Judges: P. MICHAEL RUFF
Agency: Department of Health
Latest Update: Dec. 03, 1982
Summary: Nurse who failed to properly account for controlled drugs and made false reports on medications on probation one year with mandatory continuing comprehensive education on proper drug use.
82-0855STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF NURSING, )
)
Petitioner, )
)
vs. ) CASE NO. 82-855
)
PATRICIA J. CANFIELD, )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to notice, this cause came on for hearing before P. Michael Ruff, Hearing Officer with the Division of Administrative Hearings, on September 20, 1982, at St. Augustine, Florida.
APPEARANCES
For Petitioner: W. Douglas Moody, Jr., Esquire
119 North Monroe Street Tallahassee, Florida 32301
For Respondent: Charles Pellicer, Esquire
28 Cordova Street
St. Augustine, Florida 32084
By its Administrative Complaint filed February 2, 1982, Petitioner seeks to suspend or revoke the Respondent's practical nurse's license or otherwise impose discipline upon the Respondent to the extent of her licensure status, alleging that at various times in the month of November, 1981, the Respondent, who at the time was a licensed practical nurse employed at the Florida School for the Deaf and Blind at St. Augustine, Florida, was working in the school infirmary and signed medication records for various doses of Darvon medication, recording that they were issued to certain students who were patients at the infirmary, and that those students never received the medication. It is further alleged that at various times during the month of November, 1981, that Respondent signed her name on medication administration records indicating that she had obtained various units of Phenaphen and Darvon from the dispensary for administration to student patients, but that the administration of the drugs is not noted in the nursing notes ascribed to those student patients. Petitioner is thus alleging that the Respondent's failure to document the administration of drugs to various patients and alleged failure to actually deliver and administer the medication to various patients constitutes a departure from minimum standards of acceptable prevailing nursing practice and constitutes falsely documenting medication administration records, and, further, that the Respondent is guilty of possessing a controlled substance for other than a legitimate purpose, all of which conduct is alleged to constitute violations of Subsections 464.018(1)(d) and (f), Florida Statutes, and Subsection 464.018(1)(g), Florida Statutes.
At the hearing the Petitioner presented eight witnesses and the Respondent presented one witness, the Respondent herself. Petitioner presented five exhibits, all of which were admitted into evidence.
The Respondent's Motion for Directed Verdict (more properly termed dismissal) should be granted with regard to Count II to the extent that there has been no evidence adduced in this record to establish that the Respondent engaged or attempted to engage in the possession, sale or distribution of controlled substances as set forth in Chapter 893, Florida Statutes, for any purposes whatever, legitimate or otherwise.
FINDINGS OF FACT
The Petitioner, Department of Professional Regulation, Board of Nursing, is an agency of the State of Florida having jurisdiction over the licensing, regulation of licensure status, and regulation of practice of professional nurses in the State of Florida.
The Respondent, Patricia J. Canfield, is a licensed practical nurse, holding license No. 27935-1 authorizing the practice of practical nursing in the State of Florida. The Respondent has been so licensed at all times material to this proceeding. At all times material to this proceeding the Respondent has been employed as a licensed practical nurse in the infirmary at the Florida School for the Deaf and Blind located in St. Augustine, Florida.
The Respondent was employed on November 29 and November 30, 1981, in the infirmary at the School for the Deaf and Blind when student Aaron Henderson was checked into the infirmary. Petitioner's Composite Exhibit 1 consists of the medication records by which nurse-employees obtained medication, as pertinent hereto Darvon, from the school infirmary dispensary. The Respondent, when she obtained Darvon from the dispensary, initialed this record with the initials "PC." On the dates in question the medication administration records in evidence established that the Respondent signed as having received into her possession one Darvon tablet, reputedly to be administered to patient Aaron Henderson on each of the days, November 29 and November 30. Aaron Henderson, testifying for the Petitioner, was shown a unit of Darvon established to be identical to that dispensed at the infirmary during the material time period in November, 1981. Witness Henderson stated he had never received such a pill from the Respondent, whom he identified as the nurse on duty in the infirmary when he was there on the two days in question.
Witness Patty Grant was a patient in the infirmary on November 16, 1981. It was established that the Respondent signed the medication administration record as having received from the dispensary a Darvon tablet, reputedly to be administered to patient Grant on that date. Patient Grant received asthma medication from the Respondent on that date, but maintained that she had never received a Darvon tablet from the Respondent on that date after being shown a sample Darvon tablet established to be identical to that dispensed by the infirmary during November, 1981.
Student-patient Stratton was a patient in the infirmary on October 22, 1981. On that date the Respondent signed the subject record indicating that she checked out a unit of Darvon from the dispensary on behalf of patient Stratton. Patient Stratton recalled receiving some medication from the Respondent on that date, but did not recall her administering to him a pill of the appearance of the Darvon tablet in use by the dispensary during the time in question.
The Respondent initialed the Darvon medication chart for November 13, 1981, indicating that she had received from the dispensary a Darvon tablet to be administered to patient Diane Matthews. Patient Matthews testified that the Respondent had never given her a Darvon tablet on the date in question.
Included as a part of Petitioner's Composite Exhibit 1 are the Nurses' Notes for the various patients named in the Administrative Complaint. With regard to patient Aaron Henderson, the medication administration records revealed that the Respondent signed for and obtained a unit of Phenaphen on December 8, 1981, for that patient, but the administration of the drug is not recorded in the nursing notes pertaining to patient Henderson. With regard to patient John Wise, the medication administration records revealed that on November 13, and November 16, 1981, the Respondent signed out Darvon tablets on behalf of that patient, but the Nurses' Notes pertaining to patient Wise made no reference whatever to the ultimate disposition of the Darvon.
The medication administration records pertaining to patient Ray Jackson for November 4, 1981, established that the Respondent signed for a unit of Darvon for that patient, but the Nurses' Notes for that patient on that date do not reflect any notation regarding the administration or disposition of that unit of Darvon. The medication administration records for patient Duffy for the date of October 16, 1981, establish that Respondent obtained from the dispensary one unit of Darvon on behalf of that patient; however, her Nurses' Notes contain no indication of the ultimate disposition of that unit of Darvon.
Expert testimony presented by the Petitioner establishes that the failure to document the administration of a drug on a patient's chart does not meet the minimum acceptable and prevailing standards of nursing practice, and that any licensed nurse knows or should know that documenting the administration of medication is a proper and required procedure.
The Respondent testified on her own behalf and established that she has been licensed since 1969 in Michigan and Florida and has worked in St. Augustine at the subject school since 1975. Her duties involve general nursing duties and she customarily sees 50 to 100 student-patients per day on her shift. Frequently, she signs for medication which is obtained from the dispensary or secure area and another person on duty actually administers it, which would explain in part the students not remembering that she administered any Darvon. Often this procedure involves the Respondent working in the back room of the infirmary, obtaining the medication or signing for the medication, and the nurse on duty at the front desk actually giving it to the patient, with that nurse generally keeping the record slip made of the administering of the Darvon. The Respondent acknowledged, however, that Mrs. Harvey, the Head Nurse, had talked to her on one occasion about her neglecting to "chart medication." The Respondent also established that she was under Dr. Gurling's care in November and December of 1981 for a physical condition involving severe vascular headaches, for which she took Darvoset. She took Darvoset, containing Darvon and Tylenol (different from the Darvon tablets involved in this proceeding), because she has an allergy to aspirin and codeine. She filled her prescription for Darvoset in November, 1981, as Dr. Gurling directed and also filled a prescription for December, 1981, at the direction of her doctor. She maintains she never signed out for a drug and converted that drug to her own use and has never improperly taken drugs from the infirmary. She established that although she signed out for some Darvon orders, that they were requested by other nurses who would have been responsible for administering it to the particular students involved. She admits, however, that at times she either forgot to chart medication administered by her or lost the record slip which she normally uses
for charting. In corroboration of her testimony regarding her own medical condition and the use of her own prescriptions for Darvon or Darvoset, Harold E. Waldron, a licensed pharmacist (testifying for the Petitioner), established that a large amount of Darvon had been obtained from his pharmacy by the Respondent in November of 1981 through prescriptions from her doctor. Mr. Waldron's recollection was that she received approximately 180 units of Darvon from his pharmacy in November of 1981. Although Mr. Waldron feels this may indicate some dependency on the drug, his testimony was not allowed on that theme because it was too speculative and non-expert in nature. Indeed, the fact that she received a large amount of Darvoset pursuant to legitimate prescriptions during November and December of 1981, militates in part against a finding that she converted drugs from the dispensary to her own use.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties to and the subject matter of this proceeding. Section 120.57(1), Florida Statutes.
The Administrative Complaint herein charges that the Respondent is guilty of violations of Section 464.018(1)(d), (f), and (g), Florida Statutes, which provide as follows:
The following acts shall be grounds for disciplinary action set forth in this section:
(d) Making or filing a false report or record, which the licensee knows to he false, intentionally or negligently failing to file
a report or record required by state or federal law, willfully impeding or obstructing such filing or inducing another person to do so.
Such reports or records shall include only those which are signed in the nurse's capacity as a licensed nurse.
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.
Engaging at attempting to engage in the possession, sale, or distribution of controlled substances as set forth in chapter 893, for any other than legitimate purposes.
The evidence adduced in this record does not establish in a clear and convincing way, or even by a preponderance, that as a matter of law the Respondent can be found guilty of a violation of the above authority to the extent that she falsely documented medication administration records relating to patients Henderson, Grant, Stratton and Matthews by signing out for Darvon without actually dispensing it to them. The Respondent's testimony, in the face of testimony by these students that in some cases they simply did not recall receiving a Darvon tablet from the Respondent and in all cases their testimony being generally to the effect that the Respondent did not administer a Darvon tablet, is explained to a satisfactory extent by the Respondent's testimony, which was not refuted, that her shift was the busiest one of the day for the
infirmary, and that with 50 to 100 patients being seen on her shift, she frequently would indeed "sign out" on the medication administration record as receiving the drugs on behalf of the students involved, but often another nurse would actually administer the drugs, hence, the students' failure to recall that the Respondent had actually administered the medication to them. Such evidence clearly cannot establish, that the Respondent signed for Darvon, which she then converted to her own use.
The Petitioner has, however, presented sufficient proof that the Respondent failed to properly chart the disposition and administration of the scheduled drugs, as she admits she failed to do on occasion. Such a failure to properly chart disposition and administration of scheduled drugs constitute unprofessional conduct in violation of minimal nursing standards. See Board of Nursing v. Crawford, DOAH. Case No. 79-1024, RO 17 July 1979; Board of Nursing
v. Hegedus, DOAH. Case No. 78-2058, RO 20 April 1979; Board of Nursing v. Jo Ann Dickey, DOAH. Case No. 79-2304, RO 26 March 1980; Board of Nursing v. Shultz, DOAH. Case No. 79-1456.
In summary, the uncontroverted evidence in the record establishes that the Respondent is guilty of a violation of Subsection 464.018(1)(f), Florida Statutes (1981), by failing to properly document the administration of Darvon to patients Henderson, Wise, Jackson and Duffy. The Petitioner has not presented sufficient proof, however, to establish that a violation of Subsection (d) has occurred, in that it was not shown that the Respondent knowingly made a false report or negligently failed to file a report or record required by state and federal law, or willfully impeded or obstructed the filing of such a report or record, nor induced another person to do likewise.
It must also be concluded that the Petitioner has not presented adequate proof that a violation of Section 464.018(1)(g) has occurred since, although the Respondent signed out for Darvon for the patients discussed hereinabove, it was not established by clear and convincing evidence that these patients had not had Darvon administered to them by someone. Further, even if they had not had Darvon administered to them by the Respondent, it was not established that this was a violation since the Respondent's testimony establishes that at busy times she would sign out for the drugs and they would actually be administered by another nurse, nor was it shown that she converted any drugs to her own use or for sale to others. In a penal proceeding such as this, such evidence cannot constitute a basis for a violation of the laws pertaining to licensure such that such evidence can place a respondent's licensure status in jeopardy. See Bowling v. Department of Insurance, 394 So.2d
165 (Fla. 1st DCA 1981); Reid v Florida Real Estate Commission, 188 So.2d 846 (Fla. 2nd DCA 1966).
In summary, it is concluded that the Respondent is guilty of a violation of Subsection 464.018(1)(f) in that she engaged in unprofessional conduct and departed from minimal standards of acceptable, prevailing nursing practice to the extent that she failed to properly chart the disposition and administration of scheduled drugs to patients Henderson, Wise, Jackson and Duffy.
In view of the fact that no serious disciplinary infractions are extant on the Respondent's record as a licensed nurse (other than one occasion when she failed to timely renew her license), it is deemed by the undersigned Hearing Officer that a minimal penalty is warranted.
RECOMMENDATION
Having considered the foregoing Findings of Fact, Conclusions of Law, the evidence in the record, the candor and demeanor of the witnesses, and the pleadings and arguments of the parties, it is, therefore
RECOMMENDED:
That a Final Order be entered by the Petitioner imposing a one-year probationary term on the licensure status of the Respondent, Patricia J. Canfield, L.P.N., and that she be required to take a continuing education course designed to enhance her competency in the area of properly accounting for, recording and conducting transactions with medications, especially controlled substances.
DONE and ENTERED this 2nd day of December, 1982, in Tallahassee, Florida.
P. MICHAEL RUFF Hearing Officer
Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32301
(904) 488-9675
FILED with the Clerk of the Division of Administrative Hearings this 2nd day of December, 1982.
COPIES FURNISHED:
W. Douglas Moody, Esquire
119 North Monroe Street Tallahassee, Florida 32301
Charles Pellicer, Esquire
28 Cordova Street
St. Augustine, Florida 32084
Helen P. Keefe, Executive Director Board of Nursing
Room 504
111 East Coastline Drive Jacksonville, Florida 32202
Samuel R. Shorstein, Secretary Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
Docket for Case No: 82-000855
Orders for Case No: 82-000855
| Issue Date |
Document |
Summary |
|
Dec. 03, 1982 |
Recommended Order
|
Nurse who failed to properly account for controlled drugs and made false reports on medications on probation one year with mandatory continuing comprehensive education on proper drug use.
|
