vs. ) CASE NO. 76-1548
Respondent. )
A hearing was held in the above captioned matter, after due notice, on January 5, 1976, at Crestview Florida before the undersigned Hearing Officer.
For Respondent: Ernest L. Cotton and
Woodburn S. Wesley, Jr., Esquires
Whether Respondent's license as a licensed practical nurse should be revoked for alleged violation of Section 464.21(1)(b), Florida Statutes.
The hearing in this case was originally set for November 1, 1976 but was continued until January 5, 1977, at the request of the Respondent.
Respondent is licensed by Petitioner as a licensed practical nurse, License Number 21725-1 and was so licensed during the years 1974 and 1975.
Respondent was first employed by Okaloosa Memorial Hospital Crestview Florida in 1965 as a nurse's aide and remained in this capacity until 1968 when she took a leave of absence to attend classes to obtain her license as & practical nurse. She was employed as a licensed practical nurse at the hospital from September 1969 until August 27, 1975. Her primary duty as an LPN was medication nurse on the 7-3 shift. (Respondent's Composite Exhibit 1)
On September 27, 1974, Respondent signed out for 100 mg. of "meperidine inj" at 2:15 P.M. on a hospital Narcotic Administration Record for that drug for Station Number 1. The record reflects that the drug was drawn from hospital stock to be administered to patient Tommy Davis. Demerol is the trade name for
meperidine and it is a controlled narcotic analgesic drug. Although the Nurses Bedside Record for the patient for that day should have reflected administration of the drug to the patient by the initials of the Respondent, the record does not show such an entry by her or anyone else. Hospital practice also requires that administration of medication be shown on the nurses progress notes for the patient, but there is no record in such notes for the date in question regarding patient Davis having received the medication in question. (Testimony of Bronson, Mitchell, Petitioner's Exhibits 2, 5).
A hospital Narcotic Administration Record for "meperidine, 100 mg., inj." for Station Number 1 reflects that on February 8, 1975 at 2:00 P.M. Respondent withdrew 100 mg. of the drug for patient Roy Bringhurst. However, neither the Nurses Bedside Record nor the nurses progress notes reflect that the drug was administered to the patient by Respondent or anyone else at that time. (Testimony of Bronson, Mitchell; Petitioner's Exhibits 3, 6).
A hospital Narcotic Administration Record for "meperidine 75 mg. inj." for Station Number 1 shows that on February 23, 1975, at 1:00 P.M., Respondent signed out for 75 mg. of the drug for patient Mary Corbin. Neither the Nurses Bedside Record nor nurses progress notes for the patient reflect that the drug was administered at that time by Respondent or anyone else. (Testimony of Bronson, Mitchell; Petitioner's Exhibits 1, 4).
In early August, 1975, personnel of the hospital pharmacy brought to the attention of the hospital administrator the fact that a large quantity of the drug, Thorazine, was being used at Station 1 in the hospital. Medical records reflected that the drug had been used only four times during a five day period when ten vials had been issued. Each vial would provide about five to ten normal injections. It was further noted that after Respondent went on a ten day leave of absence, no Thorazine was used during that period at Station 1. When Respondent returned on August 19th, she requisitioned two bottles of Thorazine for Station Number 1 from the pharmacy and these bottles were given to her by pharmacy personnel on that date. During Respondent's noon hour absence, the hospital Administrator and Director of Nursing went to the medication room of Station 1 and observed a partially full bottle of Thorazine which had been there for some time and had been issued to the station on August 8th. The bottle also had been observed in the medication room by the Director of Nursing at 6:30 A.M. on August 19th before Respondent started her shift. At that time, it also was noted that the trash can in the medicine room was empty.
During the noon hour investigation, it was discovered that an empty bottle of Thorazine was in the trash can and another empty bottle was found in general trash outside the hospital. When Respondent returned from lunch, she was asked to step into the medicine room and there the Administrator asked her what had happened to the two bottles of thorazine. Respondent stated that she had administered one injection to patient Barnes and another to patient Nelson and that a third injection had been given to her son. She was unable to account for the remaining amount that had been drawn earlier that day. She consented to the Administrator examining her handbag and therein was found twelve Thorazine tablets in a medicine cup. When asked about them, Respondent admitted that they came from hospital stock supplies and that she had planned to take them home for use by her husband who suffered from heart trouble. Later that day, patient Nelson told the Director of Nursing that he had not received an injection since early in the morning of August 19th and patient Barnes denied having received any injection of the drug that day. Subsequent to August 19, Respondent provided a written statement to hospital authorities in which she said that she gave Thorazine intramuscularly rather than orally to patient
Nelson by mistake and that she gave a Thorazine injection to patient Barnes due to her negligence in not ascertaining that such medication had not been ordered for him. Contrary to the statement she had made concerning her son, in fact, the shot which she administered to him at the hospital on August 19 was penicillin which he had brought from home to the hospital on that day. He was then suffering from a cold. The penicillin had been purchased at a pharmacy by Respondent in June, 1975, for possible future use. (Testimony of Mitchell, Howard, Helms, Carl Godwin, Petitioner's Composite Exhibit 7, Petitioner's Exhibit 8, Respondent's Exhibit 2).
Respondent testified as a witness and admitted taking the 12 Thorazine tablets from hospital supplies on August 19, 1975, because her husband was not feeling well and she thought the medication would help him. She conceded that it was wrong for her to take the tablets and offered no other excuse for her action. Although she admitted requisitioning the two bottles of Thorazine on August 19th, she testified that these were not delivered to her but that she saw them in a basket in the medicine room about 10:00 A.M. She further testified that it was entirely possible that she could have made the charting errors, as alleged, due to the fact that frequently she had a large number of patients asking for medication at the same time and she was not able to chart such medication until after her shift had finished. At such times she might have forgotten a particular dosage administered to a patient. She stated that she had ordered the two bottles of Thorazine on August 19th because the Director of Nursing had previously required that two bottles be in stock at Station Number 1 at all times. (Testimony of Respondent).
In 1975, it was not uncommon for the hospital's nurses to chart their medication at the end of their shift rather than at the time of administration. Although hospital employees were routinely provided such medications as aspirin or antacid from hospital supplies, there was no authorization for them to take or receive other drugs without a doctor's orders. Although several witnesses testified that there were rather loose practices in the hospital regarding employees receiving medication, no specific instances were cited to establish that taking drugs without permission was the norm. (Testimony of Howard, McLaughlin, Downes, Deaton).
In view of the foregoing findings the, following further findings are made:
On three separate occasions in 1974 and 1975, while on duty as a medication nurse at the Okaloosa Memorial Hospital, Crestview, Florida, Respondent drew quantities of meperidine (demerol) from hospital supplies for specified patients and failed to chart the administration of such drugs in patient records.
On August 19, 1975, Respondent wrongfully took twelve Thorazine tablets from Okaloosa Memorial Hospital supplies for personal use.
On August 19, 1975, Respondent received two bottles of Thorazine from the Okaloosa
Memorial Hospital pharmacy ostensibly for patient use, but wrongfully disposed of the same in an unknown manner.
Respondent enjoys a good reputation as a licensed practical nurse. In fact, the hospital Administrator is of the opinion that she was the best medication nurse in the hospital before she became ill in 1974. Her coworkers attest to her loyalty, honesty, and conscientious work. She enjoys a good reputation in her community where she has lived for a lifetime, and a number of her former patients submitted statements concerning her excellent work while under her care. She has been employed at the Crestview Nursing Convalescent Home, Crestview, Florida, since September 30, 1975 and has performed her duties there in a very commendable manner. Her employer wishes to retain her as a licensed practical nurse due to the fact that she is particularly qualified to handle elderly patients and competent nurses for this type of work are difficult to find. (Testimony of Howard, McLaughlin, Sanford, Downes, Deaton, Baldwin, Respondent's Composite Exhibit 1).
CONCLUSIONS OF LAW
Petitioner seeks to revoke Respondent's license as a practical nurse and her right to practice thereunder for unprofessional conduct in violation of Subsection 464.21(1)(b), Florida Statutes which provides pertinently as follows:
464.21 Disciplinary proceedings.--
(1) GROUNDS FOR DISCIPLINE. -- The Board shall have the authority to. . .discipline the holder of a license. . .who has been heard and found guilty by the board of:
(b) 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.
Although Chapter 464, F.S. does not define the terms "unprofessional conduct" or "minimal standards of acceptable and prevailing nursing practice", Subsection 464.021(2)(b), F.S. sheds light on the matter by defining practical nursing as follows:
464.021 Definitions. -- As used in this chapter unless the context clearly indicates otherwise:
(2)(b) "Practice of practical nursing means the performance of selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirm, and the maintenance of health and prevention of illness of others under the direction of a registered nurse, a licensed physician, or a licensed dentist.
The professional nurse and the practical nurse shall be responsible and accountable for making decisions that are based upon the individual's educational preparation and experience in nursing.
It thus can be seen that the proper administration of medications is a key aspect of practical nursing practice. Respondent's failure to "chart" a
controlled drug to show that it was administered to particular patients on three different occasions unquestionably constitutes a departure from minimal acceptable and prevailing nursing practice as established by the testimony of hospital personnel. Although perfect recordkeeping may not be possible when hospital wards are crowded and nursing personnel are pushed for time, the testimony of hospital authorities and Respondent herself acknowledged the importance of accurately charting medication to ensure that unnecessary multiple doses are not given to a patient by a succeeding nurse who is unaware of the previous administration of a drug.
Further, it is clear that Respondent's unauthorized taking of hospital drugs in the form of twelve Thorazine tablets for the use of her husband constitutes unprofessional conduct. Additionally, her failure to adequately account for the disposition of two bottles of Thorazine that she had obtained from the hospital pharmacy indicates at best a gross disregard of her responsibilities as a medication nurse to safeguard and account for drugs entrusted to her care.
In view of the foregoing, it is concluded that Respondent has exhibited unprofessional conduct in violation of Subsection 464.21(1)(b), Florida Statutes.
In considering an appropriate penalty for Respondent's above-stated misconduct, cognizance is taken of her otherwise excellent record as a licensed practical nurse at the Okaloosa Memorial Hospital, the good reputation she enjoys in the community, and her exemplary performance of duty over the past year at the Crestview Nursing and Convalescent Home. However, her negligence in proper maintenance of patients' records and her derelictions with respect to drugs are serious matters and warrant adequate disciplinary measures. It is considered that the ends of justice properly would be served by suspension of her license to practice for a period of six months, but that the enforcement of such suspension be held in abeyance and that she be placed on probation for a like period.
That Respondent's license as a licensed practical nurse be suspended for a period of six months, but that the enforcement thereof be suspended for a like period during which time Respondent should be placed on probation.
DONE and ENTERED this 24th day of January, 1977, in Tallahassee Florida.
THOMAS C. OLDHAM
Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304
Ernest L. Cotton &
Woodburn S. Wesley, Jr., Esquires
