STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

FLORIDA STATE BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 78-1857

) FSBN DOCKET NO. 78-82

MARY KAREN FASOLKA, R.N. )

)

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 case on November 30, 1978, at Ft. Lauderdale, Florida.

APPEARANCES

For Petitioner: Julius Finegold, Esquire

1107 Blackstone Building

Jacksonville, Florida 32202

For Respondent: Maurice Graham, Esquire

2161 East Commercial Boulevard Ft. Lauderdale, Florida 33308

By Administrative Complaint filed September 18, 1978, the Florida State Board of Nursing, Petitioner, seeks to revoke, suspend or otherwise discipline the registration of Mary Karen Fasolka, R.N., Respondent, and Respondent's right to practice thereunder. As grounds therefor it is alleged that during the period from April 15, 1978, to April 21, 1978, Respondent, while employed as a Registered Nurse at Broward General Medical Center, Ft. Lauderdale, Florida, was guilty of unprofessional conduct in the signing out for controlled narcotics for patients and failing to properly chart the administration of same; signing out for Demerol in dosages greater than required and failing to properly account for same; signing out for Demerol for patients at intervals more frequent than called for by doctors' orders; signing out for Demerol for patients in dosages contrary to that ordered by the physician; and signing out for narcotics for patients for whom there were no doctors' orders for such medication.

Respondent's motion to dismiss the complaint on the grounds that Respondent had been fired by Broward General Medical Center on April 26, 1978, and delay of the hearing until November 30, 1978, was untimely, was denied. Thereafter, four witnesses were called by Petitioner and Respondent testified in her own behalf.

FINDINGS OF FACT

1. Mary Karen Fasolka at all times here involved was licensed by the Florida Board of Nursing as a Registered Nurse and was employed by Broward General Medical Center in that capacity.

2. On April 21, 1978, Respondent signed on the narcotic records for 50 mg. Demerol at 10:15 a.m., 11:30 a.m., and 12:15 p.m. and thereon indicated the medication was for patient Pustelnick. At 10:30 a.m. on the same date Respondent signed out for 30 mg/ml of Codeine to be administered to Ms. Pustelnick. Doctor's orders in effect at this time authorized the administration of Demerol every four hours to Ms. Pustelnick as necessary for pain. There were no orders in effect authorizing administration of Codeine to Ms. Pustelnick. Neither the patient's medication administration record nor the nurses' notes showed either medication had been administered to Ms. Pustelnick to Ms. Pustelnick at or about the time they were signed out by Respondent.

   
   

3. On April 19, 1978, Respondent signed two entries on the narcotic record. The first entry was 10:45 a.m., Demerol withdrawn for patient Dominico and marked "wasted". The following entry also signed by Respondent showed a time of 9:00 a.m. for the withdrawal of Demerol for Dominico. Dominico was admitted to the hospital at 2:55 p.m. on April 19, 1978, and doctor's orders authorizing administration of Demerol every four hours as needed were entered at 4:40 p.m. Neither of these signouts appeared on patients' medication administration record or in nurses' notes.

   
   

4. On April 21, 1978, Respondent signed out for Demerol at 10:30 a.m. to be administered to patient Davis. No physician's orders were in effect for such medication, and the medication was charted on neither the patient's medication administration record nor the nurses notes.

   
   

5. On April 15, 1978, Respondent signed out for Demerol at 10:00 a.m., at 11:00 a.m., at 2:00 p.m. and at 2:30 p.m. for patient Surless. Doctor's orders authorized Demerol every four hours as needed for pain. Patient's medication administration record does not show this medication was administered and nurses' notes signed by Respondent show patient resting quietly at 10:00 a.m. with no entries respecting administration of Demerol. A 2:40 p.m. entry stated "IV and PO sedation given as ordered".

   
   

6. Acceptable nursing practice requires the charting of medication given a patient in order that other nurses and doctors can ascertain what the patient has received in case an emergency arises after the nurse who administered the medication has gone off duty. Not knowing that narcotics had recently been administered to the patient could lead to the administering of an overdose by another doctor or nurse. Administering medication not included on doctors' orders or on standing orders is not an accepted medical practice.

   
   

7. Taking or using narcotics that have not been prescribed, by a nurse on duty entrusted with the care of seriously ill patients, is also an unacceptable nursing practice.

   
   

8. Testifying in her own behalf Respondent averred that she was not addicted to Demerol and never tried to sell Demerol or to take same from the hospital. She acknowledged that failure to chart medications and failure to follow doctors' orders respecting the administration of narcotics were grave errors which could lead to serious consequences and harm to the patient.

   
   

9. No evidence in mitigation of the offenses alleged was submitted. Supervisors of Respondent had no particular problems with Respondent's performances of duty during the two and one-half years she had worked at Broward General other than the incidents leading to the charges here considered.

   CONCLUSIONS OF LAW

   
   

10. The Division of Administrative Hearings has jurisdiction over the parties and subject matter of these proceedings.

    
    

11. Grounds for disciplinary proceedings against the holder of a license from the nursing board are contained in Section 464.21, Florida Statutes. Among those offenses for which the Board may, upon a finding of guilty, take such disciplinary action, is:

    
    

    (b) Unprofessional conduct, which shall include any departure from, or the failure to conform to, the minimal standards of acceptable and prevailing nursing practice....

    
    

12. Here the evidence was clear and unrebutted that Respondent withdrew narcotics for the recorded purpose of administering same to specific patients and did not chart the medication as having been given to the patients. The only conclusions that can be drawn are that Respondent used the narcotics herself, gave them to the patients and failed to chart the administration of this medication, or disposed of the narcotics in some other unauthorized and illegal manner. The clear inference from all the testimony produced was that the Respondent took the Demerol and Codeine, not charted as administered to a patient, herself.

    
    

13. From the foregoing it is concluded that Mary Karen Fasolka during the period April 15 through April 21, 1978, was guilty of unprofessional conduct as alleged. It is, therefore,

RECOMMENDED that the registration of Mary Karen Fasolka as a Registered Nurse be REVOKED.

DONE and ENTERED this 19th day of December, 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 1107 Blackstone Building

Jacksonville, Florida 32202

Maurice Graham, Esquire

2161 East Commercial Boulevard Ft. Lauderdale, Florida 33308

Docket for Case No: 78-001857

Orders for Case No: 78-001857