STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO. 2019-09580 MICHELL KLOTZ, 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, Michell Klotz, 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 Administrative Compiaint, Respondent was a licensed registered nurse (R.N.) within the state of Florida, having been issued license number RN 9443214. 3. | Respondent's address of record is 7830 Bristol Park Road, Apollo Beach, Florida 33572. | 4. Respondent may also be found at 9734 Myrtle Creek Drive, Apartment 103, Riverview, Florida 32578. 5. | The Ohio Board of Nursing is the licensing authority for nurses in the state of Ohio. 6. Onor about March 14, 2019, the Ohio Board of Nursing issued a “Consent Agreement” between the Respondent and the Ohio Board of Nursing. 7. Section 464.018(1)(b), Florida Statutes (2018), provides that having a license to practice nursing revoked, suspended, or otherwise acted against, including the denial of licensure, by the licensing authority of another state, territory, or country constitutes grounds for disciplinary action. 8. Respondent had a license to practice nursing acted against by the licensing authority of another state when on or about March 14, 2019, the Ohio Board of Nursing issued the Consent Agreement placing her license on probation and under further restrictions. Department of Health v Michell Klotz, R.N. . 2 Case Number 2019-09580 9. Based on the foregoing, Respondent violated Section 464.018(1)(b), Florida Statutes (2018), by having a license to practice nursing revoked, suspended, or otherwise acted against, including the denial of licensure, by the licensing authority of another state, territory, or country. Department of Health v Michell Klotz, R.N. 3 Case Number 2019-09580 WHEREFORE, the Petitioner respectfully requests that the Board of Nursing enter an order imposing one or more of the following penaities: 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 30" day of September, 2019. Scoit A. Rivkees, M.D. State Surgeon General DEPARTMENT OF HEALTH [of Dirlie A. McDonald DEPUTY CLERK Dirlie A. McDonald . Ns Assistant General Counsel! a Ora, 2019 Florida Bar No. 885061 So ee Horida Department of Health Office of the General Counsel] 4052 Bald Cypress Way, Bin #C65 Tallahassee, FL 32399-3265 Telephone: (850) 558-9696 Facsimile: (850) 245-4662 Email: Dirlie.Mcdonald@fihealth.gov /DAM PCP: September 27, 2019 PCP Members: Hapgood (chair) and Johnson Department of Health v Michell Klotz, R.N. 4 Case Number 2019-09580 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 cali and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. A request or petition for an administrative hearing must be in writing and must be received by the Department within 21 days from the day Respondent received the Administrative Complaint, pursuant to Rule 28-106.111(2), Florida Administrative Code. If Respondent fails to request a hearing within 21 days of receipt of this Administrative Compiaint, Respondent waives the right to request a hearing on the facts alleged in this Administrative Complaint pursuant to Rule 28-106.111(4), Florida Administrative Code. Any request for an administrative proceeding to challenge or contest the material facts or charges contained in the Administrative Complaint must conform to Rule 28-106.2015(5), Florida Administrative Code. Mediation under Section 120.573, Fiorida Statutes, is not available to resolve this Administrative Complaint. 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. Department of Health v Michell Klotz, R.N. 5 Case Number 2019-09580

Docket for Case No: 21-001125PL