STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

In re: The revocation of the )

license of Audrey D. Potts Kyle, ) CASE NO. 75-583 R. N., R. N. #62079 )

)

RECOMMENDED ORDER

By administrative complaint filed April 14, 1975 the Florida State Board of Nursing seeks to revoke or suspend the license of Audrey D. Potts Kyle, R. N.

APPEARANCES

For Petitioner: Julius Finegold, Esquire

1130 American Heritage Building Jacksonville, Florida 32202

For Petitioner: Jeffrey M. Mart, Esquire

17891 South Dixie Highway Miami, Florida 33157

The administrative complaint contains some twelve counts alleging unprofessional conduct in that on seven occasions specified in the complaint the licensee signed out on the narcotics record for various narcotics, but did not enter those on the chart of the patient as having been administered; three charges allege that licensee signed out for narcotics on the narcotics record and entered on the patient's chart as administered by someone other than herself, and two of the charges alleged that the licensee signed our for larger vials of Demerol than was necessary for the dosage that was given to the patient.

Exhibits 1 through 7 inclusive are hospital records of the medication sheets of Mabel Condon, Virginia Kabel, and Mike McCary. Exhibits 8 through 13, Narcotic and Hypnotic Disposition Records from the files of the hospital were also admitted into evidence. At the conclusion of the testimony, the original records were withdrawn and copies thereof were substituted. Hospital custodians of the record presented these exhibits. The licensee's objection that the exhibits did not show the proper custody was overruled.

Mr. Margaret Maxwell, the night supervisor of nurses at South Miami Hospital, testified to the procedure used in maintaining the exhibits that had been admitted into evidence. Exhibits 1 through 7 are those that are maintained by the duty nurses and contain all the medications that are given to the patient during his stay in the hospital. When a nurse is required to issue narcotics to a patient, these narcotics are withdrawn from the narcotics drawer to which the nurse on duty has the key, entered on the Narcotics and Hypnotic Disposition Record, and immediately thereafter administered to the patient. Control of the narcotics is maintained by the oncoming shift counting the narcotics remaining in the drawer while the shift going off accounts for all those narcotics that were administered during their tour of duty. In this manner a continual inventory of narcotics is maintained, and in the event narcotics are missing, responsibility therefor is immediately apparent. During the course of Mrs.

Maxwell's cross examination, Exhibit 14, the Doctor's Orders entered in the case of Mr. McCary, was admitted into evidence. This indicates that the doctor's orders were complied with by Mrs. Kyle during the time she was on duty on November 18, 1974.

Mrs. Cynthia Taylor Brown testified that she did not administer the tablet of Tylenol #3 to Virginia Kabel, although Exhibit 3 showed her name as having done so. Mrs. Brown further explained some of the procedures that were followed in maintaining the various charts at the nurses' station.

Mrs. Kyle testified in her own behalf. She had worked at the South Miami Hospital for approximately two and a half years and received yearly evaluations of a good category. The hospital grades on the basis of average, good, and superior. She was in charge of the duty station of the unit to which she was assigned during the night shift from 10:00 P.M. to 8:00 A.M. She had suffered from headaches for a considerable period of time and some eight years ago had received an operation to alleviate those headaches. During the period involved herein she worked many hours overtime. Mrs. Kyle emphatically denied that she had ever taken any narcotics other than those that had been prescribed for her by a doctor. She denied taking any of the narcotics that the charts failed to indicate had been administered to the patient, but had been withdrawn by Mrs.

Kyle from the Narcotic and Hypnotic Disposition Record. Mrs. Kyle generally blamed failure to properly record the medication on the patient's chart on being overburdened with responsibilities and duties. She acknowledged that they should have been entered on the chart. With respect to the exhibits on which her name appears, she acknowledged all of those signatures purporting to be hers and she did not dispute any of those.

The following findings are made with respect to the various charges on the Complaint. Complaint #1 is supported by Exhibits 1 and 8. Complaint #2 is supported by Exhibits 1 and 8. With respect to Complaint #3, no witness appeared to testify that Bea Berry did not in fact administer the drug as indicated on the patient's chart. Complaint #4 is supported by Exhibits 2 and 8. Complaint #5 is supported by Exhibits 3 and 9. With respect to Complaint #6, Mrs. P. Jacobson, R. N. did not testify so there is no evidence that the licensee signed out on the narcotic record for one tab of Tylenol for a patient and entered on the patient's chart as having been administered by Mrs. P. Jacobson, R. N. Complaint #7 is supported by Exhibits 4 and 9. Complaint #8 was withdrawn by the Board during the course of the proceedings. Complaint #9, that the licensee signed out on the Narcotics Record a vial of Demerol 100 mg, but indicated use thereof of only 50 mg, and failed to follow proper procedure regarding wasted portion, was not proved. The witness who testified with respect to this indicated that there was no prescribed procedure to follow to account for the unused portion of the narcotic. With respect to Complaint #10, the records indicate that the licensee did sign out on the narcotics sheet at approximately 3:00 A.M. for 50 mg of Demerol and administered the same at 3:30 rather than 3:00 A.M. With respect to Complaint #11, that the licensee signed out narcotics on the Narcotics Record for Demerol (75 mgs) and used only 25 mgs, although a 25 mg vial was available the witness testified that 25 mg vials of Demerol were not usually available. Again the allegation of failure to follow proper procedure regarding the wasted portions was not proven, as no proper procedure was shown. Complaint #12 was supported by Exhibits 7 and 10.

From the foregoing, the hearing officer concludes that the licensee, Audrey

B. Potts Kyle, is guilty of Complaints #1, #2, #4, #5, #7, #9, and #12. Of the other complaints, the hearing officer finds the licensee not guilty.

Failure to enter medications on a patient's chart is a very serious omission on the part of a registered nurse. Since it could lead to another nurse giving medication to the patient not knowing that the patient had received previous medication, it could result in a fatal accident at the hospital.

It is therefore concluded that failure to properly maintain prescribed records and charts as herein alleged constitutes unprofessional conduct. It is therefore,

RECOMMENDED that the license of Audrey D. Potts Kyle, be suspended for a period of six (6) months.

DONE and ENTERED this 11th day of September, 1975 in Tallahassee, Florida.

K. N. AYERS, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304

(904) 488-9675

COPIES FURNISHED:

Julius Finegold, Esquire

1130 American Heritage Building Jacksonville, Florida 32202

Jeffrey M. Mart, Esquire 17891 S. Dixie Highway Miami, Florida 33157

Docket for Case No: 75-000583

Orders for Case No: 75-000583