STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 82-1223

)

PAULINE LARACH, )

)

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 June 29, 1982, at Hollywood, Florida.

APPEARANCES

For Petitioner: William M. Furlow, Esquire

Department of Professional Regulation State Office Building

400 West Robinson Street Orlando, Florida 32801

For Respondent: Respondent was not represented nor present

By Administrative Complaint dated 13 April 1982, the Department of Professional Regulation, Board of Nursing, Petitioner, seeks to revoke, suspend or otherwise discipline the license of Pauline Larach as a Registered Nurse. As grounds there for it is alleged that Respondent, while assigned to the Intensive Care Unit at Hollywood Memorial Hospital, on several occasions failed to conform to the minimal standards of acceptable and prevailing nursing practices, exhibited bizarre and inappropriate behavior, failed to practice nursing with reasonable skill and safety to patients, and failed to properly keep and maintain legible nurse's notes containing appropriate information regarding the patients.

This hearing was scheduled to commence at ten o'clock and, at that time, Respondent was not present. Attempts to contact her by telephone were unsuccessful when the operator responded to the number called with the information that the number previously assigned to the telephone at Ms. Larach's residence had been changed to an unlisted number. Since the Notice of Hearing had been mailed to Respondent's last known address and not returned, the hearing commenced at 10:20 a.m.

Petitioner called four witnesses, and seven exhibits were admitted into evidence.

FINDINGS OF FACT

1. Pauline J. Brown Larach, Respondent, is licensed by the Board of Nursing as a Registered Nurse, license No. 60268-2 and was so licensed at all times here relevant.

   
   

2. Respondent was employed by Hollywood Memorial Hospital during the period July-October, 1981, in the Intensive Care Unit (ICU). At the time of her employment Respondent represented that she was qualified to work in the ICU.

   
   

3. Hollywood Memorial Hospital sends all nurses employed through an orientation program of approximately one week before assigning them to a particular duty. Respondent went through this orientation program before she was assigned to ICU.

   
   

4. Respondent was assigned the shift under the direct supervision of Shirley Scott, who was assistant head nurse of the ICU and was supervisor on the shift to which Respondent was assigned.

   
   

5. Respondent's work was unsatisfactory and she was counselled several times by Scott. Specifically, Respondent was counselled about the manner in which she maintained her nurse's notes, her inability to schedule her time and duties, her inability to concentrate on a particular problem, her refusal to seek assistance when needed, and a penchant for ignoring serious problems.

   
   

6. The following incidents gave rise to the concern about the type of care provided by Respondent to patients in the ICU:

   
   

   1. On about October 21, 1981, a neurological patient assigned to Respondent was on the drug Nipride to keep the blood pressure low. The patient had suffered intracranial hemorrhaging. The Nepride, which is considered a dangerous drug unless its administration is carefully monitored, was administered to this patient in much less than the time it should have taken for the Nipride to be infused and the patient's blood pressure dropped very low.

      The ICU supervising nurse discovered the patient in a severely hypertensive state and Respondent had placed the patient in a position with the head below the feet. This attitude would be correct for most patients whose blood pressure is low but was contraindicated for a neuro-patient or a patient with the history of intracranial bleeding. Although the head nurse's intervention possibly avoided further intracranial bleeding, no entry of blood pressure drop or of the emergency was placed in the nurse's notes kept by Respondent.

      
      

   2. On or about August, 1981, Respondent was observed by her shift supervisor (Scott) hiding her nurse's notes under a patient's mattress so Ms. Scott could not read them.

      
      

   3. During a "code" situation Respondent offered the doctor a cookie while he was resuscitating the patient.

      
      

   4. Respondent's nurse's notes are virtually illegible and replete with trivia and inappropriate items while failing to include pertinent information. Specifically, these nurse's notes were also found deficient in that Respondent did not chart complete systems before going to another system, but instead jumped around from items in one system to items in another and included trivia while omitting essential information about the patient.

   5. On one occasion when a patient was transferred from the emergency room to the ICU as a patient to be tended to by Respondent, who had accepted the patient by phone from the emergency room, upon arrival the patient was in dire distress and Respondent left the room. Another nurse declared a "code" emergency on this patient, but Respondent did not return to the room until after the "code" situation was ended.

      
      

   6. During a "code" situation involving one of Respondent's patients, it was discovered that she had incorrectly computed the infusion rate for the drug Dopamine, which drug is intended to raise blood pressure.

      
      

7. Respondent's evaluations (Exhibit 1), which were prepared three months after Respondent commenced work at Hollywood Memorial Hospital, evaluated Respondent as unsatisfactory and far below the minimal standards required for acceptable nursing practices. This report followed numerous conferences with Respondent during this three-month period when the areas in which she was unsatisfactory were pointed out to her.

   
   

8. All of the witnesses who worked with and observed Respondent in the ICU concurred that Respondent's professional competency, as observed by them, was far below minimal acceptable standards and that they would be unwilling to have Respondent assigned under them in an ICU.

   
   

9. All expert witnesses opined that in the manner in which Respondent maintained nurse's notes, organized her work, provided care to patients, and, specifically, to react properly in an emergency situation, Respondent's performance as a nurse was far below minimal acceptable standards.

   
   

10. At the expiration of Respondent's three-month period during which her evaluation was unsatisfactory, a conference was held between Respondent and hospital staff. At this meeting the evaluations were presented to Respondent and she was given the alternatives of voluntary resignation, transfer to a less critical area of the hospital, or termination. Respondent opted for voluntary resignation.

    
    

    CONCLUSIONS OF LAW

    
    

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

    
    

12. Section 464.018(1), Florida Statutes, includes the following acts as grounds for disciplinary action against a nurse's registration:

    
    

    (d) Making or filing a false report or record, which the licensee knows to be

    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.

    (f) Unprofessional conduct, which shall include, but not be limited to, any depar- ture 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.

    (h) 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. A nurse affected under this paragraph shall at reasonable intervals be afforded an oppor- tunity to demonstrate that she can resume the competent practice of nursing with reasonable skill and safety.

    
    

13. Leaving a patient, for whom the nurse is responsible, in dire distress, and not returning to the room until the emergency is over constitutes unprofessional conduct, without a rational explanation or reason for departure. Maintaining illegible and incomplete nurse's notes also fails to conform to minimally acceptable standards of nursing practice, as does a failure to properly monitor the administration of a dangerous drug or place a patient susceptible to intracranial bleeding in a head-down position.

    
    

14. While offering a cookie to a doctor during a "code" situation and attempting to hide nurse's notes from a supervisor constitute bizarre behavior, this is not sufficient to prove the nurse is unable to practice nursing with reasonable skill and safety to patients by reason of illness, drunkenness, use of drugs, etc. No evidence was presented regarding Respondent's mental state other than she was "flighty" and could not seem to concentrate on a particular subject for more than a brief period.

    
    

15. To constitute a violation of Section 468.018(1)(d) Florida Statutes, specific intent is required. The inaccurate and incomplete nurse's notes that formed the basis of this charge were not shown to have been written with intent to deceive. In fact, no entry in Respondent's nurse's notes was shown to be false. While these entries were shown to be incomplete, illegible, and ineptly written, they were not shown to have been made with the specific intent to mislead or misinform.

    
    

16. From the foregoing it is concluded that Pauline Larach is guilty of unprofessional conduct as alleged and that she is not guilty of filing a false report or of being unable to practice nursing with reasonable skill and safety to patients by reason of illness, drunkenness, use of drugs, etc.

    
    

17. Respondent was not present and offered no testimony. Whether this resulted from Respondent's lack of concern for the consequences of the administrative hearing or from her reported penchant of running away from difficult situations is, of course, unknown. Respondent has been a registered nurse in Florida for ten years and presumably was once fully qualified for such registration. The evidence presented clearly indicates that Respondent should not be assigned to an Intensive Care Unit but no evidence was presented regarding Respondent's performance in other duties to which registered nurses are assigned.

    
    

18. It is noted that Respondent was offered a less stressful position than the ICU as one of the alternatives at Hollywood Memorial Hospital before she opted for resignation. This indicates that the same people who had determined Respondent was incompetent in an ICU were prepared to give her another

opportunity in a different environment. Since Respondent has been a member of this profession for at least ten years, revocation of her license, thereby depriving her of the ability to earn her livelihood in the profession for which she was trained without another opportunity to show that she can function satisfactorily in some nursing field, appears too harsh. It is, therefore,

RECOMMENDED that the license of Pauline Larach be suspended for a period of one (1) year or until she demonstrates to the Board of Nursing that she is capable of performing specific nursing functions as designated by the Board, whichever first occurs.

ENTERED this 2nd day of August, 1982, at Tallahassee, Florida.

K. N. AYERS, 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 August, 1982.

COPIES FURNISHED:

William M. Furlow, Esquire Department of Professional

Regulation

State Office Building

400 West Robinson Street Orlando, Florida 32801

Pauline B. Larach

3700 Northwest 21st Street, #204 Lauderdale Lakes, Florida 33311

Helen P. Keefe, Executive Director Board of Nursing

Department of Professional Regulation

111 East Coastline Drive, Room 504 Jacksonville, Florida 32202

Samuel R. Shorstein, Secretary Department of Professional

Regulation

130 North Monroe Street Tallahassee, Florida 32301

================================================================= AGENCY FINAL ORDER

=================================================================

STATE OF FLORIDA DEPARTMENT OF PROFESSIONAL REGULATION

BOARD OF NURSING

IN RE:

Petition for Reinstatement of: CASE NO. 19553 PAULINE B. LARACH, R.N., DOAH NO. 82-1223

License No. 60286-2

/

ORDER

This cause came on for hearing before the Florida Board of Nursing on February 4, 1983, in Tallahassee, Florida, for the purpose of determining whether the Board should grant the Petition for Reinstatement of Pauline B. Larach. The licensee was present and addressed the Board.

FINDINGS OF FACT

1. Pursuant to a Final Order of the Board dated October 12, 1982 the license of Pauline B. Larach was suspended for one year or until she appeared before the Board and can demonstrate that she is capable of safely engaging in the practice of nursing.

   
   

2. The licensee did address the Board and showed that since the events forming the Findings of Fact of the Final Order she has worked successfully in an intensive care unit at Emory University in Atlanta and has completed courses in that field.

   
   

3. The licensee showed that an undiagnosed medical problem may have contributed to her previous violations of the Nurse Practice Act.

CONCLUSIONS OF LAW

1. Section 464.018(3), F.S., provides that the Board shall not reinstate the license of a nurse until such time as it is satisfied that the nurse has complied with all the terms and conditions set forth in the Final Order and is presently capable of safely engaging in the practice of nursing.

   
   

2. Based on the foregoing facts, the Board is satisfied that the Licensee has so complied and is presently capable of safely engaging in the practice of nursing.

Therefore, it is ORDERED that the Petition for Reinstatement of Pauline B. Larach be and is hereby GRANTED subject to the licensee's being placed on PROBATION for a period of one year subject to the following terms and conditions:

The licensee shall not violate any Federal or State law, rule, or order of the Board of Nursing.

During the probation the licensee shall report any change in her residence address, any change in her employer or place of employment, or any time she is arrested. These events will be reported immediately (and in any event within ten working days) by certified mail to the Board of Nursing, Probation Section,

111 Coastline Drive East, Suite 504, Jacksonville, Florida 32202.

While employed as a nurse, the licensee shall be responsible for causing reports to be furnished by her employer to the Board; these reports shall set out the licensee's current position, work assignment, level of Performance, and any problems. The reports shall be submitted every three months as scheduled by the probation supervisor.

Any deviation from the requirements of this probation without the prior written consent of the Board shall constitute an violation of this probation.

Upon a finding of probable cause that a violation of this probation has occurred, the licensee's license to practice nursing shall be subject to immediate and automatic suspension pending the licensee's appearance before the next Board meeting (or such other meeting as mutually agreed by the licensee and the Department). The licensee will be given notice of the hearing and an opportunity to defend.

The probationary period shall automatically terminate at the end of the prescribed time, but only if all terms and conditions have been met. Otherwise, the probation shall be terminated only by Order of the Board upon proper petition of the licensee, supported by evidence of compliance with this Order.

Done and Ordered in Jacksonville, Florida this 4th day of February, 1983.

Sandra S. Bauman Chairman

cc: Pauline B. Larach

P.O. Box 1007I5

Ft. Lauderdale, Florida 33310

Docket for Case No: 82-001223

Orders for Case No: 82-001223