STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF HEALTH, BOARD OF ) NURSING, )

)

Petitioner, )

)

vs. )

) MADELINE CHAMBERS, L.P.N., )

)

Respondent. )

Case No. 05-1452PL

)

RECOMMENDED ORDER

Pursuant to notice, a final hearing was held in this case on July 6, 2005, in Tampa, Florida, before Susan B. Harrell, a designated Administrative Law Judge of the Division of Administrative Hearings.

APPEARANCES

For Petitioner: J. Blake Hunter, Esquire

Obinna Chukwuanu, Esquire Department of Health

4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265

For Respondent: Madeline Chambers, pro se

7612 East 25th Avenue Tampa, Florida 33619

STATEMENT OF THE ISSUE

Whether Respondent violated Subsection 464.018(1)(n), Florida Statutes (2003),1 and Florida Administrative Code Rule 64B9-8.005(2)(b), and, if so, what discipline should be imposed?

PRELIMINARY STATEMENT

Petitioner, Department of Health, Board of Nursing (Department), filed an Amended Administrative Complaint against Respondent, Madeline Chambers (Ms. Chambers). The Amended Administrative Complaint alleges that Ms. Chambers violated Subsection 464.018(1)(n), Florida Statutes, for unprofessional conduct as defined by Florida Administrative Code Rule 64B9- 8.005(2)(b), by improperly injecting patient M.A.B. with insulin and failing to report the error to the proper supervisors.

Ms. Chambers requested an administrative hearing pursuant to Sections 120.569 and 120.57, Florida Statutes (2004), and the case was forwarded to the Division of Administrative Hearings on April 18, 2005, for assignment to an administrative law judge.

The final hearing was held on July 6, 2005, in Tampa, Florida. At the final hearing, the Department called the following witnesses: Lois Evlyn Ashcraft, C.N.A.; Christine Martinez, R.N.; Melissa Reisinger, R.N.; Leonard Lacey, Jr., L.P.N.; Edward William White, L.P.N.; and Rosemary Nunn-Hill, R.N., an expert in licensed practical nursing. Petitioner's Exhibits 1 through 9 were admitted in evidence. At the final hearing, Ms. Chambers testified in her own behalf and presented no exhibits.

The parties agreed to file their proposed recommended orders within ten days of the filing of the one-volume

Transcript, which was filed on July 21, 2005. The Department filed a Proposed Recommended Order on July 29, 2005. On August 26, 2005, Ms. Chambers filed a letter dated August 24, 2005, which is taken to be her post-hearing submittal. A copy of the letter does not appear to have been provided to counsel for the Department. A Notice of Ex-Parte Communication was issued on August 29, 2005.

FINDINGS OF FACT

1. The Department is the state agency charged with the responsibility of regulating the practice of licensed practical nurses pursuant to Section 20.43 and Chapters 456 and 464, Florida Statutes.

2. Madeline Chambers is a certified Licensed Practical Nurse (L.P.N.) licensed by the Department under license

   No. 849561.

   
   

3. On June 14, 2004, Ms. Chambers was employed by Staffing Source, a temporary nurse staffing agency, and assigned to work as an L.P.N. at Sun Terrace Health Center (Sun Terrace) in Sun City, Florida.

4. Sun Terrace is a 120-bed skilled nursing facility. Sun Terrace has approximately forty nurses on staff and uses agency nurses when needed.

5. On June 14, 2004, Ms. Chambers was assigned to the

   11:00 p.m.-to-7:00 a.m. shift on the 100 wing of Sun Terrace. A female patient identified as M.A.B. was located in the 100 wing of Sun Terrace during the 11:00 p.m.-to-7:00 a.m. shift on

   June 14, 2004.

   
   

6. Apparently a water leak in M.A.B.'s original room caused Sun Terrace to transfer M.A.B. to a room in the 100 wing, which had been previously occupied by a male patient, D.M. D.M. is a diabetic, who requires insulin injections.

7. Each patient has a Medication Administration Record (MAR), which lists the patient's medications, the time for administration, the dosage, and the route. The MAR has the first and last name of the patient listed. The MAR is kept on the medication cart, and the drugs in the medication cart are stored according to the patient's room number. D.M.'s medications were not moved on the medication cart to reflect his new room number, when M.A.B. moved into D.M.'s room. Thus, if one looked only at the room number on the medication cart, it would appear that D.M.'s medications were to be administered to M.A.B.

8. One of Ms. Chambers' duties was to administer medication to patients on the 100 wing. Near the end of her shift on June 14, 2004, she took the medication cart and went to M.A.B.'s room to administer medication. Ms. Chambers looked at the chart and saw the last name of the patient, which was the

   last name of D.M. D.M.'s first name, which could not be confused as the name of a female, also was on the chart, but apparently did not register in Ms. Chambers' mind. D.M.'s chart showed that he was to receive 34 units of 30/70 insulin.

9. Ms. Chambers went into M.A.B.'s room, and did not check M.A.B.'s arm band, which M.A.B. was wearing. The arm band listed M.A.B.'s name. M.A.B. had a certified nursing assistant (C.N.A.), Lois Ashcraft, who had been hired to sit with M.A.B. during the night. Ms. Chambers did not ask Ms. Ashcraft the identity of M.A.B.

10. Ms. Chambers used an Accu-check to check M.A.B.'s blood-glucose level. After checking the blood-glucose level, Ms. Chambers injected M.A.B. with 34 units of 30/70 insulin. 30/70 insulin consists of 30 percent of insulin which begins to act within 30 minutes and 70 percent of insulin which continues to increase the blood-glucose level of the patient for up to 24 hours.

11. Shortly after giving M.A.B. insulin, Ms. Chambers realized she had made an error and proceeded to give M.A.B. pudding and juice to offset the effects of the insulin.

    Ms. Chambers claims that she attempted, but failed to provide proper notification to the appropriate supervisors to indicate that she incorrectly gave M.A.B. insulin. Her testimony is not

    credited. None of the staff, with whom Ms. Chambers claims she spoke, remembers having such a conversation with her.

12. At the end of her shift, Ms. Chambers left Sun Terrace and headed to her employer, Staffing Source, without providing notice of the incident to an appropriate supervisor.

13. Ms. Ashcraft was in the room when Ms. Chambers administered the insulin to M.A.B. Ms. Ashcraft brought the incident to the attention of M.A.B.'s mother shortly after 8:00 a.m. on June 14, 2004. M.A.B.'s mother then notified the staff at Sun Terrace that her daughter may have been given an improper injection of insulin.

14. Rosemary Nunn-Hill, a licensed registered nurse who was qualified as an expert in licensed practical nursing, creditably testified that the proper procedure when giving a patient medication requires an L.P.N. to correctly identify a patient before administering any medication, and report any errors in administering the medication to a supervisor, the relief nurse, or the patient's physician.

15. Ms. Chambers has not had her license disciplined prior to this proceeding.

    CONCLUSIONS OF LAW

    
    

16. The Division of Administrative Hearings has jurisdiction over the parties to and the subject matter of this proceeding. §§ 120.569 and 120.57, Fla. Stat. (2004).

17. The Department has the burden to establish the allegations in the Amended Administrative Complaint by clear and convincing evidence. Department of Banking and Finance v. Osborne Stern and Co., 670 So. 2d 932 (Fla. 1996). In Slomowitz v. Walker, 429 So. 2d 797 (Fla. 4th DCA 1983), the court developed a working definition of "clear and convincing evidence," which has been adopted by the Florida Supreme Court in In re Davey, 645 So. 2d 398 (Fla. 1994). The court in Slomowitz stated:

    [C]lear and convincing evidence requires that the evidence must be found to be credible; the facts to which the witnesses testify must be distinctly remembered; the testimony must be precise and explicit and the witnesses must be lacking in confusion as to the facts in issue. The evidence must be of such weight that it produces in the mind of the trier of fact a firm belief or conviction, without hesitancy, as to the truth of the allegations sought to be established.

    
    

    Slomowitz, 429 at 800.

    
    

18. The Department alleged that Ms. Chambers violated Subsection 464.018(1)(n), Florida Statutes, which provides that disciplinary action may be taken for "[f]ailing to meet minimal standards of acceptable and prevailing nursing practice[.]" The Department further alleged that Ms. Chambers violated Florida Administrative Code Rule 64B9-8.005(2)(b), which states that failing to meet or departing from minimal standards of

    acceptable and prevailing nursing practice shall include, but not limited to, administering medications or treatments in a negligent manner.

19. The Department has established by clear and convincing evidence that Ms. Chambers administered medications in a negligent manner by failing to properly identify M.A.B., erroneously administering 34 units of 30/70 insulin to M.A.B., and failing to provide proper notice of the mistake to the appropriate supervising staff. Thus, the Department has established a violation of Subsection 464.018(1)(n), Florida Statutes, for unprofessional conduct as defined by Florida Administrative Code Rule 64B9-8.005(2)(b).

20. Florida Administrative Code Rule 64B9-8.006(3)(p) provides that the range of penalties for a first-time violation of Subsection 464.018(1)(n), Florida Statutes, is from a $250 fine to a $500 fine and probation.

RECOMMENDATION

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

RECOMMENDED that a final order be entered finding Madeline Chambers guilty of violating Subsection 464.018(1)(n), Florida Statutes; imposing an administrative fine of $250; and placing her on probation for one year with terms to be set by the Board of Nursing.

DONE AND ENTERED this 31st day of August, 2005, in Tallahassee, Leon County, Florida.

S

SUSAN B. HARRELL

Administrative Law Judge

Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

(850) 488-9675 SUNCOM 278-9675

Fax Filing (850) 921-6847 www.doah.state.fl.us

Filed with the Clerk of the Division of Administrative Hearings this 31st day of August, 2005.

ENDNOTE

1/ Unless otherwise indicated, citations to the Florida Statutes shall be to the 2003 version.

COPIES FURNISHED:

J. Blake Hunter, Esquire Obinna Chukwuanu, Esquire Department of Health

4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265

Madeline Chambers 7612 East 25th Avenue Tampa, Florida 33619

R. S. Power, Agency Clerk Department of Health

4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701

Dan Coble, RN, PhD, CNAA C, BC

Executive Director Board of Nursing Department of Health

4052 Bald Cypress Way, Bin C02 Tallahassee, Florida 32399-3252

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

15 days from the date of 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: 05-001452PL

Orders for Case No: 05-001452PL