The Issue Whether or not the Respondent, Hermine Ledoux Lane, is guilty of a violation of 464.21(1)(a), (1)(b), based upon a revocation of her license to practice as an licensed practical nurse, in the State of Vermont, effective January 14, 1976, after a hearing on December 3, 1975, in which it was concluded that the Respondent had on several occassions signed her name on a patient's clinical record and used the letters "R.N." after said signature and had on three occassions signed her name on a billing form using the initials "R.N." following her signature, when in fact the Respondent was not a registered nurse in the State of Vermont. The Vermont State Board of Nursing concluded this showed the Respondent was guilty of unprofessional conduct in willfully and repeatedly violating Vermont's statutes governing the practice of nursing, in that she did practice professional nursing without being duly licensed.
Recommendation It is recommended that the charges placed against Hermine Ledoux Lane, L.P.N., under license no. 05372-1 be dismissed. DONE and ENTERED this 11th day of February, 1977, in Tallahassee, Florida. CHARLES C. ADAMS, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1130 American Heritage Life Building Jacksonville, Florida 32202 Hermine Ledoux Lane 51 North Union Street Burlington, Vermont 05401
Findings Of Fact Based on the admissions of the parties, on the exhibits received in evidence and on the testimony of the witnesses at the hearing, I make the following findings of fact. Respondent, Kimberly Bauzon, L.P.N., is a licensed practical nurse in the state of Florida, having been issued license number PN 0803361. Respondent has been so licensed at all times material to the allegations in the complaint. Between the dates of October 25, 1985, and December 2, 1985, the Respondent was employed as an LPN by the Care Unit of Jacksonville Beach. On various occasions during her employment as an LPN at the Care Unit of Jacksonville Beach, Respondent charted vital signs for patients that she had not, in fact, taken. On or about November 21, 1985, while employed as an LPN on duty at the Care Unit of Jacksonville Beach, without authority or authorization, Respondent left her unit within the Care Unit for at least thirty (30) minutes. During that period of at least thirty (30) minutes on November 21, 1985, during which Respondent was out of her unit, there was no nurse present in the unit to take care of patient needs. Also on or about November 21, 1985, while on duty at the Care Unit of Jacksonville Beach, Respondent was asleep for a period of at least two (2) hours. On one occasion during Respondent's employment at the Care Unit of Jacksonville Beach, Respondent pulled a male adolescent by the waistband at the front of his trousers in the course of directing the patient to provide a urine specimen. The manner in which Respondent pulled on the patient's clothing was inappropriate and unprofessional. It is unprofessional conduct and a departure from minimal standards of acceptable and prevailing nursing practice for an LPN to be asleep while on duty. It is unprofessional conduct and a departure from minimal standards of acceptable and prevailing nursing practice for an LPN to chart vital signs which she has not, in fact, taken. It is unprofessional conduct and a departure from minimal standards of acceptable and prevailing nursing practice for an LPN to leave her unit for a period of thirty (30) minutes in the absence of a replacement nurse.
Recommendation In view of all of the foregoing, it is recommended that the Board of Nursing enter a final order in this case finding the Respondent guilty of one incident of violation of Section 464.018(1)(d), Florida Statutes, and four incidents of violation of Section 464.018(1)(f), Florida Statutes. And in view of the provisions of Rule 210-10.05(4)(d), Florida Administrative Code, it is recommended that the Board of Nursing impose a penalty consisting of a letter of reprimand and further consisting of a requirement that Respondent attend required specific continuing education courses, with an emphasis on the legal responsibilities of a nurse to the patients under her care. DONE AND ORDERED this 19th day of March, 1987, at Tallahassee, Florida. M. M. PARRISH Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 19th day of March, 1987. COPIES FURNISHED: Lisa Bassett, Esquire Staff Attorney Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Kimberly Bauzon, LPN 2968 Songbird Trail Atlantic Beach, Florida 32233 Kimberly Bauzon, LPN 216B Seagate Avenue, #B Neptune Beach, Florida 32233 Joe Sole, General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Van Poole, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Judie Ritter, Executive Director Board of Nursing Department of Professional Regulation Room 504, 111 East Coastline Drive Jacksonville, Florida 32201 =================================================================
The Issue Whether the Respondent's license as a Licensed Practical Nurse should be suspended or revoked for alleged violation of Sections 464.21(1)(b) and (d), F.S., as set forth in Administrative Complaint, dated August 3, 1978. The Respondent did not appear at the hearing. Notice of Hearing was issued by the Hearing Officer under date of October 25, 1978, to the address provided by Petitioner, 7124 Bay Drive No. 1, Miami Beach, Florida 33141. This is the address reflected on the envelope which enclosed Respondent's request for hearing on the Administrative Complaint sent to Petitioner under postmark August 28, 1978. It being determined that adequate notice had been provided to Respondent, the hearing was conducted as a uncontested proceed, pursuant to Rule 28-5.25(5), Florida Administrative Code. (Exhibit 5)
Findings Of Fact Respondent Michaela Fives holds License No. 27554-1 as a Licensed Practical Nurse and was so licensed in November, 1977. (Testimony of Johnson) On November 5, 1977, Detective Kenneth Valentine, Hialeah Police Department, was acting in an undercover capacity on an investigation of narcotics. Pursuant to his investigation, he met with Respondent at her apartment located at 5960 NW 38th Street, Apartment 210, Virginia Gardens, Miami, Florida. Lynn Sampson and Danny Cundiff were also present in Respondent's apartment at the time. Cundiff and Sampson wrote out a prescription of 60 300 mg. Quaalude tablets on a printed prescription form. The top of the form showed the name Lacy, Adler, M.D., P.A., followed by "Andrew P. Adler, M.D., Ray C. Lacy, M.D., 221 West Flagler Street, Miami, Florida 33130, Telephone: 887-9339." The prescription was handed to Valentine and Respondent gave him $15.50 to have it filled at the My Pharmacy, 1550 West 84th Street, Hialeah-Miami Lakes, Florida. By pre-arrangement with the pharmacist, Valentine had the prescription filled there and took the pills back to the apartment. Sampson divided them among Respondent, Cundiff and herself, and each of them ingested one tablet. Valentine purchased ten tablets from Sampson and Cundiff for $35.50. (Testimony of Valentine) On November 9, 1977, Valentine again met with the three individuals at Respondent's apartment and was provided another prescription for the same amount of drugs. It reflected the patient's name as Robert Southern, and registration number 178855. It was purportedly signed by "S. Adler, M.D." Prior to this meeting, the Hialeah police had determined that Doctors Adler and Lacy were not listed in the telephone book nor were they located at the address shown on the prescription form. They also determined that the phone number shown on the prescription form was a pay telephone located in Hialeah, Florida. After the individuals at the apartment discussed the fact that the pharmacist would probably call the phone number listed on the prescription form to verify its authenticity, Valentine took the Prescription to the My Pharmacy and had it filled, using his own money for the purchase. At this time, another police officer present at the pharmacy called the phone number listed on the prescription form to ostensibly verify the prescription. Lieutenant Paul Gentesse of the Hialeah Police Department had previously placed himself in a position to observe the pay telephone. He saw the Respondent answer the telephone and then followed her back to her apartment. When Valentine returned with the filled prescription, he gave it to Cundiff who divided the tablets among Respondent, Sampson and Valentine Valentine paid $30.00 for ten tablets. Other police officers then arrived at the apartment and Respondent, Cundiff and Sampson were placed under arrest. (Testimony of Valentine, Gentesse, Exhibit 3) The tablets taken from the possession of Respondent and the others were analyzed by a chemist in the Crime Laboratory of the Dade County Public Safety Department and were found to contain Methaqualone, a controlled substance under Chapter 893, Florida Statutes. Quaalude is a common tradename for Methaqualone. (Testimony of Lynn, Exhibit 2, supplemented by Exhibit 1) On January 9, 1975, Petitioner had suspended the license of the Respondent for period of two years as a result of prostitution charges. The record of that proceeding contained the testimony of Respondent that she had been involved In the illegal use of controlled drugs and had been attending a drug rehabilitation program for the treatment of drug abuse as a result of court order. Respondent thereafter petitioned for reconsideration of the suspension and, on June 29, 1976, Petitioner stayed its order of suspension and placed Respondent on probation for the remainder of the period of suspension. (Testimony of Johnson, Exhibit 4)
Recommendation That Respondent's license as a Licensed Practical Nurse be revoked for violation of Section 464.21(1)(d) , Florida Statutes. DONE and ENTERED this 2nd day day of January, 1979, in Tallahassee, Florida. THOMAS C. OLDHAM Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1007 Blackstone Building Jacksonville, Florida 32202 Geraldine Johnson, R.N. Investigation and Licensing Coordinator 6501 Arlington Expressway, Bldg B Jacksonville, Florida 32211 Michaela Fives, L.P.N. 7124 Bay Drive No. 1 Miami Beach, Florida 33141
Findings Of Fact Margie Leverson, petitioner, was registered with the Florida State Board of Nursing in 1978 as a licensed practical nurse holding license number 13107-1. On the evening of March 9, 1978, petitioner was assigned to work the 11 p.m. through 7 a.m. shift in the critical care unit of Palm Springs General Hospital, Homestead, Florida. An audit of administration records at the Hospital disclosed that petitioner failed to properly chart medications administered to a number of patients, that she failed to complete the nurses' notes of patients under her care, and that she did not sign the medication administration profile sheets or nurses' notes for any of the patients under her care during the time at issue. The importance of conforming to these requirements is to assure that all medications have been given when scheduled and to assure continuity in evaluating a patient's illness. With critically ill patients, it is necessary to be able to ascertain when a condition or problem was noted and how it was treated. Otherwise, continuity is lost, and it is possible that decisions as to treatment may not be accurately made, and the nurse in charge cannot in every case be identified unless her signature appears on the documents. Failure to chart medications administered to patients. On two occasions, petitioner failed to chart medications administered to patients. Specifically, Juan Pinera was to receive 2 million units of penicillin intravenously every four hours, including twice during the time he was in petitioner's care. However, the prescribed medication was not charted as having been given to the patient during this time. Another patient, Peter L. Garcia, was scheduled to receive ampycillin 500 mg. at midnight and 6 a.m., and garamycin 40 mg. at midnight. Such administrations, if given, were not charted by petitioner. Failure to adequately and properly chart the nurses' notes of patients in the nurse's care. In the case of four patients under the care of petitioner, no nurses' notes were kept. (Exhibit Nos. 1, 2, 5, & 6). For the other three patients, the notes were of minimal, if any, value because they did not provide any evaluation or explanation of the problems noted. (Exhibit Nos. 3, 4 & 7). Petitioner herself acknowledged that the words were written in her hand writing and were of no value to anyone attempting to determine the patient's condition. Failure to sign medication administration profile sheets and nurses' notes. The petitioner failed to sign the medication administration profile sheets and nurses' notes for any of the patients under her care during the time at Issue. In mitigation, petitioner had earlier completed a 3 p.m. through 11 p.m. shift at another hospital on the same date. She arrived on duty at the Hospital around 11:30 p.m. Because of an argument with a co-worker, she was transferred by her supervisor to another unit around 1:00 a.m. and claims she cannot be held accountable for the failures as to the seven patients who were under her care. Petitioner stated she ultimately left the hospital on leave around 3:00 a.m. due to a pinched nerve in her back.
Recommendation Based upon the foregoing findings of fact and conclusions of law, it is RECOMMENDED the application of Margie Leverson for reinstatement of her license as a licensed practical nurse be granted subject to the conditions set forth in conclusion 14 above. DONALD R. ALEXANDER Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675 COPIES FURNISHED: Ms. Margie Leverson 4030 Northwest 190th Street Opa Locka, Florida 33055 Frank A. Vickory, Esquire Assistant Attorney General The Capitol Tallahassee, Florida 32301
Findings Of Fact Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant facts are found: At all times pertinent to these proceedings, respondent was a licensed practical nurse holding license number 26892-1. The designation of "-1" in the license number is the Board's designation for a licensed practical nurse, and the designation "-2" is for a registered nurse. Respondent is not now and has never been a licensed registered nurse in the State of Florida. In June of 1974, respondent went to the nursing director's office of the Bryan Cameron Community Hospital in Bryan, Ohio, and applied for a position as a registered nurse in the operating room. Respondent could not substantiate that he was a licensed registered nurse. On the day that respondent was to report to work, the hospital administrator, Mr. Rusty O. Brunicardi, told respondent that he was having a problem verifying his registry and asked respondent if he would fill out a form saying that he was a registered nurse. Respondent then filled out and signed a form, witnessed by two persons, certifying that he was a licensed registered nurse in the State of Florida and that, his license number is 26892-1. Mr. Brunicardi also informed respondent that he should contact the Florida State Board of Nursing and have them call him and that, upon Brunicardi's receipt of a call from the Board, respondent could start to work. Respondent indicated to Brunicardi that there was some kind of mixup in the Board's files and that he would straighten it out. Respondent then left and Brunicardi never heard from him again. Respondent began his employment with the Manhattan Convalescent Center in Tampa, Florida, on October 17, 1975. As a part of the orientation procedure for new employees, respondent was made aware of the Center's policy or procedure with respect to patient trust funds. The policy was that when patients with money in their possession are admitted to the Center, the money was to be taken by the admitting nurse to the business office and put into a trust fund account for the patient. After the money had been turned in, the nurse would give the patient a receipt. The business office kept a ledger card for each patient. when a patient requested money, the nurse was to write it down in the trust fund book on the station, take it to the office and deliver the money requested to the patient on the following day. On or about November 20, 1975, Gloria Elizabeth Adams was admitted as a patient to the Manhattan Convalescent Center having in her possession $44.00 in cash. She gave $35.00 of this amount to her admitting nurse, respondent herein, for the purpose of putting it into a trust fund for her. Respondent wrote in his nursing notes on Adams' admission that she had brought money in and that it had been put in her trust fund. A day or two thereafter, respondent asked her to write a check for the trust fund. She asked respondent what had happened to the $35.00 she had previously given him and, not receiving a satisfactory answer, she refused to give him a check. Ms. Adams then went to the desk and asked to withdraw $5.00 from her account. She was told she would receive it the following day. She then saw respondent, who again asked her to write a check for $35.00 for the trust fund. She again refused and told him she had asked to withdraw $5.00 from her account. He then brought her $5.00, and she never saw him again. About a week after Ms. Adams was admitted, the Director of Nursing at the Center, Phyllis Hereford, learned that there was a problem with Ms. Adams' trust fund. Since respondent was Adams' admitting nurse, Ms. Hereford spoke to him about it. He at first told her that he had put the money in an envelope and put the envelope in a narcotic book for Sister Edna Mae, the next nurse coming on duty. Ms. Hereford suggested that he call Sister to see if she remembered. He did so and Sister was very adamant that she did not receive an envelope with money in it in the narcotic book, and that, had the envelope been there, she would have seen it when she was counting drugs. Director Hereford told respondent that since he had mishandled Ms. Adams' money, he was responsible for it and should pay it back. He indicated that he would do so, but he did not return to work more than one day thereafter. The administrator of the Center determined that the missing $30.00 would be deducted from respondent's pay check and placed into the Adams' trust fund. The ledger card for Ms. Adams reveals that on December 9, 1975, a deposit was made for $30.00 "to cover mishandled monies on Station 2." There was nothing on the ledger to indicate that an earlier deposit had ever been made. Ms. Hereford learned that another patient, Doris Clark, had $10.00 mishandled by respondent and the Center deducted $10.00 from respondent's paycheck and reimbursed Clark's trust fund by such amount. No objection or complaint was received by the Center from respondent concerning the $40.00 deduction from his salary.
Recommendation Based upon the findings of fact and conclusions of law recited above, it is recommended that the Board dismiss that charge relating to the monies of Doris Clark; find respondent guilty of unprofessional conduct in his actions surrounding the monies of Ms. Adams; and find respondent guilty of willfully violating F.S. ss. 464.081(1) and 464.24(1)(d) in his actions surrounding his attempt at employment with the Bryan Cameron Community Hospital. It is further recommended that, for such offenses, the Board suspend respondent's license number 26892-1 for a period of one (1) year. Respectfully submitted and entered this 5th day of August, 1976, in Tallahassee, Florida. DIANE D. TREMOR, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Mr. Danny L. Pressler 3 Seashore Drive Ormand Beach, Florida Mr. Danny L. Pressler 307 Southeast Avenue Montpelier, Ohio 43543 Ms. Geraldine Johnson Florida State Board of Nursing 6501 Arlington Expressway Jacksonville, Florida 32211 Julius Finegold 1130 American Heritage Life Building Jacksonville, Florida 32202
Findings Of Fact At all times pertinent to the allegations contained herein, Respondent, Tracie Ann Johnson, was licensed as a practical nurse in Florida under license number NI20852451. The Board of Nursing was and is the state agency responsible for the licensing of practical nurses in Florida. On March 28, 1987, Deborah W. Murphy was a licensed practical nurse and charge nurse at the Hillsborough County Development Center assigned to the 3 - 11 PM shift. As a part of her duties that evening she was assigned to conduct an orientation of the Respondent, Tracie A. Johnson, who had recently been employed by the facility. As a part of her routine duties, Ms. Murphy conducted a count of all controlled drugs at the beginning of her shift, when medications were passed, and again at the end of her shift. The initial count, less the drugs passed, should have resulted in the number present at the end of shift count. On the night in question, Ms. Murphy, along with the Respondent, went to each individual house at the facility to pass medications. Drugs are kept in a locked cabinet in a locked storage room in each house. In order to get to the drugs, it takes two separate keys - one for the room and one for the drug cabinet. Both keys were kept within the personal control of the charge nurse on duty, and on the night in question, Ms. Murphy, as the sole nurse on duty, had the only keys. When Ms. Murphy was out of the drug room passing medicines, she would leave the room unoccupied save for Respondent for a few moments. During this period, the drug cabinet was unlocked as well. On the night in question, no one else, other than Ms. Murphy or Respondent, was present or had access to the drug room and cabinet. When Ms. Murphy finished passing medicines in the house where the shortage in question here was noted, she and Respondent were to go to another house to pass medicines. However, prior to leaving, Ms. Johnson indicated she had to go to the bathroom and they agreed that she would meet Ms. Murphy at the next house. Ms. Johnson did not show up and Ms. Murphy went back to find her. When she did, she found that Respondent was still in the bathroom. When Respondent came out of the bathroom, she was pale and sweaty, and her eyes appeared glassy. She said at that point that the "Doritos" must have made her sick. The two nurses went back to the nurse's station but Respondent was unable to stay awake to continue the orientation. In Ms. Murphy's opinion, Respondent was under the influence of some substance, either alcohol or a drug. When Ms. Murphy conducted the 11 PM count of drugs at the end of her shift, she found that one 100 mg phenobarbital capsule was missing from one of the drug cabinets in the room where she had left Respondent unaccompanied. Both Ms. Murphy and her replacement night nurse searched thoroughly for the pill but could not find it. As a result, Ms. Murphy called Ms. Cottrell, the assistant director of nursing, who advised her to fill out an incident report which all parties involved were to sign. When asked to sign this report, Respondent refused, stating that she was not present during the search and therefore could not vouch for its effectiveness. Ms. Murphy indicates that even before the medicines were passed, Respondent disappeared with her purse often and her conversation seemed to be somewhat inappropriate. She was highly talkative and after the passing of medicines, it appeared that her demeanor changed. She was much quieter and did not go with Ms. Murphy on any of the other medicine passes that evening. Ms. Cottrell, herself a recovered impaired nurse, was called by Ms. Murphy when the shortage was noticed. In a meeting the next morning, Ms. Murphy reported that Respondent's performance and demeanor had been inappropriate and Ms. Cottrell had heard from other nurses as well that Respondent appeared to be under the influence of some substance. When Ms. Murphy attempted to question Respondent about her familiarity with a venous puncture, she reportedly stated she did not have to observe that as she had experience in sticking needles in her own veins. After receiving a complete report from Ms. Murphy, Ms. Cottrell called Respondent in at which time Respondent indicated strong signs of impairment. These included repeated absences to go to the bathroom, drowsiness, sweating, and paleness. During their conversation, Respondent appeared to be bored and angry at having to come in early to talk. Ms. Cottrell spoke of her concerns about Respondent's behavior and condition, and Respondent's refusal to sign the incident report, and asked Respondent to be evaluated by an addiction counselor rather than to be reported to the Board. At this point, Respondent, already angry, got angrier. She denied taking drugs, made a few more inappropriate comments, and stomped out of the room. This type of conduct is consistent with a drug dependance denial but is also consistent with innocence. After the interview, during which Respondent declined to be evaluated by an addiction counselor, Ms. Cottrell felt she had no choice but to discharge Respondent from employment with the Center. In her opinion, based on her personal experience and her training in drug addiction, Respondent was under the influence of something at the time. Her symptoms are not consistent with food poisoning but with a drug high. She is satisfied that Ms. Murphy is not responsible for the loss of the pill and Ms. Murphy denied having taken it. She is further satisfied that none of the patients assigned to the residence from which the pill was missing was capable of taking it. It is found, therefore, that Respondent took the phenobarbital from the drug room while Mrs. Murphy was out of the room and ingested it. It is also found that her symptoms, as described by the three nurses who observed her, are consistent with drug ingestion and that she was under the influence of drugs whale on duty with Ms. Murphy on March 28, 1987.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is, therefore: RECOMMENDED that Respondent's license as a practical nurse in Florida be suspended for three years or until such time as she proves to the satisfaction of the Board of Nursing that she is capable of safely engaging in the functions of the profession of nursing. RECOMMENDED this 15th day of November, 1988, at Tallahassee, Florida. ARNOLD H. POLLOCK, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 15th day of November, 1988. COPIES FURNISHED: John Cobb, Law Clerk Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Tracie Johnson 1906 East Hamilton Tampa, Florida 33610 Bruce D. Lamb, General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Judie Ritter, Executive Director DPR, Board of Nursing Room 504, 111 East Coastline Drive Jacksonville, Florida 32201
The Issue Whether one or more of the following penalties should be imposed on Elizabeth Worden: revocation or suspension of the Ms. Worden's practice, imposition of an administrative fine, and/or any other relief that the Board of Nursing deems appropriate?
Findings Of Fact Elizabeth Worden is, and has been at all times material hereto, a licensed practical nurse in the State of Florida. Ms. Worden holds State of Florida license number 0739611. Her license lapsed on April 1, 1987, and remained lapsed at least through September 20, 1988. On September 11, 1985, Ms. Worden was arrested and charged with one count of driving under the influence (hereinafter referred to as "DUI") and five counts of possession of controlled substance. On February 24, 1986, Ms. Worden was found guilty of DUI. Additionally, an Order Withholding Adjudication of Guilt and Placing Defendant on Probation was entered based upon a plea of nolo contendere by Ms. Worden to the five counts of possession of controlled substance. Ms. Worden was placed on three years probation for the charge of possession of controlled substance and was placed on a year of probation (to run concurrently with the sentence for possession of controlled substance), ordered to pay a fine, perform community service and had her drivers license suspended for six months for the charge of DUI. During at least part of 1986 and 1987, Ms. Worden was employed as a licensed practical nurse at the Ocala Geriatrics Center (hereinafter referred to as the "Center"). Ms. Worden was one of three licensed practical nurses at the facility during the 11:00 p.m. to 7:00 a.m. shift and was in charge of the patients on one floor of the facility. While on duty at the Center Ms. Worden retired to room 5 in the east wing of the Center almost every night to sleep. She generally went to the room at about 2:00 a.m. and remained in the room until approximately 6:00 a.m. While Ms. Worden slept, she left the certified nurses aides in charge of patient care and assigned duties to the aides which should have been conducted by a licensed nurse. Ms. Worden told the aides to wake her only if a patient needed medication, if another nurse appeared on her floor, and at 6:00 a.m. On three occasions Ms. Worden left the Center while she should have been on duty, leaving certified nurses aides in charge of patient care. On these occasions Ms. Worden was gone from fifteen to thirty minutes carrying out personal errands. Ms. Worden admitted on one occasion to a certified nurses aide that she had consumed a couple of beers before coming to work. Ms. Worden's breath often smelled of alcohol and the room in which she slept also smelled of beer on occasion. During 1987, Ms. Worden entered the Intervention Project for Nurses. She was dismissed from the program in August, 1987, for noncompliance with the program's requirements. On May 18, 1987, Ms. Worden was arrested and charged with DUI and resisting arrest without violence. She was adjudicated guilty of both offenses on July 13, 1987.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that Elizabeth Worden be found guilty of having violated Sections 464.018(1)(c) and (g), Florida Statutes, as alleged in Count One and Count Three of the Administrative Complaint. It is further RECOMMENDED that the portion of the Administrative Complaint alleging that Ms. Worden is guilty of having violated Sections 464.018(1)(f) and (h), Florida Statutes, as alleged in the second Count One and Count Three of the Administrative Complaint be dismissed. It is further RECOMMENDED that Ms. Worden's license as a practical nurse be suspended until the later of the end of a five (5) year period from the date of the final order issued in this case or the date that Ms. Worden provides proof acceptable to the Petitioner of her successful completion of a rehabilitation program acceptable to the Petitioner. DONE and ENTERED this 18th day of November, 1988, in Tallahassee, Florida. LARRY J. SARTIN Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 18th day of November, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 88-2548 The Petitioner has submitted proposed findings of fact. It has been noted below which proposed findings of fact have been generally accepted and the paragraph number(s) in the Recommended Order where they have been accepted, if any. Those proposed findings of fact which have been rejected and the reason for their rejection have also been noted. The Petitioner's Proposed Findings of Fact Proposed Finding Paragraph Number in Recommended Order of Fact Number of Acceptance or Reason for Rejection 1 1. 2 3. 3-4 2. 5 3-4. 6 5. 7 7. 8 9. 9 10. 10 10-11. COPIES FURNISHED: Michael A. Mone' Staff Attorney Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Elizabeth Worden 412-A Clark Street St. Charles, Missouri 63301 Bruce D. Lamb General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Lawrence A. Gonzalez Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Judie Ritter Executive Director Department of Professional Regulation Room 504, 111 East Coastline Drive Jacksonville, Florida 32201
Findings Of Fact Respondent, Ann Claycomb (Claycomb), was at all times material hereto a licensed practical nurse in the State of Florida, having been issued license number 39853-1. On December 24, 1987, Claycomb was employed as an agency nurse by Alpha Health Care, Inc., and was on assignment to Health South Rehabilitation, a skilled nursing and rehabilitation facility in Miami, Florida. While at the facility on that date, Claycomb worked the morning shift 7:00 a.m. to 3:30 p.m., and was assigned to the skilled nursing floor. The skilled nursing floor contained 20-25 elderly, though mostly alert patients. At the commencement of Claycomb's shift, it was her responsibility to administer medications to these patients which conformed with that prescribed by their medication administration record (MAR). Shortly after Claycomb began her rounds, Elaine Wood, the Unit Manager at Health South Rehabilitation, began to receive complaints from patients for what they perceived to be errors in the medicinal drugs administered or attempted to be administered to them by Claycomb. Upon investigation, the following medication errors were discovered. Claycomb administered what she believed to be two Tylenol tablets to patient H.B. Following administration, the patient became lethargic and her vital signs deteriorated but later returned to normal. Lethargy is not a side effect of Tylenol. Although the MAR prescribed two Slow K tablets at 9:00 a.m., and Lilbrax as needed, Claycomb recorded having administered one Slow K tablet and Atarax to patient H.R. Claycomb dispensed Atarax to patient A.J. at 9:00 a.m. when the MAR prescribed dose to be given at 1:00 p.m. Patient refused medication because given at the wrong time. In committing the foregoing medication errors Claycomb's practice fell below the minimal standards of acceptable and prevailing nursing practice in the administration of medicinal drugs. Verification of other complaints received by Ms. Wood could not be verified because, contrary to accepted and prevailing nursing practice, Claycomb did not annotate some patients' MAR upon dispensing medications.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that a final order be entered suspending the license of respondent, Ann Claycomb, until such time as she submits proof satisfactory to the Board of Nursing that she can practice nursing safely. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 27th day of December, 1988. WILLIAM J. KENDRICK Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 27th day of December, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 88-3603 Petitioner's proposed findings of fact are addressed as follows: 1. Addressed in paragraph 1. 2-4. Addressed in paragraphs 2 and 3. 5 & 6. Addressed in paragraphs 46. Addressed in paragraph 4c. Subordinate or not necessary to result reached. Not necessary to result reached. Not necessary to result reached. To the extent supported by competent proof addressed in paragraph 4. Proposed findings 11a and 11d are based on hearsay which does not supplement or explain any competent proof. 12-15. Not pertinent nor necessary to result reached. COPIES FURNISHED: Michael A. Mone', Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Ms. Ann Claycomb 4175 South West 98th Avenue Miami, Florida 33165 Lawrence M. Shoot, Esquire 6011 West 16th Avenue Hialeah, Florida 33012 Judie Ritter, Executive Director Board of Nursing 504 Daniel Building 111 East Coastline Drive Jacksonville, Florida 32201 Bruce D. Lamb, Esquire General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
The Issue Whether the license of the Respondent, Virginia Downey White, License No. 24571-1, should be revoked or suspended, or whether the Respondent should be placed on probation.
Findings Of Fact The Respondent, Virginia Downey White, holds Licensed Practical Nurse License No. 24571-1. During the time pertinent to this hearing the Respondent was employed as a licensed practical nurse at St. Catherine Laboure Manor a nursing home in Jacksonville, Florida. An Administrative Complaint was issued against the Respondent on April 20, 1979, alleging unprofessional conduct. The Respondent requested an administrative hearing. Prior to an investigation by the personnel at St. Catherine Laboure Manor, and prior to the issuance of the Administrative Complaint against Respondent White, a call had been received at the nursing home stating that medications were not being properly given by the Respondent to her patients. On her own initiative, Priscilla Garske, a co-worker and licensed practical nurse who knew Respondent White, made a random selection of ten (10) patients from approximately twenty-five (25) assigned to the Respondent, listing the names of those ten (10) selected and listing their medications by their names in her nursing notes on March 25, 1979. Ms. Garske did not work on March 26, but on March 27, 1979, she returned to work on the 7:00 a.m. to 3:00 p.m. shift. On that date, after Ms. Garske had again counted medications for the same patients listed in her nursing notes, she reported to Florence Thibault, R. N., Director of Nurses at St. Catherine Laboure Manor, that the count was identical. Ms. Garske had checked the patients' medication sheets on which medications which had been given were to be charted and found that the medications had in fact been charted for these particular patients on March 25, 26 and 27, 1979, by the Respondent. Ms. Garske gave her nursing notes to Ms. Thibault when she reported her findings. Ms. Thibault examined the list of patients in Ms. Garske's nursing notes and their list of medications and immediately directed two (2) other nurses to check the medication cards against the list. Alberta Neeley and Eva Itameri, both licensed practical nurses, went to the units and checked Ms. Garske's list against the medication cards for the numbers of medications that were left. They returned with their findings, which indicated that six (6) of the ten (10) patients on the list had the same numbers of pills on their cards on that date, March 27, as they had had on March 25, 1979. Ms. Thibault then made a list of the same patients with their medications by their names, called Respondent White and discharged her from her employment, indicating to the Respondent that she had failed to give patients their medications while improperly charting on their records that they had received such medication. Of the ten (10) patients listed in Ms. Garske's nursing notes and by Ms. Thibault, it was alleged that Respondent White had failed to give medications to six (6) of them, whose records were introduced into evidence. It was stipulated at the hearing that the remaining four (4) patients on the list had in fact received their medications from the Respondent. Respondent White was responsible for giving medications to half of some fifty-eight (58) patients on her floor, who were mainly aged and infirm people. The patients on the list had not been questioned as to whether they had in fact received medication during the time in question. Each patient on the floor had a medication card with twenty-five (25) to thirty (30) pills on it, each pill being encircled by a plastic bubble. Some patients had more than one card. Some patients had one card opened and one not opened, and some patients had two (2) cards opened, although it was the policy of the nursing home to give all the pills from one card before a new card was opened. On the medication cart there were additional stock medications, such as vitamins, which were given the patients from time to time. The counts made on the medication cards of the patients on the list who were the responsibility of the Respondent were made from one medication card only according to the testimony of Ms. Garske. Eva Itameri, a nursing supervisor at St. Catherine Laboure Manor during the time pertinent to this hearing, and who had been instructed by Ms. Thibault to accompany Alberta Neeley to the floor on which Respondent White worked and to make an examination of the medication cards of the ten (10) patients on the list, pulled the cards from the patients' files, and Ms. Neeley wrote down their names and the numbers of medications on their cards. Ms. Itameri did not question the patients at the time she was making her investigation, stating that the patients on the floor whore the Respondent worked were very confused and disoriented. Ms. Itameri stated that it normally took about an hour to pass out medications each morning, and that sometimes the stock medications from the medication cart were also dispensed to the patients. Alberta Neeley, the licensed practical nurse who accompanied Ms. Itameri as instructed by Ms. Thibault at the time pertinent to this hearing, stated she talked in general with the patients at that time, but that she did not make a list of those to whom she had talked and did not specifically ask whether they had received their medications. Ms. Neeley also stated that the situation at St. Catherine Laboure' Manor was subject to "a turn- over in staff." At the hearing, Ms. Garske stated that all ten (10) patients listed in her nursing notes had had the same numbers of medications on their cards when counted by her on March 27, 1979, as they had had on March 25, but that each of those patients had been charted by Respondent White as having been given their medications each day as required. It can not be reliably ascertained from the testimony and evidence presented at the hearing whether the medications for the six (6) patients, whose records were introduced into evidence, had in fact been given to them as indicated on their charts. Whether Respondent White gave them medications from a different card than previously used, whether some medications were given from the stock medications, or whether some of the six (6) patients were not medicated is unknown. The patients were not questioned, and if they had been questioned would not have remembered. Respondent White stated she gave the medications as required. There was ill feeling between Respondent White and Ms. Garske, her co- worker, who made the initial count of the medications and reported that the Respondent had not given medications to the patients. Alberta Neeley, one of the witnesses for the Petitioner Board, was in doubt as to whether the count she and Ms. Itameri made as instructed by Ms. Thibault would conclusively indicate that medications had not been given patients. From time to time during her employment at St. Catherine Laboure Manor, Respondent White misplaced medications for patients and required assistance from other nurses to locate such medications. She finished giving her patients medications in less time than did the two (2) other nurses, although each nurse had approximately the same number of patients to medicate. Both Eva Itameri and Alberta Neeley, as witnesses for the Petitioner Board, stated they felt Respondent White to be a good nurse, but they had some reservations as to her general nursing performance. No proposed findings of fact or memoranda of law were submitted to the Hearing Officer by the parties.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, the Hearing Officer recommends that the Petition in this matter be dismissed. DONE and ORDERED this 22nd day of October, 1979, in Tallahassee, Leon County, Florida. DELPHENE C. STRICKLAND Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1107 Blackstone Building 233 East Bay Street Jacksonville, Florida 32202 William J. Sheppard, Esquire 215 Washington Street Jacksonville, Florida 32202 Geraldine B. Johnson, R. N. Board of Nursing Ill Coastline Drive East, Suite 504 Jacksonville, Florida 32202
The Issue Whether Respondent should take final action to deny Petitioner's application for licensure as a practical nurse on the grounds set forth in Respondent's Notice of Intent to Deny.
Findings Of Fact Background On May 1, 2011, Petitioner graduated from Southeastern Community College (West Burlington, Iowa) with a certificate in Practical Nursing (PN). Thereafter, Petitioner received a passing score on the Iowa PN licensure examination, and was issued an Iowa PN license on June 13, 2012. Although both he and his wife hail from Iowa, Petitioner desired to relocate to Florida and seek employment as a practical nurse. In pursuit of that goal, Petitioner submitted an application for PN licensure by endorsement on October 19, 2012. Petitioner’s Criminal History Prior to submitting the Florida application, Petitioner had run afoul of the law on three occasions, only two of which are relevant to the application at issue. On May 10, 2007, Petitioner entered a plea of guilty to misdemeanor battery in Henderson County, Illinois. As a result of this plea, Petitioner was sentenced to two years of supervision and was required to complete anger management counseling. At the request of the Florida Board of Nursing (Board), Petitioner provided a written account of the circumstances surrounding the battery charge as follows: I had just gotten married and my wife and I were out celebrating her birthday at a club. A bouncer came to me and said that the person I had came in with was being bothered by someone else and that I should go check on her. I got my wife and we were in the process of leaving along with the rest of our group. The person bothering my wife continued talking and fussing. As I turned my back to leave, the person grabed [sic] me by the shoulder and lunged at my wife. In reaction I instinctively protected my wife feeling that she was in danger. Everyday since then this has haunted me. If I had taken a different path I would not be writing you this letter today. I feel I have learned the hard lesson from this mistake. I completed the requirements of the court for this along with my own self evaluation of life of how better to handle the situation or avoid them all together. Petitioner’s unrebutted testimony at hearing regarding the circumstances of the battery incident was consistent with his written account above, and is found to be credible. Henderson County court records reflect that Petitioner was accused of striking the person who had been bothering his wife “in the face with his fist.” On July 27, 2011, Petitioner was charged with driving under the influence, also in Henderson County, Illinois. On August 30, 2011, Petitioner entered a plea of guilty to the misdemeanor charge. In his written submission to the Board, Petitioner explained the circumstances surrounding this incident as follows: Regarding my DUI, I had just finished my semester for LPN. I was out celebrating with some classmates. I was pulled over because my oversized tires went over the white line. I was arrested for DUI. I went to the states attorney and explained my situation. He informed me that he would allow me to have court supervision if I pled guilty and pay a hefty fine. My lawyer informed me that this was not a reasonable means for stopping me, but since I had already talked to the states attorney, he informed me that it would not be wise to fight this case because I had already spoke with the states attorney and gave a verbal agreement of what I agreed to do. I have completed all of my classes, I am still paying monthly on my fine, which will be finished this year. I have learned my lesson from this situation. As a nurse I have a high standard to uphold to help people get better and by drinking and driving I was endangering many lives which is the opposite of my civic, humanitarian and the basic oath I took when I decided to become a nurse. Petitioner’s unrebutted testimony at hearing regarding the circumstances of the DUI charge was consistent with his written account above, and is found to be credible. As a result of his guilty plea, Petitioner was ordered to pay a fine and attend a substance abuse class, which he successfully completed. Petitioner’s Application Respondent introduced a copy of Petitioner’s “Initial Application for Licensure” which was submitted by Petitioner through the Board’s online website. The online application contains the following question: Criminal History Have you ever been convicted of, or entered a plea of guilty, nolo contender, or no contest to, a crime in any jurisdiction other than a minor traffic offense?2/ Your answer: NO At hearing, Petitioner testified that although he carefully reviewed his application before submitting it, he did not intend to answer the above question in the negative, and that “he made a mistake” when he did so. On cross-examination Petitioner confirmed that he read and understood the Affirmation Statement at the end of the application, and that he affirmed that the information he provided was true and correct. There is no question that Petitioner provided a false response on his application regarding his criminal history. However, the evidence of record does not support a finding that the false statement was intentional. At hearing, Petitioner presented as an articulate, intelligent, and well-educated individual. Petitioner had also successfully undergone the PN application process in Iowa, and was therefore familiar with the application review process. As such, it is reasonable to infer that Petitioner was aware that the information he provided on his application would be verified by Board personnel. This makes it increasingly unlikely that Petitioner intentionally falsified his application, since he could have no reasonable expectation of successfully perpetrating a fraud on the Board. Petitioner was notified by correspondence dated November 10, 2012, that he was required to provide information concerning his criminal history. As noted, it was not until after the notification that Petitioner provided explanations regarding his criminal charges to the Board. Petitioner included several letters of reference with his application to the Board. One of those letters was from his former employer in Iowa, Wayland Mennonite Home Association. In that letter, the facility’s director of nursing wrote: December 4, 2012 To Whom it may Concern: Hosea Pratt has been employed as a licensed practical nurse, at Parkview Home, Wayland, Iowa. He started employment September 11, 2012. Our pre-employment criminal background evaluation revealed a court proceeding regarding the suspension of his Iowa driver’s license. There was no disposition on this case and Iowa Department of Human Services ruled this did not preclude him from practicing nursing. He had a valid Iowa driver’s license at the time of hire. Hosea functioned independently as a night shift charge nurse. He assisted with orientation of new nursing staff. He completed assigned tasks during his scheduled shift. He proved to be a thoughtful young man, who demonstrated kindness towards our residents. He had good assessment skills and excellent computer technical abilities. He would be welcomed back to work in this facility. On April 9, 2013, the Board informed Petitioner that it intended to deny his Florida application. Petitioner thereafter challenged the intended denial of his application, and the instant proceeding ensued.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that the Board of Nursing issue a final order approving Petitioner's pending application for licensure as a practical nurse without conditions. However, should the Board determine that approval with conditions is warranted, a one-year probationary period is recommended. DONE AND ENTERED this 22nd day of October, 2013, in Tallahassee, Leon County, Florida. S W. DAVID WATKINS Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 22nd day of October, 2013.
