Feb 1 2006 13:00 4 J STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO. 2005-51080 BONITA ANN PETOSA, R.N., 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 Respondent, Bonita Ann Petosa, R.N., and in support thereof alleges: | 1. Petitioner is the state department charged with requlating the practice of nursing pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 464, Florida Statutes, 2. At all times material to this Complaint, Respondent was a Registered Nurse (R.N.) within the state of Florida, having been issued license number 2151512, J:\PSU\Nursing\D'Eramo\A-C\A, C, ESO\RN\BONITA ANK PFTOSA, R.N,, IMPAIRMENT, CONVECTIONS.doc 1 FEB-@1-2886 12:14 AHCA P.a4 Meso Feb 1 2006 13:01 FEB-@1-2886 12:14 AHCA P.@S wd 7) 3. Respondent's address of record is 325 Trailblazer Drive, Lake Helen, Florida 32744. 4. At al times material to this order, Respondent was licensed to | practice nursing in the State of Florida, pursuant to Chapter 464, Florida Statutes. 5. On or about May 1, 2003, Respondent submitted to a pre- employment drug test at the request of Halifax Medical Center (Halifax), which test returned positive for Morphine. 6. Respondent did not have a lawful prescription or legitimate reason for using morphine. 7. Morphine is prescribed to treat moderate to severe pain and is in a class of drugs called opiates or opioids, which are drugs related to or derived from opium. According to Section 893.03(2), Florida Statutes (2002), morphine is a Schedule rT controlled substance, which can cause severe physical and psychological dependence. 8. On or about May 6, 2003, Halifax referred her to the Intervention Project for Nurses (“IPN”) due ta the pre-employment urine drug screen that returned positive for morphine. 3:\PSU\Nursing\P'Eramo\A-C\A. C. ESO\RN\BONITA ANN PETOSA, R.N., IMPAIRMENT, CONVICTIONS.goc ? Feb 1 2006 13:01 FEB-@1-2686 13:15 AHCA P.@6 J 9. IPN is the impaired practitioner program for the Board of Nursing, pursuant to Section 456.076, Florida Statutes. IPN is an independent program that monitors the evaluation, care and treatment of impaired nurses. IPN oversees random drug screens and provides for the exchange of information between treatment providers, evaluators and the Department for the protection of the public, 10. On or about May 23, 2003, Respondent underwent an IPN facilitated psychiatric evaluation conducted by Richard Sinai, M.D., a specialist in addiction psychiatry. During that evaluation, Respondent admitted to taking Lortab and MS Contin without a prescription. Respondent obtained the drugs by forging prescriptions while working in a pain clinic. Respondent also reported a history of alcohol abuse, drinking up to six to eight drinks every other day. 11. Lortab contains the opioid drug hydrocodone. According to Section 893.03(3), Florida Statutes (2002), hydrocodone, in the dosages found in Lortab, is a Schedule III controlled substance, which can cause physical and psychological dependence. 12. MS Contin contains the opioid drug morphine described above in paragraph seven (7). J:A\PSU\Nursing\D'Erama\A-C\A. C. ESO\RN\BONITA ANN PETOSA, R.N., IMPAIRMENT, CONVICTIONS. doc 3 FEB-@1-2886 13:15 AHCA Feb 1 2006 13:01 ) 13. Dr. Saini diagnosed opioid dependence, probable alcohol abuse, and depressive disorder. Dr. Saini recommended that Respondent receive intensive outpatient treatment, and participate in IPN with monitoring and random drug screens. 14, On or about June 20, 2003, Respondent began intensive outpatient treatment with Community Out-Reach Services, Inc (“CORS”) located in DeLand, Florida. 15. On or about August 20, 2003, Respondent entered into a five- year monitoring and advocacy contract with IPN that included completion of the outpatient treatment, aftercare counseling, participation in Alcoholics Anonymous (“AA”) or Narcotics Anonymous (“NA”), and random urine drug screens. 16. On or about September 3, 2003, while still receiving treatment with CORS, Respondent submitted a urine drug screen that returned positive for opiates. Reports from CORS indicate that Respondent admitted to taking opiates to help control abdominal pains from irritable bowel syndrome. The specific drug used was not identified. 17, Opiates or opioids are drugs related to or derived from opium, According to Section 893.03(2), Florida Statutes (2003), opiates are a J:\PSU\Nursing\D'Eramo\A-C\A, C. ESO\RN\BONTTA ANN PETOSA, R.N,, IMPAIRMENT , CONVICTIONS. coc 4 FEB-@1-2886 13:15 AHCA Feb 1 2006 13:01 ) Schedule JI controlled substance, which can cause severe physical and psychological dependence. 18. Respondent did not have a lawful prescription or legitimate reason for using these opiates. 19. On or about November 20, 2003, Respondent submitted a urine drug screen that returned positive for morphine. 20. On or about December 4, 2003, an IPN case manager questioned Respondent about the positive drug screen. Respondent admitted to taking Roxanol, a drug that had been prescribed to her now deceased son, Respondent stated that she used the drug to contro! the pain caused by irritable bowel syndrome. 21. Roxanol contains the controlled substance morphine described in paragraph seven (7). 22. Respondent did not have a lawful prescription or legitimate reason for using morphine or Roxanol. 23. Respondent completed her intensive outpatient treatment with CORS on or about December 4, 2003. A discharge summary submitted to IPN on or about January 14, 2003, indicated that Respondent needed inpatient residential treatment. J:A\PSU\Nurging\D'Eramo\A-C\A, C. ESO\RN\BONITA ANN PETOSA. BN, IMPAIRMENT, CONVICTIONS. aoc c Feb 1 2006 13:02 FEB-@1-2886 13:15 AHCA P.@9 ) ) 24, IPN referred Respondent to John Tanner, D.O., for a pain management and substance abuse evaluation. Respondent reported for the evaluation with Dr. Tanner on or about December 15, 2003. During that evaluation Respondent admitted to abusing opiates to help cope with her son’s death, which occurred in or about August 2001. She also stated that the drugs helped control the pain she suffered as a result of irritable bowel syndrome. When Dr. Tanner directed Respondent to provide a urine sample for a drug screen, Respondent became angry. When Dr. Tanner asked what would show up in the drug screen, Respondent indicated Lortab and nothing else. Respondent refused to continue with the evaluation. 25. Due to Respondent’s refusal to complete the evaluation, Dr. Tanner recommended a second opinion evaluation, preferably an inpatient evaluation. 26. On or about January 7, 2004, Respondent contacted IPN and reported that she was in relapse. She admitted to taking Lortab and drinking alcohol. The IPN case manager encouraged Respondent to report for an inpatient evaluation as soon as possible. JN\PSU\Nursing\D'Erama\a-C\4. C. ESO\RN\BONITA ANN PETOSA. R.N., IMPAIRMENT, CONVICTIONS. doc 6 Feb 1 2006 13:02 FEB-@1-2886 13:16 AHCA P.1a ) 27. Onor about January 8, 2004, Respondent reported for a 5-day inpatient evaluation at Alternatives in Treatment, an addiction treatment center located in Boca Raton, Florida. Respondent was cut and bruised when she arrived for her evaluation and reported the injuries were due to overturning her truck after driving while intoxicated, 28. Based on the driving while intoxicated incident, staff from Alternatives in Treatment advised Respondent to waive the evaluation and immediately enter the thirty-day inpatient treatment program. Respondent agreed. 29. On or about January 13, 2004, while at Alternatives in Treatment, Respondent received a psychiatric evaluation by David Gross, M.D., a specialist in psychiatry. Dr. Gross diagnosed Respondent with opioid dependence and alcohol dependence. Respondent completed her inpatient treatment on or about February 7, 2004. 30. On or about February 16, 2004, Respondent entered into a second advocacy contract with IPN, The requirements of that contract included aftercare counseling, participation in AA or NA meetings weekly, and random drug testing. The contract also required Respondent to be seen by a chronic pain management specialist if her chronic pain required J:\PSU\NUrsiNG\D'Eramo\A-C\A. C, ESO\RN\BONITA ANN PETOSA, R.N., IMPAIRMENT, CONVICTIONS. co: 7 Feb 1 2006 13:02 FEB-@1-2886 13:16 AHCA P.ii ) treatment with mood or mind altering drugs such as opiates. Respondent was approved to return to work with a restriction from access to controlled substances. 31. On or about January 10, 2005, Respondent submitted to a random urine drug screen that returned positive for propoxyphene. 32. Propoxyphene is a synthetic opioid narcotic. According to Section 893.03(4), Florida Statutes (2004), propoxyphene is a Schedule IV controlled substance, which can cause physical and psychological dependence. 33. On or about January 18, 2005, Respondent informed IPN that the propoxyphene was prescribed to treat pain for her irritable bowel syndrome. She also stated that she “always had Darvocet around” and used it periodically for pain. Darvocet is a brand name for a drug containing propoxyphene. 34. IPN requested Respondent provide | information from her physician to confirm that propoxyphene was prescribed. IPN also recommended that Respondent undergo a chronic pain evaluation as required by her IPN advocacy contract. Respondent refused and informed IPN that she no longer wished to participate in the program. J:\PSU\Nursing\D'Eramo\A-C\A, C, ESO\RN\BONITA ANN PETOSA, R.N.. IMPAIRMENT, CONVICTIONS. oc: & FEB-@1-2886 13:16 AHCA Feb 1 2006 13:03 d 35. On or about February 14, 2005, Respondent was dismissed from IPN. 36. On or about May 27, 2005, the Department ordered Respondent to submit to a mental and physical examination to determine if Respondent was able to practice nursing with reasonable skill and safety. That examination was scheduled on or about June 22, 2005. 37. On or about June 22, 2005, Respondent was evaluated by Todd B. Jaffe, M.D., a specialist in pain management. During the evaluation, Respondent was asked to submit to a urine drug screen which returned positive for_opiates. Dr. Jaffe diagnosed Respondent with opiate addiction. Dr. Jaffe opined that Respondent was in relapse and that she was not safe to practice nursing until she completed, at a minimum, a thirty - day inpatient treatment program for addiction. 38, Respondent did not have a lawful prescription or legitimate reason for using opiates referenced in paragraph thirty seven (37). 39. On or about July 6, 2005, a Department representative contacted the IPN to determine if Respondent had entered into a treatment or monitoring program, As of that date, Respondent had not made any JA\PSU\Nursing\D'Eramo\a-C\a. C. ESO\RN\BONITA ANN PETOSA, R.N., IMPAIRMENT, CONVICTIONS.doc Q Feb 1 2006 13:03 FEB-@1-2686 13:17 AHCA P.13 ) further contact with IPN since her dismissal from the program in February 2005. COUNT ONE 40. Petitioner re-alleges and incorporates paragraphs one (1) through seven (7) as if fully set forth herein. 41. Section 456.072(1)(z), Florida Statutes (2002), states that testing positive for any drug, as defined in Section 112.0455, Florida Statues (2002) on any confirmed pre-employment or employer-ordered drug screen when the practitioner does not have a lawful prescription and legitimate medical reason for using such drug constitutes grounds for disciplinary action. 42, On or about May 1, 2003, Respondent tested positive for morphine following a confirmed pre-employment drug screen and did not have a lawful prescription or legitimate medical reason for using the drug. 43. Based on the foregoing, Respondent has violated Section 456.072(1)(z), Florida Statutes (2002) by testing positive for a drug (morphine) as defined by Section 112.0455, Florida Statutes (2002) on a J:\PSU\Nursing\D'Eramo\a-C\a. C. ESO\RN\BONITA ANN FETOSA, R.N., IMPAIRMENT, CONVICTIONS. doc 10 FEB-@1-2886 12:17 — AHCA ) Feb 1 2006 13:03 confirmed employer-ordered drug screening when Respondent did not have a lawful prescription or legitimate medical reason for using the drug. COUNT TWO 44. Petitioner re-alleges and incorporates paragraphs one (1) through four (4), seven (7), fourteen (14) through twenty-two (22), and thirty (30) through thirty-eight (38) as if fully set forth herein. 45. Section 464.018(1)(n), Florida Statutes (2003) (2004), provides that failing to meet minimal standards of acceptable and prevailing nursing practice constitutes grounds for disciplinary action by the Board of Nursing. 46. Rule 64B9-8.005(2)(k), Florida Administrative Code, states that failing to meet or departing from minimal standards of acceptable and prevailing nursing practice shall include testing positive for any drugs under Chapter 893, Florida Statutes (2003) (2004), on any drug screen when the nurse does not have a prescription and legitimate medical reason for using such drugs. 47. Respondent tested positive for opiates, morphine, and Propoxyphene, each of which are controlled substances under Chapter 893, Floride Statutes, on or about September =, 2003, November 20, 2003, J:\PSU\Nursing\D'Erama\A-C\A. C. ESO\RN\BONITA ANN PETOSA, R.N.. IMPAIRMENT, CONVICTIONS. dac 1] FEB-@1-2886 12:17 AHCA Feb 1 2006 13:03 d January 10, 2005, and June 22, 2005 respectively. Respondent’ did not have lawful prescriptions or legitimate medical reasons for using the each |. of these drugs. 48. Based on the foregoing, Respondent has violated Section 464.018(1)(n), Florida Statutes (2003) (2004), by failing to meet minimal standards of acceptable and prevailing nursing practice as defined by Rule 64B9-8.005(2)(k), Florida Administrative Code, by testing positive for drugs (each of opiates, morphine, propoxyphene on the enumerated instances) on drug screens, when Respondent did not have a lawful prescriptions or legitimate medical reasons for using the drugs. COUNT THREE 49. Petitioner re-alleges and incorporates paragraphs one (1) through thirty-nine (39) as if fully set forth herein. 20. Section 464.018(1)(j), Florida Statutes (2002) (2003) (2004), provides that being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, or chemicals, or any other type of material or as a result of any mental or JAPSU\Nursing\D'Eramo\A-C\A. C. ESO\RN\BONITA ANN PETOSA, R.N., IMPAJRMENT, CONVICTIONS. cox 12 Feb 1 2006 13:04 FEB-@1-2886 12:17 AHCA P.16 2 physical condition constitutes grounds for disciplinary action by the Board of Nursing. D1. As set forth above, Respondent has a long - term, well documented opiate addiction and alcohol dependence and a history of relapses. According to a recent Department of Health ordered mental and physical examination, Respondent was determined to be in relapse and unable to practice nursing with reasonable skill and safety. Respondent has not resumed a treatment and/or monitoring program with IPN. 52. Based on the foregoing, Respondent violated Section 464.018(1)(j), Florida Statutes (2002) (2003) (2004), by being unable to practice nursing with reasonable skill and safety to patients by reason of iliness or use of alcohol, drugs, narcotics, or chemicals, or any other type of material or as a result of any mental or physical condition. 7EAPSU\Nursing\D'Eramo\A-C\a. C. ESO\RN\BONITA ANN PETOSA, R.N., IMPAIRMENT, CONVICTIONS, doc 3 FEB-@1-2886 13:18 SIGNED this _#? FILED DEPARTMENT OF HEALTH cur Hhunvon. Mekenr DATE -$- OT PFD Reviewed and approved PCP: os” Feb 1 2006 13:04 > day of PugurT , 200g 7 AHCA John O, Agwunobi, M.D., M.B.A., M.P.H. Secretary, Department of Health LLi-— Pout F, D'Eramo Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Florida Bar No, 0370339 (850) 414 - 8126 Telephone (850) 414 - 1991 Facsimile by: 3" _(initials) 2fee / ">__(date) PCP Members: 4. /ierug?y- / tf kere’ fh J:\PSU\Nursing\D'Eramo\A-C\A. C. ESO\RN\BONTTA ANN PETOSA, R.N., IMPAIRMENT, CONVICTIONS.00¢ Feb 1 2006 13:04 FEB-@1-2686 13:18 AHCA P.18 ) NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120,57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested, NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed. 3:\PSU\Nursing\D'Eramo\4-C\A. C, ESO\RN\BONITA ANN PETOSA B.A. IMPAIRMENT, CONVICTIONS. dac 15

Docket for Case No: 06-000407PL