Judges: ARNOLD H. POLLOCK
Agency: Department of Health
Latest Update: Dec. 19, 1986
Summary: Nurse who failed to chart administrator of controlled substance to patients after he checked them found to fail to conform to minimum standards and is misconduct
84-4191.PDFSTATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF NURSING, )
)
Petitioner, )
)
vs. ) CASE NO. 84-4191
)
ANTHONY SALZANO, )
)
Respondent. )
)
RECOMMENDED ORDER
Consistent with the Order Denying Continuance entered by the undersigned on August 20, 1986, a hearing was held in this case before Arnold H. Pollock, a Hearing Officer with the Division of Administrative Hearings, in Homestead, Florida, on August 28, 1986. The issue for consideration was whether Respondent's license as a registered nurse in the State of Florida should be disciplined because of the alleged misconduct outlined in the Administrative Complaint filed herein.
APPEARANCES
Petitioner: William T. Furlow, Esquire
130 North Monroe Street Tallahassee, Florida 32301
Respondent: Was not present and was not represented.
BACKGROUND INFORMATION
On October 10, 1984, Fred Roche, Secretary of the Department of Professional Regulation (DPR), on behalf of the Board of Nursing, signed an Administrative Complaint against the Respondent alleging that on diverse occasions between October 7, and October 31, 1983, the Respondent was guilty of "activity which constitutes unprofessional conduct departing from or failing to conform with minimal standards of acceptable and prevailing nursing practice in Florida." Thereafter, Respondent executed an election of rights form in which he disputed the allegations of fact contained in the Administrative Complaint and requested a formal hearing. On November 13, 1984, the file was forwarded to the Director of the Division of Administrative Hearings for the appointment of a hearing officer and the case was initially assigned to Hearing Officer Caleen who, on February 6, 1985, set the case for hearing. However, based upon motion by Respondent the case was continued until August 6, 1985, and again, upon Respondent's request, indefinitely. On April 3, 1986, Petitioner requested the case again be set for hearing and the August 28 hearing date was set. Just before the hearing date, Respondent again moved for a continuance on the same grounds as previously used, but this time, the undersigned, to whom the case had been assigned, denied the request.
At the hearing, Respondent's counsel moved to withdraw from the case on the basis that he was unable to contact his client who was out of state, but requested to again appear on behalf of the client if such was to be appropriate. Counsel for Petitioner interposed no objection to this request which was granted. Thereafter, Petitioner requested that the records be left open for a period of 90 days after the adjournment of the hearing to allow Respondent's former counsel time to attempt to again contact him and his witness in order to secure information in Respondent's behalf. This request was also granted.
At the hearing, Petitioner presented the testimony of Hugh Francis Fitzpatrick, a medical investigator for DPR; Elissa Ann Fabian, Department Manager of Infection Control and Employee Health at James Archer Smith Hospital in Homestead and also Assistant Director of Nursing; and Gerald A. Ellis, at the time in question, Director of Pharmacy at the same hospital. Petitioner also introduced Petitioner's Exhibits 1 through 3. Neither party submitted post hearing matters.
FINDINGS OF FACT
At all times pertinent to the issues herein, Respondent, Anthony Salzano, was a registered nurse licensed as such in Florida.
On November 1, 1983, Ms. Fabian was acting as head nurse of the cardiac care unit at James Archer Smith Hospital in Homestead, Florida, where Respondent, Salzano, along with another male nurse, Blakemore, was working as a registered nurse, though on different shifts. At that particular time, Ms. Fabian had no complaints about Respondent's skills or drug control until on this date, she received a call from another nurse to come check the narcotic records on the unit. When she did so, what she saw disturbed her and she immediately contacted Mr. Ellis, the Director of the Pharmacy requesting that he look at the ward narcotic records. Mr. Ellis did so and immediately determined they were not correct. He gathered them together and, along with Ms. Fabian, started to take them to the pharmacy to check them against the pharmacy records. As Fabian and Ellis were getting on the elevator, they saw and were seen by Salzano and Blakemore who immediately left the hospital without signing out. Neither has returned. Hospital records for November 1, 1983, indicate that Salzano checked in at 2:45 p.m. for the 3 to 11 shift, but did not go to the floor or at any time report for duty.
Examination of the records in question, which include drug sign-out sheets, medical administration records, and nurses' notes revealed that there were numerous discrepancies thereon as to times, patients' names, nurses' names, and the quantities of demerol and demerol 100 used on the cardiac care unit. Cardiac patients rarely receive doses of demerol or demerol 100.
Ms. Fabian compared the Respondent's signatures on the drug sign-out sheets with other documents on which his signature appears and concluded that they were the same and that he had signed the control records. As a part of her job, she was required to be familiar with all of her nurses' signatures and was satisfied that the records in question had been made by the Respondent.
Specifically, on the dates set out in the Administrative Complaint, times of drug administration were out of sequence, dates were out of sequence, and fictitious names as administering official, the signatures for which appeared to be by Respondent, appeared on the records. Blakemore's name only appeared a few times and there was indication that the Respondent and Blakemore did not work on the same shift.
The erroneous record keeping by the Respondent could not have been because of his lack of knowledge of procedures. He had received the entire indoctrination program on the hospital's drug policies and procedures administered by not only Ms. Fabian but also the Director of Nursing and the Chief Pharmacist as well. The records show that Respondent did not properly follow the procedures which include not only accounting for the medication but also reflecting it was administered and the effect it had on the patient. Accounting for the medication would be accomplished on the drug sign-out sheet. Administration of the medication would be shown on the medicine administration record, and the effect on the patient would be shown in the nurse's notes.
The failure of the Respondent to keep the required records, in the uncontradicted opinion of Ms. Fabian, constitutes the practice of nursing in a manner far below minimum standards of acceptable and prevailing nursing practice and it is so found.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties and subject matter in this case. Section 120.57(1), Florida Statutes.
In the Administrative Complaint, Petitioner alleges that on various and diverse occasions during the month of October 1983, Respondent signed out a controlled substance and failed to properly chart its administration to various patients in the proper hospital records for such entries and that his actions constitute a violation of Section 464.018(1)(f), Florida Statutes. This paragraph authorizes disciplinary action against a license for:
(f) 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 practice. . . .
There is little question that Respondent checked out the medication as alleged and that his subsequent record keeping was totally insufficient to conform to either the hospital standards or the minimal standards of acceptable and prevailing nursing practice in Florida.
Subsequent to the 90 days from the date of the hearing requested by counsel, on December 8, 1986, Mr. Blakemore filed a purported affidavit in this case in which he indicates the drugs in question were taken by him, that he forged Respondent's signature to the records, and that Respondent was not at all involved in this incident. This letter is unsworn and cannot serve as an affidavit and is considered of no evidentiary value.
Counsel for Petitioner has requested the Board of Nursing suspend the Respondent's license as a registered nurse in this state until such time as he comes before the Board and demonstrates his ability to practice nursing safely.
RECOMMENDATION
Based on the foregoing Findings of Fact and Conclusions of Law, it is, therefore:
RECOMMENDED that Respondent's license as a registered nurse in Florida be suspended for two years or until he appears before the Board of Nursing to demonstrate he continues to be qualified to practice nursing safely to the satisfaction of the Board, whichever comes first.
RECOMMENDED this 19th day of December 1986, at Tallahassee, Florida.
ARNOLD H. POLLOCK
Hearing Officer
Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32399-1550
(904) 488-9675
FILED with the Clerk of the Division of Administrative Hearings this 19th day of December 1986.
COPIES FURNISHED:
Judie Ritter, Executive Director Board of Nursing
111 East Coastline Drive, Room 504 Jacksonville, Florida 32201
William T. Furlow, Esquire
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
Michael L. Cohen, Esquire 1615 Forum Place
Barister's Building, Suite 4-E West Palm Beach, Florida 33401
Fred Roche, Secretary
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
Wings S. Benton, General Counsel Department of Professional Regulation
=================================================================
AGENCY FINAL ORDER
=================================================================
STATE OF FLORIDA
DEPARTMENT OF PROFESSIONAL REGULATION BOARD OF NURSING
DEPARTMENT OF PROFESSIONAL REGULATION,
Petitioner,
vs. CASE NO.: 0042496
DOAH CASE NO.: 84-4191
ANTHONY M. SALZANO,
Respondent.
/
ORDER
Respondent, Anthony M. Salzano, holds Florida License No. 1261302 as a registered 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 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 February 5, 1987, in Miami, Florida, to take final agency action. Petitioner was represented by William M. Furlow, Esquire. Respondent was not present. 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
The Board generally agrees and accepts the recommendation of the Hearing Officer. However, the Board believes that the recommendation must be clarified. Based on the entire record, and the nature of the violations found as numerous charting errors involving controlled substances (Petitioner's Exhibit 2), the Board finds that in order to adequately protect the public, the minimum suspension period should be two (2) years. It is therefore ORDERED that
The license of Anthony M. Salzano is hereby SUSPENDED for two (2) years and thereafter until such time as the licensee personally appears before the Board and can demonstrate the present ability to safely engage in the practice of nursing. Such demonstration shall include, at a minimum, an in-depth psychological evaluation from a psychiatrists psychologist, or other licensed counselor, which includes an opinion that the licensee is presently capable of returning to the safe practice of nursing.
Within (30) thirty days the licensee shall return his license to the Board office, Suite 504, 111 Coastline Drive East, Jacksonville, Florida 32201 or shall surrender the license to an investigator of the Department of professional Regulation.
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 February, 1987.
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 ANTHONY M. SALZANO, 6365 Harwich Center Road, West Palm Beach, Florida 33409, by United States Mail, at or before 5:00 p.m., this 23rd day of February, 1987.
Judie Ritter Executive Director
Docket for Case No: 84-004191
Orders for Case No: 84-004191
| Issue Date |
Document |
Summary |
|
Feb. 23, 1987 |
Agency Final Order
|
|
|
Dec. 19, 1986 |
Recommended Order
|
Nurse who failed to chart administrator of controlled substance to patients after he checked them found to fail to conform to minimum standards and is misconduct
|
