Conclusions THIS CAUSE comes before the State of Florida, Agency for Health Care Administration, (“the Agency”) regarding certificate of need ("CON") application number 10157 filed by Tallahassee Medical Center, Inc. d/b/a Capital Regional Medical Center (“CRMC”) and CON application number 10156 filed by Bay Hospital, Inc. d/b/a Gulf Coast Medical Center (*GCMC”). 1. CRMC filed a CON application which sought the establishment of a 12-bed comprehensive medical rehabilitation unit within its hospital located in Leon County, Florida, Service District 2. The Agency denied CRMC’s CON application 10157. 2. GCMC filed a CON application which sought the establishment of a 20-bed comprehensive medical rehabilitation unit within its hospital located in Bay County. Florida, Service District 2. The Agency denied GCMC’s CON application 10156. 3. Both parties filed a petition for formal hearing challenging the Agency’s denials of their respective CON applications. 4. Both parties have since voluntarily dismissed their petitions for formal hearing. 5. Based upon these voluntary dismissals, the Division of Administrative Hearings entered an Order Closing Files in the above styled matter. IT IS THEREFORE ORDERED: 6. The denial of CRMC’s CON application 10157 is UPHELD. 7. The denial of GCMC’s CON application 10156 is UPHELD. ORDERED in Tallahassee, Florida on thie 2 day of Crfebe_ . 2013. hob Py eclets Elizabeth Dudk, Secretary Agency for Health Care Administration
Other Judicial Opinions A party who is adversely affected by this final order is entitled to judicial review, which shall be instituted by filing the original notice of appeal with the agency clerk of AHCA, and a copy along with the filing fee prescribed by law with the district court of appeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review proceedings shall be conducted in accordance with the Florida appellate rules. The notice of appeal must be filed within 30 days of the rendition of the order to be reviewed. CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been furnished by U.S. Mail or electronic mail to the persons named below on this f 3S day of /Voye—he/ . 2013. Richard J. Shoop, Agency Cler Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 (850) 412-3630 Janice Mills Facilities Intake Unit Agency for Health Care Administration (Electronic Mail) James McLemore, Supervisor Certificate of Need Unit Agency for Health Care Administration (Electronic Mail) James H. Peterson, IE] Administrative Law Judge Division of Administrative Hearings | (Electronic Mail) Lorraine M. Novak, Esquire Assistant General Counsel Agency for Health Care Administration (Electronic Mail) Stephen A. Ecenia, Esquire R. David Prescott, Esquire Rutledge Ecenia, P.A. 119 South Monroe Street, Suite 202 Tallahassee, Florida 32302 Counsel for CRMC and GCMC (U.S. Mail) R. Terry Rigsby, Esquire Pennington, Moore, Wilkinson, Bell & Dunbar, P.A. 215 South Monroe Street, 2"! Floor Tallahassee, Florida 32301 Counsel for HealthSouth { (US. Mail)
The Issue Whether respondent terminated petitioner's employment on account of her age, sex or national origin, in violation of the Human Rights Act of 1977?
Findings Of Fact A registered nurse since 1949, petitioner Bessie J. Armstrong, who was born October 1, 1923, moved to Florida after she retired from the United States Air Force with the rank of captain. The record does not reveal her national origin. Ms. Armstrong had worked as an emergency room nurse, a coronary care nurse, and a nursing supervisor in three large hospitals before she began working for respondent, John Knox Village of Central Florida, Inc., which operates a retirement community with 492 independent living units, 18 assisted living units and a 120-bed (up from 60 beds before 1986) skilled nursing facility, called the "Med-Center." Ms. Armstrong worked the graveyard shift at the Med-Center from October 11 or 12, 1981, until her termination. Andrea Naumovitz, who, as director of nursing at the Med-Center until January of 1986, supervised petitioner Armstrong, gave her consistently good evaluations, Petitioner's Exhibit No. 1, and spoke highly of her abilities and performance. While employed at the Med-Center, Ms. Armstrong went in Thursday mornings as a volunteer to teach residents crafts, using materials she purchased with her own money. In fact, she was coloring Easter baskets during one such session when her husband suffered his fatal heart attack. In September of 1986, Judith Osborne, who succeeded Ms. Naumovitz as director of nursing on January 9, 1986, received complaints, from nursing aides Ms. Armstrong supervised, to the effect that she left distribution of suppositories to them, that she had herself passed medicine out before the hour which residents' doctors had specified, that, on two occasions, she had fallen asleep at work, and that she had once banished a noisy resident to the shower room. After summoning Ms. Armstrong and confronting her with these accusations, Ms. Osborne decided, rightly or wrongly, that at least some of the allegations against Ms. Armstrong were true. Nurse's notes for September 13, 1985, signed by petitioner, reported that a resident had been "[p]ut in shower room for the night." Respondent's Exhibit No. 1. On September 24 or 25, 1986, she terminated Ms. Armstrong's employment. Although in theory, the nursing home administrator or respondent's executive director might have reversed the decision to terminate petitioner's employment, in practice the decision was Ms. Osborne's to make. As far as the evidence shows, neither respondent nor Ms. Osborne has any policy to terminate or harass employees on account of their age, sex or national origin. Because of a critical shortage of nurses in the geographical area, sexagenarians not uncommonly work as floor nurses at the Med Center. The nursing staff is overwhelmingly, if not exclusively, female. Respondent's Exhibit Nos. 4 and 5. On July 29, 1987, eleven of respondent's approximately 240 employees were older than petitioner. Respondent's Exhibit No. 5. On the same date, 54 employees had worked long enough to be eligible for three weeks' annual vacation. Reversing the determination of the claims adjudicator dated October 24, 1986, Appeals Referee Mildred C. Anderson concluded in a decision dated November 26, 1986, that Ms. Armstrong had not been guilty of "misconduct connected with work" within the contemplation of the unemployment compensation law. Docket No. 86-25342U.
Findings Of Fact In March 1975, Respondent was employed as a registered nurse at the Sarasota Memorial Hospital, Sarasota, Florida. On March 26, 1975, he was performing duties as "charge" nurse on the 3 P.M. to 11 P.M. shift in the Orthopedic Clinic. At approximately 4 P.M., Muriel Johnson, R.N., Clinical Supervisor, while making her initial rounds for the shift, talked to two of the patients who indicated they felt no need for medication and had not received any. She then observed that the patients' medication and treatment sheets indicated that Respondent had given them Percodan, a narcotic drug, that afternoon. She then checked Respondent's nurses notes and the federal narcotic control sheet used to keep track of narcotics on the floor, and found no entries for the patients in question on either document. Both of these documents should have reflected the administration of medication to the patients at the time it was given. She proceeded to report the apparent discrepancy to her supervisor. (Testimony of Johnson) The Sarasota police was notified and two police officers arrived at the hospital about 11:15 P.M.. They were informed by a nurse that Respondent was suspected of checking out narcotics, but not issuing them to patients. Based on the foregoing information, they followed Respondent's automobile as he left the hospital that evening and stopped it about a quarter of a mile south of the hospital on US highway 41. Respondent's wife was driving the automobile at the time. Respondent was placed under arrest and, upon a search of his person, various drugs in hospital containers or packages were discovered, including seven Percodan tablets, six Synalgos DC capsules, and two Empirin with Codeine tablets. Percodan is a controlled Schedule 1 drug used to relieve pain and Synalgos DC is a Schedule 3 drug. Respondent was cooperative at the time of his arrest. He was charged with three counts of illegal possession of drugs and, on September 12, 1975, in the Sarasota County Circuit Court, Case No. 75-229-CF-A- 01, upon a plea of Nolo Contendere, adjudication of guilt was withheld and Respondent was placed on probation for two years, fined $1,000.00, and ordered to undergo psychiatric counselling. (Testimony of Hogle, Peterson, Perry, Petitioner's Exhibit 1,2, Composite Exhibit 3). On March 12, 1975, at the Sarasota Memorial Hospital, Respondent signed for 1 capsule of Chloral Hydrate, 300 mg. for a patient named Lena J. Herman. He indicated on the narcotic and barbituate administration record number 126951 that the medication was refused and destroyed. Hospital policy as set forth in written procedures provides that destruction of narcotics or barbituates must be witnessed and countersigned on the narcotics and barbituate administration record by another nurse. No such witnessing signature was shown on number 126951. (Testimony of Kuebler, Petitioner's Composite Exhibit 5). On March 13, 1975, at 8:00 P.M., at the Sarasota Memorial Hospital, Respondent signed out 1 tab of Demerol, 50 mg. for a patient named Herman on narcotic and barbituate administration record number 128232, and on the same date and the same hour for the same patient signed out for another tab of Demerol, 50 mg. on narcotic and barbituate administration record number 128097. The medication record and nursing notes for that patient on the date in question show that only one of the tablets was administered by Respondent to the patient subsequent to signing it out. (Testimony of Kuebler, Petitioner's Composite Exhibits 4 & 5). Respondent was an excellent nurse who had been employed at the Sarasota Memorial Hospital for over one year. He was dependable and took good care of his patients. (Testimony of Johnson, Kuebler, Bowden, Respondent's Composite Exhibit 1). Respondent has received comprehensive alcoholism counseling and treatment in state facilities and at the First Step of Sarasota, a counseling and treatment center. He recognizes his problem with alcohol and has managed to keep it under control while living at First Step with the assistance of the drug Antabuse. He has helped at First Step with other patients and the Executive Director there would like to hire him as a nurse when an opening occurs. He has been a cooperative and cheerful probationer in the opinion of his probation officer. (Testimony of Bowden, Ves'sells, Clark).
Recommendation That the license of Faris E. Moyer to practice as a registered professional nurse be revoked for unprofessional conduct, in violation of Section 464.21(1)(b), Florida Statutes. DONE and ENTERED this 12th day of August, 1976, 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 1330 American Heritage Building Jacksonville, Florida 32202 Robert J. Elkins, Esquire 2187 Siesta Drive Post Office Box 15425 Sarasota, Florida 33579
Findings Of Fact The Respondent is a registered nurse who began her employment at South Lake Memorial Hospital on August 29, 1977, and was terminated on April 23, 1980. During her employment, the Respondent received four poor evaluations and/or warnings for her nursing practice. The first warning occurred on August 1, 1979. This warning involved allegations of poor nursing performance by the Respondent. These allegations included the Respondent leaving her unit, failing to properly organize her work, failing to properly restrain a patient, wasting time by running too many EGG strips instead of performing her assigned functions, failing to take vital signs timely when coming onto shift, becoming hostile with the Director of Nursing, and failing to obey the direct order of the Director of Nursing to leave the hospital and go home after an argument on July 12, 1979. Although there was no direct evidence as to most of the allegations, the Respondent admitted to late charting, failing to timely take vital signs, spending time working with ECG strips, and failing to obey a direct order to-go home given by the Director of Nursing. The next evaluation occurred on November 26, 1979. The deficiencies in Respondent's practice as alleged by the Director of Nursing were that the Respondent gave a patient whole blood instead of packed cells as ordered by the physician, failed to verify an error in transcription by the ward clerk which resulted in a patient's x-rays being delayed for a day, and improperly charting when the Respondent noted on the nursing notes that at 9:00 p.m. there was no significant change in a patient's condition, when in fact the patient had left the hospital at 8:30 p.m. The lack of direct evidence of these allegations was compensated for by the Respondent's admissions as she testified concerning the circumstances surrounding why the incidents occurred. The third warning occurred on March 19, 1980. The allegations in the warning concerned the Respondent having shouted at a supervisor, abandoning her patients, allowing two I.V.s to run dry, failing to carry out a doctor's orders, and failing to chart. Again, there was no direct evidence of the allegations, however, the Respondent admitted that she left her duty station because of sickness prior to relief arriving in the unit, failed to properly follow doctor's orders, and failed to chart for the time she was present in the unit prior to her reporting to the emergency room. The fourth and final warning, which resulted in termination, occurred on April 23, 1980. The allegations by the Director of Nursing were that the Respondent hung one-fourth percent normal saline solution rather than the one- half percent normal saline solution ordered by the physician, and that the Respondent failed to administer the 5:00 p.m. medication. Again, the allegations were admitted by the Respondent as she attempted to explain why they occurred. The Director of Nursing testified that during each of these warnings, the Respondent's attitude was that she had done nothing wrong and, therefore, could not improve on her performance. The testimony of the Department's nurse investigator was to the effect that the Respondent's actions failed to meet the minimal standard of acceptable and prevailing nursing practice. The investigator also testified that, in her opinion, a nurse with Respondent's poor attitude could be extremely dangerous in a hospital setting. After many years of difficult and stressful work, many nurses suffer from what is commonly referred to as "burn out" and are no longer useful, and can be dangerous in a high stress area of nursing. Respondent testified in her own behalf and offered an explanation for each allegation presented by Petitioner. Respondent testified that relative to the first warning, even though she only had two patients, she did not have adequate time to do her charting during her shift and, therefore, had to stay two hours late. Respondent further testified that on one occasion she had not timely taken her vital signs because the Director of Nursing had delayed her with a needless confrontation. Respondent testified that she did not leave the facility as ordered on August 12, 1979, because she was afraid that she would be abandoning her patients, and could lose her vacation and sick leave benefits. With respect to the November 26, 1979 evaluation, the Respondent testified that she gave whole blood instead of packed cells because the whole blood was incorrectly labeled as packed cells. Respondent further testified that she became aware of the error after the solution had infused, and that had she looked at the solution earlier she would have been able to see that it was an incorrect blood product, and would have been able to correct the problem. As to the incorrect transcription resulting in a patient's x-rays being delayed, the Respondent stated that it was the ward clerk's responsibility, not hers, to transcribe the doctor's orders. With respect to the 9:00 p.m. nursing notes when the patient had left the facility at 8:30 p.m., the Respondent's response was that she had been aware that the patient was gone, but was summarizing the patient's condition during the entire shift up to the point the patient left. Respondent acknowledge that the nursing notes may have been misleading. As to thee warning of termination on March 19, 1980, the Respondent admitted leaving her unit prior to relief arriving. Her explanation gas that she had been attempting for one hour to get assistance, to no avail. Upon questioning, she admitted that she was-only "a little dizzy" and had diarrhea. On that day she did not chart any nursing care given by her while on duty. The Respondent was caring for twelve patients at that time. With respect to the April 23, 1980 termination, Respondent admitted that she hung the incorrect percentage saline solution, but that she did so because a prior nurse obtained the incorrect solution from a supply room. The Respondent then also admitted failing to give out the 5:00 p.m. medication as ordered, but stated the reason for her failure to administer the medication was her inability to obtain help from her supervisor which was necessary because she was overworked. Respondent also testified that during this time period, she went on rounds with a doctor, and also went to dinner. The Respondent testified that she felt she was a good and qualified nurse. Respondent also testified that she had been fired previously from Leesburg General Hospital. The Respondent believes her attitude to be good and indicated that the hospital was overreacting to a few isolated incidents.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED: That the Respondent's license to practice nursing in the State of Florida, license number 39108-2, be suspended indefinitely. If the Respondent seeks reinstatement, it will be her responsibility to undergo counseling with a psychologist or psychiatrist, for an in-depth evaluation and treatment, the results of which shall be submitted to the Board of Nursing if and when the Respondent wishes to apply for reinstatement of her nursing license. If the Respondent applies for reinstatement of her license, it shall be her responsibility to demonstrate to the Board that she is able to engage in the practice of nursing in a safe, professional, proficient and legal manner. This demonstration shall include but not be limited to a report by her psychologist or psychiatrist, along with a recommendation from him that she be reinstated to the practice of nursing. 1/ DONE and ORDERED this 8th day of January, 1982, in Tallahassee, Florida. SHARYN L. SMITH, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 8th day of January, 1982.
