STATE OF FLORIDA DEPARTMENT OF HEALTH 0 ey, : Y tA DEPARTMENT OF HEALTH e7, S& to ~O Petitioner, L VS. ANDREA DERBY, Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, DEPARTMENT OF HEALTH, by and through its undersigned counsel and files this administrative complaint before the Board of Nursing against the Respondent, ANDREA DERBY, and in support thereof alleges: . 1. Petitioner is the state agency charged with regulating the practice of nursing pursuant to Chapters 20, 456, and 464, Florida Statutes. ° 2. Pursuant to the authority of Section 20.43(3)(g), Florida Statutes, the Petitioner has contracted with the Agency for Health Care ‘Administration to provide consumer complaint, investigative and prosecutorial services required by the Division of Medical Quality Assurance, councils or boards, as appropriate, including the i issuance of emergency orders of suspension or restriction. 3. Respondent is and has been at all times material hereto, a licensed 7 REGISTERED NURSE in the State of Florida, having been issued license number RN 1732402. 4. Respondent's last known address is 7640 NW 13th Court, Ft. Lauderdale, Florida 33322. Count | 5. On or between March 1998 and July 1999, while employed by Comprehensive Medical Services (CMS) and assigned to work at Jackson Memorial Hospital (JMH), Respondent practiced below the minimal acceptable standards of prevailing nursing practice, to wit: Respondent submitted false and or inaccurate and or fraudulent and or forged time slips to her employer ‘regarding hours that Respondent worked at JMH as a nurse resulting in JMH being billed for nursing Services that Respondent did not provide. 6. Based on the foregoing, Respondent is subject to discipline pursuant to section 464.018(1)(h), Florida Statutes, by unprofessional conduct by failing to conform to the minimal acceptable standards of prevailing nursing» practice. Count Il 7. On or about May 22, 2000, Respondent was convicted, found guilty or entered a plea of nolo contendere to, fegardiess of adjudication, acrime which . directly relates to the Practice of nursing or the ability to practice nursing, to wit: Forgery. 8. Based on the foregoing, Respondent is subject to discipline pursuant to section 464.018(1 Xe), Florida Statutes, by being convicted or found guilty of, or entering a plea of nolo contendere to, regardless of adjudication, a ey crime in any jurisdiction which directly relates to the practice of nursing or to the ability to practice nursing. WHEREFORE, Petitioner respectfully request that the Board of Nursing enter an Order imposing one or more of the following penalties: Revocation or suspension of Respondent's license, imposition of an administrative fine, | issuance of a reprimand, placement of the Respondent on probation, costs, and/or any other relief that the Board deems appropriate. Signed tnid WH yrsay ot Robert G. Brooks, M.D. Secretary, Department of Health 200 . Nancy Snurkowsk\ Chief Attorney On Behalf of the Agency for Health Care Administration - COUNSEL F HE PETITIONER: FIL D Reginald D. Dixon, Senior Attorney DEPARTMENT OF HEALTH Aan, ae > Ad DEPUTY CLERK _.. Agency for Ith Care Administration A ys : Allied Health Section ouerk Yakik. Fenen Post Office Box 14229 DATE (2) Tallahassee, Florida 32317-4229 ~ (50) 414 - 8576 RDD/rd PCP: DOM: MEK AA Yo) lee gene tne “ee ES TES Se

Docket for Case No: 01-002706PL