STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 83-2278

)

BEVERLY MONTGOMERY, )

)

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 September 27, 1983, at Tampa, Florida.

APPEARANCES

For Petitioner: Julia P. Forrester, Esquire

Department of Professional Regulation

130 North Monroe Street Tallahassee, Florida 32301

For Respondent: Fred Buckine, Esquire

Suite 203, 518 Tampa Street

Tampa, Florida 33601

By Administrative Complaint dated April 29, 1983, the Department of Professional Regulation, Board of Nursing, Petitioner, seeks to revoke, suspend, or otherwise discipline the license of Beverly Montgomery, Respondent, as a registered nurse. As grounds therefor it is alleged that on February 11, 1983, Respondent engaged in a physical and verbal altercation with patient Ernest Thibodeau at Tampa General Hospital, Tampa, Florida.

At the hearing three witnesses were called by Petitioner; two witnesses, including Respondent, were called by Respondent; and seven exhibits were offered into evidence. Objections on grounds of hearsay were sustained to Exhibits 3-7.

The parties' proposed findings, to the extent they are incorporated herein, are adopted; otherwise, they are rejected as not being supported by the evidence, unnecessary to the results reached, or mere recitation of testimony given by the witnesses.

FINDINGS OF FACT

1. At all times relevant hereto Respondent was licensed as a registered nurse by the State of Florida and was employed as a registered nurse at Tampa General Hospital, Tampa, Florida.

2. Ernest Thibodeau was involved in an automobile accident in January, 1983, in which he suffered a broken jaw, hip, and ribs and facial lacerations. He was a patient at Tampa General Hospital from the date of his accident until February 18, 1983. On February 11, 1983, Thibodeau was a patient in a four-bed ward with one bed unoccupied. At the time of the events giving rise to charges here involved, one patient was outside the room, Thibodeau was in his bed in one corner of the room, and Richard Rogers was in his bed in the opposite corner of the room. Thibodeau's leg was in a cast and in traction, his jaws were wired shut, and needles were inserted in his arms but they were probably not connected to a feeder tube. Thibodeau could talk, his bed was cranked to a sitting position, and he had use of both arms. On occasion Thibodeau had yelled at the nurses attending him about his pain medication and had been a bit obstreperous when he thought this medication was late arriving.

   
   

3. Respondent was the team leader of the team with responsibility for Thibodeau's room on the morning shift of February 11, 1983. Around 9:30 that morning Respondent entered the room to give Thibodeau and Rogers their medication. Thibodeau could only take oral medication in a liquid form through a straw, so pills had to be crushed and dissolved in water for him. When Respondent entered the room, she went to Thibodeau's bed where he was engaged in bathing his face and arms. He asked Respondent why she had told another nurse that he was prejudiced against blacks. Respondent replied, "Who told you that?"; the conversation rapidly escalated to shouts and name-calling, and Respondent pushed the wash basin off the bedside table onto Thibodeau, soaking him and his bed; he took a glass of water from the bedside table and threw it in Respondent's face; and the protagonists proceeded to throw everything at hand at each other including, but not limited to, wash cloths, towels, water pitchers, urinal and wash basin. Thibodeau threw a hairbrush at Respondent which missed, she picked it up and broke it over his head. When things readily at hand had been dispatched Respondent was standing in the middle of the room in a "come on" boxing stance. Thibodeau suddenly recognized the ridiculousness of the situation and started to laugh. Respondent started out of the room and was met by an LPN coming into the room. Someone called the supervisor who in turn called the Director of Surgical Nursing, Sylvia Watkins, apparently the senior nurse on duty at the hospital at that time.

   
   

4. When Ms. Watkins arrived on the scene, the Maalox, which had been in a cup on Thibodeau's bedside table, was all over Thibodeau and his bed, Thibodeau was soaking wet, as was his bed, Respondent was wet, the washbasin and pitcher were broken and on the floor with the urinal, which was behind the head of Thibodeau's bed, Thibodeau had a red spot on his head which was swelling, a hairbrush was in two pieces, with one piece on the bedside table and the handle on the bed, a metal pin in Thibodeau's right knee (which was in a cast and in traction) had worked its way almost out of the knee, and towels were on the bed and floor.

   
   

5. When Ms. Watkins asked Respondent what had happened, the latter initially said she yelled at Thibodeau and she may have thrown a towel but she did not hit him. When asked why she did not leave the room before things got out of hand, Respondent replied she just couldn't. Upon Ms. Watkins' arrival, Thibodeau was yelling for the police. When she calmed him down, Ms. Watkins asked Thibodeau what had happened. Included with his reply that she (Respondent) threw towels, bedpan, and Maalox at him, hit him with a bedside waterbasin, and bent his hand, was his statement "No matter what I said, I don't think she should hit me."

6. Although Respondent denies that she touched Thibodeau or hit him with anything, the other patient in the room, Richard Rogers, saw the fracas and testified to the facts reported in paragraph 3 above. The physical evidence, as observed by Ms. Watkins upon her arrival in the room, such as the location of the urinal behind the head of Thibodeau's bed, the position of the broken pieces of water pitcher and basin on the floor, the broken hairbrush, the welt on Thibodeau's head, and the physical appearance of Thibodeau and Respondent, belies Respondent's testimony.

   
   

7. Immediately following this incident Respondent was dismissed by Tampa General Hospital.

   
   

8. Difficulties between patients and nurses are sufficiently common that standard procedures and guidelines have been adopted for handling unruly or disruptive patients. The primary rule, unless the patient is in danger of injuring himself or another, is for the nurse to walk away and report the incident to a superior who will take appropriate action. If the patient and the nurse just do not get along, it is customary to assign the patient to another nurse if so requested by the nurse. If the patient is physically abusive, the nurse should get away or get help, if necessary, to restrain the patient. Only if the patient is incoherent should the nurse defend herself and, even then, should not strike the patient. Under the circumstances that existed in this case with Thibodeau unable to get out of his bed, the fracas could easily have been avoided by Respondent just walking out of the room.

   
   

   CONCLUSIONS OF LAW

   
   

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

   
   

10. Respondent is charged with unprofessional conduct which constitutes grounds for disciplinary action including revocation or suspension of a license. Section 464.018(1)(f) Florida Statutes, defines unprofessional conduct as:

    
    

    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.

    
    

11. From the foregoing it is concluded that the acts of Respondent, as noted in the findings above, constitute clear and convincing evidence of unprofessional conduct by reason of allowing herself to become involved with a patient first in a shouting match immediately followed by a battle royal at which dangerous objects were thrown by Respondent.

    
    

12. Respondent testified that she had been in the nursing field for three years, one as an LPN and two and an RN; and, prior to her dismissal, worked only at Tampa General Hospital. She is presently employed as a registered nurse at Good Samaritan Hospital.

Having considered the fact that this is the first reported incident involving Respondent and a patient, and Respondent's experience as a nurse, it is

RECOMMENDED that the license of Beverly Montgomery as a registered nurse be suspended for a period of two (2) years.

ENTERED this 27th day of October, 1983, 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 27th day of October, 1983.

COPIES FURNISHED:

Julia P. Forrester, Esquire Department of Professional

Regulation

130 North Monroe Street Tallahassee, Florida 32301

Fred Buckine, Esquire

Suite 203, 518 Tampa Street

Tampa, Florida 33601

Helen P. Keefe, Executive Director Board of Nursing

Department of Professional Regulation

Room 504, 111 East Coastline Drive

Jacksonville, Florida 32202

Fred M. Roche, Secretary Department of Professional

Regulation

130 North Monroe Street Tallahassee, Florida 32301

Docket for Case No: 83-002278

Orders for Case No: 83-002278