STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, Petitioner, WN Case No. 2011-11956 VICTORIA ANN CASEDEI, RN. Respondent. | N M N COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Nursing against Respondent, Victoria Ann Casadei, R.N., and in support thereof alleges: 1. Petitioner is the state agency 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 (RN) within the state of Florida, having been issued license number RN 9282459. Filed January 12, 2012 3:14 PM Division of Administrative Hearings 3. Respondent's address of record is 6072 Royal Birkdale Drive, Lake Worth, Florida 33463, 4. At all times material, Respondent was employed as a registered nurse at Manatee Memorial Hospital in the Center for Behavioral Health. 5. On or about May 28, 2011, Respondent was scheduled to work a night shift. When she reported to work, Respondent exhibited slurred speech and an unsteady gait. When the supervisor on duty arrived on the unit, she observed Respondent Sleeping in a chair. The supervisor relieved Respondent of her duties, but believed Respondent was not safe to drive home. The supervisor allowed Respondent to sleep in an empty patient's room. 6. On or about May 31, 201 1, Respondent was confronted by the Unit Director, the Nursing Supervisor, and the Human Resources Director (supervisors) about the incident, Respondent reported that she had taken two Soma tablets prior to reporting to work on or about May 28, 2011. Respondent was suspended from her employment at that time. 7. Soma is the brand name for carisoprodol, a muscle relaxant commonly prescribed to treat muscular pain. According to Section 893.03(4), Florida Statutes (2011), carisoprodol is a Schedule IV controlied DOH v. Victoria Ann Casadei, R.N. 2 Case Number: 2011-11956 J:\PSU\Nursing\Vahn J Trultt\Nursing\AC's\RN Victoria Casadei, RN j, unprof, violate order.doc substance that has a low potential for abuse relative to the substances in Schedule TIT and has a currently accepted medical use in treatment in the United States. Abuse of carisoprodol may lead to limited physical or psychological dependence relative to the substances in Schedule ITI. 8. Carisoprodol has sedative properties and may impair the mental and/or physical abilities required for the performance of certain activities such as driving a motor vehicle or operating machinery. 9. After meeting with Respondent, the supervisors reviewed Respondent's documentation of controlled substances and discovered several instances where Respondent removed a controlled substance from the narcotic cart for a patient, but failed to document in the patient's medical record that she administered the drug to the patient, Respondent failed to document doses of Norca, Serax, Ativan, Roxicodone, and Xanax. All these medications have sedative Properties and may impair mental and/or physical abilities, 10. Norco is the brand name for a drug that contains hydrocodone and acetaminophen and is prescribed to treat pain. According to Section 893.03(3), Florida Statutes (2011), hydrocodone, in the dosages found in Norco, is a Schedule III controlled substance that has a potential for abuse DOH v. Victoria Ann Casadei, R.N. 3 Case Number: 2011-11956 2APSU\NursingVohn 3 Truitt\Nursing\AC's\RN\ Victoria Casadai, RN j, unprof, violate order.doc less than the substances in Schedules I and II and has a currently accepted medical use in treatment in the United States. Abuse of the hydrocodone may lead to moderate or low physical dependence or high psychological dependence. ll. Serax is the brand name for oxazepam, a sedative commonly Prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes (2011), oxazepam is a Schedule IV controlied substance that has a low potential for abuse relative to the substances in Schedule III and has a Currently accepted medical use in treatment in the United States. Abuse of oxazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. . 12. Ativan is the brand name for lorazepam, a sedative commonly 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 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 ITT. DOK v. Victoria Ann Casadei, RN. 4 Case Number: 2011-11956 J:\PSU\Nursing\ohn J Truitt\Nursing\AC’s\RN\Victoria Casadei, RN J, unprof, violate order.doc 13. Roxicodone is the brand name for oxycodone, commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes (2011), oxycodone is a Schedule IT 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. Abuse of oxycodone may lead to severe psychological or physical dependence. 14. Xanax is the brand name for alprazolam, a sedative commonly prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes (2011), alprazolam is a Schedule IV controlled substance that has @ low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States. Abuse of alprazolam may lead to limited physical or psychological dependence relative to the substances in Schedule ITt, 15. The following table summarizes the controlled substances Respondent removed from the narcotic cart, ostensibly for patients, but failed to document that she administered the medications to the patients: DOH v. Victoria Ann Casadel, R.N. 5 Case Number: 2011-11956 2:\PSU\Nursing\Jonn J Trultt\Nursing\AC's\RN\ Victoria Casadel, RN j, unprof, violate order.doc Patient | Medication | Date and | Waste Physician | Time |Comments Removed Time or Order Drug from Removed | Discard charted Narcotic Cart of the as L Drug given P.P. | Two lorazepam! 5/3/11 None Ativan 2 Not Two (Ativan) 1 mg 9:24 a.m. mg by charted | lorazepam tablets mouth as given | tablets not every 4 accounted hours as for, needed D.H. Two 5/3/11 None Xanax 1 Not Two alprazolam 12:14 mg by charted | alprazolam (Xanax) 0.5 p.m. mouth | as given | tablets not mg tablets every 6 accounted hours as for. needed D.H. Two 5/3/11 None Xanax 1 | 4:00 | This dose is alprazolam 3:35 p.m. mag by p.m. too early if (Xanax) 0.5 mouth the dose mg tablets every 6 removed at hours as 12:14 was needed given to D.H. D.H. Two | -5/7/li_| None | Xanax Not Two | alprazolam 8:30 a.m. mag by charted | alprazolam (Xanax) 0.5 mouth as given | tablets not mg tablets every 6 accounted hours as for. needed DOH v. Victoria Ann Casadei, R.N. Case Number: 2011-11956 T:\PSU\Nursing\iohn J ‘Truitt\Nursing\AC's\RN\Victoria Casadei, RN i, unprof, violate orcer.doc Patient; Medication Date and | Waste Physician | Time (Comments Removed Time or Order Drug from Removed | Discard charted Narcotic Cart of the as Drug given D.H, One 5/10/11 | None Xanax i Not One alprazolam 4:59 p.m. mg by charted | alprazolam (Xanax) 1 mg mouth | as given | tablet not | tablet every 6 accounted hours as for, needed {. +. —{ a RL. One 5/21/11 None |Roxicodone} Not One Roxicodone 2:38 p.m. 5 mg by | charted | Roxicodone (oxycodone) 5 mouth | as given | tablet not mg tablet three times accounted | a day as for. At needed for 3:00 p.m. pain. nurse note indicated R.L. had no pain. R.L. | One lorazepam 5/2i/ii | None | Ativan Not One (Ativan) 1 mg 2:38 p.m. mg by charted | lorazepam tablet mouth | as given| tabiet not every 4 accounted hours as for. needed __. SS. [One 5/22/11 | None | Norcoi | Not | One Norco | hydrocodone/ 9:35 a.m. tablet charted | tablet not acetaminophen every4 | as given) accounted (Norco) tablet hours as for. needed. a _ DOH v. Victoria Ann Casadei, RN. Case Number: 2011-11956 J:\PSU\Nursing\ohn 3 Truitt\Nursing \AC's\RN\ Victoria Casadei, RN j, unprof, violate order.dec Patient! Medication Date and | Waste | Physician | Time Comments Removed Time or Order Drug from Removed | Discard charted Narcotic Cart of the as Drug given S.S. One 5/22/11 | None Norco i Not One Norco hydrocodone/ 11:57 tablet charted | tablet not acetaminophen a.m. every4 | as given | accounted (Norco) tablet hours as for. i needed a ve a S.M. One Serax 5/22/11 None Serax 30 Not One Serax (oxazepam) 30 9:38 a.m. mg by charted | tablet not mg tablet mouth | as given} accounted every 6 for. hours as needed D.B. Two | 5/22/11.) None Two Not Two Roxicodone 10:02 Roxicodone | charted | Roxicodone (oxycodone) 5 a.m. 5 mg as given | tablets not mg tablets tablets accounted every 4 for. At hours as 9:30 a.m. needed for nurse note pain. indicated D.B. had no pain, D.B, Two 5/22/11 | None Two Not Two Roxicodone 5:11 p.m. Roxicodone | charted | Roxicodone (oxycodone) 5 5 mg as given | tablets not mg tablets tablets accounted every 4 for. hours as needed DOK v. Victoria Ann Casadei, R.N, Case Number: 2011-11956 J:\PSU\Nursing\Vohn J ‘Truitt\Nursing\AC’s\RN\Victoria Casadei, RN J, unprof, violate order.doc 16. In summary, Respondent failed to account for a tota! of three lorazepam _— tablets, _five alprazolam tablets, two Norco (hydrocodone/acetaminophen) tablets, four Roxicodone (oxycodone) tablets, and one Serax (oxazepam) tablets. 17, Failing to document medications in a patient’s medical record puts the patient at risk for receiving a higher dose of medication than intended by the physician's order because subsequent caregivers will not be alerted that the patient has already received the undocumented medication. 18. On or about June 7, 2011, the supervisors met with Respondent again and asked her to explain the medication discrepancies, Respondent denied that she took any of the controlled substances for her own use. The supervisors encouraged Respondent to contact the Intervention Project for Nurses (IPN) and terminated her employment. 19. IPN is the impaired practitioner program for the Board of Nursing, pursuant to Section 456.076, Florida Statutes (2011). IPN is a program that monitors the evaluation, care and treatment of impaired nurses. IPN oversees random drug screens and provides for the exchange DOH v. Victoria Ann Casadei, R.N. 9 Case Number: 2011-11956 J:\PSU\Nursing\John 3 ‘Truitt\Nursing\AC's\RN Victoria Casadei, RN j, unprof, violate order.dec of information between treatment providers, evaluators and the Department for the protection of the public, 20. On or about August 9, 2011, a Department investigator interviewed a co-worker who observed Respondent on or about May 28, 2011. The co-worker stated that she observed Respondent at the nurses’ Station slumped in a chair with her head to the side, sleeping. The co- worker stated that she needed Respondent to open the door to allow her to exit the area, but Respondent did not respond to the buzzer or the co- workers repeated attempts to awaken Respondent. The co-worker stated she finally had to bang on the glass behind which Respondent was seated. At that time, Respondent did awaken, but did not make any sense, was waving her arms in the air, had very slurred speech, and appeared “really out of it” according to the co-worker. 21. On or about August 10, 2011, a Department investigator contacted IPN to determine if Respondent was in a treatment or monitoring program. The IPN representative reported that Respondent is not enrolled in IPN. 22. On or about August 15, 2011, Respondent provided a siatement to the Department and explained that she had been working “45 DOH v. Victoria Ann Casadel, RN. i Case Number, 2011-11956 J:\PSU\Nursing\John J Truitt\Nursing AC's \RN\Victoria Casadei, RN j, unprof, violate order.doc plus” hours a week for several weeks and worked 40 hours prior to the night in question. Respondent stated she was asked to work a night shift and initially said no, but eventually was persuaded to work on the night in question, on or about May 28, 2011. Respondent stated she took a prescribed Soma tablet at 11:00 a.m. for muscle spasms and another Soma tablet at 5:00 p.m. and was scheduled to report to work at 11:00 p.m. Respondent reported that she was unable to fall asleep until about 10:00 p.m. and ended up reporting to work late. Respondent stated she was exhausted and could not stay awake so the supervisor told her to sleep in an empty room. With regard to the controlled substances Respondent failed to document, Respondent stated that she pulled the medications at the scheduled times or within the parameters of the physician orders, but forgot to initial that she gave the drugs on the patient's medication administration records. 23. On or about August 26, 2011, the Department ordered Respondent to submit to a mental and physical examination to determine her ability to practice nursing with reasonable skill and safety pursuant to the authority granted in Section 464.018(1)(j), Florida Statutes (2011). DOH v. Victoria Ann Casaciel, BLN. 11 Case Number: 2011-11956 2:\PSU\Nursing\VJohn J Truitt\Nursing\AC’s\RN\ Victoria Casadei, RN j, unprof, violate order.doc The examination was scheduled for September 21, 2011 with E. Lazarou, M.D., a specialist in psychiatry. 24. On or about August 31, 2011, Respondent was hand served with the order compelling her to submit to a mental and physical examination on September 21, 2011. 25. On or about September 20, 2011, Respondent left a voicemail message at Dr. Lazarou’s office regarding the examination. Initially in the message, Respondent stated she was calling to confirm her appointment, but later in the message, Respondent stated she would not be attending the appointment. Dr. Lazarou described the message and stated: . [Respondent] sounded as though she was intoxicated when she was leaving the message. The message was rambling and at first I didn't know who it was, but later, she confirmed it when she finally left her name. She was out of sorts, with her speech slurred and jumbled. She wasn’t making sense. She said that she was calling to confirm her appointment with me, but then she said something about that she possibly wasn’t going to show because of “family issues” with where they were going to be staying. Later in the very long message, she said that she wasn’t going to be coming because she was going to be evicted from her home and had to be out the day of the evaluation? /sic] It was as If she had forgotten that she left the first part of the message and then left the second half. In the background of the call, it sounded as though she was stumbling and things DOH v. Victoria Ann Casadei, R.N. 12 Case Number: 2011-11956 2\PSU\Nursing\Vohn J Truitt\Nursing\AC's\RN\Victoria Casadei, RN j, unprof, violate order.doc were falling. I believe she showed poor judgment even calling the office knowing why she was going to be seeing me when she was in that shape. 26. Dr. Lazarou further stated, “I do not believe given the evidence that she is able to work from a Psychiatric perspective pending a clinical examination. . . . there is no way that [Respondent] can take care of patients in the state that she was in when she left that message.” 27. On or about September 21, 2011, Respondent contacted a Department representative and stated she was not going to the evaluation because she was being evicted that day. Respondent's speech was slurred and rambling when she spoke to the Department representative. COUNT I 28. Petitioner realleges and incorporates paragraphs 1 (one) through 27 (twenty-seven) as if fully forth herein. 29. Section 464.018(1)(j), Florida Statutes (2011), subjects a licensee to discipline, including suspension, for 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 (OF as a result of any mental or physical condition, DOH v. Victoria Ann Casadei, RN. 13 Case Number: 2011-11956 2:\PSU\Nursing\John J Truitt\Nursing\AC’s\RN \Wictoria Casadei, RN j, unprof, violate order.dec 30. Respondent is unable to practice nursing with reasonable skill and safety to patients as demonstrated by her impaired behavior at the workplace, her admission that she took Soma, a sedating medication, prior to reporting for work, and her impaired speech on a voicemail message that Respondent left for the psychiatrist who was going to evaluate her. According to that psychiatrist, given Respondent's speech on that voicemail message, Respondent is not able to take care of patients pending an evaluation, Respondent did not attend that evaluation 31. Based on the foregoing, Respondent violated Section 464,018(1)(j), Florida Statutes (2011), by 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 physical condition. COUNT II 32. Petitioner realleges and incorporates paragraphs 1 (one) through 27 (twenty-seven) as if fully forth herein. 33. Section 464.018(1)(h), Florida Statutes (2010), provides that unprofessional conduct as defined by board rule constitutes grounds for discipline by the Board of Nursing. DOH v. Victoria Ann Casadei, RN, 14 Case Number: 2011-11956 JA\PSU\Nursing\Vohn J Truitt\Nursing\AC's\RN\WVictoria Casadei, RN j, unprof, violate order.dec 34. Rule 64B9-8.005(1), Florida Administrative Code, states that unprofessional conduct shall include inaccurate recording 35. While working at Manatee Memorial Hospital, Respondent committed unprofessional conduct by removing several controlled substances from the narcotic cart, ostensibly for patients, but failed to document in the medical record that she administered those medications to the patients as set forth in the chart above. 36. Based on the foregoing, Respondent violated Section 464.018(1)(h), Florida Statutes (2010), for unprofessional conduct as defined by board Rule 6489-8.005(1), Florida Administrative Code, to include inaccurate recording. COUNT TT 37. Petitioner realleges and incorporates paragraphs 1 (one) through 27 (twenty-seven) as if fully forth herein. 38. Section 456.072(1)(q), Florida Statutes (2011), subjects a licensee to discipline, including suspension, for violating a lawful order of the department or the board, or failing to comply with a iawfully issued subpoena of the department. DOH v. Victoria Ann Casadei, R.N, 15 Case Number: 2011-11956 J:\PSU\Nursing\onn J Trultt\Nursing AC’ s\RN\Victoria Casadei, RN j, unprof, violate order.dec 39. Respondent violated a lawful order of the department that required her to attend a mental and physical examination scheduled on or about September 21, 2011. Respondent did not attend the examination. 40. Based on the foregoing, Respondent violated Section 456.072(1)(q), Florida Statutes (2011), by violating a lawful order of the department or the board, or failing to comply with a lawfully issued subpoena of the department 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. DOH v. Victoria Ann Casadel, RN, 16 Case Number: 2011-11956 2\pSu\Wursing\Vohn J Truitt\Nursing \AC's\RN\Wictoria Casadei, RN j, unprof, violate order.doc SIGNED this 2 4 day of _Woemb. , 2011. H. FRANK FARMER, JR., M.D., Ph.D., F.ACP, State Surgeon General Florida Department of Health NICHOLAS W. ROMANELLO General Counsel Florida Department of Health WM. FREEMAN MILLER Attorney Supervisor Prosecution Services Unit ~ TRUNT Assistant General Counsel Fla. Bar No. 0084752 Florida Department of Health FILED Office of the General Counsel ae ENT OF HEALTH 4052 Bald Cypress Way, Bin C-65 CLERK Angel Sanders Tallahassee, Florida 32399-3265 DATE NOV 08 2011 Telephone: (850) 245-4640 Facsimile: (850) 245-4683 Email: john_truitt@doh.state.fl.us PCP: 1{-Q-)) PCP Members: 0 Vavag ard Linde Hotton DOH v. Victoria Ann Casadei, R.N, 7 Case Number: 2031-11956 JAPSU\Nursing\John J ‘Truitt\Nursing\AC's\RN\Victoria Casadei, RN j, unprof, violate order.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 include attorney hours and costs, on the Respondent in addition to any other discipline imposed. DOH v. Victoria Ann Casadei, R.N, 18 Case Number: 2011-11956 J:\PSU\Nursing\John J Truitt\Nursing\AC's\RN\ Victoria Casadel, RN j, unprof, violate order.doc

Docket for Case No: 12-000166PL