STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 79-281

)

MARY STELLA GHANSAH, )

)

Respondent. )

)

RECOMMENDED ORDER

This case was heard pursuant to notice in Miami Beach, Florida, on April 3, 1979, by Stephen F. Dean, assigned Hearing Officer of the Division of Administrative Hearings. This case was presented on an administrative complaint alleging that Mary Stella Ghansah had violated Section 464.21(1)(b) and (d), Florida Statutes.

APPEARANCES

For Petitioner: Julius Finegold, Esquire

1107 Blackstone Building

233 East Bay Street Jacksonville, Florida 32202

For Respondent: Joyce H. Knox, Esquire

824 Northwest 7th Street Road Miami, Florida 33136

FINDING OF FACT

1. Mary Stella Ghansah is a registered nurse holding license #83538-2 issued by the Florida State Board of Nursing.

   
   

2. On April 10, 1978, Ms. Ghansah was employed at Mt. Sinai Medical Center in Miami Beach, Florida, in a unit described as 2 Warner as a registered nurse on the 3:00 to 11:00 shift.

   
   

3. On April 10, 1978, Ms. Ghansah signed' out for Dilaudid, a controlled substance, for Louis Saichek at 2300 and 2320 hours. Ms. Ghansah also signed out for Dilaudid at 2000 hours for a patient whose name is illegible. The only patient in the unit with a name close to that appearing on the narcotic sign out registered was Saichek.

   
   

4. The medication administration record for Saichek shows that Ms. Ghansah administered Dilaudid to Saichek at 2200 and 2300 hours on April 10, 1978. An earlier entry for April 10, 1978, shows that Dilaudid was administered to Saichek at 1800 hours by Ms. Ghansah.

5. The physician's order for Dilaudid for relief of pain as needed every four hours was entered on April 5, 1978, and orders for controlled substances expire automatically at the end of 72 hours at Mt. Sinai Medical Center.

   
   

6. Ms. Ghansah administered this controlled substance without a physician's order, administered the medication two times within approximately one hour, and failed to chart the times correctly as they relate to the times reflected on the sign out sheet.

   
   

7. Ms. Ghansah signed out for 50 mg of Demerol, a controlled substance, on the narcotic sign out sheet at 2100 hours. The patient's name and physician's name is illegible due to having been written over. Ms. Ghansah asserted this entry was for a patient, Morris Rudin. Rudin's medication administration record reflects physician's orders for Demerol 50 mg in three places. An initial order was entered on April 3, 1978. A second order was entered on April 8, 1978. A one-time order was entered at 0700 hours on April 11, 1978. The one-time order was ordered for Wednesday before 8:00 a.m.

   
   

8. The physician's order on April 8, 1978, covered administration of Demerol, but no entry was made on the medication administration record of the administration.

   
   

9. Ms. Ghansah signed out for 2 mg of Dilaudid at 1800 hours on April 10, 1978, for a patient, Behzat Ozan. The physician's orders of April 9, 1978, prescribed 1/48 grain (approximately 1.5 mq) of Dilaudid as needed for relief of pain every three hours. The wastage was recorded on the back of the form but was not witnessed as required.

   
   

10. Ms. Ghansah signed out phenobarbital 15 mg tablets for a patient, Ida Rubinfeld, at 1600 hours on April 10, 1978. Phenobarbital 15 mg had been prescribed for Rubinfeld for administration at bedtime. Rubinfeld's medication administration record reflects that she received the medication at 2200 hours.

    
    

11. Ms. Ghansah explained that medications prescribed for specific times were drawn at one time, placed on her cart which was locked, and then administered. This saved time in medication administration, and the drugs were secure. There is no apparent violation of any procedure or safeguards in this practice.

    
    

12. Ms. Ghansah went to another unit, 4 Warner, on April 10, 1978, and obtained 2 ampuls of Dilaudid 2 mg for patients on 2 Warner, Alex Rodin and Jacob Cohen. These were signed out to her in accordance with hospital procedures. The medication records of neither Cohen nor Rodin reflect physicians' orders for Dilaudid on April 10, 1978, and no record of administration was made. No record of the disposition of these two ampuls was made.

    
    

13. It is contrary to accepted nursing standards to:

1. Administer medications without a physician's orders;

2. Fail to chart the administration of medications; and

3. Waste narcotic drugs without a witness to the wastage.

CONCLUSIONS OF LAW

1. The Florida State Board of Nursing charges that Ms. Ghansah has violated Section 464.21(1)(b), Florida Statutes, by engaging in unprofessional

   conduct, and Section 464.21(1)(d) by violating Chapter 893, Florida Statutes, by being in possession of a controlled substance.

   
   

2. Section 464.21(1)(b) , supra, provides that the Florida State Board of Nursing may discipline a licensee who is determined to be guilty of unprofessional conduct which is the departure from or failure to conform to accepted prevailing nursing practices. The statute does not require any actual injury to be established.

   
   

3. Ms. Ghansah's administration of controlled sub stances without a physician's order was a violation of Chapter 893, Florida Statutes, and a clear departure from accepted and prevailing practices. Ms. Ghansah's failure to chart the administration of medication was a clear departure from accepted and prevailing nursing standards. Ms. Ghansah's failure to have a witness sign the disposal of excess controlled substance was a departure from accepted and prevailing nursing practice. Ms. Ghansah violated Section 464.21(1)(b), supra.

   
   

4. Section 464.21(1)(d) provides that engaging in the possession of a controlled substance as defined by Chapter 893 for other than a legitimate purpose shall be grounds for discipline by the Florida State Board of Nursing.

   
   

5. Ms. Ghansah signed out for and received two ampuls of Dilaudid 2 mg from Donna Leah (phonetic) ostensibly for two patients, Cohen and Rudin. Dilaudid is the trade name for hydromorphone, a Class I substance as defined by Chapter 893, Florida Statutes. Review of Cohen's and Rudin's records reveals no physicians' orders for this drug, and the 4 mg of Dilaudid was not accounted for by notation of its administration. A nurse may only possess a controlled substance by prescription for herself, or pursuant to orders for administration duly issued by appropriate authority. It is clear that Ms. Ghansah lacked the authority to administer this controlled substance to either patient for whom it was drain. The Dilaudid was delivered to Ms. Ghansah, and she did possess a controlled substance as defined by Chapter 893, supra, without any legitimate purpose. Ms. Ghansah violated Section 464.21(1)(d) , Florida Statutes.

   
   

   MITIGATION

   
   

6. Mary Stella Ghansah has been a registered nurse for approximately three years. She received the majority of her training outside the United States. She is hampered to some degree in her practice by the shift to U.S. standards of practice. She has been working dual shifts regularly in order to support her son's college education. This apparently has placed substantial strain on her ability to handle her professional responsibilities. Although there is no evidence that Ms. Ghansah used any of the controlled substances which were unaccounted for, there is substantial circumstantial evidence that she had possession of the drugs and the opportunity to dispose of them for profit or use them herself.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of Law the Hearing Officer would recommend that the license of Mary Stella Ghansah be revoked.

DONE and ORDERED this 17th day of April, 1979, in Tallahassee, Leon County, Florida.

STEPHEN F. DEAN, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304

(904) 488-9675

COPIES FURNISHED:

Julius Finegold, Esquire 1107 Blackstone Building

233 East Bay Street Jacksonville, Florida 32202

Joyce H. Knox, Esquire 825 NW 7th Street Road Miami, Florida 33136

Docket for Case No: 79-000281

Orders for Case No: 79-000281