STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vi CASE NO. 2011-12741 SHAMRUL NESHAW ALI, C.N.A., 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, Shamrul Neshaw Ali, C.N.A., and: in support thereof alleges: 1. Petitioner is the state agency charged with regulating the practice of nursing assistance pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 464, Florida Statutes, 2. At all times material to this Administrative Compiaint, Respondent was a certified nursing assistant (C.N.A.) within the state of Florida, having been issued license number CNA 64949, Filed December 8, 2011 2:26 PM Division of Administrative Hearings 3. Respondent's addrass of record is 4701 Teaiwood Trail, Wesley Chapel, Florida 33544. 4. At all times material, Respondent was licensed to practice as a certified nursing assistant in the State of Florida and was employed as a certified nursing assistant at John Knox Village of Tampa Bay, an assisted living facility. 5. Certified nursing assistants provide patients and/or residents with assistance with activities of daily living such as helping patients with bathing, toileting, dressing, and mobility. In the course of providing this assistance, certified nursing assistants have access to patient's and/or rasident’s personal information and property. 6. Sometime in or about early July of 2011, L.F, a resident of John Knox Village, discovered that approximately 130 dollars was missing from her room. L.F. notified staff at John Knox Village and also notified her nephew, C.0. 7, At all times material, L.F, as a resident of John Knox Village, was a patient under Respondent's care. 8. After igarning about L.F's missing property, C.O. installed a surveillance camera in L.R’s room. DOH v. Shamrul Neshaw Ail, C.NLA. 2 Case No. 2011-12741 ; J:\PSU\Nursing\Jonin J Truitt\AC's\CNA\shamrul Ali, CNA unprof conduct stealing.doc 9. On or about July 19, 2011, L.E discovered that she was missing 100 doliars and some jeweiry that had been located in her room. LE notified C.O. who reviewed the footage on the video camera which was installed in LF’s room. The video revealed Respondent rummaging through drawers, taking out boxes, opening them and looking at the jewelry in the boxes. Respondent selected a piece of jewelry and placed it in her pocket. Respondent continued to jook through drawers and pulied out a box which contained money, the value of which appeared to be a 100 dollar bill. Respondent took possession of that as well. 10. After reviewing the video footage, C.O. notified the Director of John Knox Village who also reviewed the video footage. After seeing the theft, the Director terminated Respondent's employment and notified the Hillsborough County Sheriff's. Office. ii, On or about July 19, 2011, Respondent was arrested for petit theft and exploitation of the elderly. During the arrest, Respondent had lorazepam in her possession without a prescription. She was also charged with possession of a controlled substance. The criminal case is ongoing. 12. Lorazepam is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes (2011), lorazepam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in DOH v. Shamrul Neshaw Ali, CNA. 3 Case No. 2011-12741 3:\PSU\Nursing\John J Truitt\AC’s\CNA\Shamrul Ali, ONA unprof conduct stealing.doc Schedule IIT and has a currently accepted medical use in treatment in the United States. Abuse of lorazepam may lead to limited physical or psychological dependence relative to the substances in Schedule ITI. 13. Section 464.204(1)(b), Florida Statutes (2011), provides that intentionally violating any provision of Chapter 464, Chapter 456, or the rules adopted by the board, constitutes grounds for disciplinary action by the Board of Nursing. 14. Section 464.018(1)(h), Florida Statutes (2011), provides that unprofessional conduct, as defined by Board rule, constitutes grounds for disciplinary action by the Board of Nursing. 15. Rule 64B9-8.005(4), Florida Administrative Code, provides that unprofessional conduct includes stealing from a patient. 16. Respondent, while working as a C.N.A. at John Knox Village, used her position to intentionally rummage through rasident/patient L.F’s dresser and intentionally stole jewelry and money from.L.E i7. Based on the foregoing, Respondent violated Section 464.204(1)(b), Florida Statutes (2011), by intentionally violating Section 464.018(1)(h), Florida Statutes (2011), that provides that unprofessional conduct as defined by Rule 6489-8.005(4), Florida Administrative Code, inciudes stealing from a patient. DOH v. Shameul Neshaw Ali, C.N.A. 4 Case No. 2011-12741 ; J:\PSU\Nursing\John J Truitt\AC's\CNA\Shamrul All, CNA unprof conduct stealing.doc WHEREFORE, 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. SIGNED this _\(* day of _Ortetee 2011, H. Frank Farmer, Jr, M.D., Ph. D., FA.CP. State Surgeon General Ti Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 a LED 4 Florida Bar Number 0084752 OF HEALT pEPARTNT uty GLERK (850) 245 - 4640 Telephone M ise! (850) 245 - 4683 Facsimile CLERK git 40 / 1212 TE pat PCP: Ook \\, Lott PCP Members: Kiar ede ¥ Drm DOH v. Shamrul Neshaw All, C.NLA. 5 Case No. 2011-12741 ; J:\PSU\Nursingonn 3 Trtth\AC's\CNA\Shamrul Al, CNA unprof conduct stealing.doc 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 inciude attorney hours and costs, on the Respondent in addition to any other discipline imposed. DOH v. Shamru! Neshaw Ali, C.N.A. 6 Case No. 2011-12741 J:\PSU\Nursing\Vohn J Truitt\AC’s\CNA\Shamrul Ali, CNA unprof conduct stealing.doc

Docket for Case No: 11-006226PL