STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

FLORIDA BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 76-038

) STELLA MAE BROWNING BRUMLEY, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, K. N. Ayers, held a public hearing in the above styled cause on May 4, 1976, at Ft. Myers, Florida.

APPEARANCES

For Petitioner: Julius Finegold, Esquire

1130 American Heritage Life Building

Jacksonville, Florida 32202

For Respondent: Stephen Lubow, Esquire

1104 Concord Building

66 West Flagler Street Miami, Florida 33130

RECOMMENDED ORDER

By Administrative Complaint filed December 12, 1975, the Florida State Board of Nursing seeks to revoke the license of Stella Mae Browning Brumley for unprofessional conduct in administering medications without a doctor's order and violating written staff physicians orders. At the beginning of the hearing Respondent moved for a dismissal of the proceedings on the grounds that since the Career Service Commission had held hearings to consider the same evidence this proceeding would result in double jeopardy. The Motion was denied.

Thereafter both Petitioner and Respondent called six witnesses and Petitioner recalled two of these witnesses in rebuttal.

FINDINGS OF FACT

1. Respondent, Stella Mae Browning Brumley, has been a registered nurse in Florida since 1954 and worked at the Sunland Development Center in Ft. Myers for approximately 10 years before she was dismissed in June, 1975 by the hospital authorities.

   
   

2. During the period March-May, 1975 Mrs. Brumley entered on the clinic log that she had administered tannic acid, 20 percent solution, to approximately

   14 "clients of the center who had suffered minor cuts, abrasions etc. At the time this medication was administered the standing orders did not provide for use of this medication and there was no doctor's order for this treatment to be given to any of the "clients" so treated.

   
   

3. Tannic acid was supplied to the medicine cabinets in each of the cottages where the clients reside and was available for use by the "parents" although all of the Petitioner's witnesses testified that a doctor's order was required before thee use of tannic acid was authorized. Dr. Murray, present Medical Director at Sunland, introduced the use of tannic acid at Sunland but never put it on the standing orders. He considers tannic acid to be an effective medication for minor abrasions. There are standing orders for treating minor skin irritations and rash but there is nothing in the standing orders providing specifically for treatment of abrasions (TR p 44, 47). Webster's New Collegiate Dictionary shows another sense of the word, abrasion, to be irritation. Cottage parents generally considered that medications made available in the medicine cabinets and not kept locked, such as tannic acid, were there for use in first aid treatment, and frequently used same assuming it was authorized by standing orders.

   
   

4. On or about February 27, 1975, Manuel Horton, a client at Sunland received ant bites which resulted in his being taken to the clinic. The doctor ordered treatment with furacil and entered same on clinic chart. No copy of the orders or the medication was sent to the cottage. Later that evening Respondent was called to the cottage to administer to Horton. He had scratched himself in several places deeply enough to draw blood. After ascertaining that no record of treatment ordered was in the cottage Mrs. Brumley called the nurse'supervisor on duty in the clinic to discuss treatment but she did not go across the road to the clinic to look at the clinic chart. Mrs. Miller, the supervisor on duty in the clinic, was partially supervisor of the cottage nurses and Mrs. Brumley testified she considered Mrs. Miller to be so because she was a grade higher. Mrs. Miller advised that she had caladryl available if someone could come for it. Mrs. Brumley testified that calomine was received and Horton was treated with calomine. She entered on his chart that he was treated with caladryl. Furasin, which was ordered by the doctor, is an antibiotic while caladryl, a combination of benedryl and calamine, is an antihistimatic.

   
   

5. During a period when pin worms were prevalent Povan was ordered administered to all employees as well as the clients. In the initial planning stages Mrs. Brumley was asked to administer the treatment in the cottages in the evening but she demurred. Later it was decided that the treatment would be given only during the day hours. Mrs. Brumley understood the time limitation on treatment during day hours applied only to the children and on the evening of April 15, 16, and 17 she administered Povan to employees in the cottages.

   
   

6. On February 14, 1975 Kenneth Skogland and Linda Sallak, clients at Sunland, were administered Visteril by Respondent Brumley. At the time Thorozine was the authorized sedative when a child became unruly. No doctor's orders for substitution of Visteril for Thorozine was entered. Respondent contends that during a conversation with Dr. Murray he suggested the substitution of Visteril for Thorozine and she considered that to be authorization for the substitution. Visteril is both an antihistamine and a sedative. Dr. Miller denied he ever said that Visteril could be substituted for Thorozine.

   
   

7. In March, 1972 Respondent entered on the medical records that bread, butter, and cotton was administered to a patient who had swallowed pins. At the

   hearing Mrs. Brumley acknowledged that she had administered the cotton sandwich but its use had been authorized by a doctor at Sunland who is now deceased. No record of such an order was found. Mrs. Brumley's testimony that she and the prescribing doctor had discussed the cotton sandwich with the Medical Director at the time gas disputed by the Medical Director at the hearing. He had no recollection of such conversation although he recalled the incident where the patient was so treated. No adverse effects resulted from this treatment and the pins were eliminated by the patient without surgery being required.

   
   

   CONCLUSIONS OF LAW

   
   

8. Respondent is charged with unprofessional conduct. Section 464.21(1)(b) F.S. provides the Board of Nursing shall have the authority to discipline the holder of a nurses license who has been found guilty of:

   
   

   "Unprofessional conduct, which shall include any departure from, or the failure to conform to, the minimal standards of acceptable and prevailing nursing practice, in which proceeding actual injury need not be established."

   
   

9. Here the evidence was clear that medication was to be administered only pursuant to a doctor's order and that standing orders did not authorize the use of tannic acid for treatment of minor abrasions. However, it is also clear that the Medical Director of Sunland considered tannic acid to be a good medication to apply to such minor injuries to which most children are susceptible; and that each cottage was provided with tannic acid for such use. This medication was widely used by cottage parents for treating minor skin abrasions without specific orders to do so.

   
   

10. The other treatments administered by Respondent which are alleged to constitute unprofessional conduct were likewise not included in standing orders nor authorized by specific doctor's orders. Doctor's orders that are given orally should be entered in the patient's records. Many such orders were issued orally that did not find their way onto the patients' charts.

    
    

11. It is the duty of the nurse to record those doctors' orders that are issued orally. Otherwise medication could be prescribed without knowledge that another medication had already been administered which would make the proposed medication contraindicated. Even if the orders authorizing the substitution of Visteril for Thorozine had been issued orally (which the evidence does not support) it was the duty of the Respondent to record such order. The fact that a doctor may make a comment regarding the use of a specific drug is not sufficient to constitute an order to administer it to a specific patient.

    
    

12. With respect to the failure of Respondent to ascertain that Furacil had been ordered for Horton before he was treated with caladryl several odd circumstances arose. First, it appears that administration procedures were not established to insure that the treatment prescribed for a patient was made known to those responsible for administering this treatment. Second, it is apparent that several people, including Respondent, were aware that Horton had gone to the clinic. Third, Respondent was aware that doctors' orders may be entered on the clinic record as well as on the patient's record. Not finding the patient's record in the cottage, failure to check the clinic record before administering the caladryl constituted negligence.

13. The issue with respect to the cotton sandwich occurred some three to five years ago and apparently was forgotten until charges were preferred for the events that occurred in 1975. While there is no statute of limitation in administrative law the doctrine of laches is applicable. Here the hospital authorities were aware of the administering of the cotton sandwich concurrently with the event. If this constituted conduct calling for disciplinary action, such action should have been taken at that time. To wait three years until other acts of Respondent are called into question before raising the earlier issue is repugnant to principles of fair play and due process. Without reaching the merits of the defense that the administration of the cotton sandwich was done pursuant to a doctor's order, I would bar consideration of that charge such a long time thereafter. See: Fla. Bar v. Wagner, 197 So.2d 823; Fla. Bar v. KING, 74 So.2d 398: Fla. Bar v. Randolph, 238 So.2d 635.

    
    

14. From the foregoing it is concluded that Respondent administered tannic acid to patients without doctor's orders and far that the practice of doing so was prevalent at the Sunland Developmental Facility in Fort Myers in 1975. Accordingly this is not conduct that can be categorized as unprofessional. Administering the drug Visteril without a specific order to do so does constitute unprofessional conduct. Failure to check the clinic records to ascertain if medication had been prescribed for Horton before deciding to administer treatment constitutes unprofessional conduct. Those charges relating to the 1972 treatment of a cotton sandwich should be dismissed. It is therefore,

RECOMMENDED that the license of Stella Mae Browning Brumley be suspended for a period of one year. It is further

RECOMMENDED that this suspension be considered to have commenced June 2, 1975, the day Respondent was dismissed from her position at Sunland.

DONE and ENTERED this 14th day of June, 1976, in Tallahassee, Florida.

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

Docket for Case No: 76-000038

Orders for Case No: 76-000038