STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF NURSING, )
)
Petitioner, )
)
vs. ) CASE NO. 84-1764
)
JANET B. MANGOS, )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, James E. Bradwell, held a public hearing in this case on February 12, 1986, in Fort Lauderdale, Florida.
APPEARANCES
For Petitioner: Stephanie A. Daniel, Esquire
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
For Respondent: Craig K. Satchell, Esquire
4700 Sheridan Street, Building E Hollywood, Florida 33021
ISSUE PRESENTED
The issues presented for decision herein are whether or not disciplinary action should be taken against Respondent, based on conduct set forth hereinafter in detail, due to alleged violations of Chapter 464, Florida Statutes, as contained in the Second Amended Administrative Complaint filed herein on February 8, 1985.
BACKGROUND
On or about April 5, 1984, the Department of Professional Regulation filed an Amended Administrative Complaint against Respondent. On or about April 25, 1984, Respondent executed an Election of Rights form requesting a formal hearing on the Amended Administrative Complaint. The Amended Administrative Complaint was then filed with the Division of
Administrative Hearings, along with Respondent's Election of Rights form and an Answer filed by Respondent.
On or about August 10, 1984, a Motion to Abate was filed by Petitioner and was granted by order of this Hearing Officer on August 14, 1984. By letter dated November 28, 1984, Petitioner advised the undersigned Hearing Officer that an abatement of the above-styled action was no longer necessary and requested that this matter be set for formal hearing.
On or about February 1, 1985, a Motion to Amend Complaint was filed by Petitioner to correct inaccuracies in the Amended Administrative Complaint, by substituting a Second Amended Administrative Complaint. The Motion to Amend Complaint was granted by order of this Hearing Officer by Order dated February 13, 1985.
On or about February 1, 1985, Petitioner served upon Respondent, Petitioner's First Request for Admissions. Respondent failed to timely respond to Petitioner's First Request for Admissions. Respondent's counsel has advanced several reasons for his failure to respond to Petitioner's First Request for Admissions. Respondent's counsel's first reason is that his office was relocated during the period in which Petitioner's First Request for Admissions was filed and counsel could not truthfully and definitively state whether he received the Request for Admissions submitted by Petitioner. Based on those reasons, and the fact that Petitioner's counsel did not file a motion to compel Respondent to respond to the Request for Admissions, the undersigned received and considered a copy of Respondent's Answers to Petitioner's First Request for Admissions received by the Division on April 9, 1986.
The Second Administrative Complaint filed against Respondent by Petitioner alleges that Respondent, in eight (8) instances violated Section 464.018(1)(f), Florida Statutes (1981), by unprofessional conduct which failed to conform to or departed from standards of acceptable and prevailing nursing practice; had violated Section 464.018(1)(j), Florida Statutes, by willfully or repeatedly violating, in three (3) instances, Board of Nursing Rule 210-10.05(2)(d), Florida Administrative Code, and in four (4) instances, Rule 210.05(2)(e), Florida Administrative Code; in three (3) instances, has violated Section 464.018(1)(g), Florida Statutes, by engaging or attempting to engage in the possession, sale or distribution of Demerol, a controlled substance as defined in Chapter 893, Florida Statutes, for other than legitimate purposes; and in three (3) instances, had violated Section 464.018(1)(h), Florida Statutes, by being unable to practice nursing with reasonable skill and safety to patients by reasons of drugs or narcotics.
On or about February 10, 1986, Respondent's counsel filed a Motion for Continuance in the above-referenced case which was denied by order of this Hearing Officer.
At the hearing herein, Respondent's counsel arrived approximately one (1) hour after the hearing commenced and was afforded an opportunity to make a brief opening statement. Respondent's counsel thereafter presented Respondent's testimony after which Respondent and her attorney left the hearing. The hearing continued in their absence.
At the formal hearing, Petitioner presented the following witnesses; Janet Mangos, Ernesto Casanova, Peggy Bosshart, Carol McHugh, Blanch Miller, Margaret Faucher, Sue Gleason, Jan Fisher, Suzan Hills, Bertha Richardson, Katherine Brooks, Carol Bentley, Hazel Latham-Chung, Narissa Ferguson, Marie Joseph, Dorothy Powell, Diane Robie, Lucille Markowitz and Nancy Cox.
At the formal hearing, Petitioner offered Petitioner's Exhibits 1 through
19 which were received in evidence. Respondent's Exhibit #1 was offered but was rejected by the undersigned Hearing Officer.
Petitioner's counsel has submitted a Proposed Recommended Order on March 14, 1986 which was considered by me in preparation of this Recommended Order. Proposed findings of fact which are not adopted are the subject of specific rulings made in the Appendix to this Recommended Order.
FINDINGS OF FACT
Based upon my observation of the witnesses and their demeanor while testifying, documentary evidence received and the entire record compiled herein, I hereby make the following relevant factual findings.
Respondent is, and has been at all times material hereto, a licensed registered nurse in the State of Florida, having been issued license number RN76324-2. Respondent's last known address is 2911 S.W. 9th Avenue, Fort Lauderdale, Florida, 33316.
Between approximately June 27, 1983 and October 31, 1983, Respondent was employed as a registered nurse at Miami General Hospital and/or International Hospital.
On or about October 28, 1983, Respondent noted the withdrawal of Demerol 75mg for a patient, Granda, on the narcotics sheet for Unit Seven at Miami General Hospital at 11:30 p.m.
On or about October 28, 1983, Respondent charted the administration at 11:30 p.m. of Demerol 74mg to patient Granda on both the medication administration record (MAR) and the nurse's notes for patient Granda.
On approximately October 29, 1983, Respondent noted the withdrawal of 75mg for patient Granda on the narcotic sheet for Unit Seven at the Miami General Hospital on two (2) separate occasions, at 2:45 a.m. and 6:40 am., respectively. (TR p. 36).
On or about October 29, 1983, Respondent charted the administration at 2:45 a.m. and 6:40 a.m., of Demerol 75mg to patient Granda on the MAR and the nurse's notes for patient Granda.
If Respondent administered the above-mentioned dosages of Demerol 75mg to patient Granda, she did so without a valid physician's order as the original physician's order for patient Granda was dated October 14, 1983 for Demerol 25mg to be given intramuscularly every four (4) hours as needed, with Vistaril. (TR pp. 142 and 143).
At Miami General, as with most hospitals, there is a policy that a narcotic order, if not renewed within seventy-two (72) hours, is considered non- existent. The original doctor's order, dated October 14, 1983, for Demerol 25mg to be administered intramuscularly was never renewed and therefore expired October 17, 1983. (TR p. 143 and Petitioner's Exhibit 2)
It is the medicating nurse's responsibility to ensure that a valid doctor's order exists for narcotics prior to administering narcotic medication to a patient. (TR p. 143).
Respondent failed to sign the MAR for patient Granda on October 28 and 29, 1983 as the nurse administering medication to that patient. (Petitioner's Exhibit 2 and TR pp. 144 and 145).
Granda's nurse on October 28, 1983 was Marie Joseph. (Petitioner's Exhibit 2, TR p. 144).
The nurse's notes for patient Granda reflect that at 12:00 midnight on October 29, 1983, patient Granda was twice medicated with Demerol and Vistaril; and at 6:40 a.m. patient Granda was again medicated with Demerol and Vistaril. The 12:00 midnight administration was not signed by the nurse making the entry. The second entry written at 6:40 a.m. on October 29, 1983 is completed by what appears to be Respondent's signature. Respondent signed the nurse's notes dated October 29, 1983 as patient Granda's nurse for the 11:00 p.m. to 7:00 a.m. shift, whereas Marie Joseph was Granda's nurse on that date. (Petitioner's Exhibit 2)
The nurse's notes for patient Granda do not reflect a 2:45 a.m. administration of Demerol to patient Granda but instead reflect the two above- mentioned 12:00 midnight administrations of Demerol to patient Granda. (Petitioner's Exhibit 2).
On October 30, 1983, Respondent charted the administration of Demerol 75mg to patient Granda at 7:00 a.m. on the MAR for patient Granda. (TR p. 37). Patient Granda was not assigned to Respondent on October 30, 1983 for patient care.
Respondent's administration of medication to patient Granda on October 30, 1983, was done without communicating to the assigned nurse, Marie Joseph, who was responsible for patient Granda's care. (TR p. 149).
On October 30, 1983, Respondent was assigned as a "temporary" to work on the floor with Marie Joseph, a Registered Nurse at Miami General Hospital. Marie Joseph observed Respondent's behavior inasmuch as Respondent appeared erratic in terms of recording the administration of medications for patients. (TR 131). At 6:30 a.m. on October 30, 1983, Marie Joseph checked the narcotic records for patient Granda and noted that Respondent had made an entry in the records indicating the withdrawal of Demerol 75mg for patient Granda. Respondent's notation was inaccurate inasmuch as Marie Joseph had been tending patient Granda as early as 6:30 a.m. on October 30, 1983 and during that time patient Granda neither complained of pain nor requested pain medication during that time period. Finally, Respondent did not advise Nurse Joseph that she (Respondent) was medicating her assigned patient, Granda. (TR pp. 131-134).
On October 28, 1983, Respondent did not administer Demerol 75mg to patient Granda at Miami General Hospital at 11:30 p.m.
On October 29, 1983, Respondent did not administer Demerol 75mg to patient Granda at Miami General Hospital at 2:45 a.m.
On or about October 29, 1983, Respondent did not administer Demerol 75mg to patient Granda at Miami General Hospital at or about 6:40 a.m.
On or about October 30, 1983, Respondent did not administer, at any time during the day, Demerol 75mg to patient Granda at Miami General Hospital.
COUNT II
On or about October 18, 1983, at 11:30 p.m., Respondent signed out one
(1) vial of Demerol 75mg which was to be administered to patient Powell.
On or about October 18, 1983, Respondent charted the administration, at 11:30 p.m., of Demerol 75mg to patient Powell on both the MAR and the nurse's notes for patient Powell. (TR p. 38).
On or about October 19, 1983, Respondent signed out two (2) vials of Demerol 75mg which were to be administered to patient Powell. The vials were signed out on the narcotic sheet at approximately 3:00 a.m. and 7:00 a.m., respectively. (TR p. 38).
On or about October 19, 1983, Respondent charted the administration of Demerol 75mg to patient Powell at 3:00 a.m., and then again at 7:00 a.m. on both the MAR and the nurse's notes for patient Powell. (TR p. 38).
Patient Powell did not receive any Demerol on the weekend of October
18 and 19, 1983, despite Respondent's charting the administration of same as being given both on the MAR and the nurse's notes for patient Powell. On one occasion, during the weekend of October 18 and 19, 1983, Respondent attempted to give patient Powell an injection but patient Powell refused the injection. (TR pp. 138-139).
COUNT III
On October 18, 1983, at approximately 11:30 p.m., Respondent signed out one (1) vial of Demerol 50mg for administration to patient Duphilley on the narcotics sheet for Unit Seven at Miami General Hospital.
On the nurse's notes for patient Duphilley, Respondent charted the administration of Demerol 50mg at approximately 12:00 midnight on October 19, 1983. (TR p. 40).
On or about October 19, 1983, at approximately 4:30 a.m., Respondent signed out one (1) vial of Demerol 50mg for administration to patient Duphilley on the narcotic sheet for Unit Seven, Miami General Hospital.
On the nurse's notes for patient Duphilley, Respondent charted the administration, of Demerol 50mg, at approximately 4:30 a.m. on October 19, 1983. (TR p. 40)
On the MAR, Respondent charted the administration of the dosages of Demerol described as having been given all on October 18, 1983 and not on both October 18 and 19, 1983 as reflected in the nurse's notes and the narcotics sheet. (Petitioner's Exhibit 4 and TR pp. 160-162).
There was no valid physician's order in effect on October 18 and 19, 1983 for the administration of any quantity of Demerol to patient Duphilley. Patient's records bin effect for patient Duphilley reflect that on October 11, 1983 there was a valid physician's order for Demerol 25-50mg to be given intramuscularly every four to six hours as needed. As this physician's order was not renewed within seventy two-hours, it expired October 14, 1983. (Petitioner's Exhibit 4).
The MAR for patient Duphilley indicated that Duphilley was given Demerol 50mg once on October 11, 1983 and Duphilley did not receive the medication again until October 18, 1983 when she was again medicated by Respondent. (Petitioner's Exhibit 4).
Respondent did not administer Demerol 50mg to patient Duphilley at 11:30 a.m. on October 18, 1983 or at any time on October 19, 1983.
COUNT IV
On October 28, 1983, Respondent signed out Demerol 50mg for patient Gordon at 7:00 a.m. on the narcotics sheet. (TR p. 44)
Respondent failed to chart the administration of the Demerol on the nurse's notes. (Petitioner's Exhibit 3).
Respondent did not sign the MAR for patient Gordon on October 30, 1983 as the nurse administering medication on the 11:00 p.m. to 7:00 a.m. shift. (Petitioner's Exhibit 3).
Prior to administering medication to Gordon on October 30, 1983, Respondent did not communicate to Marie Joseph, the nurse responsible for patient Gordon's care, that Respondent was medicating Joseph's patient. (TR pp. 136-137).
COUNT V
On March 18, 1982, Respondent submitted an application for employment as a registered nurse to Quality Care Nursing Service (Quality) in Fort Lauderdale, Florida. Quality is an agency which provides nursing care on a referral as needed basis. Quality Care will refer private duty nurses to different entities or individuals seeking to utilize such nursing care upon request.
At all times material hereto, Respondent was employed by Quality as a registered nurse. (TR p. 42).
Between approximately November 5 and 8, 1983, Respondent was engaged through Quality as a private duty nurse at Broward General Medical Center in Fort Lauderdale, Florida.
While engaged as a private duty nurse at Broward General, Respondent failed to sign the private duty nurse roster for November 5, 6 and 8, 1983 even though she was engaged as a private duty nurse at Broward General for such dates. (Petitioner's Exhibit 18 and TR pp. 175-176).
At Broward General, private duty nurses and sitters are required to sign a private duty roster for nurses and sitters for those dates on which they are so employed.
At times material hereto, Respondent was engaged as a private duty nurse for one patient only. Respondent as a private duty nurse had no duties or responsibilities with reference to the care of other patients (which she was not assigned) at Broward General.
On November 5, 1983, Respondent administered two dosages of 50mg of Demerol to Lucie Hines at Broward General at 4:00 p.m. and 8:05 p.m. respectively. (TR p. 44).
Patient Hines, to whom Respondent administered the Demerol, was not Respondent's assigned patient.
Respondent failed to chart on the nurse's notes, the 8:05 p.m. administration of Demerol (to Hines) which occurred on November 5, 1983. (Petitioner's Exhibit 11).
Respondent charted the above-described administration of Demerol on the MAR, however her initials were illegible. (TR pp. 170, 171).
While Respondent charted the 4:00 p.m. administration of Demerol to Lucie Hines on the nurse's notes, her signature was illegible. (TR p. 170).
On November 6, 1983, Respondent administered two (2) doses of Demerol 50mg to patient Hines at Broward General at 5:10 p.m. and 9:30 p.m., respectively. (TR p. 46).
Respondent was not assigned to administer care to patient Hines on November 6, 1983.
While Respondent charted the above-referred 5:10 p.m. and 9:30 p.m. administrations of Demerol 50mg on the MAR for patient Hines, her initials were illegible. (TR pp. 172-173).
Respondent charted the above-described administrations of Demerol on the nurse's notes for patient Hines, however her signature was illegible. Respondent charted the 9:30 p.m. administration of Demerol on the nurse's notes but did not sign the entry. (Petitioner's Exhibit 11).
COUNT VI
On November 6, 1983, Respondent administered Demerol 50mg to patient Elma Snyder at Broward General at 3:30 p.m. (TR p. 47).
Patient Snyder was not assigned to Respondent for care on November 6, 1983. (TR p. 47).
Respondent failed to sign the MAR for patient Snyder as the person administering medication for patient Snyder on the 3:00 p.m. to 11:00 a.m. shift on November 5, 1983. (TR p. 173 and Petitioner's Exhibit 9).
On November 8, 1983, Respondent administered 50mg of Demerol to patient Snyder at Broward General at 5:00 p.m.
Patient Snyder was not Respondent's assigned patient on November 8, 1983.
Respondent charted the above-described administration of Demerol on the MAR, however her initials were illegible. Additionally, Respondent failed to sign the MAR as the person administering medication for that patient on the 3:00 p.m. to 11:00 p.m. shift on November 8, 1983. (Petitioner's Exhibit 9).
Respondent did not communicate to Nurse Narissa Ferguson, the nurse responsible for patient Snyder on November 6, 1983, that she was administering Demerol to patient Snyder.
COUNT VII
On November 6, 1983, Respondent administered two doses of Demerol 75mg to patient Mardell Johnson at Broward General at 6:30 p.m. and 10:40 p.m., respectively. (Petitioner's Exhibit 8).
Patient Johnson was assigned to Narissa Ferguson for health care on November 6, 1983. Respondent did not communicate the administration of Demerol to Narissa Ferguson on November 6, 1983. (TR pp. 125-128).
Respondent charted the 6:30 p.m. administration of Demerol on the nurse's notes for patient Johnson, however, she failed to chart the 10:45 p.m. administration of Demerol on November 6, 1983 on the nurse's notes for patient Johnson. (Petitioner's Exhibit 8 and TR pp. 168, 169).
On November 8, 1983 at 4:15 p.m., Respondent administered Demerol 75mg to patient Johnson at Broward General. (Petitioner's Exhibit 8).
Patient Johnson was not Respondent's assigned patient on November 8, 1983. Additionally, Respondent did not communicate the administration of Demerol on November 8, 1983 to the nurses responsible for patient Johnsons' care. (Petitioner's Exhibit 8 and TR pp. 125-128).
While Respondent charted the administration of medication to patient Johnson on the nurse's notes, her signature was illegible. (Petitioner's Exhibit 8).
COUNT VIII
During times material, Respondent was engaged as a private duty nurse at North Broward Medical Center. Respondent was engaged at North Broward through Helpmates Nursing Services, a referral agency which provides private duty nursing care.
While at North Broward Medical Center, Respondent was the private duty nurse responsible for the care of Reuben Cohen. (TR p. 51).
During times material, Fred J. Carson, M.D., Cohen's physician, appeared to have given Respondent a verbal order for the administration of Demerol to patient Cohen. (TR p. 51).
Patient records for Cohen reflect that, provided Respondent received a verbal order from Dr. Carson for the administration of Demerol, Respondent failed to record the verbal order in the patient's records. (Petitioner's Exhibit 7).
On December 24, Respondent withdrew two (2) vials of Demerol 50mg for administration to patient Cohen at 4:45 p.m. and 8:00 p.m., respectively, and noted same on the narcotics sheet. (TR p. 52).
While Respondent charted the administration of Demerol given patient Cohen on the nurse's notes, Respondent failed to chart the administration of either dosages of Demerol on the MAR for patient Cohen.
On December 25, 1983 at approximately 11:30 p.m., Respondent withdrew one (1) vial of Demerol 50mg for administration to patient Cohen on the pertinent narcotics sheet. (TR p. 52).
Respondent charted the administration of Demerol 50mg to patient Cohen at approximately 11:30 p.m. on December 25, 1983 on the nurse's notes. Respondent, however failed to chart the administration of Demerol 50mg on the MAR for patient Cohen. (TR p. 52).
On December 26, 1983, Respondent withdrew two (2) vials of Demerol 50mg for patient Cohen at 2:40 a.m. and 6:30 a.m., respectively, on the pertinent narcotics sheet. (TR p. 52)
On December 26, 1983, Respondent charted the administration of Demerol 50mg at 2:40 and 6:30 a.m. on the nurse's notes for patient Cohen. However, Respondent did not chart the administration of Demerol 50mg on the MAR for patient Cohen. (See TR p. 52).
Nancy Cox, a critical care educator employed at Miami Children's Hospital, has been a licensed registered nurse in Florida since 1959. Ms. Cox specialized in critical care and critical care education and the legal implications of professional nursing. As such, she provides hospital staff with the duties and responsibilities of a professional nurse. Cox emphasizes to practicing nurses the importance of documentation, the implications of receiving and transcribing physician's orders, carrying out such orders, observation of patients, assessments of patients and performing treatments. She provides information as to the manner of providing patient's safety and the implementation of physician's orders to provide for patient's safety. One of the areas regarded as highly important is the accurate charting and documentation of medications in a timely fashion so that the patient's safety is not jeopardized. As example, if a medication would be omitted from medication administration records or from nurse's notes, there is the hazard of another nurse coming along giving the same medication not realizing medication has already been administered. (TR 178- 181).
Ms. Cox was received as an expert in the area of general nursing, critical care nursing, quality assurance, record keeping and record reviews. (TR 183).
Ms. Cox' review of Respondent's records regarding the administration of narcotic medication indicates that Respondent failed to follow normal procedures for administering medication for hospitals. (TR 184) .
Record keeping is regarded as one of the fundamental cornerstones of nursing. As example, a physician is with a patient but a brief period of time daily whereas the nurse, by her records, (nursing notes and other documentation) is in fact keeping a log for their physician of all that transpires in the interim between his (the physician's) visits. It is therefore extremely important that it be factual, explicit, timely and contain observations and assessments. Without such documentation, the quality of care falls very far below the required minimum. (TR 185-186).
Ms. Cox' review of Respondent's conduct forces the conclusion that Respondent's conduct was unprofessional in nature because it failed to conform to and departed from minimal standards of nursing care and practice. Particular note was given to the legibility of Respondent's signature which is important in
that a nursing care provider must be able to recognize the signature on nursing notes which are, after all, regarded to be legal documents. Such providers are accountable for what is written on the nursing notes and if they cannot be properly identified, the accountability falls below that minimum which is required of such care providers. (TR 187).
The nursing notes are part of the medical records which graphically illustrate the course of treatment for a given patient. Omissions or inconsistencies in that record fail to serve the purpose for which it was designed and therefore fall below the minimum standards of care. Respecting Respondent's pattern of administering narcotics to patients which were not properly assigned her without properly communicating the administration to the nurse responsible for that patient, constitutes unprofessional conduct. (TR 101-102).
Respondent's repetitious pattern of failing to perform above the minimal standards, in spite of counseling by supervisors, leads to a factual conclusion that Respondent's actions were not mistakes or possibly accidental but amount to a failure to conform to the minimal standards of acceptable and prevailing nursing practice. It is so concluded.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the subject matter and the parties to this action. Section 120.57(1), Florida Statutes.
The parties were duly noticed pursuant to the notice provisions of Chapter 120, Florida Statutes.
The authority of the Petitioner is derived from Chapter 464, Florida Statutes.
Respondent, a registered nurse, is subject to the disciplinary guides of Chapter 464, Florida Statutes.
Section 464.018, Florida Statutes, authorizes the Petitioner, Board of Nursing, to revoke, suspend or otherwise discipline a nurse who has violated any of the following provisions of Section 464.018(1), Florida Statutes:
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 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;
Being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics or chemicals or any other type of
material or as a result of any mental or physical condition. In enforcing this paragraph, the Department shall have, upon probable cause,
authority to compel a nurse to submit to a mental or physical examination by physicians or health care practitioners . . .; and
(j) willfully or repeatedly violating any provision of this Chapter, a Rule of the Board
or the Department, or a lawful order of the Board or the Department previously entered in a disciplinary proceeding or failing to comply
with a lawfully issued subpoena of the Department.
Petitioner has the burden of proof in this license disciplinary case and must prove, clearly and convincingly, that the alleged violation of the above-cited statutory provisions occurred. Bowling v. Department of Insurance,
394 So.2d 165 (Fla. 1st DCA 1981); Robinson v. Florida Board of Dentistry, 447 So.2d 930 (Fla. 3rd DCA 1984); and Sneij v. Department of Professional Regulation, 454 So.2d 795 (Fla. 3rd DCA 1984).
Competent and substantial evidence was offered herein to establish that Respondent was guilty of unprofessional conduct or conduct which departs from or failed to conform to minimal standards of acceptable and prevailing nursing practice as related to her treatment and care for patients Granda, Gordon, Powell, Duphilley, Johnson, Snyder, Hines and Cohen based on the following acts:
making repeated errors in charting and failing to chart the administration of narcotics appropriately;
failing to properly record a verbal doctor's orders on the physician's order sheet; and
recording the administration of narcotics on the appropriate records when in fact the medications were not given (patients Granda, Duphilley and Powell).
By Respondent's failure to administer Demerol (Meperidine), a controlled substance for patients Granda, Duphilley and Powell, Respondent engaged in the possession of a controlled substance for other than legitimate purposes in violation of Chapter 893, Florida Statutes and therefore violated Section 464.018(1)(g), Florida Statutes.
Insufficient evidence was offered herein to establish that Respondent was not able to practice nursing with reasonable skill and safety to patients by reason of illness or use of drugs, alcoholic, narcotics or chemicals or any other type of material as a result of any mental or physical condition as alleged.
Competent and substantial evidence was offered herein to establish that the Respondent willfully and repeatedly violated a rule of the Board of Nursing in violation of Section 464.018(1)(j), Florida Statutes, based on her false misrepresentation of facts on patients Powell, Duphilley and Granda's medical records by charting the administration of narcotics when the narcotics were not in fact administered to the patient and thus engaged in a repeated violation of Rule 210-10.05(1)(d), Florida Administrative Code.
Additionally, competent and substantial evidence was offered herein to establish that the Respondent inaccurately recorded or falsified the patient
records by failing to appropriately chart the administration of narcotics to patients and recording the administration of narcotics which had not in fact been administered and misappropriated Demerol by doing something other than administering the medication to the patient for whom the medication was withdrawn in violation of Rule 210- 10.05, Florida Administrative Code. Based on the repetitious nature of the violations, Respondent thereby violated Section 464.018(1)(j), Florida Statutes. It is so found.
Based on the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that the Respondent's license number RN7634-2, be suspended for a period of two (2) years.
RECOMMENDED this 24th day of April, 1986, in Tallahassee, Florida.
JAMES E. BRADWELL
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 24th day of April, 1986.
APPENDIX TO RECOMMENDED ORDER IN CASE NO. 84-1764
Rulings on Petitioner's Proposed Findings of Fact:
Petitioner's Proposed Findings of Fact numbered 1, 2, 3, 4, 5, 6, 7, 8, 9,
10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33,
34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53,
54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73,
74, 75, 76, 77, 78, 79, and 80 are adopted and incorporated in the Recommended Order.
Petitioner's Proposed Findings of Fact numbered paragraphs 20, 21, 22 and
23 are adopted based on Petitioner's First Request for Admissions and Respondent's answers thereto.
COPIES FURNISHED:
Stephanie A. Daniel, Esquire Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32301
Craig K. Satchell, Esquire 4700 Sheridan Street Building E
Hollywood, Florida 33021
Fred Roche, Secretary Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32301
Salvatore A. Carpino General Counsel
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
Judie Ritter, Executive Director Board of Nursing
Room 504, 111 East Coastline Drive
Jacksonville, Florida 32201
=================================================================
AGENCY FINAL ORDER
=================================================================
STATE OF FLORIDA
DEPARTMENT OF PROFESSIONAL REGULATION BOARD OF NURSING
DEPARTMENT OF PROFESSIONAL )
REGULATION, )
)
Petitioner, )
) CASE NO. 0042012
vs. ) 0042437
) 0044398
JANET B. MANGOS, ) DOAH CASE NO. 84-1764
)
Respondent. )
)
ORDER
Respondent, Janet B. Mangos, holds Florida License No. 76324-2 as a registered nurse and Florida License No. 28359-1 as a licensed practical nurse. Petitioner filed an Administrative Complaint seeking revocation, suspension, or other disciplinary action against the license.
Respondent requested a formal hearing and one was held before the Division of Administrative Hearings. A Recommended Order has been forwarded to the Board pursuant to Section 120.57, Florida Statutes. A copy of the Recommended Order is attached to and by reference made a part of this Order.
The Board of Nursing met on June 4, 1986, in Jacksonville, Florida, to take final agency action. The Board has reviewed the entire record in the case.
FINDINGS OF FACT
The Board accepts and adopts the Findings of Fact contained in the Recommended Order.
CONCLUSIONS OF LAW
The Board accepts and adopts the Conclusions of Law contained in the Recommended Order.
PENALTY
Based on its review of the complete record and the matters set forth in Petitioner's Motion for Increased Penalty, attached, the Board rejects the recommended penalty of the hearing officer. The Board adopts and incorporates the facts, argument and citations of Petitioner's Motion for Increased Penalty, and by reference makes it a part of the Order. It is therefore
ORDERED that the license of Janet B. Mangos is hereby REVOKED.
Pursuant to Section 120.59, Florida Statutes, the parties are hereby notified that they may appeal this final order by filing one copy of a notice of appeal with the clerk of the agency and by filing the filing fee and one copy of a notice of appeal with the District Court of Appeal within thirty days of the date this order is filed.
This Order shall become effective upon filing with the clerk of the Department of Professional Regulation.
DONE and ORDERED this 23rd day of June 1986.
Jessie Trice, Chairman Florida Board of Nursing
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing Order has been sent to JANET B. MANGOS, 2911 Southwest 9th Avenue, Fort Lauderdale, Florida 33316 and to CRAIG K. SATCHELL, ESQUIRE, 4700 Sheridan Street, Building E, Hollywood, Florida 33021, by United States Mail, at or before 5:00 p.m., this 23rd day of June, 1986.
Judie Ritter Executive Director
| Issue Date | Proceedings |
|---|---|
| Apr. 24, 1986 | Recommended Order (hearing held , 2013). CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Jun. 23, 1986 | Agency Final Order | |
| Apr. 24, 1986 | Recommended Order | Respondent's license suspended for unprofessional conduct (charting errors, improper recording of doctor's orders, and improper administration of narcotics). |
DEPARTMENT OF HEALTH, BOARD OF NURSING vs RACHELLE CHIARO VASLOWSKI, R.N., 84-001764 (1984)
RICHARD S. DAVIS vs. DIVISION OF RETIREMENT, 84-001764 (1984)
DEPARTMENT OF HEALTH, BOARD OF NURSING vs JAMES THOMAS CHERRY, R.N., 84-001764 (1984)
POPIEL ODGEN HORAN, A/K/A ANNETTE P. HORAN vs. BOARD OF NURSING, 84-001764 (1984)
