dr. David Russin and Iris Arnell into evidence. Petitioner objected to the admission of these statements because: (1) they were irrelevant; (2) they were taken in connection with an unrelated case involving an different standard of care; (3) there was no opportunity for Petitioner to cross examine the deponents or present rebuttal evidence; and (5) they could not be authenticated. Respondent acknowledged that the statements were merely cumulative to other testimony presented at the hearing. Petitioner's objection was sustained.
APPENDIX TO RECOMMENDED ORDER IN CASE NO. 94-2793
The following constitutes my specific rulings pursuant to
Section 120.59(2), Florida Statutes, on all of the Proposed Findings of Fact submitted by the parties to this case.
FOR THE PETITIONER:
Accepted in Finding of Fact (FOF) #1.
Accepted in FOF #4.
Accepted in FOF #2.
Accepted in FOF #4.
Accepted in FOF #5.
Accepted in FOF #5.
Accepted but unnecessary to resolution of case.
Accepted in FOF #6.
Cumulative to substance of FOF #5.
Cumulative to substance of FOF #5.
Cumulative to substance of FOF #5.
Accepted in FOF #8.
Accepted in FOF #7 & #9.
Accepted in FOF #10.
Accepted in FOF #11.
Accepted in FOF #11.
Accepted in FOF #12.
Accepted as modified in FOF #15.
Accepted in FOF #12.
Accepted in FOF #12.
Accepted in FOF #12.
Accepted in FOF #12.
Accepted in FOF #13, #12, & #15.
Accepted as modified in FOF #16.
Accepted in FOF #16.
Accepted in FOF #15.
Accepted in FOF #18.
Accepted in FOF #18.
Accepted in FOF #19.
Accepted in FOF #18.
Accepted in FOF #20 & #21.
Accepted in FOF #22.
Accepted in FOF #21.
Accepted in FOF #22.
Accepted in FOF #22.
Accepted in FOF #23.
Accepted in FOF #23.
No persuasive competent evidence.
Accepted in FOF #19 as to December 24, 1990 only.
Accepted in FOF #25.
Accepted in FOF #26.
FOR THE RESPONDENT:
Accepted in FOF #2.
Accepted in FOF #2.
Accepted in FOF #2.
Accepted in FOF #2.
Accepted in FOF #4 & #16.
Accepted in FOF #4.
Accepted in FOF #5.
First sentence accepted in FOF #6. Second sentence unsupported by competent substantial evidence. The "treatment record" indicates that the wound was supposed to be dressed every three (3) days at 10 A.M. and the patient turned every two (2) hours. This record shows that the ulcer was treated on successive days at times and, on at least one occasion, on the fourth day.
Accepted but unnecessary for resolution of the case.
Rejected. No persuasive competent substantial evidence.
First sentence rejected; blood pressure was only vital sign recorded daily. Accept that E. R.'s temperature was 99 degrees on 12/20/90 at 5 P.M. Her blood pressure was recorded as being 136/34 at 9 A.M. on 12/24/90.
Irrelevant.
First three (3) sentences irrelevant as to Respondent's guilt but taken into consideration as mitigation. No persuasive competent substantial evidence to support sentence four (4).
Accepted in FOF #23 & #24.
No persuasive competent substantial evidence.
No persuasive competent substantial evidence.
Accepted in FOF #8.
Dr. Cottler examined the patients at Arch Creek once a month. He made weekly visits there. His testimony relative to which records he reviewed and when he reviewed them is conflicting and therefore not persuasive.
Dr. Waxman's testimony was not persuasive competent substantial evidence.
Irrelevant.
Irrelevant.
First and last sentence accepted in FOF # 22. Balance of information irrelevant.
Irrelevant. The undersigned has not considered the pictures (Petitioner's Exhibits 6-10) as evidence of the size of the wound on 12/24/90.
Rejected. No persuasive competent substantial evidence that Respondent told the day nurse about the ulcer.
Not persuasive competent evidence.
Accept that a Duoderm works by dissolving the eschar. Accept that even in "clean" conditions, anarodes on skin can cause some odor. No signs of infection were ever reported to Dr. Cottler.
Accepted as modified in FOF #20.
Accepted in FOF #8.
No persuasive competent substantial evidence; see #18 above.
No persuasive competent substantial evidence as applied to this case on December 24, 1990.
Accept that a decubitus ulcer is like an iceberg; it may have a small sore on top and large hole underneath.
No persuasive competent substantial evidence.
No persuasive competent substantial evidence to support Respondent's claim that she reported E. R.'s condition to the nursing supervisor; therefore, rejected.
Accept that it would be reasonable for an LPN to rely upon what a RN tells her about a patient; however, there is no persuasive competent substantial
evidence of what Ms. McDonald told Respondent about E. R. Accept that Charlene McAlpin, R.N., was not familiar with Arch Creek standards for charting in terms of the number of notes per shift. However, she was familiar with the minimal standards of acceptable and prevailing nursing practice.
Irrelevant.
Accept that the wound was not 12" by 8" when E. R. left Arch Creek.
No persuasive competent substantial evidence.
Accept that Respondent worked under the supervision of Ms. McDonald. No persuasive competent substantial evidence of what Respondent told Ms. McDonald concerning E. R.
No persuasive competent substantial evidence.
Accepted in FOF #24.
COPIES FURNISHED:
Donna L. Korora, Esquire
Agency for Health Care Administration 1940 North Monroe Street, Suite 60
Tallahassee, Florida 32399-0792
Barbara McCauley, Esquire 3445 North West 7th Street Miami, Florida 33125
Judie Ritter Executive Director Board of Nursing AHCA
504 Daniel Building
111 East Coastline Drive Jacksonville, Florida 32202
Harold D. Lewis General Counsel
The Atrium, Suite 301
325 John Knox Road Tallahassee, Florida 32303
NOTICE OF RIGHT TO SUBMIT EXCEPTIONS
All parties have the right to submit written exceptions to this Recommended Order. All agencies allow each party at least 10 days in which to submit written exceptions. Some agencies allow a larger period within which to submit written exceptions. You should consult with the agency which will issue the Final Order in this case concerning its rules on the deadline for filing exceptions to this Recommended Order. Any exceptions to this Recommended Order should be filed with the agency which will issue the Final Order in this case.
================================================================= AGENCY FINAL ORDER
=================================================================
STATE OF FLORIDA BOARD OF NURSING
AGENCY FOR HEALTH CARE ADMINISTRATION,
Petitioner
vs. CASE NO. 92-10468
DOAH CASE NO. 94-2793
CATHERINE HARDISKY EVANOFF,
Respondent.
/
FINAL ORDER
Respondent, CATHERINE HARDISKY EVANOFF, holds Florida license number LPN 0876551 as a licensed practical nurse. Petitioner has filed an Administrative Complaint seeking disciplinary action against the license and the matter proceeded to formal hearing pursuant to Section 120.57(1), Florida Statutes, before Suzanne Hood, Hearing Officer.
The matter appeared before the Board of Nursing on April 6, 1995, in Dania, Florida, for consideration of the Recommended Order pursuant to Section 120.57(1), Florida Statutes. Petitioner was represented by Laura P. Gaffney, Attorney at Law. Respondent was present and represented by Barbara C. McCauley, Attorney at Law. The Board received and reviewed the complete record in this cause pursuant to Section 120.57(1)(b), Florida Statutes. Respondent filed Written Exception to Recommended Order, a copy of which is attached to this Final Order.
RULINGS ON EXCEPTIONS
Paragraph one is DENIED. This is mere disagreement with competent, substantial evidence in the record, including the testimony on pages 47-53 in the hearing transcript.
Paragraph two is DENIED. Whether others were charged or committed the same wrongdoing is not relevant nor included in the record.
Paragraph three is DENIED. The essence of the violation is the lack of documentation and there was competent, substantial evidence in the record that nothing was done. This exception was mere disagreement with the evidence, including the testimony on pages 104-105 in the hearing transcript.
Paragraph four is DENIED as it is mere disagreement with competent, substantial evidence in the record, including the testimony on page 111 in the hearing transcript.
Paragraph five is GRANTED as to the first three sentences. The last sentence is DENIED as irrelevant and includes matters discussed in Ruling on Exception two.
Paragraph six is DENIED. An exception to the appendix is not appropriate. This is mere disagreement with the ultimate conclusion which the hearing office reached in weighing the evidence, conflicts in the evidence, and the lack of evidence.
Paragraph seven is DENIED. This is mere argument, disagreement with the ultimate conclusion, and addresses matters irrelevant to and not in the record.
Paragraph eight stating the penalties do not include fines is DENIED in that the disciplinary guidelines and statue do include administrative fines.
The remainder of the paragraph is DENIED as they are comments on matters not in the record. The recommended disposition is within the Board's rules and statutes. That there may have been preliminary negotiations for a lesser penalty and that Respondent chose not to accept such a settlement is not in the record nor is it properly admissible into evidence.
The Recommended Order is attached to and made a part of this Final Order as outlined below.
FINDINGS OF FACT
The Board ACCEPTS the hearing officer's fact in paragraphs 1-26, excluding paragraph 19 as found in Ruling on Exception paragraph five, and adopts them as its own.
CONCLUSIONS OF LAW
The Board accepts the Conclusions of Law in paragraphs 27-37 in the Recommended Order and adopts them as its own.
DISPOSITION
Based on the Findings of Fact and Conclusions of Law, the Board finds Ms. Evanoff to be guilty of violating Section 464.018(1)(h), Florida Statutes, and accepts the recommended penalty.
Pursuant to Section 464.018(2), Florida Statutes, the Board orders the following:
The license of CATHERINE EVANOFF is reprimanded.
The license of Catherine Evanoff is placed on probation for two years, subject to the following conditions:
The licensee shall not violate chapters 455 or 464, Florida Statutes, the rules promulgated pursuant there to, any other state or federal law, rule, or regulation relating to the practice or the ability to practice nursing. The licensee must report any change in her address, telephone number, employment, employer's address or telephone number, or any arrests, in writing by certified mail within 5 working days to the Probation Supervisor at the Board of Nursing Office, 904/359-6331, 111 Coastline Drive, East, Suite 516, Jacksonville, Florida 32202. The probationer's failure to supply such information on a
timely basis shall constitute grounds for the licensee to attend the next Board meeting to show cause why the probation should not be modified or the license suspended.
The licensee shall submit written reports to the Probation Supervisor at the Board of Nursing office, which contain the licensee's name, license number, current address, name, address, and phone number of each current employer, whether employed as a nurse or not, and a statement by the licensee describing her employment. This report shall be submitted to the Probation Supervisor every three (3) months in a manner as directed, by the Probation Supervisor. If the licensee fails to submit a quarterly report on a timely basis, she will be required to attend the next Board meeting to show cause why the probation should not be modified or the license suspended.
All current and future settings in which the probationer practices nursing shall be promptly informed of the licensee's probationary status. Within five days of the receipt of this Order, the licensee shall furnish a copy to her nursing supervisor or supervisors, if there are multiple employers. The supervisors must acknowledge this probation to the Board probation supervisor in writing on employer letterhead within ten days. Should the licensee change employers, she must supply a copy of this Order to her new nursing supervisor within five days. The new employer shall acknowledge probation in writing on employer letterhead to the Board probation supervisor within ten days. The licensee shall be responsible for assuring reports from the nursing supervisors will be furnished to the Board probation supervisor every three (3) months.
That report shall describe the licensee's work assignment, work load, level of performance, and any problems.
The probation supervisor shall inform the Board regarding any report indicating an unprofessional level of work or other problem at the next scheduled Board or probable cause panel meeting. Any unsatisfactory reports shall be grounds for modification of the terms of this probation and possible suspension of licensure. The licensee shall be notified to attend the next scheduled Board meeting to show cause why further action, including suspension, should not be taken.
Should the licensee desire to return to school to attend a nursing program, the licensee shall provide a copy of this Order to the Program Director prior to beginning class. The Program Director must inform the Board in writing on school letterhead, acknowledging receipt of a copy of the Order. If the school is willing to comply with the licensee's conditions of probation during clinical experiences, that should be specified. Otherwise the probation shall be tolled. Any requests for modification or accommodation by the school or the probationer shall be considered on an individual basis by the Board.
If the licensee leaves Florida for thirty days or more or ceases to practice nursing in the state, her probation shall be tolled until the licensee returns to active practice of nursing in Florida. Then the probationary period will resume.
The licensee must work in a setting under direct supervision and only on a regularly assigned unit. Direct supervision requires another nurse to be working on the same unit as respondent and readily available to provide assistance and intervention. She cannot be employed by a nurse registry, temporary nurse employment agency or home health agency. Multiple employers are prohibited. The licensee cannot be self-employed as a nurse.
The licensee shall enroll in and successfully complete courses in decubitus care and charting. This shall be in addition to other normally required continuing education courses. Verification of course content and course completion must be submitted to the Probation Supervisor within six months from the date of this Order. If the licensee fails to complete the courses on a timely basis, she will be required to attend the next Board meeting to show cause why the probation should not be modified or the license suspended.
The licensee must pay an administrative fine of $1,000 within one year. Failure to pay the fine in a timely manner will require the licensee to show cause at the next Board meeting why the license should not be suspended. The probationer has the responsibility to document financial hardships prior to the due date of the fine payment.
Pursuant to Section 120.68, Florida Statutes, the parties are hereby notified that they may appeal this Final Order by filing one copy of a notice of appeal with the clerk of the agency and by filing a filing fee and one coy of a notice of appeal to the District Court of Appeal within thirty days of the date this Final Order is filed.
This Final Order shall become effective upon filing with the Clerk of the Agency.
DONE and ORDERED this 22nd day of May, 1995.
BOARD OF NURSING
Betty A. Taylor, RN, MSN
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been furnished by certified mail to Catherine Evanoff, 1475 NE 125 Terrace #605, N. Miami, Florida 33161-5267 and Barbara McCauley, 3445 NW 7th Street, Miami, Florida 33125 and by interoffice mail to Laura Gaffney, Esquire, Agency for Health Care Administration, 1940 N. Monroe Street, Tallahassee, Florida 32399-0773, and Suzanne F, Hood, Hearing Officer, Division of Administrative Hearings, The DeSoto Building, 1230 Apalachee Parkway, Tallahassee, Florida 32399-1550, this 15th day of June, 1995.
Brandon L. Moore
| Issue Date | Proceedings |
|---|---|
| Jun. 15, 1995 | Final Order filed. |
| Nov. 28, 1994 | Recommended Order sent out. CASE CLOSED. Hearing held 10-6-94. |
| Nov. 17, 1994 | (Respondent) Supplement to Respondent's Proposed Recommended Order filed. |
| Nov. 12, 1994 | Petitioner's Proposed Recommended Order filed. |
| Nov. 02, 1994 | Transcript of Proceedings filed. |
| Oct. 24, 1994 | Respondent's Proposed Recommended Order filed. |
| Oct. 11, 1994 | Order sent out. (Motion for fees and costs is DENIED) |
| Oct. 06, 1994 | CASE STATUS: Hearing Held. |
| Sep. 30, 1994 | (C. Evanoff) Petition for Fees and Costs filed. |
| Sep. 30, 1994 | (Petitioner) Notice of Taking Deposition filed. |
| Sep. 30, 1994 | Order sent out. (motion to compel denied) |
| Sep. 29, 1994 | Petitioner's Motion to Compel Remaining Discovery filed. |
| Sep. 29, 1994 | (Petitioner) Unilateral Pre-Hearing Stipulation filed. |
| Sep. 28, 1994 | (Respondent) Notice of Filing Affidavit w/Affidavit filed. |
| Sep. 27, 1994 | Letter to B. McCauley from (RE: enclosing copy of order issued 6/16/94) sent out. |
| Sep. 27, 1994 | Order sent out. (motion granted) |
| Sep. 27, 1994 | Petitioner's Motion in Limine to Limit Number of Expert Witnesses filed. |
| Sep. 20, 1994 | (Respondent) Motion to Compel Better Answers; Request to Produce; Interrogatories; Response to Request to Admit; Notice of Deposition(s) filed. |
| Sep. 20, 1994 | (Petitioner) Notice of Service; Petitioner`s Response to Respondent`s Request for Admissions filed. |
| Sep. 14, 1994 | Order Compelling Discovery sent out. (motion granted) |
| Sep. 13, 1994 | Petitioner's Motion to Strike Counsel for Petitioner's Name from Respondent's Witness List filed. |
| Sep. 13, 1994 | (Respondent) Request to Admit filed. |
| Sep. 13, 1994 | (Respondent) Supplemental Witness List; Notice of Deposition(s) filed. |
| Sep. 12, 1994 | (Petitioner) Notice of Service filed. |
| Aug. 25, 1994 | Supplemental Witness List filed. (From Barbara C. Cause) |
| Aug. 22, 1994 | Order sent out. (motion to compel denied) |
| Aug. 19, 1994 | Petitioner's Motion to Compel Discovery w/Exhibit-A filed. |
| Aug. 18, 1994 | Petitioner's Response to Respondent's Request to Produce filed. |
| Aug. 17, 1994 | (Respondent) Response to Request to Admit; Motion to Compel; Request to Produce filed. |
| Aug. 05, 1994 | Notice of Service of Petitioner's First Set of Interrogatories, Request to Produce And Request for Admissions filed. |
| Aug. 04, 1994 | Letter to DOAH from B. McCauley (RE: request for subpoenas); Witness List for Respondent filed. |
| Jun. 16, 1994 | Order sent out. (motion to compel better answers is denied) |
| Jun. 15, 1994 | (Respondent) Motion to Compel Better Answers filed. |
| Jun. 08, 1994 | Order Requiring Exchange of Information and Prehearing Stipulation sent out. |
| Jun. 08, 1994 | Notice of Hearing sent out. (hearing set for 10/6/94; 9:00am; Miami) |
| Jun. 06, 1994 | Notice of Service of Petitioner's Answer to Respondent's Interrogatories; Joint Response to Initial Order filed. |
| May 25, 1994 | Initial Order issued. |
| May 16, 1994 | Agency referral letter; Administrative Complaint; Request for Formal Hearing, ltr form; Election of Rights filed. |
| Issue Date | Document | Summary |
|---|---|---|
| May 22, 1995 | Agency Final Order | |
| Nov. 28, 1994 | Recommended Order | Nurse failed to assess or chart condition of decubitis ulcer and failed to chart vital signs and call doctor. Placed on probation and fined. |
