Mar 16 2009 13:54 MAR-16-2009 13:36 _ AHA rr STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO. 2004-15988 BETH ANN WELLMAN, R.N., RESPONDENT. / INISTRATIVE 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, Beth Ann Wellman, R.N., and in support thereof alleges: 1. Petitioner is the state department charged with regulating 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 RN 1882292. Mar 16 2009 13:54 —16— : AHCA MAR-16-2089 13:36 1 ~ 3. Respondent’s address of record is 1042 Silcox Branch Circle, Oviedo, Florida 32765. 4. On or about November 19, 2002, while employed at Florida Hospital as an R.N., Respondent was observed by staff at Florida Hospital making paranoid statements such as, “they're listening” and referencing “the helicopters,” and being very focused on police. Staff reported Respondent's bizarre and paranoid behavior to Respondent’s Nurse Manager at Florida Hospital. In addition to the reported paranoid and bizarre behavior, Respondent’s Nurse Manager was also concerned about Respondent's behavior because Respondent had been tardy in reporting to work at Florida Hospital and had been a “no show” for work on one occasion. When questioned about her failure to report to work, Respondent gave only “one-word responses” and offered no valid reason. Based on the staff reports of paranoid behavior and her Own concerns, the Nursé Manager escorted Respondent to the Florida Hospital Employee Clinic (‘Clinic’). When Respondent arrived at the Clinic, she initially declined to have a drug screen or to have an Employee Assistance Program (“EAP”) evaluation. Respondent later agreed to provide the required drug Mar 16 2009 13:55 MAR-16-2889 13:37 AHCA P.@6 ry ~ screen and to return on November 21, 2002, for a physical and an EAP evaluation. 5. On or about November 22, 2002, Respondent was examined by Carol Griffin, ARNP, (“Ms. Griffin’), who is the manager of the Clinic. Respondent was adamant that the day was Thursday, November 21, when it was actually Friday, November 22. She refused to sign necessary releases and she refused to allow a physical examination. She refused to accompany Ms, Griffin to the EAP office. She stated that she needed to talk to the police. She also told Ms. Griffin that people were looking at her through a window in Ms. Griffin’s office. Respondent opened the blinds of the window to show Ms. Griffin the people who were looking at her. When Respondent realized that no one was looking at her through the window, she stated, “[t]hey must have gone.” Ms. Griffin placed Respondent on a medical leave of absence pending compliance with Florida Hospital's fitness for duty policy, which requires an evaluation, clearance by a psychiatrist, followed by clearance by Florida Hospital’s EAP. Respondent left the Clinic. Later that same day, Respondent returned to the Clinic and stated that she was “here for the physical.” She signed the required releases. Respondent continued to make comments about her need to contact the police. Ms. Mar 16 2009 13:55 MAR-16-2889 13:37 AHCA . Tv * + Griffin's assessment of Respondent following the examination was “acute mental health change; paranoia, stressors in personal life not defined.” 6. In about December 2002, Respondent was hospitalized at Florida Hospital for about six (6) days for a “psychotic break.” At that time, Respondent was diagnosed as suffering from a delusional disorder. 7. On or about March 14, 2003, Florida Hospital referred Respondent to the Intervention Project for Nurses CIPN”) because Respondent had failed to complete the fitness for duty process at Florida Hospital. Respondent was given three (3) days from receipt of Florida Hospital’s letter to contact IPN. 8. IPN is the impaired nurses 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 and the Department for the protection of the public. 9. On or about April 4, 2003, Respondent contacted IPN. She stated that she was not on any medication, although she acknowledged being depressed. She stated that she had an appointment with her family Mar 16 2009 13:55 MAR-16-2889 13:37 a AHCA P.@8 ™ doctor and hoped that he would give her a release to return to work. Respondent was advised at that time that she would not be returning to work until IPN completed the process of evaluating her for returning to nursing practice. 10. On or about June 2, 2003, Martha E. Brown, M.D., (“Dr. Brown”) a Board certified psychiatrist, performed an IPN-facilitated evaluation of Respondent. Based on her evaluation, Dr, Brown diagnosed Respondent as suffering from a delusional disorder. 11, On or about July 9, 2003, Dr. Brown provided additional information to IPN concerning Respondent’s evaluation. Dr. Brown reviewed Respondent's treatment records from Florida Hospital. Dr. Brown noted that Respondent had been given a diagnosis of delusional disorder and depression upon her discharge from Florida Hospital. Dr. Brown also noted that Respondent had been prescribed medication at the time of her discharge, but that Respondent was not taking any medications when she evaluated Respondent on or about June 2, 2003. Dr. Brown recommended that Respondent undergo psychological testing to further “elucidate” Respondent’s mental condition. Dr. Brown also recommended that Respondent seek intensive treatment, including medication management, Mar 16 2009 13:56 MAR-16-2689 13:38 AHCA La ro and that she see a psychiatrist to restart her anti-psychotic medications. In addition, Dr. Brown recommended that Respondent see a psychiatrist on a frequent basis until her mental condition stabilized. Dr. Brown also opined that Respondent should not be returned to nursing practice until all of Respondent’s psychological issues were addressed. 12. On or about July 10, 2003, Dr. Brown informed IPN that Respondent was not safe to practice nursing. 13. On or about July 23, 2003, Respondent underwent psychological testing by Arthur Rosenblatt, Ph.D., (‘Dr. Rosenblatt”). 14. On or about August 8, 2003, Dr. Rosenblatt submitted a report of his evaluation of Respondent. Dr. Rosenblatt opined that the test results suggested an individual with significant emotional problems. The testing further indicated that if Respondent were not presently psychotic, the potential for her developing a psychosis could not be minimized. The testing also suggested that Respondent had a schizoid personality. Dr. Rosenblatt diagnosed Respondent as suffering from a delusional disorder with avoidant and dependent personality traits. Dr. Rosenblatt recommended that Respondent was not safe to practice nursing and that she should engage in therapy and an anti-psychotic medication regimen. MAR-16-2089 13:38 . AHCA Mar 16 2009 13:56 ¥ 15. On or about August 8, 2003, Dr. Brown reviewed Dr. Rosenblatt’s evaluation of Respondent's psychological testing results. Dr. Brown noted that individuals with testing results similar to Respondent's are generally described as autistic, fragmented, tangential, circumstantial, and with thought content that is likely to be bizarre. Difficulties in concentrating and poor judgment are also common. Based on her review of Dr. Rosenblatt’s evaluation and her previous evaluation of Respondent, Dr. Brown opined that Respondent should be required to see a psychiatrist on a frequent basis, take medications as prescribed, and not be returned to nursing practice until she had at least a three (3) month period of stability with regard to her psychiatric disorders. 16. On or about August 11, 2003, Rafael Perez-Espejo, M.D., (Dr. . Perez-Espejo”), a Board certified psychiatrist, contacted IPN. Dr. Perez- Espejo stated that he had seen Respondent at Florida Hospital when she was hospitalized for treatment for her delusional disorder in about December 2002. He attributed Respondent's need for hospitalization to the death of her mother in about October 2002. He stated that Respondent would benefit from medication but that she refused to take medication, Mar 16 2009 13:56 MAR-16-2689 13:38 AHCA P.ii roF y Dr. Perez-Espejo thought that with “pressure” from IPN, Respondent might be convinced to go on medication. 17. On or about August 16, 2003, Respondent entered into a five (5) year mental health contract with IPN. The contract required medication management, monthly visits with her psychiatrist, monthly reports from her psychiatrist, mental health group therapy, and monitoring reports. The contract also required that the first monitoring reports be due on November 12, 2003. 18. On or about September 11, 2003, Dr. Perez-Espejo reported that Respondent remained unsafe to practice. Dr. Perez-Espejo’s report also indicated that Respondent would not accept medications and that she had refused to sign the evaluation. 19, On or about October 6, 2003, IPN received a hand-written letter from Dr. Perez-Espejo that was dated May 20, 2003, and addressed “[t]o whom it may concern,” The letter stated in its entirety: “Respondent may return to work without restrictions, in her position of RN at the ICU/Alorida Hospital.” Another letter was also sent with Dr. Perez-Espejo’s letter. That letter, dated October 1, 2003, was signed by Respondent and stated that based on Dr. Perez-Espejo’s May 20 letter, she expected to be Mar 16 2009 13:56 MAR-16-2089 13:38 AHCA scheduled for work “immediately.” Respondent also stated that she had experienced “unnecessary aggravation and financial hardship” because IPN had ignored this release for four (4) months. Respondent concluded her letter by stating, “[t]his hindrance is unacceptable.” 20. On or about October 6, 2003, in response to the correspondence described above, IPN advised Respondent that her IPN contract stated that approval to return to work would be reviewed by IPN in November 2003. IPN also advised Respondent that the letter from Dr. Perez-Espejo dated May 20, 2003, was not acceptable because it was not current and because more recently, on or about September 11, 2003, Dr. Perez-Espejo had reported that Respondent was not safe to return to practice. Respondent informed IPN that she would go to Dr. Perez- Espejo’s office and “make him write out a statement” clearing her to return to work. 21. On or about October 6, 2003, Dr. Perez-Espejo met with Respondent. Dr. Perez-Espejo noted that Respondent was not taking the anti-psychotic medication he had prescribed for her. Dr. Perez-Espejo also noted that Respondent had shredded the prescriptions he had written for her. Respondent told Dr. Perez-Espejo that she did not need to take Mar 16 2009 15:57 MAR-16-2889 13:39 AHCA P.i3 — + medication. He observed that her behavior and mental state remained unchanged. She was elusive, vague and very hesitant in her answers. She avoided discussion of paranoia, mind control or any delusions she had had in the past. She continuously interjected that she needed to go back to work. Dr. Perez-Espejo diagnosed Respondent as suffering from schizophrenia with a schizoid personality. 22. On or about October 6, 2003, Dr. Perez-Espejo informed IPN that Respondent was being terminated from his care. Dr, Perez-Espejo stated that he had been receiving harassing phone calls from Respondent and her sister and that Respondent had “camped out” at his office demanding a return to nursing recommendation. Dr, Perez-Espejo stated that he wrote the letter dated May 20, 2003, recommending that Respondent was cleared to return to work because Respondent had demanded that he write out a statement that she was cleared to return to nursing practice, and she had refused to leave his office until she had the statement releasing her to work in her possession. He also stated that he was still “very fearful” that if he did not recommend that Respondent could © return to work, Respondent might sit outside his office and shoot him. Mar 16 2009 13:57 MAR-16-2689 13:39 : AHCA ’ 23. On or about October 14, 2003, Respondent called IPN concerning her release to return to work. When informed that she would need to re-engage a medication management specialist to replace Dr. Perez-Espejo, Respondent stated she did not feel she needed a psychiatrist. IPN records note that Respondent had her “mind set on returning to nursing practice.” 24. On or about October 16, 2003, IPN sent a letter of impending dismissal to Respondent and instructed Respondent that in order to avoid dismissal from IPN she needed to engage in treatment with another IPN- approved psychiatrist for medication management by October 30, 2003. 25. On or about October 17, 2003, Respondent informed IPN that Dr. Perez-Espejo would continue to serve as her medication management specialist. She further stated that she had discussed this with Dr. Perez- Espejo on or about October 13, 2003. 26. On or about October 20, 2003, IPN contacted Dr. Perez-Espejo to confirm Respondent's report that he would continue to serve as Respondent’s medication management specialist. Dr. Perez-Espejo stated that this was incorrect. He further reiterated that he was discharging Mar 16 2009 13:57 MAR-16-2089 13:39 AHCA Y ’ Respondent as a patient and that he had instructed her to find another medication management specialist. 27, On or about October 21, 2003, Jennifer Sigman, a therapist at the EAP office of Florida Hospital, informed IPN that Respondent had contacted the EAP office and stated that she was soon to be cleared by IPN. Ms. Sigman stated that Respondent was “looking to be placed back on the schedule.” 28. On or about November 3, 2003, “a very angry” Respondent called IPN because the medication management specialist she had selected, Kevin J. DiCesare, M.D., (‘Dr. DiCesare”) declined to accept her as a patient. According to staff at Dr. DiCesare’s office, the doctor had declined to accept Respondent based on her harassment of, and attempt to dictate treatment with, Dr. Perez-Espejo. 29. On or about November 3, 2003, Respondent’s IPN Nurse Support Group Facilitator, Joseph L. Trim, Ed.D., (Dr. Trim”) called IPN and stated that Respondent was “about to drive him crazy with her demand to return to nursing practice.” 30. On or about November 4, 2003, IPN sent Respondent an impending dismissal letter because she had failed to obtain treatment with MAR-16-2089 13:39 . AHCA Mar 16 2009 13:58 a another IPN-approved psychiatrist for medication management. IPN extended the period of time for Respondent to engage a medication management specialist unti! November 18, 2003. 31. On or about November 5, 2003, Respondent informed IPN that she was going to seek treatment at New Life Counseling Center. Respondent screamed and became inappropriate when IPN informed her that treatment at the New Life Counseling Center would not be acceptable under the terms of her IPN contract and that she still needed to re-engage in medication management with an IPN-approved psychiatrist. Respondent also asked IPN to remove the medication management requirement from her IPN Advocacy contract. 32. On or about December 18, 2003, Respondent contacted IPN and informed her case manager that she could not engage in medication management because she no longer had insurance coverage. Respondent also stated that she believed medication management was unnecessary. Respondent stated that she could not understand why she had not been Cleared to return to work. In a somewhat confused manner, Respondent also stated that she wanted to take her case before the Board of Nursing, -13- Mar 16 2009 13:58 MAR-16-2889 13:40 AHCA P.t? — ™ but then stated that she wanted her case to go before the IPN “Board.” She also asked to speak with the Executive Director of IPN. 33. On or about December 30, 2003, IPN Executive Director, Jean D’Aprix, (Ms. D’Aprix”) returned a call from Respondent. Respondent informed Ms. D’Aprix that she did not believe that she needed any medication or treatment by a psychiatrist and that she had been cleared to return to work in May of 2003. Respondent stated that IPN was forcing her to take medication. Ms. D’Aprix explained that IPN would not clear Respondent to return to nursing practice until she was cleared by a psychiatrist and IPN had a recommendation that she was safe to return to nursing practice. Respondent informed Ms, D’Aprix that she was withdrawing from IPN. Ms. D’Aprix explained that Respondent’s case would be sent to the Department if she were dismissed from IPN. Respondent stated that she would “deal with the Department herself.” 34. On or about January 6, 2004, IPN sent Respondent another letter of impending dismissal for failing to engage in medication management and for failing to file required reports. Respondent was given until January 20, 2004, to comply with IPN requirements. Mar 16 2009 13:58 MAR-16-2889 12:48 a AHCA ~ 35. Onor about January 9, 2004, Respondent engaged the services of Heidi J. Napolitano, M.D., (‘Dr. Napolitano”). Dr. Napolitano is not a Board certified psychiatrist. Dr. Napolitano prepared an IPN medication management evaluation for Respondent which indicated that Respondent was safe to practice nursing and that no medication was recommended for Respondent. 36. On or about January 12, 2004, Respondent sent a letter to IPN stating that, based on Dr. Napolitano’s January 9, 2004 report, she had satisfied IPN’s requirements, and she requested dismissal from IPN’s requirements. 37. On or about January 12, 2004, Carol Tompkins, (Ms. Tompkins”) from the employee relations office of Florida Hospital, contacted IPN concerning Respondent's return to nursing practice. Respondent had presented Ms. Tompkins with a letter from Dr, Napolitano releasing her to return to nursing practice. Respondent also told Ms. Tompkins that IPN had released her to return to nursing practice. IPN informed Ms. Tompkins that Respondent had not been cleared by IPN to return to nursing practice and that there was a letter of impending Mar 16 2009 13:58 MAR-16-2889 12:48 AHCA P.1i9 dismissal that had been sent to Respondent requiring her to re-engage in her medication management. 38. On or about January 14, 2004, Respondent’s IPN clinical team met to discuss clearing Respondent to return to work based on Dr. Napolitano’s January 9, 2004 report and Dr. Trim’s (the Nurse Support Group Facilitator's) agreement with Dr. Napolitano’s recommendation. The team deferred a decision regarding Respondent’s return to work at that time. 39. On or about January 22, 2004, at about 3:12, 3:15, 3:21, and 3:24, p.m., Respondent called IPN and left four (4) separate voice mail Messages stating that she had applied for a position in ICU at Florida Hospital and requested that a return to nursing letter be sent to the hospital. 40. On or about January 23, 2004, IPN contacted Dr. Napolitano to confirm Dr. Napolitano’s opinion that Respondent was safe to return to nursing practice. Dr. Napolitano recommended that Respondent was safe to return to work on a part-time basis with a review for return to full-time nursing within six (6) weeks. Dr. Napolitano also confirmed that Respondent was not on any medications for her mental disorder. -16- Mar 16 2009 13:59 MAR-16-2889 13:41 AHCA P.28 rm 7 41. Onor about January 23, 2004, IPN referred Respondent to Dr. Brown for a fitness for duty evaluation. 42. On or about January 26, 2004, IPN, verbally and in writing, informed Respondent that she needed to be seen for a fitness for duty evaluation prior to clearing her to return to duty. Respondent was also informed that she was required to re-engage in all IPN requirements. In response, Respondent informed IPN that she had completed her IPN requirements and that she wanted a letter from IPN clearing her to return to work. Conversation with Respondent was terminated when Respondent became hostile. 43. On or about February 2, 2004, Respondent underwent an evaluation by Dr. Brown. As part of the evaluation, Respondent also participated in psychological testing, which was conducted on February 19, 2004. Dr. Brown observed that Respondent's overall appearance, demeanor, behavior, and thought patterns did not look significantly different from the date of her previous evaluation in about June 2003. Psychological testing indicated that Respondent had a high degree of anger, great trouble managing angry feelings, and might express anger in passive-aggressive ways. Psychological testing also indicated that “~I7- Mar 16 2009 : MAR-16-2889 13:41 AHCA eee ros Respondent believed that she had “special mystical powers or a special ‘mission’ in life that others do not understand or accept.” In addition, psychological testing indicated that Respondent was experiencing a severe mental disorder warranting “professional observation and inpatient care.” The testing also suggested that Respondent’s moods “exhibit a high degree of emotional lability and impulsive and angry outbursts alternating with recurring depressive complaints and sulking.” The testing indicated that Respondent was suffering from a delusional (paranoid) disorder and she may exhibit periods of aggressive behavior and uncontrollable rages. Dr. Brown opined that the possibility that Respondent could act out in an aggressive manner on her delusional ideas should be further evaluated. Based on her evaluation and the results of the psychological testing, Dr. Brown diagnosed Respondent as suffering from a delusional disorder and alcohol dependency in full remission, rule out major depressive disorder with psychotic features. She also diagnosed Respondent as having narcissistic and self-defeating personality traits. Dr. Brown opined that Respondent could not practice nursing with reasonable skill and safety, and that Respondent was in need of medications and long-term treatment. Dr. Mar 16 2009 13:59 MAR-16-2889 13:41 AHCA P22 rom 7 Brown recommended that Respondent enter residential in-patient mental health treatment for stabilization of her mental disorder. 44. On or about February 23, 2004, IPN issued a letter of impending dismissal from IPN and instructed Respondent that in order to remain in IPN she was required to engage in in-patient treatment by March 8, 2004. 45. On or about February 26, 2004, Respondent called IPN and spoke to Angela Blake (“Ms. Blake”), Respondent's IPN Case Manager. Ms. Blake described Respondent as irate and demanding, at times yelling and screaming. Respondent told Ms. Blake that she did not agree with Dr. Brown’s recommendation that she needed residential treatment. Respondent refused to seek the recommended treatment and stated that IPN could dismiss her case. Respondent also stated that she had received a letter clearing her to return to nursing practice. Ms. Blake explained to Respondent that she was not cleared to return to work. Ms. Blake had to terminate her conversation with Respondent because Respondent continued screaming that she wanted to return to work and expressed no understanding of the information Ms. Blake was relaying to her. -19 - veR-16-2009 13244 auca Mar 16 2009 13:59 46. On or about March 9, 2004, IPN dismissed Respondent for noncompliance with her IPN mental health contract and filed a complaint against Respondent with the Department. In the IPN memorandum to the Department concerning Respondent's dismissal, Alice L. Smith, ARNP, a consultant for the Department of Health, opined that Respondent was unsafe to practice her profession with reasonable skill and safety and was a threat to the health, safety and welfare of the citizens of Florida based on: 1) her diagnosis of delusional disorder, alcohol dependency in sustained full remission, rule out major depressive disorder with psychotic features; 2) her recent allegations of impairment; and 3) her refusal to enter recommended treatment. 47. Section 464.018(1)(j), Florida Statutes (2003), subjects a licensee to discipline for being unable to practice nursing with reasonable . skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, chemicals, or any other type of material as a result of any mental or physical condition. 48. As described above, Respondent has demonstrated that she is unable to practice nursing with reasonable skill and safety by reason of her mental illness based on her diagnosis of delusional disorder, the -20 - MAR-16-2689 13:42 AHCA Nar Be 2009 aes evaluations of Drs. Brown and Rosenblatt that she is unsafe to practice, her refusal to participate in recommended treatment, her threatening behavior toward treatment providers, and her failure to comply with IPN contract requirements. 49, Based on the foregoing, Respondent has violated Section 464.018(1)(j), Florida Statutes (2003) for being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, chemicals, or any other type of material as a result of any mental or physical condition. WHEREFORE, the Petitioner respectfully requests that the Board of Nursing enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. -34- WOR-16-2009 13142 aca Mar 16 2009 14:00 SIGNED this | he day of (i ae | ; 200¥. John O. Agwunobi, M.D., M.B.A. Secretary, Department of Health iy = § Rachel H. Siebert “oak LEO sn DOH Prosecution Services Unit DEPUTY CLERK 4052 Bald Cypress Way, Bin C-65 CLERK COU Tallahassee, Florida 32399-3265 DATE 82x04 Florida Bar No.: 572748 (850) 414 - 8126 Telephone (850) 414 - 1991 Facsimile RS/mf Reviewed and approved by: 2- _(initials) (date) POP: $}25/oy PCP Members: Maa Herrera, U0, Maceqems Beth Anne Wellman, R.N., 2004-15988 ~“? -22- MOR-16-2000 13:42 Mar 16 2009 14:00 AHCA 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. -23. TOTAL FP.26

Docket for Case No: 09-001380PL