STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 91-2668

)

DEBORAH BRESKI, )

)

Respondent. )

)

RECOMMENDED ORDER

This matter was heard by William Dorsey, Jr., the Hearing Officer designated by the Division of Administrative Hearings on September 3, 1991, in Fort Pierce, Florida.

APPEARANCES

For Petitioner: Tracey S. Hartman, Esquire

Department of Professional Regulation

1940 North Monroe Street Tallahassee, Florida 32399-0792

For Respondent: Deborah Breski, pro se

803 Cory Campbell Road Fort Pierce, Florida 34982

STATEMENT OF THE ISSUE

The issue is whether the Respondent's license as a practical nurse should be disciplined for the violations as set forth in the Administrative Complaint.

PRELIMINARY STATEMENT

An Administrative Complaint filed March 19, 1991, by Petitioner, Department of Professional Regulation, charged that Respondent, Deborah Breski, violated the provisions of Chapter 464.018(1)(f) and (h), Florida Statutes, and Chapter 210-10.005(1)(e)(1) and (2), Florida Administrative Code.

In general, the Department alleged that during the 7:00 a.m. to 3:00 p.m. shift at the Sunrise Manor Nursing Home on August 26, 1990, Ms. Breski was assigned to care for patient G. M., who resided on Hoffman A Wing, and who was suffering from throat cancer. She charted administration of the medicine but did not watch the patient take it. Later the medication was found untaken. Ms. Breski did not dispose of the medication approriately.

At the Formal Hearing, Petitioner presented the testimony of Judith Donohoe, Michelle Y. Delancy, and Virginia K. Beatty, and offered Exhibits 1-4 into evidence, all of which were received. Respondent presented the testimony of Kathleen Anton and offered Exhibit 1 into evidence, which was received.

A transcript was filed by September 11, 1991.

FINDINGS OF FACT

1. At all times relevant hereto, Respondent, Deborah Breski, held a license as a practical nurse in the State of Florida, license number 0584471.

   
   

2. On August 26, 1990, Ms. Breski was employed at Sunrise Manor Nursing Home, Ft. Pierce, Florida, worked the morning shift on Hoffman A Wing, and was assigned to care for patient G. M.

   
   

3. G. M.'s physician had ordered that 20 mg of Morphine be administered orally to G. M. no more often than every 4 hours, as needed for pain. Due to his throat cancer, G.M. had difficulty swallowing.

   
   

4. On August 26, 1990, at approximately 2:00 p.m., Respondent signed-out

   20 mg Morphine liquid for patient G. M. on this patient's Controlled Drug Record.

   
   

5. Respondent subsequently initialed patient G. M.'s Medication Record and Profile to indicate her administration of Morphine liquid to this patient at approximately 2:00 p.m.

   
   

6. Respondent charted the administration of 10 cc Morphine [the same as 20 mg] to patient G. M. at approximately 2:00 p.m. on August 26, 1990, on the Nurse's Medication Notes. She did not watch the patient ingest the drug, because it takes him a long time to swallow, and she had other patients who needed their medication. She did not, however, chart the effectiveness of the drug on the patient later in her shift.

   
   

7. At approximately 3:15 p.m. on August 26, 1990, Respondent was relieved from her assignment on Hoffman Wing by LPN Michelle Delancy.

   
   

8. Ms. Delancy prepared patient G. M.'s 6:00 p.m. dose of Morphine liquid. When she came to the patient she discovered a cup of liquid at the patient's bedside.

   
   

9. Nurse Delancy asked G. M. if he had taken his pain medication earlier, and he respondend "no".

   
   

10. Ms. Delancy then summoned Mr. Breski to patient G. M.'s room and questioned her as to the cup and its contents.

    
    

11. Ms. Breski asked Ms. Delancy what Respondent should do with the unused medication, and Ms. Delancy indicated that it was Ms. Breski's Morphine and that she should take care of it.

    
    

12. Ms. Breski then poured the unused Morphine back into patient G. M.'s original prescription bottle, in an effort to allow its reuse, and save the patient expense.

13. The proper procedure for wasting medications such as Morphine is to dispose of the medication in the presence of another nurse, and to obtain that nurse's signature as verification that she had witnessed the wastage.

    
    

14. Ms. Delancy did not witness Respondent's "disposal" of patient G. M.'s unused Morphine. The Department does not contend that Ms. Breski improperly took the Morphine herself or gave it to anyone else; it was poured back into the bottle.

    
    

15. Ms. Breski did not document patient G. M.'s failure to consume his Morphine liquid, or her disposal of the medication by pouring it back into the prescription bottle; neither did she correct her previous charting. Patient G. M.'s records indicate that he received and ingested his scheduled 2:00 p.m. dose of Morphine.

    
    

16. Ms. Breski's failure to observe the patient consume his medication created a potentially harmful situation. The patient G. M. could have taken his medication just prior to receiving his next scheduled dose, and would then have received a double dose of Morphine, which would have exceeded his physician's order.

    
    

17. An expert for the Department opined that based upon a review of the evidence presented by Petitioner, Ms. Breski inaccurately and falsely recorded that she had administered medication to a patient when she had not actually done so; that Respondent did administer medication in a negligent manner, by not watching (and therefore ensuring) that the patient took the medication; and she made or filed a false report or record which she knew to be false, by documenting that she had administered the medication to the patient when she had not actually done so.

    
    

    CONCLUSIONS OF LAW

    
    

18. The Division of Administrative Hearings has jurisdiction over the parties, and the subject matter Section 120.57(1), Florida Statutes.

    
    

19. Since this is a case in which the Department is seeking to discipline the Respondent's license and could thereby adversely affect her ability to continue to practice nursing, the Department has the burden of establishing the basis for license disciplinary action by clear and convincing evidence.

    
    

20. The Department has charged Respondent with violating Sections 464.018(1)(f) and (h), Florida Statutes, (1989), which provide in pertinent part as follows:

    
    

    Section 464.018, Florida Statute (1989) on Disciplinary actions:

    1. The following acts shall be grounds for disciplinary actions set forth in this section:

       * * *

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

       * * *

       (h) unprofessional conduct, which shall include, but not be limited to, any departure from, or the failure to conform to, the min- imal standards of acceptable and prevailing nursing practice, in which case actually injury need not be established.

       
       

21. The Department has proven by clear and convincing evidence that Respondent violated Sections 464.018(1)(f) and (h), Florida Statutes.

    
    

22. She also violated Rule 210-10.005(1)(e)(1), by Florida Administrative Code, by inaccurate recording of patient records; and Rule 210-10.005(1)(e)(2), Florida Administrative Code, by administering medication in a negligent manner.

    
    

23. The Board's penalty guidelines (found at Rule 210-10.011, Florida Administrative Code) prescribe the following penalty ranges for the violations proven in this case:

    
    

    Offense Penalty Range

    
    

    Knowingly making or filing a from reprimand and fine of false report $250 to revocation and

    $1,000 fine

    
    

    Unprofessional conduct in from one year probation and delivery of nursing services appropriate continuing

    education courses to suspension until proof of safety to practice, followed by probation

    
    

24. No party offered evidence for the purpose of aggravation or mitigation of the penalty.

RECOMMENDATION

Based upon the foregoing, it is recommended that the Board of Nursing enter a Final Order finding that Deborah Breski has violated Sections 464.018(1)(f) and (h), Florida Statutes, (1989) and Rule 210-10.005(1)(e)(1) and (2), Florida Administrative Code. Respondent should therefore be reprimanded by the Board, fined an administrative fine of $250.00, and placed on probation for a period of one year, subject to the requirement of taking an appropriate continuing education course which includes instruction on the administration, charting and proper means to waste medication.

RECOMMENDED in Tallahassee, Leon County, Florida, this 4th day of October, 1991.

WILLIAM R. DORSEY

Hearing Officer

Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-1550

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 4th day of October, 1991.

COPIES FURNISHED:

Tracey Scott Hartman Senior Attorney

Department of Professional Regulation

1940 North Monroe Street Tallahassee, Florida 32399-0792

Deborah Breski

803 Cory Campbell Road Fort Pierce, Florida 34982

Jack McRay, General Counsel Department of Professional

Regulation

1940 North Monroe Street Tallahassee, Florida 32399-0792

Judie Ritter, Executive Director Department of Professional

Regulation Board of Nursing

111 Coastline Drive, East Room 50 Jacksonville, Florida 32202

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS:

All parties have the right to submit written exceptions to this Recommended Order. All agencies allow each party at least 10 days in which to submit written exceptions. Some agencies allow a larger period within which to submit written exceptions. You should contact the agency that will issue the final order in this case concerning agency rules on the deadline for filing exceptions to this Recommended Order. Any exceptions to this Recommended Order should be filed with the agency that will issue the final order in this case.

Docket for Case No: 91-002668

Orders for Case No: 91-002668