STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 76-741

) DOROTHY MARIE HALL COBB, L.P.N., )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, an administrative hearing was held before Diane D. Tremor, Hearing Officer with the Division of Administrative Hearings, at 11:00

1. on July 19, 1976, in the Board of Nursing Conference Room, Building B, 6501 Arlington Expressway, Jacksonville, Florida.

   
   

   APPEARANCES

   
   

   For Petitioner: Juluis Finegold

   1130 American Heritage Life Building Jacksonville, Florida 32202

   
   

   For Respondent: Dorothy M. Hall Cobb

   1720 West 13th Street Jacksonville, Florida 32209

   
   

   INTRODUCTION

   
   

   By an amended administrative complaint dated March 15, 1976, the petitioner seeks to revoke respondent's license number 11005-1 on the ground that she is guilty of unprofessional conduct in violation of F.S. s. 464.21(1)(b).

   Specifically, the complaint charges that respondent did:

   
   

   1. On or about April 8, 1975, while employed as an LPN at St. Vincent's Medical Center in Jacksonville, withdrew a total of 250 mgm of the controlled drug Demerol for administration to patients and her nurse's notes reveal that only 75 mgm of Demerol was charted; and

      
      

   2. on or about April 9, 1975, withdrew a total of 450 mgm of Demerol, a controlled drug, and her nurse's notes reveal that she only charted as having administered 290 mgm of Demerol.

Respondent signed and returned the Election of Rights form, indicating thereon that the complaint contained disputed issues of material fact and requesting an administrative hearing. During the course of the hearing, respondent requested that the hearing be continued for the purpose of allowing her to retain and reappear with an attorney. Upon the ground that she was previously advised of her right to be represented by counsel in both the

administrative complaint dated March 15, 1975, and in the notice of hearing dated June 14, 1976, the request for a continuance was denied.

FINDINGS OF FACT

Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant facts are found:

1. At all times pertinent to this proceeding, respondent was a licensed practical nurse holding license number 11005-1.

   
   

2. On April 8th and 9th 1975, respondent was employed at St. Vincent's Medical Center in Jacksonville, Florida.

   
   

3. As required by federal law and the normal course of the business of pharmacy, the pharmacist of the Center maintains and retains narcotic control records which chart the withdrawal and disposition, of controlled substances.

   
   

4. The narcotic control records introduced into evidence as Exhibit 2 record the disposition of various dosages of meperidine ampuls. Demerol is the trademark name of the generic drug meperidine, which is a controlled substance under Ch. 893 of the Florida Statutes.

   
   

5. St. Vincent's Medical Center has specific procedures to be followed when withdrawing and administering narcotic drugs. When a nurse withdraws a narcotic drug for a patient, it is her duty to fill out the narcotic control record showing the date, the time, the dosage, the patient to whom the drug is to be administered, the treating physician and the signature of the person withdrawing and administering the substance. The substance should then be administered to the patient within minutes of the withdrawal time, and the time of administration and dosage should immediately be noted or charted on that portion of the patient's medical record entitled "Nurses Notes."

   
   

6. From the testimony adduced at the hearing, and by comparing the narcotic control records with the "Nurses Notes" on several patients; it is clear that on April 8th and 9th, 1975, respondent did not chart or note as having administered a substantial quantity of the drugs withdrawn by her. Furthermore, many that she did chart were not specific as to the time administered or the time charted was a half hour or more from the time listed on the narcotic control record.

   
   

7. There was no evidence that respondent was using these drugs for her own purposes or that the patients, in fact, did not receive their medication after it was withdrawn by respondent.

   
   

8. It was respondent's testimony that the discrepancies existing between the narcotic control sheets and the "Nurse's Notes" resulted from either errors in charting on another patient's chart or mistakenly forgetting to chart the administration due to being so busy or short-staffed. Respondent denied taking any of the narcotic drugs herself.

   
   

   CONCLUSIONS OF LAW

   
   

9. Respondent is charged with unprofessional conduct in that she did, on April 8th and 9th, 1975, withdraw a greater quantity of controlled drugs than her nurse's notes reveal as having been administered. The undersigned concludes that the evidence adduced at the hearing is clear that respondent did in fact

   fail to chart the administration of controlled drugs to the patient's for whom such drugs were withdrawn. Thus, the issue is whether this constitutes unprofessional conduct and, if so, the severity of the penalty to be imposed.

   
   

10. The Board of Nursing has the authority under F.S. s. 464.21(1)(b) to discipline the holder of a nurse's 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."

    
    

    Obviously, it is the acceptable and prevailing practice for a nurse to timely and accurately record medication administered in order to assure proper patient care. The center in which respondent was employed mandated such procedure and respondent was aware of the procedure. While instances may, perhaps, occur where an administration of medicine is not properly recorded on a patient's chart due to either a busy schedule or forgetfulness, this fact does not remove the requirement of accurately and timely charting medicine from acceptable and prevailing nursing practices. The undersigned thus concludes that the respondent's failure to chart the administration of controlled drugs to patients constitutes unprofessional conduct.

    
    

11. The penalties of suspension and revocation of a professional license should always be sparingly and cautiously utilized and directed at those who have committed grievous breaches of duty, endangered patients or would be a threat to patients were they permitted to continue the practice of their profession. Pauline v. Borer, 274 So.2d 1 (Fla. 1973). It is the conclusion of the undersigned that the unprofessional conduct engaged in by respondent represents a grievous breach of duty which could have the effect of endangering patients. However, it is also concluded that the offense committed is not one resulting from lack of skill, training or ability on the part of respondent and that the penalty to be imposed should serve both the disciplinary purposes of the law as well as the public in general who are entitled to receive the benefit of respondent's training. With this in mind, it is felt that the penalty of revocation of respondent's license would be too harsh, and that a penalty of suspension would be more appropriate.

RECOMMENDATION

Based upon the findings of fact and conclusions of law recited above, it is recommended that the Board of Nursing find respondent guilty as charged in the administrative complaint and suspend respondent's license for a period of six

(6) months.

Respectfully submitted and entered this 9th day of August, 1976, in Tallahassee, Florida.

DIANE D. TREMOR, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304

(904) 488-9675

COPIES FURNISHED:

Ms. Geraldine Johnson

Florida State Board of Nursing 6501 Arlington Expressway

Jacksonville, Florida 32211

Mr. Juluis Finegold

1130 American Heritage Life Building Jacksonville, Florida 32202

Ms. Dorothy M. Hall Cobb 1720 West 13th Street Jacksonville, Florida 32209

Docket for Case No: 76-000741

Orders for Case No: 76-000741