Jun 10 2009 14:41 JUN-18-2889 15:24 AHCA STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, ve. CASE NO, 2007-22516 CYNTHIA ANN SIMS, L.P.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, Cynthia Ann Sims, L.P.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 Stalules; and Chapter 464, Florida Statutes. 2, At all times material to this Administrative Complaint, Respondent was a licensed nurse practitioner (L.P.N.) within the state of Florida, having been issued license number LPN 5153959. SUN-Lo-sene | 1S:24 ace Jun 10 2003 14:41 3. Respondent's address of record is 9323 East River Drive, Navarre, Florida 32566. 4. At all times material to this Administrative Complaint, Respondent was employed by Bay Breeze Nursing & Retirement Center (BBNRC), which is located in Gulf Breeze, Florida. 5. At all times material to this Administrative Complaint, Resident V.D. had a physician’s order for Hydracadane. 6. Aydrecadone/APAP contains hydrocodone and acetaminophen, or Tylenol and is prescribed to treat pain. According to Section 893.03(3), Florida Statutes, hydrocodone, in the dosages found in hydrocodone/APAP is a Schedule I] controlled substance that has a potential for abuse less than the substances in Schedules I and Il and has a currently accepted medical use in treatment in the United States, and abuse of the substance may lead to moderate or low physical dependence or high psychological dependence. 7. Onor about June 16, 2007, Respondent documented removing the morning and afternoon doses of Hydrocodone-APAP 5/500 for Resident V.D., Respondent circled the morning dase on the narcotic sign out sheet, Deparunent of Health v. Cyntina Ann Sims, LYN 2 Case Nurnibar 2007-22516 T:\PSU\Nursing\Cowan, Casey\braftad ACs\Diversinn, Inaccurate According\sims, GA (LPN, inaccurate recordiny).doc JUN-1a-2089 «15124 Jun 10 2009 14:42 AHCA which indicates the medication was not administered to the patient. Respondent did not properly waste the medication with a witness. 3. On or about June 16, 2097, Respondent documented administering both ihe morning and afternoon doses of inedication on Patient V.D.'s Medication Administration Report (MAR). 9. On or about June 17, 2007, Respondent documented removing the morning. and afternoon doses of Hydrocadane-APAP §/500 for Resident V.D. Respondent circled the morning dose on the narcotic sign out sheet, which indicates the medication was not administered to the patient. Respondent did not properly waste the medication with a witness. 10. On or about June 17, 2007, Respondent documented administering both the morning and afternoon doses of medication on Patient V.D,'s MAR. 41. On or about June 30, 2007, Respondent documented remaving the morning and afternvon doses of Hydrocodone-APAP 5/500 for Resident V.D. Respondent circled the marning dose on the narcotic sign out sheet, which indicates the medication was not administered to the patient. Respondent did not properly waste the medication with a witness. Departmant of pealth v. Cynthia Ann Sims, L-P.N, 3 Case Number 2007-77516 T:\PSU\Nursing\Cowan, Casey\Drafled AC&\Diversion, Inaccurate Acrordiny\sims, CA (LPN, inaccurate reenreing) .uuc SUN-Lo-sene | 1S:24 ace Jun 10 2009 14:42 12. On or about June 30, 2007, Respondent documented administering both the morning and afternoon doses of medication on Patient V.D.’5 MAR. 13. On or about July 1, 2007, Respondent documented ramoving the morning and afternoon doses of Hyarocadone- APAP 5/500 tor Resident V.D. Respondent circled the morning dose on the narcotic sign out shect, which indicates the medication was not administered to the patient. Respondent did not properly waste the medication with a witness. i4. On or about July 1, 2007, Respondent documented administering both the morning and afterncon doses of medication on Patient V.D.'s MAR. 15. At all times material to this Administrative Complaint, Resident D.W. had a physician's order tor 0.5 mg of Ativan. 16. Ativan is the brand name for lorazepam and is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes, loravepam is a Schedule IV controlled substance that has a low potential for abuse rolative to the substances in Schedule IIT and has a currently accepted medical use in treatment in the United States, and abuse of the substance Department of Health v. Cynthia ann Sims, L.P.N. 4 Case Number 2007-22516 J:\PSU\Nursing\Cowan, Capey\iratren aCs\Diversion, Inaccurate According\Sims, CA (1 Pry, inaccurate recording}.doc SUN-Lo-2ene | 1S125 auca Jun 10 2009 14:42 may lead to limited physical or psychological dependence relative to the substances in Schedule III. 17, On or about June 16, 2007, Respondent documented removing the morning and afternoon ¢.5mg doses of Ativan for Resident D.W. On the narcotic sign out sheet Respondent documented that the morning dose was wasted or withheld and ithe afternoon dosé was administered. Respondent did not praperly waste the morning dose wilh a witness. 18, On or about June 16, 2007, Respondent documented administering bath the morning and afternoon dases of medication on Patient D.W.’s MAR. 19. On or about June 17, 2007, Respondent documented removing the morning and afternoon 0.5mg doses of Ativan for Resident D.W. On the narcotic sign out sheet Respondent documented that the morning dose was wasted or withheld and the afternoon dose was administered, Respondent did not properly waste the morning cose with a witness. 20. On or about June 17, 2007, Respondent documented administering both the morning and afternvon doses of medication on Patient D.W.’s MAR. Department of Health v. Cyntie Ann Sims, L.PLN. § Case Number 2007-22516 JA\PSU\Nursing\Cowan, Casev\orafieu ACs\Diversion, Inoceurate According\Sims, (A (LPN, inaccurate recording).doc JUN-18-2889 15:25 Jun 1 : pHCA n 10 2009 14:42 24. On or about June 30, 2007, Respondent documented removing the morning and afternvon 0.5mg doses of Ativan tor Resident D.W. On the narcotic sign out sheet Respondent documented that the morning dosé was wested or withheld and the afternoon dose was administered. Respondent did not praperiy waste the morning dose with 3 witress. 22, On or about June 30, 2007, Respondent documented administering both the morning and afternoon doses of medication on Patient D.W.’s MAR. 23. On or about July 1, 2007, Respondent documented removing the moming and afternoon 0.5mg doses of Ativan for Resident D.W. On the narcotic sign out sheet Respondent documented that the morning dose was wasted or withheld and the afternoon dose was administered. Respondent did not properly waste the morning dose with a witness. 24, On or about July 1, 2007, Respondent documented administering both the marning and afternoon doses of medication on Patient D.W,’s MAR. 25. At all times material to this Administrative Complaint, Resident J,.W. had a physician's order for Provigil. Departmen of Health v. Cynthis Ann Sims, L Pil. 6 Case Number 2007-22516 J\PSU\Nursing\Cawan, Casey\Dratted ACs\lversion, Inaccurate Accarding\Sims, CA UPN, Inaccurale recording).doc JUN-18-2889 15:25 oncA Jun 10 2009 14:43 26, Provigil is the brand name for Modafinil. Modafinil decreases extreme sleepiness due to narcolepsy and other sleep disorders such as difficult or irregular breathing during sleap. It is also used to stay awake during work hours for people with work schedules that interfere with 4 normal sleep routine. It Is not known how madafinil works to increase wakefulness. It is thought fo work by affecting certain chemicals in the brain that control the sieep/wake cycle. 27. Onor about June 3, 2007, Respondent documented removing 4 duse of Provigil ostensibly for Patient JW. On the narcotic sign out sheet Resporident circled the dose, which indicates that the medication was wasted or withheld. Respondent did not properly waste the medication with a witness. 28. On or about June 3, 2007, Respondent dacumented administering the dose of Provigil on Patient J.W.'s MAR. 29. Onor about June 17, 2007, Respondent documented removing 3 dose of Provigil ostensibly for Patient .W. On the narcotic sign out sheet Respondent circled the dose, which indicates that the medication was wasted or withheld. Respondent did not properly waste the medication with a witness. Department of Health v. Cynthia Ann sims, LPN. 7 Case Number 2007-77516 1,APSU\Nursing\cowan, Casey\Drefled AC&\Diversion, Inaccurate Arcordiny\simns, CA (LIN, inaccurate racarding}.cac JUN-18-2889 15:25 SHCA Jun 10 2009 14:43 30, On or about June 17, 2007, Respondent documented administering the dase.of Provigil on Patient 3.W.'s MAR, 31. Onor about July 1, 2007, Respondent documented removing 4 dase of Pravigil ostensibly tor Patiant 3.W. On the narcotic sign out sheet Respondent circied the dose, which Indicates that the medication was wasted or withheld. Respondent did not properly waste the medication with a witness. 32. On or about July 1, 2007, Respondent documented administering the dose of Provigil on Patient J.W.’s MAR. 33, At all times material to this Administrative Complaint, Resident MJ. had a physician’s order for 15 mg of Morphine Sulfate SA. 34. Morphine is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, morphine is a Schedule Il controlled substance that has a high potential for abuse -and has a currently accepted but severely restricted medical use in treatment in the United States, and abuse of morphine may lead to severe psycholagical or physical dependence. 35. On or about June 17, 2007, Respondent documented removing 15 mg of Morphine Sulfate ostensibly for Patient M.J. On the narcotic sign Department of Health v. Cynthia Ann Sins, LPN. g Case Number 2007-22515 3:\P5U\Nursing\Cowan, Gasay\praned ACs\Divergion, Inaccurate: according\$irns, CA (LPN, inaccurate recurding).doc JUN-18-2889 15:26 eHCA Jun 10 2009 14:43 out sheet Respondent circled the dose, which indicates that the medication was wasted or withheld. Respondent did not properly waste the medication with a witness. 36. On or about June 17, 2007, Respondent documented administering 15 mg of Morphine Sulfate on Patiant M.J.‘s MAR. 37. On or about July 1, 2007, Respondent documented removing 15 mg of Morphine Sulfate ostensibly for Patient M.J, On the narcotic sign out sheet Respondent circled the dose, which indicates that the medication was wasted or withheld. Respondent did not properly waste the medication with a witness. 38, On or about july 1, 2007, Respondent documented administering 15 mg of Morphine Sulfate on Patient MLJ.’S MAR. COUNT E 39, Petitioner realleges and incorporates paragraphs one (1) through thirty-eight (38), as if fully set forth herein. 40. Section 464.018(1)(h), Florida Statutes (2006, 2007), provides that unprofessional conduct as defined by board rule constitutes grounds for disciplinary action. Department of Healt v. Cynthia Ann Sims, LEAR. 9 Case Number 7007-22516 3:\PSU\Nursing\Cowan, Casey\Drafted ACs\uiversian, Inaccurate According\sims, CA (LPN, inaccurate rRecording).doc JUN-18-2889 15:26 HCA Jun 10 2009 14:43 41. Rule 64B9-8.005(1)%a), Florida Administrative Code, provides that unprofessional conduct includes inaccurate recording. 42, Respondent engaged = in unprofessional conduct when Respondent removed medications and failed to properly record the administration or wasting of the entire amount of medications Respondent removed far one or more of the following patients: a. Patient V.D. b. Patient D.W. c. Patient 1.W. d. Patient M.J. 43. Based on the foregoing, Respondent violated Section 464.018(1)(h), Florida Statutes (2006, 2007), by engaging unprofessional conduct as defined by Rule 64B9-8.005 (1)(a), Florida Administrative Code, to include inaccurate recording. COUNT TWO 44. Petitioner reallegcs and incorporates paragraphs one (1) through thirty-eight (38), as if fully set forth herein. 45. Section 464.018(1)(), Florida Statutes (2006, 2007), provides that unprofessional conduct as defined by board rule constitutes grounds Department of Health v. Cymtila Ann gims, L-P.N- 10 Case Number 2007-22575 J:\PSU\Nursing\Cowan, Casey\Diafted ACas\Diversion, InAccurale According’sims, CA (LEN, inaccurate recording).doc JUN-Lo-sene | 1S:26 Jun 10 2009 14:44 AHCA for disciplinary action. 46, Rule 6489-8.005(1)(e), Florida Administrative Code, provides that unprofessional conduct includes acts of negligence eltier by omission ar commission, 47. Respondent engaged in unprofessional conduct in one or more: of the following ways: a. By failing to record the administration of hydracadone lo patients in the satients! medical records; b. By failing to record the wasting of hydrocodone removed ustensibly for patients in the patients’ medical records; c. By failing to recurd the administration of Ativan to patients in the patients’ medical records; d. By failing to record the wasting of Ativan removed astensibly for patients in patients’ medical records. e. By failing to record the administration of Provigil to patients in the patients’ medical records; f. By failing to record the wasting of Provigil removed ostensibly for patients in the patients’ medical records; Department of Heallir v. Cynthia Ann Sims, t PLN. il Cage Numher 2007-22516 JA\PSU\wursing\Cuwan, Cagey\Draftad ACe\Diersion, Inaccurate Aceerding\sims, CA (LPN, Innceurate recording) An: SUN-Lo-ene 1126 Jun 10 2009 14:44 AHCA g. By failing to record the administration of morphine ta patients in the patients’ medical records; h. By failing to record the wasting of morphine removed ostensibly for patients in the patients’ medical records. 48. Based on the foreaging, Respondent viviated = Secuon 464.018(1)(n), Floriaa Statutes (2006, 2007), by engaging unprofessional conduct as defined by Rule 64B9-8.005 (1)(e), Florida Administrative Code, to include acts of negligance either by omission or commission. Department of Health v. Cynthia Ann Sims, LPN. 12 ace Number 2007-2 4518 JAPSU\Nursing\Cawan, Casey\Diafted ACa\Diversion, Ingecurate aAcrording\ Sins, CA (LPN, ingecurate recerding).doc Jun 10 2009 14:44 JUN-18-2889 15:27 AHCA WHEREFORE, the Petitioner respectfully requests that the Board of Nursing enter an order imposing one or more of the following penalties: permanent revocation of suspension of Respandant’s ficenss, rastriction of practice, imposition of an administrative fine, issuance Of a raprimand, placement of the Respondent on probation, corrective action, refund oF feos bilied or colleclad, remedial education and/or any other relief that the Board deems appropriate. SIGNED this 234 day of Aan lary , 2004. Ana M. Viamonte Rose, M.D., M.P.H. State Surgean General (ass 4 ow Casey L. ‘Cowan Assistant General Counsel Pe DOH Prosecution Services Unit <7) aR 4052 Bald Cypress Way, Bin C-65 wg. SES Tallahassee, Florida 32399-3265 GLERE: ~fF at i ” ' sen ele lee a4" rida Bar Number 0035536 (850) 245 - 4640 Telephone (850) 245 - 4683 Facsimile /CLC L KIRKPATRICK PCP: § BOWEN PCP Members: 1/22/09 Department of Health v. Cynthia Ann Sims, |.P.N. 13 Case Number 2007 22516 JNPSU\Nursing\Gowan, Casey\Drattes ACs \piversion, Inaccurate According\Sima, C& (LPN, inaccurate recording) coc JUN-18-2889 15:27 ance Jun 10 2009 14:44 NOTICE OF RIGHTS Respondent has the right to request @ 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 igsued on his or her behalf if a hearing is requested. NOTICE REGARDING ASSESSMENT OF cosTs Respondent ts 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. Department nf Health v. Cynthia Ann Sims, LP 14 Cage Number 2007-22516 J,\PSU\Nursing\Cowan, Cagey\Drafied acs\Diverslon, Tnaccurate Arcoraing\giiris, CA (LPN, inaccurate recoruing).dac ee _—_ TOTAL P.2i

Docket for Case No: 09-003107PL