STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

STATE OF FLORIDA, DEPARTMENT ) OF PROFESSIONAL REGULATION, ) BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) DOAH Case No. 85-4151

) DPR Case No. 0060332

ANTHONY EDWARD SIDDELL, )

)

Respondent. )

)

RECOMMENDED ORDER

Following the provision of notice, a formal Section 120.57(1), Florida Statutes, hearing was held in this case on February 23, 1987. The hearing location was Jacksonville, Florida. Charles C. Adams was the hearing officer. The parties have submitted proposed recommended orders. Those proposals have been considered in deciding this case. The fact finding suggested by the parties has been utilized in some instances, otherwise the facts submitted by the parties are distinguished for reasons explained in the appendix to this recommended order.

APPEARANCES

For Petitioner: Robert D. Newell, Jr., Esquire

102 South Monroe Street Tallahassee, Florida 32301

For Respondent: Gerald S. Bettman, Esquire

1027 Blackstone Building

233 East Bay Street Jacksonville, Florida 32202

ISSUES

The issues in this case are those fashioned by the administrative complaint brought by the Petitioner against the Respondent, claiming certain improprieties in his conduct while participating as a member of a response team pertaining to an injured worker. In particular, Respondent is accused of improperly strapping a patient to a backboard and refusing to change the strapping when told that the technique of strapping

was wrong. Further, Respondent is accused of acting inappropriately by, among other conduct, yelling and screaming obscenities at co-workers, attempting to eject a co-worker from the emergency vehicle they were working from and assaulting a co- worker. These events are said to be violative of Section 464.018(1)(f), Florida Statutes, which prohibits unprofessional conduct, of a sort which departs from or fails to conform to minimal standards of acceptable and prevailing nursing practice. Out of these events, Petitioner seeks to discipline Respondent's nursing license.

FINDINGS OF FACT

Facts found based upon stipulation of counsel

1. Petitioner, Department of Professional Regulation, is the state agency charged with regulating the practice of nursing pursuant to Section 20.30, Florida Statutes, Chapter 455, Florida Statutes, and Chapter 464, Florida Statutes.

   
   

2. Respondent is, and has been at all times material hereto, a nurse in the state of Florida, having been issued license number 11991162. Respondent's last known address is 11668 Cape Horn Avenue., Jacksonville, Florida 32216.

   
   

3. At all times material hereto Respondent was employed by Central Technical Services, St. Johns River Power Plant (CTS), Jacksonville, Florida.

   
   

   Facts found based upon evidence presented at the final hearing

   
   

4. In addition to the Respondent, Lanta Craig, emergency medical technician; Mary Roberts, paramedic; and Arthur Punsky were employed on June 24, 1985, at the St. Johns River Power Plant. Craig and Roberts were working for CTS and Arthur Punsky was a safety engineer for Foster Wheeler Energy Corporation, a company doing work at the plant site.

   
   

5. Respondent's specific duties on June 24, 1985, were as a registered nurse.

   
   

6. In the early afternoon of June 24, 1985, Craig, Roberts and the Respondent were at the first aid station at the job site. At that point, an emergency call was made to the aid station to have the employees of CTS respond to an injury suffered by a worker at the construction site. Craig, Roberts and Respondent left the first aid station and went to the site where the worker had suffered his injury. The three individuals took the

   emergency response vehicle or ambulance as transportation.

   
   

7. At the scene of the accident, Respondent and Roberts went to an elevator where the injured man was being brought down from his work site. Craig remained with the emergency response vehicle. Respondent and Roberts were informed that the injured worker had suffered a back injury. This information was provided before the patient arrived on the elevator. Upon the arrival, Roberts went back to the ambulance and retrieved a backboard to use in moving the injured worker. The backboard is a device employed in immobilizing patients with possible back injuries and neck injuries.

   
   

8. The injured worker, when he got off the elevator, was ambulatory. Respondent placed the backboard on the ground, and with the assistance of another emergency worker, assisted the injured employee by lowering that individual onto the backboard, holding the injured employee's arms in this process.

   
   

9. In the course of strapping the injured worker to the backboard, Respondent improperly applied the strap to the hand space and not to the hole which the strap should be passed through in securing the individual to the backboard. The effect of this was to cause the backboard straps to cross over the injured worker's neck, as opposed to the area of his shoulders and chest.

   
   

10. A conversation ensued between Respondent and Roberts, in which Roberts told the Respondent that he had improperly set the straps. Respondent did not attempt to correct the problem before placing the patient in the ambulance.

    
    

11. After the patient was placed in the ambulance, he was transported to the first aid station.

    
    

12. When on board the ambulance, the Respondent took a cervical collar and placed it on the neck of the injured worker. This collar caused the improperly placed strapping to press against the patient's neck beneath the cervical collar. Roberts was concerned that this arrangement was one which possibly would cause an occlusion of the airway of the injured worker.

    
    

13. In the course of the transport of the worker back to the first aid station, Roberts removed the cervical collar, believing that the problem with the improper strapping was choking the patient. It is not clear that the strapping did in fact cause a problem for the patient. Respondent took umbrage at Roberts' gesture and began screaming profanity at Roberts, and in the course of this situation, yanked the straps on the backboard. The worker was conscious and was aware of this exchange between

    Roberts and the Respondent. Roberts put her hands on the straps and told the Respondent to leave the patient alone. Respondent grabbed Roberts by her right wrist and jerked her up.

    
    

14. At the first aid station, Craig got out of the ambulance and Roberts and Respondent remained in the ambulance and continued to argue as they had during the transport.

    
    

15. Eventually Craig came to the side door of the ambulance and having stepped up into the ambulance, Respondent began to shout obscenities at Craig and physically forced her out of the ambulance. As she came to the ground, she knocked over Punsky.

    
    

16. Marjorie Lander Smith, at times relevant to the inquiry, was licensed in Florida as a registered nurse, emergency medical technical and paramedic. Smith was received as an expert in emergency nursing, emergency medical technician and paramedic skills and standards of conduct. Her testimony established that Respondent departed from the normal standards of acceptable and prevailing nursing practice, to the following extent:

    
    

    1. Yelling and screaming of profanity and the use of verbal abuse toward other workers in the ambulance while in the presence of a conscious patient is unacceptable behavior for a nurse. This is true because the patient is dependent upon the ambulance personnel for a sense of security and must be provided a calm, supportive environment.

       
       

    2. Physically removing the fellow worker from the ambulance is unacceptable behavior on the part of a nurse, in that a nurse should only use violence to protect or defend herself or himself. In this instance, in the face of Smith's opinion, and the facts presented at the hearing, Respondent is not found to have been entitled to physically eject Craig from the ambulance in some effort at self defense.

       
       

17. There was some controversy among Craig, Roberts and the Respondent on the subject of who was in charge of the ambulance response team when they were dealing with the call pertaining to the injured worker. It is unclear exactly what the lines of authority were in this organization related to that subject. Nonetheless, based upon the remarks of the witness, Smith and her opinion of appropriate standards of acceptable and prevailing nursing practice, Respondent screamed obscenities at co-workers and physically forced Craig out of the ambulance, all conduct

    which is improper regardless of who might have been in charge of the ambulance in this setting. Respondent also inappropriately accosted Roberts when he grabbed her wrist and jerked her up.

    
    

18. Notwithstanding any general hard feelings between the members of the crew, the above-described actions of the Respondent were not justified.

    
    

    CONCLUSIONS OF LAW

    
    

19. The Division of Administrative Hearings has jurisdiction over the subject matter and the parties to this action pursuant to Section 120.57(1), Florida Statutes.

    
    

20. Respondent is accused of (1) improperly strapping a patient to a backboard and refusing to change the strapping when advised that it was wrong, and (2) acting in an inappropriate manner while on duty at his position with Central Technical Services, including but not limited to yelling and screaming obscenities at co-workers, attempting to eject a co-worker from the ambulance and assaulting a co-worker. These events are said to have occurred on or about June 24, 1985. As to the first item, the proof shows that Respondent improperly strapped the patient to a backboard. It does not indicate that he then refused to change the strapping when advised it was wrong. The proof does show that on the date in question, Respondent yelled and screamed obscenities at the co-workers Craig and Roberts in the presence of the patient and that he physically forced Craig out of the ambulance and assaulted Roberts by grabbing her by the wrist and jerking her up. These actions evidenced unprofessional conduct, including a departure from or a failure to conform to minimal standards of acceptable and prevailing nursing practice within the meaning of Section 464.018(1)(f), Florida Statutes. Accordingly, in keeping with Section 464.018(2), Florida Statutes, discipline may be imposed against the Respondent.

Based upon a consideration of the facts found and the conclusions of law reached, it is

RECOMMENDED:

That the Respondent's license be suspended for a period of twenty days.

DONE AND ENTERED this 13th day of May, 1987, at Tallahassee, Florida.

CHARLES C. ADAMS, Hearing Officer

Division of Administrative Hearings The Oakland Building

2009 Apalachee Parkway

Tallahassee, Florida 32399

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 13th day of May, 1987.

COPIES FURNISHED:

Robert D. Newell, Jr., Esquire

102 South Monroe Street Tallahassee, Florida 32301

Gerald S. Bettman, Esquire 1027 Blackstone Building

233 East Bay Street Jacksonville, Florida 32202

Judie Ritter, Executive Director Board of Nursing

Department of Professional Regulation.

Room 504, 111 East Coastline Drive

Jacksonville, Florida 32201

Van Poole, Secretary Department of Professional

Regulation

130 North Monroe Street Tallahassee, Florida 32399-0750

Joseph A. Sole, General Counsel Department of Professional

Regulation

130 North Monroe Street Tallahassee, Florida 32399-0750

APPENDIX

The following factual distinctions are drawn between the recommended order and the proposed recommended orders of the parties. In essence, all proposed facts were utilized in the recommended order, with the exception of those facts discussed subsequently.

Petitioner's facts

The second sentence of paragraph 13 and all of paragraphs 18 and 19 are not necessary to resolution of the dispute.

Paragraphs 20 and 21 constitute argument and are otherwise addressed in the recommended order and the appendix to the recommended order in discussing Respondent's proposed facts.

Paragraph 22(a) and (d) concern opinion testimony about matters not alleged in the administrative complaint.

Respondent's facts

Paragraph 3 is contrary to facts found.

Paragraph 5 is not needed, in that no facts were found which held Respondent accountable for failure to change the strapping when advised to do so.

Paragraph 8 is contrary to the facts found.

Paragraph 9 is not necessary to the resolution of the dispute and constitutes a recitation of testimony and not fact finding.

Paragraphs 10 and 11 are not necessary to resolution of the- dispute.

Paragraph 12 is not necessary to resolution of the dispute and constitutes argument concerning testimony of

Paragraph 13 is not necessary to the resolution of the dispute, nor is paragraph 14, which also includes recitation of testimony and not fact finding.

Paragraph 15 is irrelevant.

Paragraph 16 is not necessary to the resolution of dispute.

Paragraph 17 constitutes a recitation of testimony and not fact finding.

Paragraph 18, whether true or not, is not necessary to resolution of the dispute.

Paragraph 19 is argument and recitation of testimony as opposed to fact finding.

Paragraph 20 is repetitive of other proposed facts.

The first two phrases of the first sentence to paragraph 21 are not necessary to resolution of the dispute; the last phrase within that sentence is subordinate to facts found. The first phrase within the last sentence of paragraph 21 is not accepted, and the last phrase within that sentence is not necessary to resolution of the dispute.

Paragraph 22 is subordinate to facts found with the exception that Roberts is not seen to have caused the argument between the Respondent and herself.

Paragraph 23 constitutes an inaccurate recitation of testimony and not fact finding.

Paragraph 24 is not necessary to resolution of the dispute. Paragraph 25 is argument.

Paragraph 26 constitutes argument or a recitation of testimony and not fact finding, except the last sentence, which is not accepted as factually correct.

Paragraph 27 is not necessary to the resolution of the dispute.

Paragraphs 28 and 29 recite testimony as opposed to suggested fact finding.

Paragraph 30 is not necessary to the resolution of the dispute, and the last sentence of paragraph 30 sets forth facts which do not preclude the opinion testimony of the witness Marjorie Lander Smith.

Paragraph 31 is not necessary to the resolution of the dispute or constitutes a recitation of testimony and not fact finding.

Paragraphs 32 an 33 constitute the recitation of testimony and not fact finding.

Paragraph 34 constitutes the recitation of testimony and not fact finding and is otherwise not necessary to the resolution of the dispute.

Paragraphs 35 and 36 constitute the recitation of testimony and not fact finding.

The first sentence of paragraph 37 is not relevant. The second sentence of paragraph 37 is not necessary to the resolution of the dispute.

Paragraphs 38 and 39 are not necessary to the resolution of the dispute.

The first sentence of paragraph 40 is not necessary to the resolution of the dispute. The second sentence is not accepted as fact and the remaining sentences within that paragraph are not necessary to resolution of the dispute.

The sentences in paragraph 41 are not necessary to the resolution of the dispute or are the recitation of testimony and not fact finding, with the exception of the last sentence which is subordinate to facts found in the recommended order.

Paragraph 42, up to the word "however" constitutes a recitation of testimony and not facts finding. Beyond that word the phraseology is not accepted.

The first sentence of paragraph 43 is not accepted as factually correct. The second sentence of paragraph 43 is not necessary to the resolution of the dispute. The third sentence

within paragraph 43, up to the word "and," is not necessary to the resolution of the dispute. Beyond the word "and" the facts are not accepted as correct, nor is the last sentence within that paragraph considered to be factually correct.

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

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

STATE OF FLORIDA DEPARTMENT OF PROFESSIONAL REGULATION

BOARD OF NURSING

STATE OF FLORIDA, DEPARTMENT OF PROFESSIONAL REGULATION, BOARD OF NURSING,

Petitioner,

vs. DOAH Case No. 85-4151

DPR Case No. 0060332

ANTHONY EDWARD SIDDELL,

Respondent.

/

FINAL ORDER

Respondent, Anthony Edward Siddell, holds Florida License No. 1191162 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 June 11, 1987, 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

Petitioner filed its Motion for Increased Penalty, which was heard and considered by the Board. Having reviewed the record and heard the arguments of counsel for both parties, the Board is in agreement with Petitioner's Motion. The Board finds that an increased penalty is appropriate, for the reasons stated in Petitioner's Motion, as follows:

It is apparent from the Recommendation that the Hearing Officer did not appreciate the seriousness of the violation committed by Respondent. The actions described in the Findings of Fact not only violate the Nurse Practice Act, as found by the Board herein, but have serious implications for potential harm to patients under Respondent's care. Expert testimony related that a patient is very dependent on health care professionals for a sense of security and will rely on the health care professionals to provide him with a calm, supportive environment. (T. 152) Respondent's actions in yelling and screaming obscenities in the presence of the patient are not in conformance with that concept of calm supportiveness, and amount to totally unacceptable behavior for a nurse. (T. 153) Moreover, when Respondent, in his agitated state, yanked on the straps which were securing the patient (Findings of Fact 13), there was the potential for further injury or discomfort to the patient. (T. 92-93)

Of further concern to the Board is Respondent's failure to understand or acknowledge the acceptable standards of professional nursing conduct. The Hearing Officer rejected Respondent's version of the incidents relating to the charges (Appendix to Recommended Order). In addition, Respondent's testimony reflects his opinion that he has done nothing wrong and did not behave in an unprofessional manner. (T. 300) Respondent's actions, taken together with his stated opinion of his conduct, reflect a misunderstanding of acceptable behavior for a nurse in a professional setting.

Based on the foregoing, it is therefore ORDERED that

The license of Anthony Edward Siddell is hereby SUSPENDED for one (1) year 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 psychiatrist, psychologist., or other licensed counselor, which includes an opinion chat the licensee is presently capable of returning to the safe practice of nursing. Upon reinstatement, the Board may place the license on probation for a period of time, and subject to such terms and conditions, as the Board determines necessary and appropriate.

The licensee shall pay an administrative fine of $1000 to be paid prior to reinstatement of his license.

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 25th day of 1987.

Filed JUN 25 1987 FLORIDA STATE BOARD OF NURSING

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 E. SIDDELL, 11668 Cape Horn Avenue, Jacksonville, Florida 32216, GERALD S. BETTMAN, ESQUIRE, 1027 Blackstone Building, 233 East Bay Street, Jacksonville, Florida 32232, CHARLES C. ADAMS, Hearing Officer, Division of Administrative Hearings, 2009 Apalachee Parkway, Tallahassee, Florida 32399-1550, and to GARY D. BEATTY, ESQUIRE, Department of Professional Regulation, 130 North Monroe Street, Tallahassee, Florida .32399-0750, by United States Mail, at or before 5:00 p.m., this 25 day of June, 1987.

Julie Ritter Executive Director

Docket for Case No: 85-004151

Orders for Case No: 85-004151