STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

FLORIDA STATE BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 77-969

)

LAURA A. MORGAN, L.P.N., )

)

Respondent. )

)

RECOMMENDED ORDER

This matter came on for hearing in Jacksonville, Florida, before the Division of Administrative Hearings by its duly designated Hearing Officer, Robert T. Benton, II, on September 2, 1977. The parties were represented by counsel:

APPEARANCES

For Petitioner: Mr. Julius Finegold, Esquire

1005 Blackstone Building

Jacksonville, Florida 32202

For Respondent: Mr. Frederic A. Buttner, Esquire

Barnett Bank Building Jacksonville, Florida 32202

By administrative complaint mailed April 29, 1977, petitioner accused respondent of certain irregularities in connection with missing drugs at University Hospital in Jacksonville, where she was employed on January 21, 1977.

FINDINGS OF FACT

1. Respondent, a licensed practical nurse, worked the 7 to 3 shift on the south end of the eighth floor of University Hospital, Jacksonville, Florida. She and the nurses with whom she worked were divided into two teams, each of which took responsibility for certain patients. Respondent was on team one. The patient Lena Rogers, who was on eighth floor south on January 21, 1977, was assigned to team two. On the morning of January 21, 1977, respondent reported for work as usual.

   
   

2. As a routine matter, the hospital pharmacy had earlier delivered to eighth floor south a box containing 25 ampules of Demerol. Each ampule contained 50 cc of Demerol. Accompanying the box of ampules were three sheets of different colored paper, each of which was stamped with the same number as the box. The green sheet was signed by a nurse on eighth floor south and returned to the pharmacy as its receipt for the Demerol. The yellow control sheet was lost in its entirety. While this is not an every day occurrence, such sheets are lost about once a month at University Hospital, and the evidence was devoid of any indication that the yellow control sheet had been intentionally

   mislaid. The white sheet, containing 25 shingled charge slips, remained with the box of Demerol. Nurses administering Demerol to patients were expected to fill out one of the slips each time an ampule of Demerol was used, indicating which patient should be billed for the drug.

   
   

3. The accepted procedure is for nurses, after administering drugs to their patients, to note that fact on the patients' charts, in the nurse's notes, and on a medication graph. These records are supposed to be updated immediately after medicine is administered but, not infrequently, nurses wait until the end of their shifts to do record keeping. This departure from accepted practice is less frequent, however, in the case of controlled drugs like Demerol. When it is necessary for a nurse to waste drugs like Demerol, accepted practice requires that the wasting be witnessed by another nurse, after which both nurses are to sign the yellow control sheet.

   
   

4. On January 21, 1977, respondent Morgan signed 16 charge slips, but crossed through her signature on one of them. The remaining charge slips signed by respondent indicated a patient named Williams should be billed for four ampules of Demerol; that a patient named Fowler should be billed for four ampules of Demerol; that a patient named Fisher should be billed for three ampules of Demerol; and that patients named Rogers and Richards should each be billed for two ampules of Demerol. About half past one on the afternoon of January 21, 1977, Jonti Lute, R.N., who also worked on eighth floor south, noticed that respondent appeared drowsy and as if she were in a daze.

   
   

5. Ms. Karen Harris, the house supervisor for the 7 to 3 shift, was on eighth floor south on the afternoon of January 21, 1977, making her rounds. Ms. Harris observed respondent sitting at the nurses station, writing on charts, and occasionally nodding. Respondent's eyes were dry and she was continually wetting her lips with her tongue. When she stood up, she held on to a table for support. As she left the nurses' station, she tripped over her own feet and bumped into a partition. Her speech was slurred. Ms. Harris suggested that respondent accompany her to the hospital employees' clinic. Respondent protested and the director of nursing, Ms, Apol, was summoned.

   
   

6. Before her shift ended, respondent went to the employees' clinic where she was examined by Dr. Lipkovich. As part of the examination, respondent gave a urine specimen, 50 cc of which was sent to a laboratory for chemical analysis. Mr. Bush, a chemist, testified that analysis disclosed the presence of Demerol in this sample in a quantity of "25 mg. per cent." By her own admission, respondent injected herself with the contents of one ampule of Demerol, while she was on duty. Respondent testified that she administered some of the remaining Demerol to the patients she had indicated on the charge slips should be billed for the medicine, and wasted the remainder by ejecting it from syringe(s) into a sink. None of the charts of the patients whom respondent indicated should be billed for Demerol on January 21, 1977, contained any indication that Demerol had been administered to the patients on that date. Respondent testified that nobody had witnessed her wasting Demerol on January 21, 1977.

   
   

   CONCLUSIONS OF LAW

   
   

7. Petitioner demonstrated that respondent was guilty of a "departure from

. . . the minimal standards of acceptable and prevailing nursing practice," within the meaning of Section 464.21(1)(b), Florida Statutes (1975)

RECOMMENDATION

Upon consideration of the foregoing, it is RECOMMENDED:

That petitioner revoke respondent's nursing license.

DONE and ENTERED this 28th day of October, 1977, in Tallahassee, Florida.

ROBERT T. BENTON, II

Hearing Officer

Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304

COPIES FURNISHED:

Mr. Julius Finegold, Esquire 1005 Blackstone Building

Jacksonville, Florida 32202

Mr. Frederic A. Buttner, Esquire Barnett Bank Building Jacksonville, Florida 32202

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AGENCY FINAL ORDER

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BEFORE THE FLORIDA STATE BOARD OF NURSING

IN THE MATTER OF:

Laura A. Morgan

3149 West 19th Street

Jacksonville, Florida 32205 Docket No. 77-969

As a Licensed Practical Nurse License Number L.P.N. 38934-1

/

ORDER

The above entitled cause came on to be heard by the Florida State Board of Nursing on the 17th day of January, 1978, in the Board of Construction Industry Conference Room, 6501 Arlington Expressway, Building B, Jacksonville, Florida 32211.

The Board, having reviewed the entire record, including all the pleadings, exhibits admitted into evidence, the transcript of hearing proceedings, the Findings of Fact, Conclusions of Law and Recommended Order of the Hearing Officer, adopts the Findings of Fact of the Hearing Officer.

Based upon the Findings of Fact, the Board concludes that the Respondent is guilty of unprofessional conduct in violation of Florida Statutes, Chapter 464.21(b) and IT IS THEREFORE:

ORDERED AND ADJUDGED that the licensed practical nurse license number 38934-1 of the Respondent, Laura A. Morgan, be suspended for a period of two years. That the suspension be stayed after a period of one year and the licensee be placed on probation for the period of one year with the following terms and conditions:

1. That the Respondent shall return license number 38934-1 issued to practice nursing as a licensed practical nurse to the Florida State Board of Nursing within seven (7) days of the receipt of this Order. The failure to comply shall be deemed a violation of this condition of the probation.

   
   

2. That the Respondent refrain from violation of any law, Federal, State, or Local.

   
   

3. That the Respondent contact an Adult Mental Health Clinic or qualified Psychiatrist for counseling and provide this office with a report every three

1. months of her progress in the program.

   
   

2. That the Respondent inform the Florida State Board Nursing immediately of any change of address or change of employment.

   
   

3. That the Respondent contact the Florida State Board of Nursing every three (3) months and inform this office of her residence address and place of employment.

   
   

4. That the Respondent request her employer to provide this office with an evaluation of her nursing performance every (3) months while on probation to this Board.

DONE AND ORDERED this 30th day of January, 1978, at Jacksonville, Florida.

BOARD SEAL

ccs: Laura A. Morgan

3149 West 19th Street

Dorothy C. Stratton, R.N., President Florida State Board of Nursing

Jacksonville, Florida 32205

Mr. Frederic A. Buttner, Esquire Barnett Bank Building Jacksonville, Florida 32202

Mr. Julius Finegold, Esquire

Docket for Case No: 77-000969

Orders for Case No: 77-000969