STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

FLORIDA STATE BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 79-2304

)

JOANNE N. DICKEY, L.P.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 4 March 1980 at Fort Lauderdale, Florida.

APPEARANCES

For Petitioner: Julius Finegold, Esquire

1107 Blackstone Building

233 East Bay Street Jacksonville, Florida 32202

For Respondent: was not present

By Amended Administrative Complaint dated 16 April 1979 the Florida State Board of Nursing, Petitioner, seeks to revoke, suspend or otherwise discipline the license of Joanne N. Dickey as a licensed practical nurse. As grounds therefor it is alleged that on November 24, 26 and 27, 1978, 7 while on duty as an LPN at Memorial Hospital, Hollywood, Florida, Respondent signed out on the Narcotic Control Record for controlled substances, to wit: hydromorphone and/or meperidine (trade name, Demerol) for patients Irving Cohen, Daniel Barkoski, Pauline Giles, Paul Scholl, Rebecca Evins and Jack Demma, and failed to enter the giving of medications on either the nurses notes or on the medication administration record. It is further alleged that failure to chart the administration of controlled substances or mishandling of these controlled substances constitutes unprofessional conduct. Four witnesses were called by Petitioner and 14 exhibits, consisting predominately of medical records of Memorial Hospital, were admitted into evidence. Exhibit 1, the receipt for certified mail containing the Amended Administrative Complaint, sent to the same address as the Notice of Hearing and signed by Respondent, was offered to show Respondent had notice of the charges on 5-26-79.

FINDINGS OF FACT

1. Joanne N. Dickey is licensed by Petitioner as a licensed practical nurse and holds license number 37835-1. During the period November 24 through November 28 Respondent was so licensed and was employed by Memorial Hospital, Hollywood, Florida on the 11:00 p.m. to 7:00 a.m. shift.

2. Standard procedures established by Memorial Hospital regarding the accounting for controlled substances are for the nurse withdrawing medication for administering to a patient to record the withdrawal on the Narcotic Inventory Sheet on which a running inventory for a 24-hour period is kept, and, upon administering the medication to the patient, chart the medication on the medication administration record and in the nurses notes for the patient. Standard procedures established for accounting for excess drugs withdrawn (e.g., where doctor's orders call for 50 mg. and only 100 mg. ampules are available) prescribe that the excess drug withdrawn be disposed of in the presence of another witness and so recorded on the waste record. These procedures are presented to all nurses at Memorial Hospital during their compulsory training periods before they administer to patients at Memorial Hospital.

   
   

3. On November 26, 1978, Respondent, at 1:15 a.m., signed out on the narcotic control record for 100 mg. meperidine for patient Cohen, but this medication was not entered on either the medication administration record or on the nurses notes for this patient. At 4:30 a.m., Respondent signed out for 75 mg. meperidine for patient Cohen and the administration of this medication was not entered on the patient's medication administration record or in the nurses notes. Doctor's orders for Cohen at this time authorized the administration of 50-75 mg. meperidine presumably not given to Cohen. No entry was made on the waste record.

   
   

4. On November 27, 1978 at 12:30 a.m., Respondent signed out for 75 mg. meperidine and at 4:00 a.m. for 100 mg. meperidine for patient Cohen on the narcotic inventory sheet, but the entry of the administering of these medications to patient Cohen was not entered on the medication administration record or in the nurses notes. Again, no waste record was made for the excess over the 50-75 mg. authorized. Further, doctor's orders in effect on November 27, 1980 for patient Cohen did not authorize administration of meperidine.

   
   

5. At 2:15 a.m. on November 27, 1978 Respondent signed out for 75 mg. meperidine and at 5:30 a.m. 50 mg. meperidine for patient Barkoski. No record of administering these medications was entered on the patient's medical administration record or in the nurses notes. Doctor's orders authorized administration of 50 mg. meperidine as necessary. No entry of disposal of the excess 25 mg. was entered in the waste record.

   
   

6. At 4:20 a.m. November 24, 1978 Respondent signed out for 75 mg. Demerol for patient Giles. No entry was entered on the medical administration record or in nurses notes that this medication was administered to patient Giles.

   
   

7. At 3:30 a.m. on November 24, 1978 Respondent signed out for 25 mg. Demerol for patient Evins but no entry was made on the patient's medical administration record or in the nurses notes that this medication was administered to the patient.

   
   

8. At 12:50 a.m. on November 24, 1978 Respondent signed out for 100 mg. Demerol and at 4:30 a.m. signed out for 50 mg. Demerol for patient Demma. No entry was made in the medication administration record or nurses notes for Demma that this drug was administered. Doctor's orders in effect authorized administration of 50-75 mg. Demerol as needed. No entry was made on waste record for the overage withdrawn.

   
   

9. On the 11-7 shift on November 27, 1978, Respondent's supervisor noticed Respondent acting strangely with dilated pupils and glassy eyes. She suggested Respondent go home repeatedly and sent her to the lounge but Respondent soon

   returned to the floor. Respondent was finally told if she didn't go home the supervisor would call Security. The supervisor had checked the narcotic inventory log at 4:50 and saw no entries thereon. By the time Respondent was finally sent home at 6:00 a.m., the entries on the Narcotic Control Record at 12:30, 1:15, 2:15, 4:30 and 5:30 were entered.

   
   

10. Failure to chart the administration of narcotics to patients does not comply with acceptable and prevailing nursing practices.

    
    

11. No evidence regarding the administering of hydromorphone was submitted.

    
    

    CONCLUSIONS OF LAW

    
    

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

    
    

13. Grounds for revocation or suspension of the license of a registered practical nurse are contained in Section 464.018(1), Florida Statutes, which provides in pertinent part:

    
    

    1. Unprofessional conduct, which shall include, but not be limited to, any departure from, or the failure to conform to, the minimal standards of acceptable and prevailing nursing practice, in which case actual injury need not be established.

    2. Engaging or attempting to engage in the possession, sale, or distribution of controlled substances as set forth in chapter 893, for any other than legitimate purposes.

    3. Being unable to practice nursing with reasonable skill and safety to patients by reason of illness, drunkenness, use of drugs, narcotics, chemicals, or any other type of material or as a result of any mental or physical condition.

       
       

14. Failure to chart the administration of drugs constitutes unprofessional conduct as defined above. Board of Nursing v. Crawford, DOAH Case No. 79-1024, R. O. 17 July 1979; Board of Nursing v. Hegedus, DOAH Case No. 78-2058, R. O. 20 April 1979.

    
    

15. Unauthorized use of or possession of controlled substances not in the course of professional practice also constitutes unprofessional conduct.

    
    

16. Here the evidence was unrebutted that Respondent, on 27 November 1978, was unfit to practice nursing by reason of being under the influence of narcotics, presumably Demerol or another drug.

    
    

17. From the foregoing it is concluded that during the period 24-28 November 1978 Joanne N. Dickey, LPN, committed numerous charting errors, failed to properly account for controlled substances, was in possession of controlled substances without authorization, and was on November 27, 1978 unfit to practice nursing by reason of being under the influence of narcotics. It is therefore

RECOMMENDED that the license of Joanne N. Dickey as a Licensed Practical Nurse, License No. 37838-1, be revoked.

K. N. AYERS, Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301

(904) 488-9675

COPIES FURNISHED:

Julius Finegold, Esquire 1107 Blackstone Building

233 East Bay Street Jacksonville, Florida 32202

Ms. Joanne N. Dickey

2903 Northwest 60th Avenue Number 112

Sunrise, Florida 33313

Docket for Case No: 79-002304

Orders for Case No: 79-002304