STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

AGENCY FOR HEALTH CARE ) ADMINISTRATION, BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 94-0278

)

MARIA C. MELEGRITO, R.N., )

)

Respondent. )

)

RECOMMENDED ORDER

A hearing was held in this case by telephone conference call attended by Respondent, counsel for the Agency for Health Care Administration, the witnesses and the undersigned, Arnold H. Pollock, a Hearing Officer with the Division of Administrative Hearings, on September 19 and October 18, 1995.

APPEARANCES

For Petitioner: Miriam S. Wilkinson, Esquire

Department of Business and Professional Regulation

1940 North Monroe Street Tallahassee, Florida 32399-0792

For Respondent: Maria C. Melegrito, R.N., pro se

Federal I.D. Number 08343-018 Federal Prison Camp

Pembroke Station

Danbury, Connecticut 06180 STATEMENT OF THE ISSUES

The issue for consideration in this hearing is whether Respondent's license as a registered nurse in Florida should be disciplined because of the matters alleged in the Administrative complaint filed herein.

PRELIMINARY MATTERS

By Administrative Complaint dated July 19, 1994, the Agency for Health Care Administration, (Agency), for the Board of Nursing, (Board), seeks to discipline the Respondent's license as a registered nurse in Florida alleging that on or about March 13 and 14, 1992, Respondent provided nursing care to her patient, L.B., which was below the acceptable standards of nursing care under the circumstances in Florida, in violation of Section 464.018(1)(h), Florida Statutes. Respondent requested a formal hearing to contest the allegations against her, and this hearing ensued. Because of the unavailability of the Respondent within the State of Florida, the hearing was held in this case by telephone conference call with, on both occasions, Respondent participating from

Connecticut, Counsel for the Agency and all Agency witnesses from New Port Richey, and the undersigned from Tallahassee.

At the hearing, Petitioner presented the testimony of K.B., the patient's wife; B.C. and G.P, the patient's daughters, Dorothy Riesebeck, a licensed practical nurse; Ray Mantell, the Department's investigator; Barbara Coon, records custodian for HCA New Port Richey Hospital and Esther Sangster, a registered nurse and expert in the field of nursing. Petitioner also introduced Petitioner's Exhibits 1 through 3. Respondent testified in her own behalf but presented no exhibits.

A transcript of the proceedings was provided and, subsequent thereto, only Counsel for Petitioner submitted Proposed Findings of Fact which have been accepted and, as appropriate, incorporated in the Appendix to this Recommended Order.

FINDINGS OF FACT

1. At all times pertinent to the issues herein, the Petitioner, Board of Nursing, was the state agency in Florida responsible for the licensing of registered nurses and the regulation of the nursing profession in this state. Respondent, Maria S. Melegrito was licensed as a registered nurse under license number RN 1138222.

   
   

2. During the month of March, 1992, L.B. was a patient at HCA New Port Richey Hospital suffering from congestive heart failure and a decubitus ulcer on his coccyx. He was in and out of the hospital frequently during the month. During this period, Respondent called Mrs. B. on the phone and solicited being hired to care for him at home when he was released from the hospital.

   Respondent is alleged to have indicated she was L.B.'s favorite nurse. At first Mrs. B. declined, but on or about March 12, 1992, K.B., the patient's wife, after checking on Respondent's credentials with her husband's physician, contracted with the Respondent to provide home health care to L.B. upon his discharge from the hospital. The arrangements were made through Maximum Care, Inc., a home health nursing agency of which Respondent was a cofounder.

   
   

3. In a telephone conversation with K.B. on March 12, 1992, the day prior to L.B.'s discharge from the hospital, Respondent assured K.B. that Respondent would supply cardiac trained registered nurses around the clock to care for L.B.

   K.B. understood from this conversation that a cardiac trained registered nurse would be waiting at the patient's home when he arrived there after discharge. No contract was signed between Respondent and L.B., his wife, or their daughters.

   
   

4. That same day, March 12, 1992, Respondent, in a conversation with B.C., one of L.B.'s daughters, indicated that Respondent would be taking care of the patient; that she would relieve the family members of their responsibilities in caring for him. Respondent indicated she was a cardiac care specialist and that she would be present at the patient's home the following days, with all necessary medical equipment, when the patient arrived from the hospital. B.C. also understood Respondent to represent that she would provide certified nursing assistants, (CNA's), and that she was familiar with the patient's condition because she had been his personal nurse while he was in the hospital.

   
   

5. In a conversation with G.P., the patient's other daughter, Respondent said she would provide private nurses around the clock; that home health aides and CNA's would be present to assist the family in caring for the patient; and

   that Respondent would personally be present at the home with the necessary oxygen equipment to greet the patient upon his arrival from the hospital.

   
   

6. According to hospital records, L.B. was discharged to the care of his wife, K.B., and his daughter, B.C., at 10:20 AM on March 13, 1992, and the evidence indicates that the discharge form was signed by K.B. The party arrived at the home shortly thereafter, but Respondent was not present there when the party, including the patient, arrived. By the same token, the oxygen ordered by the patient's physician also was not there.

   
   

7. Shortly after the patient and his family arrived home, Ms. B and one daughter went to the drug store. When they came back, they were met outside by K.B.'s grandson who kept K.B. outside while the daughter went in. It appears that while they were gone, L.B. suffered a cardiac episode. His daughter, B.C., laid him on the floor so that he would not aspirate his vomitus, but he appeared to have no pulse, no audible heartbeat, was not breathing, and appeared to turn blue from lack of oxygen. One of the family members attempted to contact the Respondent but was unable to do so. Finally, the family called the patient's physician who in turn called the oxygen supply house and directed that oxygen be delivered to the patient's home. Though the discharge form reflects the physician ordered oxygen for the patient, no evidence was presented as to who was to arrange for it.

   
   

8. At approximately 1:00 PM the same day, Respondent contacted the family indicating she would "be right there." When family members told Respondent the patient had suffered a cardiac episode, she instructed them to leave him on the floor. Notwithstanding her promise to be right there, Respondent, according to the family, did not arrive at the patient's home until sometime after 3:00 PM. When she arrived she did not have with her oxygen, a stethoscope or a blood pressure cuff. Using the equipment owned by C.P., the patient's other daughter, also a nurse, Respondent took the patient's blood pressure while he was laying prone on the floor. She found it to be 60 over 40.

   
   

9. Respondent tells a different story. While not disputing the allegation of her pre-need solicitation of the patient's family for her services, she contends that she was not advised of the immediate need for them until she received a call from one of the daughters at approximately 12:30 PM on March 13, 1992, indicating that the patient was to be discharged. She claims she immediately asked if there was anything needed for the patient's care and was told all was taken care of. She also claims she was told the patient would be at his home within 10 to 15 minutes. On cross examination, Respondent indicated the verbal agreement she had with the patient's wife called for her to be called when the patient got home and she would come, assess the patient and then decide if she or her firm could provide the services required. It is her contention that her initial visit to the patient's home on March 13, 1992 was for the purpose of rendering a patient assessment, and she ended up staying for five hours until she could arrange for follow-on nursing care to be present. This assertion is rejected, however. She had already indicated she knew the patient and was his favorite nurse in the hospital. She would have already been familiar with his condition.

   
   

10. Ms. Melegrito further claims she arrived at the patient's house at 1:25 PM to find the patient on the floor with a blood pressure cuff on his arm and oxygen being supplied. Respondent claims it is usually the discharge nurse or the social worker who makes the arrangements for oxygen to be delivered to the patient's home, and it was not her responsibility to do so. There was no

direct evidence to contradict this assertion, but it was the physician who ultimately arranged for the delivery of the oxygen.

11 Notwithstanding the allegation that the Respondent did not arrive until after 3:00 PM, the initial visit nursing notes, dated March 13, 1992, reflect in one place she arrived at 2:00 PM; in another place, that she arrived at 1:24 PM; and in a third place that she arrived at 3:00 PM. In its totality, the best evidence suggests that Respondent arrived sometime between 1:00 and 3:00 PM, neither as late as the family claims nor as early as she claims.

1. There is some substantial question as to whether Respondent performed a proper initial assessment of the patient or devised a care plan for him when she arrived. An initial visit nursing note, prepared by the Respondent and bearing date of March 13, 1992, lists the patient's temperature, his pulse rate and his blood pressure. It also discusses a history of the patient's condition and certain initial observations of him. The second page of the form indicates that certain items were covered including a description of the patient's grip, his cardio-pulmonary status, the condition of his skin, his abdomen, ENT status and comments regarding his diet and genito-urinary status. The third page of the form described the patient as being fearful, anxious, restless, confused and disoriented, suffering from headaches, vertigo and blackout spells. He is described as having irregular breath with pale, dry, pallid skin, dry mouth and several difficulties in the cardio-vascular area.

   
   

2. The body drawing on the form reflects he has an open bed sore at the base of the spine, and the intervention portion of the form indicates that the patient was found on the floor upon the Respondent's arrival, unconscious. His pressure was down and there was no palpable pulse. Patient was cyanotic and had appeared to have suffered another syncope syndrome. Nonetheless, Respondent noted that the patient's vital signs came back enough for him to regain consciousness, but notwithstanding, he was in the terminal stage of a cardiac condition and the instructions given by the family were not to resuscitate him in the event he should again reach the stage of unconsciousness.

   
   

3. The parties agree that the Respondent gave the patient a sponge bath even though, at the time, he may not have been soiled. The family claims he was clean, but Respondent contends she bathed the patient to clean fecal material, urine and sweat from him and the bed clothes. Notwithstanding the Respondent's notation that the patient was confused or disoriented, neither his wife nor his two daughters considered him to be so, and after the patient was placed back in bed and cleaned up, according to the family members, Respondent spent the remainder of the afternoon at the patient's home on the telephone, trying to find a nurse to cover the next shift. Initially, she was unable to do so, and

   B.C. claims Respondent approached her to work as an aide and deliver patient care to her father. B.C. refused to do so. Respondent admits to a discussion with B.C. about hiring her to care for the patient but claims the discussion was in response to a question by the daughter, not a solicitation by Respondent.

   
   

4. Respondent was apparently successful in securing a relief nurse because she was relieved at 5:00 PM by Dorothy Reisebeck, a licensed practical nurse, (LPN), who was not a trained cardiac nurse. According to Ms. Riesebeck she had been told by Respondent that the patient had been discharged from the hospital after minor surgery, and that she, Riesebeck, need only monitor him, check his oxygen, and make him comfortable. Notwithstanding Respondent's claim that she prepared an assessment of the patient and gave an adequate report to her relief, Ms. Riesebeck claims that Respondent failed to provide her with a care plan, an assessment sheet for the patient, or a list of the patient's

   medications and proper dosages. She also indicates Respondent did not inform her that the patient was suffering from congestive heart failure and was terminally ill. When fully advised of the patient's true condition, Ms.

   Riesebeck did not feel adequately prepared to care for him. Nonetheless, she remained on the scene until she was relieved at 7:30 the following morning. In this regard, Ms. Riesebeck claims she had been led to believe by Respondent that she would be relieved at 10:00 PM the prior evening, March 13. When she was relieved it was by another LPN, Ms. Holloway, who also had no cardiac care experience.

   
   

5. When Ms. Holloway arrived, she also looked for the assessment sheet on the patient which should have been there, but was told by Ms. Riesebeck that one did not exist. They tried without success to contact Respondent and while Ms. Riesebeck and Ms. Holloway were on the scene, the patient suffered another acute cardiac episode.

   
   

6. The family understood that since Ms. Holloway, who arrived at 7:30 AM, had worked all the previous night at the hospital, she would be there for only three or four hours until relieved by someone that Respondent had found to do so. Her shift was to end at 11:00 AM, but she was not relieved until Respondent appeared at 3:00 PM on March 14, 1992.

   
   

7. Respondent's arrival did not appear to be for the purpose of providing nursing care. She was, upon arrival, dressed in high heels, makeup, jewelry and a flowered dress. A man was waiting for her in the car outside the house, and it was obvious to everyone that Respondent was neither dressed for nor prepared to perform a shift providing care for this patient. It was clear she had no intention of staying for that purpose.

   
   

8. Before the Respondent left, however, she began arguing with Ms. Holloway, which culminated in Ms. Holloway leaving. Respondent then began arguing with both of the patient's daughters, and attempted by telephone to find someone else to cover the shift. Respondent appeared to be very disturbed. She was screaming at people on the telephone and reacting to her conversations by slamming the receiver down.

   
   

9. Before the Respondent had arrived that day, because they were having problems getting the patient's medications and a morphine IV set up, the family called the patient's physician and requested that the Respondent be replaced by Hospice. Someone other than the Respondent, presumably the physician, was able to contact a pharmacy which sent IV equipment and morphine, saline, and demerol solutions to the patient's home. These medications had been ordered by the physician for the patient's pain after he was called by the patient's daughter. Respondent was present when the pharmacy order arrived and requested that the delivery person set up the IV. That individual refused, however, indicating she was not authorized to do so by the physician.

   
   

10. Consistent with the family's request, somewhat later a representative of Hospice arrived, and upon the arrival of that individual, the patient's wife discharged the Respondent. With this, the Respondent became very angry and began screaming, banging on the table and slamming things around. All of this served to disturb and upset the patient. Because of this, it was necessary for family members to calm him down.

    
    

11. After the argument with the family, Respondent took the bag containing the patient's medications, the medication record kept by the patient's wife over the prior year, and the patient's hospital prescriptions, and told one of the

    daughters that the medications were hers because she had paid for them. Respondent then departed the home with the gentleman in the car. The daughter called the police and reported the theft. Respondent did not return the morphine, the saline solution and a bottle of 100 Valium tablets.

    
    

12. Ms. Sangster, A Registered Nurse Practitioner for 24 years, evaluated Respondent's performance in this matter for the Department. According to her, a home health nurse is supposed to go into the patient's home and assess his physical status to see what care is needed at home and to assess the ability of the nurse to provide those needs. This function also includes working with the patient's family and to help them in understanding the care required so that family members can administer medications when the nurse is not present.

    
    

13. Ordinarily, patients retain a home health agency which has an arrangement with the hospital, on referral by a physician, or directly. Before the patient is discharged the agency should have contacted the patient, and upon discharge an agency representative should go to the patient's home as quickly as possible to meet with the patient and the family. The home health agency is responsible to the family, and the nurse on duty is also responsible to provide the needed care. If the nurse sees that the needs are greater than her skills, she must notify the agency to get some with the requisite credentials.

    
    

14. The standard of care applicable to home health nurses requires the practitioner to:

    
    

    1. Report to provide care on time.

    2. Stay with the patient as long as required.

    3. Perform all tasks assigned.

    4. Perform all tasks needed.

    5. Do a complete physical assessment of the patient at the first visit.

    6. Administer proper medications on time.

    7. Perform all procedures required.

    8. Document all activities performed.

    9. Provide necessary information to the successor shift personnel either verbally or in writing.

       
       

15. If the assigned nurse cannot report on time or stay as long as scheduled, then the home health agency is responsible to provide a substitute. The nurse must advise the home health agency in advance and leave a report for the replacement. The nurse on duty must not leave until the replacement arrives.

    
    

16. The initial physical assessment establishes the starting point for future patient status. It is a part of the care plan. It must be done the first time the nurse goes into the home for the initial home visit. It is usually done by a registered nurse or, if a licensed practical nurse does it, a registered nurse must evaluate and approve it. Standard practice requires that all patient contact be documented to include what services are to be provided, and entries in the record should be made when a particular service is rendered or as soon thereafter as is possible.

    
    

17. Ms. Sangster reviewed the investigative file in this case. All nurses providing treatment to this patient under the terms of the agreement were to be registered nurses who had cardiac training. This was not what Respondent provided.

18. In addition, the physician's order sheet indicates oxygen was to be delivered to the patient's home and that Maximum Care was to provide the home health care. It is the home health agency's responsibility to insure that what is needed for the patient's care is available if not present on the arrival of the patient. Here, in Ms. Sangster's opinion, since Respondent was the first agent of the home health agency to arrive at the patient's home, it was her responsibility to call and arrange for the oxygen to be delivered. She failed to do this.

    
    

19. Ms. Sangster examined all the patient's records with the home health agency. Ordinarily such documents will describe the patient's condition, appearance and level of activity. Much of this information is in the records prepared by Respondent. However, Ms. Sangster found many inconsistencies in the assessment. These related to how the patient was described by two different people who observed him. Respondent describes the patient as confused and disoriented, suffering from blackouts, swollen and pale, but with a good appetite and normal urine. She does not, however, indicate how that confusion should be handled. Another individual notes that the patient activity is normal and he is alert, with normal respiration, temperature and skin, a clear chest, and can speak and hear without difficulty. The family contends the patient was neither confused or disoriented.

    
    

20. The Respondent's assessment notes reflect the decubitus on the patient but do not indicate how it will be treated or how any anticipated problem the patient might have should be handled. The form is a three page document. Only the first page reflects the patient's name. Ms. Sangster notes that many of the "yes" or "no" blocks checked on the second page do not have explanatory comments, and it is so found.

    
    

21. Based on her evaluation of the entire care package provided to this patient by the Respondent, Ms. Sangster concluded that Respondent's actions in this case did not meet required standards because:

    
    

    1. There was a lack of documentation to support the actions taken, and that documen-

       tation present was both inconsistent and incorrect.

    2. She failed to provide that care contracted for 24 hours per day, that is, care by cardiac trained registered nurses.

    3. She left the patient alone with his family, which constituted -

    4. The abandonment of the patient and his family,

    5. She failed to insure the required equipment was on hand.

    6. She did an improper and inadequate patient assessment.

    7. She failed to place the assessment she did in the patient's file.

    8. She failed to conduct herself with professionalism in her relationship with the patient and his family.

    9. She failed to address safety issues, and

    10. As a result of all the above, she placed her patient in great harm.

22. The allegation of abandonment is of great import. Abandonment, defined as either the nurse's failure to show up on time or to leave her patient before relief, is viewed as very serious in the nursing community. The home health nurse must, if she cannot provide coverage, make sure that her agency knows her limitations. Since in this case the Respondent was at least in part owner of the agency, she had a multiple responsibility. She should have arranged for someone to be present at the patient's home when he arrived; insured the necessary oxygen equipment was present; and done an immediate assessment of the patient, while he was on the floor, and communicated the patient's status to his physician.

    
    

23. Ms. Melegrito claims she did all that was necessary for this patient considering he was a terminal patient with a "do not resuscitate" order on record. She insists he was never neglected. The wife was briefed on the patient's medications because, Respondent claims, she wanted to administer the medications herself. Respondent got the impression that the patient's wife was resistant to her caring for the patient.

    
    

24. Respondent claims the action taken against her is racially motivated based on the fact she is the only brown skinned person being charged. Aside from the fact there is no evidence to support this assertion, she overlooks the fact she was the most qualified person involved and her credentials placed upon her a higher standard of performance than that placed on the other two nurses. Her contention is without merit.

    
    

    CONCLUSIONS OF LAW

    
    

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

    
    

26. In the Administrative Complaint, Petitioner has charged the Respondent with providing nursing services to her patient, L.B., on or about March 13, 1992, in a manner which was below the minimum standards of acceptable nursing practice, in violation of Section 464.018(1)(h), Florida Statutes. The burden of proof in this case is upon the Petitioner to establish the alleged misconduct by clear and convincing evidence. Ferris v. Turlington, 292 So.2d 510 (Fla. 1987).

    
    

27. Section 464.018(1), Florida Statutes, empowers the Board of Nursing to discipline the license of a nurse in Florida for an established violation of any of the acts enumerated therein. In the instant case, the Board alleges that by failing to provide the care which she agreed to provide to the patient in issue, and by leaving him in the care of individuals who were not qualified to provide the necessary care, Respondent was engaged in unprofessional conduct and abandoned her patient which constituted care below the acceptable standard.

    
    

28. Respondent has claimed that she had no written contract with the patient's family and, therefore, had no obligation to provide any service beyond that which she provided. She claims she agreed only to come to the patient's home after his discharge from the hospital, assess his condition and his care needs, and then, upon agreement with the family, provide for such needs. It has been found that there was no written contract between Respondent and her patient or his family. However, it has also been found that she solicited them to employ her, through her company, as a care giver at home after the patient's discharge from the hospital. Even though she arrived late on the scene, it is clear Respondent assumed that responsibility, even without a written contract.

29. The duty relationship thus established, it is also clearly shown that Respondent failed to fulfill her obligation in a proper manner. The state of the evidence makes it impossible to determine exactly how late Respondent was in arriving at the patient's home after his discharge from the hospital. It is clear, however, that she was not waiting for him when he arrived, as she was supposed to be, and that she had not made the appropriate arrangements to insure the required supplies, including oxygen, were there for him upon his arrival. Assuming, arguendo, it was not her responsibility to make the initial contact with the oxygen supply house for the delivery of the oxygen to the patient's home, it was her responsibility to check that the arrangements had been made so that that vital equipment was available for the patient if and when needed.

    This she failed to do. Most important here, however, is the fact that because of Respondent's failure to be present at the patient's home when he arrived, he was left alone with his family members who were unqualified to care for him in his condition for an extensive period of time. During this period, the patient suffered a cardiac episode with which the family members were unqualified to deal.

    
    

30. The Department's expert in nursing practice clearly established the essentials of an appropriate nursing assessment. She also established that an assessment should be done early in the relationship and left with the patient for any relief nurse or medical professional who takes her place. Respondent's assessment, when done, touches on many of the subject areas required, but not in detail on any, and was found by the expert to be insufficient and inadequate. Uncontradicted by any evidence except Respondent's opinion of her own work, the expert's evaluation is accepted.

    
    

31. The evidence also clearly establishes that the two relief nurses provided by the Respondent were neither registered nor cardiac trained, both qualifications which Respondent had agreed to provide. Further, it is clear that Respondent failed to document the patient's condition in a proper patient assessment left for the relief nurses, (neither of whom were able to find any assessment left for them by Respondent), and failed to provide proper supervision for them. She also failed to insure each was relieved by a properly qualified nurse at the scheduled end of the shift each agreed to serve. Taken as a whole, her performance was below acceptable standards.

    
    

32. To be sure, this patient was in a terminally critical situation as a result of chronic cardiac insufficiency. In short, the patient would not recover and little could be done for him other than to insure proper medications were administered and he was kept as comfortable as possible. Consequently, Respondent's shortcomings here probably had little adverse effect on this patient's long term prognosis, except for her removal of some of his medications when she left

    
    

33. Clearly, the relationship between Respondent and the patient's family was deplorable. When called to account for her failure to provide that care which the family expected, Respondent, instead of reasoning calmly with them and explaining her position, engaged in a fit of anger, screaming and petulance, much of which was heard by the patient, and which served to exacerbate an already difficult period for the family. This was clearly unprofessional conduct and well below standards. Respondent's confiscation of the patient's medications and medication records in a dispute over payment is inexcusable.

    
    

34. By way of penalty, the Petitioner proposes that Respondent's license to practice nursing in Florida be revoked. In the alternative, Petitioner

    suggests suspension of Respondent's nursing license for five years, followed by five years probation under specified conditions and an administrative fine of

    $1,000. Petitioner has been found guilty of practice below standards. Rule 59S-8.006(3)(i), F.A.C., outlining suggested penalties for a violation of various provisions of the statute authorizing discipline for misconduct, authorizes, as a minimum, a fine on no more than $1,000, plus suspension and probation with conditions for up to two years each. The rule also provides, however, at 59S-8.006(4), F.A.C, for deviation from the suggested penalty upon showing of either aggravating or mitigating circumstances.

    
    

35. It has been found that patient abandonment is viewed with great seriousness within the nursing community in this state. The evidence of record, while not establishing a classical abandonment, has clearly established professional misconduct by Respondent which constitutes a form of abandonment for which discipline may be taken. Petitioner contends the Respondent's misconduct endangered her patient's life. That appears to be too harsh a judgement in light of the patient's terminal condition. Nonetheless, the patient, and his family, have a right to expect from a nursing professional a degree of professional competence and performance which was not displayed by Respondent in the case in issue. She was calloused, unsympathetic, brash, harsh, and avaricious in her dealings with this patient's family. In her dealing with the Department, she has made several inconsistent statements and appears to be unable or unwilling to see little wrong in her actions here.

    
    

36. No evidence of prior misconduct was introduced by the Petitioner, and Respondent presented no legitimate matters in extenuation or mitigation of her actions.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of Law, it is, therefore:

RECOMMENDED that Respondent, Maria C. Melegrito's license as a registered nurse in Florida be suspended for three years, following the expiration of which it be placed on probation for an additional period of three years, under such terms and conditions as may be prescribed by the Board of Nursing, and that she pay an administrative fine of $1,000.

RECOMMENDED this 28th day of November, 1995, in Tallahassee, Florida.

ARNOLD H. POLLOCK, 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 28th day of November, 1995.

COPIES FURNISHED:

Miriam S. Wilkinson, Esquire Department of Business and

Professional Regulation 1940 North Monroe Street

Tallahassee, Florida 32399-0792

Maria C. Melegrito

Federal I.D. number 08343-018 Federal Prison Camp

Pembroke Station

Danbury, Connecticut 06180

Jerome W. Hoffman General Counsel

Agency for Health Care Administration

2727 Mahan Drive

Tallahassee, Florida 32309

Judie Ritter Executive Director Board of Nursing

Daniel Building, Room 50

111 East Coastline Drive 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 consult with the agency which will issue the Final Order in this case concerning its rules on the deadline for filing exceptions to this Recommended Order. Any exceptions to this Recommended Order should be filed with the agency which will issue the Final Order in this case.

Docket for Case No: 94-000278

Orders for Case No: 94-000278