The Issue The issue for determination in this case is whether Petitioner should be granted a temporary certificate to practice midwifery in an area of critical need.
Findings Of Fact On September 2, 1994, Petitioner, Mary C. Nous, filed an application with Respondent, Agency for Health Care Administration, for a temporary certificate to practice midwifery in Hillsborough County, Florida, an area of critical need. Petitioner holds a valid certificate (No. LMW-11) to practice midwifery in the State of South Carolina which was originally issued to Petitioner on December 21, 1992. At the time Petitioner received her certificate to practice midwifery in South Carolina, South Carolina did not require graduation from a formal midwifery program, nor did South Carolina require passage of an examination for certification as a midwife. Petitioner has not graduated from a formal midwifery program. On November 3, 1994, Respondent denied Petitioner's application for a certificate to practice midwifery in an area of critical need on the grounds: 1) that Petitioner had not graduated from a formal midwifery program; and, 2) that the statutory requirements of South Carolina at the time Petitioner received her certificate to practice midwifery were not substantially equivalent to, nor did they exceed the requirements for licensure as established by Florida law. Although Petitioner has not graduated from a formal midwifery program, Petitioner has obtained extensive practical experience and training working with health care professionals providing obstetric health care. Beginning in 1983, Petitioner was employed as an assistant to Quentin DeHaan, M.D., an experienced obstetrician, who at that time had an obstetrics practice in Hillsborough County, Florida. Petitioner's practical training with Dr. DeHaan included patient management during the prenatal period, nutritional aspects of pregnancy, and prenatal counseling. Petitioner also was trained in the labor and birth process, and management of the complications of pregnancy. Prior to her employment with Dr. DeHaan, Petitioner had attended a Licensed Practical Nursing program at Albany Medical Center in New York, and had worked with the Visiting Nurse Association. On June 13, 1984, Petitioner received her Diploma of Graduation from Leto Adult High School in Tampa, Florida. On September 13, 1984, Petitioner also received a Diploma of Graduation for a Medical Secretary from the Medical Education Center in Tampa, Florida. In 1984 Dr. DeHaan decided to move his obstetrics office and to open the Natural Childbirth Center (Center) in Tampa, Florida. The Center offered midwifery services. Shortly thereafter, Petitioner went to work at the Center. At the Center, Petitioner first worked with Barbara Hammond, a Licensed Midwife in the State of Florida. From 1984-1989, Petitioner also worked with Shawna Duran, a Licensed Midwife in the State of Florida at the Center. Petitioner continued her practical training while assisting the midwives at the Center. In 1990 Dr. DeHaan sold the Center to JoAnne Hodge, L.M., who now operates the New Beginnings Natural Childbirth Center. Petitioner has been employed with Ms. Hodge at New Beginnings since that time. During the course of her work experience, Petitioner has participated in more than nine hundred deliveries. Petitioner's skills relating to prenatal care, counseling, nutrition and the birthing process are highly regarded by Dr. DeHaan and the midwives she has worked with at the Center. Except for some theoretical aspects of the practice of midwifery, Petitioner's midwifery skills are comparable to the skills of a midwife who has graduated from a formal program. Petitioner's practical training and experience encompass the subject areas included in a formal midwifery program. In addition to her practical training, Petitioner has completed courses and seminars on childbirth offered by the International Childbirth Education Association. Petitioner also has served as an instructor on childbirth and nutrition during pregnancy at Hillsborough Community College, and is highly regarded in this capacity. Current Florida requirements for a formal midwifery program include a three-year curriculum; however, the Respondent agency has on one previous occasion, approved the application for a temporary certificate in an area of critical need of a midwife, licensed in a foreign jurisdiction, who had completed a two-year formal midwifery program which was deemed substantially equivalent by the Respondent.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that: Petitioner's application for a temporary certificate to practice midwifery in an area of critical need be DENIED. RECOMMENDED in Tallahassee, Leon County, Florida, this 30th day of August, 1995. RICHARD HIXSON Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 30th day of August, 1995. APPENDIX As to Petitioner's Proposed Findings in Recommended Order No. 1: 1-4. These paragraphs constitute proposed conclusions of law, not proposed findings of fact. As to Petitioner's Proposed Findings in Recommended Order No. 2: 1. Accepted and incorporated. 2-4. These paragraphs constitute proposed conclusions of law. As to Petitioner's Proposed Findings in Recommended Order No. 3: 1. Accepted and incorporated. 2-5. These paragraphs constitute proposed conclusions of law. As to Respondent's Proposed Findings: 1-5. Accepted and incorporated. COPIES FURNISHED: Joseph Bohren, Esquire 2507 Clark Road Tampa, Florida 33618 Laura Gaffney, Senior Attorney Agency for Health Care Administration 1940 North Monroe Street Tallahassee, Florida 32399-0792 Douglas M. Cook, Director Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Jerome Hoffman, General Cousel Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Sam Power, Agency Clerk AHCA Fort Knox Building 3, Suite 3431 2727 Mahan Drive Tallahassee, Florida 32308-5403
The Issue The issue is whether Respondent may rescind its approval of Petitioner's program to operate a practical-nurse education program.
Findings Of Fact For the past 13 years, Petitioner has operated an unaccredited education program for persons seeking licensure as practical nurses. During this period, Beverly Pryce has been the Program Director. Ms. Pryce is a registered nurse in Florida and has 27 years of clinical experience comprising 10 years as a licensed practical nurse and 17 years as a registered nurse. For the 2002-03 and 2003-04 school years, Petitioner has admitted 24 students annually from a pool of 35-40 applicants. Nineteen students graduated from the 2002-03 class, and 22 students graduated from the following year's class. In both years, Petitioner retained four faculty members--two full time and two part time. In both years, Petitioner had one faculty position vacant. In February 2003, Petitioner relocated its operations from a building in Hallandale to a building in Hollywood. Petitioner made this move without prior notification to, or consent from, Respondent. Ms. Pryce testified that, subsequent to the move, Petitioner communicated to Respondent, using Petitioner's new address, about several items, such as the names of upcoming graduates. These contacts do not represent a formal notification of a change of address, and Ms. Pryce conceded that she had not known of any requirement of notice prior to making such a move. Petitioner's formal notification of the change of address took place over one year after it had relocated its operations. The omission of prior notice denied Respondent the opportunity to inspect the proposed new facility, including classrooms, laboratories, computers, and library resources, to ensure that it met all applicable requirements for a school educating persons seeking licensure as licensed practice nurses. By letter dated May 10, 2004, Respondent advised Petitioner that the failure to notify Respondent of the change of address violated "64B-9." The notification issue arose when Respondent mailed a letter to Petitioner warning that its license would expire on June 30, 2004, and requesting a Program Evaluation Report by September 2, 2004. The postal service returned the letter as undeliverable because it was addressed to Petitioner's former address. After obtaining the new address, Respondent re-mailed the letter, on June 16, 2004, again requesting a Program Evaluation Report by September 2. Petitioner failed to provide Respondent with a Program Evaluation Report by the deadline set forth in the June 16 letter from Respondent. Thus, on September 21, 2004, Respondent sent another letter, advising Petitioner that Respondent would review Petitioner's approval status at its meeting on October 14, 2004. This letter notes that Respondent had not received any response to the request for a Program Evaluation Report, and Respondent would not accept additional documents for consideration at its October 14 meeting. Ms. Pryce claims that hurricane season and her unfamiliarity with computers delayed the timely delivery of the Program Evaluation Report, but these claims do not justify the length of time, past the deadline, before Ms. Pryce filed the report. Based on its consideration of the matter at the October meeting, Respondent issued, on November 2, 2004, an Order determining that Petitioner was not in compliance with Board rules due to the above-described relocation and failure to file a Program Evaluation Report. The Order notes that Petitioner's approval has expired and is not renewed until Petitioner timely files a Program Evaluation Report, undergoes a site visit by the Executive Director of the Board, and appears at the Board's December 2, 2004, meeting. Until then, the Order prohibits Respondent from admitting additional students, although it may continue to educate existing students, who will be eligible to take the licensure examination, upon graduation. The November 2 Order memorializes the decision of the Board--and agreed to by Ms. Pryce--to extend the deadline for filing the Program Evaluation Report to November 1, 2004. The Order requires the Program Evaluation Report to demonstrate compliance with Florida Administrative Code Rules 64B9-2.002(2) and (6) and Petitioner to demonstrate compliance with Florida Administrative Code Rule 64B9-2.015, during the site visit. On November 12, 2004--11 days after the extended deadline to which she had agreed--Ms. Pryce filed the Program Evaluation Report. Two days later, Respondent's Executive Director conducted a site visit. On his site visit, the Executive Director found that the passing rate of Petitioner's students, on the practice nursing licensure exam, for the 2002-03 school year was 63.2 percent, while the national and Florida averages were 86.5 percent, and the passing rate of Petitioner's students for the 2003-04 school year was 59.1 percent, while the national average was 88.7 percent and the Florida average was 83.6 percent. Since at least 1997, the passing rate of Petitioner's students has been at least 10 percent below the national average passing rate. The Executive Director also issued a report, dated November 17, 2004, setting forth various recommendations to the Board for consideration to improve the quality of Petitioner's program. At Ms. Pryce's request, the Board continued consideration of Petitioner's case from the December meeting to the February meeting. The December 7, 2004, letter continuing the matter also warns Petitioner to provide to Respondent any additional materials that Petitioner wants the Board to consider prior to January 3, 2005. At the February, 10, 2005, meeting, the Board asked Ms. Pryce if she had yet obtained a consultant's report with specific recommendations to improve the quality of Petitioner's nurse-education program. Ms. Pryce responded that she had a consultant in mind, but had not retained anyone yet. On February 16, 2005, Respondent issued a second Order. The Order outlines the above-stated facts and revokes Petitioner's approval, effective June 30, 2005, but allows currently enrolled students to complete the program by June 30, 2005. On March 6, 2005, a consultant issued a detailed report, recommending that Petitioner raise its admission standards and provide tutoring for students, form an advisory committee for curriculum, and increase faculty involvement and raise faculty standards.
Recommendation It is RECOMMENDED that the Board of Nursing enter a final order rescinding Petitioner's approval to operate a nurse-education program. DONE AND ENTERED this 21st day of November, 2005, in Tallahassee, Leon County, Florida. S ROBERT E. MEALE Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 21st day of November, 2005. COPIES FURNISHED: Dan Coble, Executive Director Board of Nursing Department of Health 4052 Bald Cypress Way, Bin C02 Tallahassee, Florida 32399-3252 R. S. Power, Agency Clerk Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701 Timothy M. Cerio, General Counsel Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701 Mark J. Berkowitz Mark J. Berkowitz, P. A. 524 South Andrews Avenue, Suite 200N Fort Lauderdale, Florida 33301 Lee Ann Gustafson Assistant Attorney General The Capitol, Plaza Level 01 Tallahassee, Florida 32399-1050
Findings Of Fact The Respondent, Jo Ann Murphy, is a licensed registered nurse in the State of Florida, holding license number 69367-2. The Respondent received her nursing education and training in Albany, Georgia, and became a registered nurse in Florida in 1973. In 1977 she became certified by the American College of Obstetrics and Gynecology as a nurse clinician. In 1981 she was certified as a clinical nurse practitioner in ambulatory gynecology and obstetric care. Until 1979, the Respondent was head nurse of OB/GYN Labor and Delivery, Postpartum Unit, at West Florida Hospital in Pensacola. From 1979 to 1983 she was office nurse and nurse practitioner in the office of Thomas H. Wyatt, M.D., in Pensacola. The Respondent became employed at University Hospital in Pensacola on April 25, 1983, primarily because of her knowledge in the field of Caesarian Sections. She was terminated less than one month later, on May 23, 1983, while still in her probationary period, for unsatisfactory nursing performance. On May 18, 1983, another registered nurse on the morning shift with the Respondent, testified that she smelled alcohol on the Respondent's breath at 7:30 A.M. Although this witness worked with the Respondent each day, this is the only time she contends that she smelled alcohol on her breath, and this witness did not see the Respondent stagger or exhibit any other symptom of alcohol use. This witness testified that the Respondent showed a lack of initiative, but that when the Respondent was told to do something she would do it well, and that she never had any concern regarding the Respondent's ability to function as a nurse. Two other hospital employees, a Licensed Practical Nurse (LPN) and a nurses aide, testified that they smelled alcohol on the Respondent's breath on a date unknown. The nurses aide, however, never saw the Respondent stagger, or exhibit any other sign of intoxication, and she says she only smelled alcohol on the Respondent's breath on one occasion. The LPN testified that she also saw the Respondent sitting at her desk in a daze or stupor, but this symptom was not observed or described by any other witness. Both of these witnesses worked with the Respondent each day, but only claimed to have smelled alcohol on her breath on one occasion. The Respondent denied having any alcohol to drink on or before any shift that she worked while employed at University Hospital. Her husband and her daughter confirmed that the Respondent had not consumed alcohol on the morning of May 18, 1983, before going to work. Another witness, a physician who was in the residency program at University Hospital while the Respondent worked there, had the opportunity to work in close contact with the Respondent on five or six occasions in the labor and delivery suite, and never smelled alcohol on her breath, or saw her stagger or exhibit any other sign of intoxication. This doctor found her to be alert, she performed her functions with no problems, and he had no complaints with her. The nursing director at University Hospital, who conducted the termination interview of the Respondent, observed what she characterized as red, blotchy skim on the Respondent, and the Respondent appeared to be nervous. However, this witness did not smell alcohol on the Respondent's breath, and she saw no other symptoms of alcohol use. Both the Respondent and the physician who employed her for four years confirmed the Respondent's skin blotches, but this is an inherited tendency having nothing to do with medical problems or alcohol use. The nursing director and the patient care coordinator both testified that the Respondent stated at her termination interview that she used to have an alcohol problem, but that she had been rehabilitated. The Respondent denies having made such a statement. Another physician, in addition to the one mentioned in paragraph 7 above, who was in labor and delivery with the Respondent more than ten times, and probably every day she worked at University Hospital, did not smell alcohol on her breath although they worked together closely. This witness found the Respondent's nursing abilities to be competent and very professional. Likewise, the physician who employed the Respondent for four years had no problems with her or her work, he found her prompt and attentive in her duties, and an excellent nurse. On another occasion, not specifically dated, but separate from the instances of the alleged alcohol breath, the Respondent is charged with having "defied an order to stay with a critically ill patient". The evidence is completely devoid of any explicit order given to the Respondent to stay with any patient during the time she worked at University Hospital. Instead, it is contended that the Respondent violated what are characterized as "standing orders" that a nurse should not leave a patient who has been assigned to her. These "standing orders" are supposed to have been set forth in policy manuals given to employees of the hospital, but no such manual was offered in evidence; nor was the nature of the "standing orders" explicitly described by the witnesses. On the one occasion when the Respondent is charged with defying orders to stay with a patient, the patient was being attended also by an LPN when the Respondent left to telephone the patient's physician. In the same general area, but behind the curtains of an adjoining cubicle, another registered nurse was attending a patient there. The patient whom the Respondent and the LPN attended went into deceleration after the Respondent had left to telephone her physician. The LPN needed help with the oxygen and to turn the patient. The other registered nurse in the adjoining cubicle came in and the patient was stabilized. The Respondent returned in a few minutes. It is below minimum standards of acceptable and prevailing nursing practice for a registered nurse to leave a patient, whose condition is considered critical, in the care of an LPN. Yet the patient was not in critical condition when the Respondent left to call the physician, and there was another registered nurse in close proximity who responded when the need for her arose. Thus, there is not sufficient competent evidence to support a finding of fact (1) that the Respondent either had alcohol on her breath or was in a drunken condition while on duty; (2) that the Respondent defied an order to stay with a critically ill patient; or (3) that the Respondent left a patient whose condition is considered critical in the care of an LPN. The competent evidence in the record supports a finding of fact (1) that the Respondent did not have alcohol on her breath at any time while employed at University Hospital; (2) that the Respondent did not defy an order to stay with a critically ill patient; and (3) that the Respondent did not leave a patient whose condition is considered critical in the care of an LPN.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Administrative Complaint against the Respondent, Jo Ann Murphy, be dismissed. THIS RECOMMENDED ORDER entered this 10th day of January, 1985, in Tallahassee, Florida. WILLIAM B. THOMAS 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 10th day of January, 1985. COPIES FURNISHED: Julia P. Forrester, Esquire 130 North Monroe Street Tallahassee, Florida 32301 Thomas C. Staples, Esquire P. O. Box 12786 Pensacola, Florida 32575 Ms. Helen P. Keefe Executive Director, Board of Nursing Department of Professional Regulation Room 504, 111 East Coastline Drive Jacksonville, Florida 32202 Mr. Fred Roche Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
Findings Of Fact In October 1978 Bonnie Ray Solomon Crawford, LPN was employed at the West Pasco Hospital, New Port Richey, Florida as a licensed practical nurse provided by Upjohn Company's rent-a-nurse program. On 7 October 1978 Respondent signed out at 10:00 a.m. and 2:00 p.m., and on 8 October 1973 at 8:00 a.m. and 1:00 p.m. for Demerol 75 mg for patient Kleinschmidt (Exhibit 2). Doctor's orders contained in Exhibit 4 shows that Demerol 50 mg was ordered by the doctor to be administered to patient Kleinschmidt as needed. Nurses Notes in Exhibit 4 for October 7, 1978 contains no entry of administration of Demerol at 10:00 a.m. and at 2:00 p.m. shows administration of 50 mg. and Phenergan 25 mg. Exhibit 3, Narcotic Record for Demerol 50 mg contains two entries at 8:15 a.m. on October 7, 1978 and one entry at 12:30 p.m. where Respondent signed out for Demerol 50 mg. for patients King, Zobrist and King in chronological order. Nurses Notes for King, Exhibit 6, and Zobrist, Exhibit 5, contain no entry that Demerol was administered to patient Zobrist at 8:15 a.m. or to patient King at 12:30 p.m. on 7 October 1978. In fact, the record for Zobrist shows that Zobrist was discharged from the hospital on October 5, 1978. Failure to chart the administration of narcotics constitutes a gross error in patient care and is not acceptable nursing practice. Similarly it is not acceptable nursing practice to withdraw narcotics not contained in doctors orders or administer medication not in doctors orders. When confronted by the Nursing Administrator at West Pasco Hospital with these discrepancies in the handling of Demerol, Respondent stated that she failed to check the identity of the patient before administering medication and that she didn't feel she should be giving medications any more. Following this confrontation with the hospital authorities, Respondent was fired for incompetency. No evidence was submitted regarding Respondent's 1975 disciplinary proceedings.
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
Findings Of Fact During early 1982, Petitioner submitted an application for licensure as an Advanced Registered Nurse Practitioner in the category of Midwifery. Petitioner's application was reviewed by the Respondent, Board of Nursing, on July 21, 1982. By letter of that date, Petitioner was advised that her application for certification as an Advanced Registered Nurse Practitioner did not meet the criteria for certification as set forth and defined in Section 464.012(1), Florida Statutes. Specifically, Petitioner was advised that: The midwifery training that she completed in 1962 in England was note post-basic. Enrollment as a midwife on the Central Midwife's Board has not been recognized as an "an appropriate" specialty board for certifi- cation as an Advanced Registered Nurse Practitioner, and The master's degree preparation that Petitioner acquired is not from a program leading to a master's degree in a nursing clinical specialty area. (Petitioner holds a master's degree in Education) Petitioner was further advised that she had one other means of being certified. I.e., that "registered nurses who have received their midwifery training outside the United States may be certified if they have completed an American college of nurse midwifery approved refresher program and the registered nurse is deemed eligible to take the ACNM examination. [Rule 210-11.23(2)(c), Florida Administrative Code] (Petitioner's Exhibits 2 and 3) Petitioner is a currently licensed registered nurse in the State of Florida, having been issued license number 30882-2, on January 1, 1964, by examination. Further, Petitioner was admitted to the Central Midwives' Board (London, England) after successfully completing a one year course of training undertaken by pupils who had previously qualified as state- registered general trained nurses. Petitioner took a three years' course of general nurse training at Bedford General Hospital from 1957 through 1960 and commenced midwifery training on August 1, 1961, as confirmed in the verification of her training and enrollment as a midwife. Debra Fitzgerald, a resident of Atlanta, Georgia, on May 26, 1983, was previously employed by the Respondent, Board of Nursing, from July, 1980 to February, 1983, as a nursing consultant in the educational section dealing primarily with the certification of applicants in the field of ARNP. As part of her duties as an employee of the Respondent, Ms. Fitzgerald reviewed the application of the Petitioner for certification as an ARNP. Upon review of the Petitioner's application, it is determined that the program that the Petitioner attended in midwifery during 1961-1962 in England was not a formal post-basic program equivalent to the standards required of formal post-basic programs in this country. Rule 21D-11.24, Florida Administrative Code. Petitioner was given credit for a total of one hundred four (104) didactic hours and the Board requires a minimum of one hundred twenty (120) didactic hours for proof of the equivalent of a post-basic course requirement in obstetrical nursing. (Testimony of Fitzgerald [by deposition]) Petitioner has not otherwise satisfied the criteria to be certified in keening with Rule 21D-11.23(2)(c)1 or 2, Florida Administrative Code.
The Issue The issue for disposition in this proceeding is whether Petitioner, Ms. Fearon, is entitled to licensure by endorsement as a registered nurse in Florida. This requires a determination of whether her education is substantially equivalent to or more stringent than required in Florida, pursuant to Section 464.009, Florida Statutes, and Rule 64B9-3.008, Florida Administrative Code.
Findings Of Fact Petitioner Sylem May Fearon (Ms. Fearon) was born in Jamaica, approximately 68 years ago. After being educated in Jamaica she emigrated to England to pursue an education for the practice of professional nursing. Ms. Fearon took courses in geriatric nursing in England for two years, then proceeded to do a three-year general training program (1960-1963). After the general registered nursing education, she took courses in midwifery for two years, passed an examination, and was qualified as a certified nurse midwife in September 1965. Approximately 32 years ago, Ms. Fearon responded to nursing recruiters from the United States; she emigrated to the United States and commenced working as a staff nurse in a hospital in Washington, D.C. Since emigrating to the United States, Ms. Fearon has become a citizen. She took the examinations for nursing licensure in New York and Massachusetts and was successful in obtaining licensure in both states, as well as in Washington, D.C. She maintains current licensure as a registered nurse in Washington, D.C. Approximately two years ago, Ms. Fearon moved to Florida and commenced application for licensure by endorsement as a registered nurse in this state. Florida's and other states' nursing boards do not have reciprocity with each other in the sense that if you are licensed in one state you may also practice in others. Florida and other jurisdictions have licensure by endorsement which allows an applicant for licensure to demonstrate that he or she has passed an examination in another state and has the educational background that is substantially the same or more stringent than required by the state in which the applicant is seeking licensure. This allows an applicant to become licensed without having to take another examination but does not waive other requirements for licensure such as education. After Ms. Fearon applied for licensure by endorsement in Florida, nursing board staff determined that she met all of the requirements except for some areas of her education. The Board of Nursing in Florida has developed guidelines to implement its broad rules on what specific education is required. When staff determines those guidelines are not met, the individual case is brought to the Board which then makes the ultimate decision. In Ms. Fearon's case, the Board accepted the deficiencies identified by its staff and entered the order which Ms. Fearon has challenged in this proceeding. The staff and Board considered a transcript of Ms. Fearon's registered nursing education from the University of Sheffield School of Nursing and Midwifery, hereinafter referred to as the official transcript. Ms. Fearon also provided copies of a "Statement and Recommendation by Director of Nursing" dated July 20, 1967, hereinafter referred to as Petitioner's transcript, and a copy of correspondence from the Chesterfield School of Nursing dated May 2, 1968, which stated Ms. Fearon attended lectures in elementary psychology (8 hours), psychiatry (5 hours) and head injuries (2 hours), hereinafter referred to as the 1968 supplement. The official transcript includes coursework that is not listed on Petitioner's transcript, and there are discrepancies between the official transcript, Petitioner's transcript, and the 1968 supplement; however, these discrepancies did not prejudice Ms. Fearon, according to Dr. Stiehl, executive director of the Board. According to the official transcript, Ms. Fearon's education at the Royal Hospital of Chesterfield in Derbyshire, England, consisted of the following coursework in hours: Theory Hours Anatomy and Physiology 42 Personal and Communal Health 21 First Aid 15 Nutrition 8 History of Nursing 2 Elementary Psychology 8 Bacteriology and Principles of Asepsis 15 Theory of Nursing 66 Demonstration and Practical Classes 103 Bandaging 13 Principle of Surgery and Surgical Nursing 15 Principle of Medicine and Medical Nursing 19 Operating Theatre Technique 3 Gynecology and Introduction to Obstetrics 10 Diseases of Ear, Nose and Throat 5 Genito-Urinary Diseases 4 Diseases of the Eye 3 Lecture by Anesthetist 1 Orthopaedics 4 Pharmacology 4 Communicable Disease 6 Venereal Disease 4 Pediatrics and Nursing of Sick Children 8 Psychiatry 5 Social Services 4 Disease of the Skin 4 Radiography 2 Revision and Coaching Classes 10 Practical/Clinical Hours Childrens 375 Female Surgery 487.5 Male Surgery 637.5 Ear, Nose and Throat 150 Opthalmic 300 Female Orthopaedic 75 Male Orthopaedic 300 Male Medical 412.5 Female Medical 187.5 Gynecology 300 Theatre 412.5 Casualty 300 Private Patient Unit 150 Relief Night Duty 225 Preliminary Training School 450 Study Blocks 225 A nursing license is issued by the Board of Nursing for a general practitioner, i.e. the licensee can work in any area of nursing. Therefore, to practice safely, the licensee needs a basic theoretical underpinning in all the basic areas of nursing: medical, surgical, obstetric, pediatric, and psychiatric nursing. Hours spent in patient care is not equivalent to didactic study. Study of theory provides the proper theoretical base to make good clinical decisions. The Board's guidelines establish these minimum standards that must be demonstrated before its staff may approve an applicant (education in hours): Subject Theory Clinical Medical Nursing 35 150 Surgical Nursing 35 150 Obstetric Nursing 20 70 Pediatric Nursing 20 70 Psychiatric Nursing 20 70 Community Health Nursing NO SPECIFIED MINIMUM Ms. Fearon's official transcript met the minimum requirements in Medical Nursing (theory and clinical), Surgical Nursing (theory and clinical), Pediatric Nursing (clinical only), and Community Health Nursing. The official transcript documents only 5 hours of theory in Obstetric Nursing and no clinical hours. The official Transcript demonstrates 300 hours of clinical experience in "Gynecology"; however, gynecology cannot be substituted for obstetrics training. Gynecology and obstetrics training are not interchangeable. In gynecology the training looks at the female patient in totality and at a different set of disease processes than in obstetrics; in obstetrics the training focuses not only on the mother but the growth of the fetus and the health of the child. However, Dr. Stiehl reviewed Petitioner's Exhibit no. 3 (the midwife certificate) and determined that this documents the necessary training in obstetrics. The official transcript documents only 8 hours of theory in Pediatric Nursing and no clinical hours. Ms. Fearon testified that her midwifery training covered pediatrics; however, it does not meet the requirements for theory and clinical training in pediatrics. Midwifery training covers the child from birth to age one; pediatrics covers children from birth to age 18. The official transcript documents only 5 hours of theory in Psychiatric Nursing. The 1968 supplement demonstrates 5 hours in Psychiatric Nursing and 8 hours in Elementary Psychology. Psychology cannot be substituted for psychiatric training. Basic psychology training looks at normal behavior; psychiatric nursing training deals with comparing normal with abnormal and with disease processes such as manic depression. The course in head injuries is not identified as training in psychiatry. Petitioner's transcript documents 12 weeks of clinical training in psychiatry, and the Board staff reviewer gave her full credit for the needed hours. (See worksheet Respondent's Composite Exhibit no 1.) Although Ms. Fearon asserted that she had psychiatric training in her midwifery program, it would not provide the necessary minimum education in psychiatric theory. Ms. Fearon's documentation demonstrates deficiencies in psychiatric theory, pediatrics theory, and clinical training. Even if the information on Petitioner's transcript regarding psychiatric clinical experience is accepted, Petitioner still has not demonstrated sufficient theoretical education. Ms. Fearon testified that she completed two years of geriatric nursing training. No documentation has been provided of what the content of the course was. Education for a lower level of licensure would not be considered as meeting the requirements for licensure as a registered nurse. Ms. Fearon also testified that she completed courses in order to sit for her U.S. licensing examination. However, the courses were not identified, and no documentation of the courses has been submitted. Ms. Fearon did not document the requirements for licensure in New York in 1973, when she was first licensed in the United States. Instead she has responded to the staff's inquires with an effort to provide documentation of her education, most of which occurred over 35 years ago in a program which no longer exists.
Recommendation Based on the foregoing, it is hereby RECOMMENDED: That the Board of Nursing enter its Final Order denying Petitioner's application for licensure by endorsement without prejudice to her right to pursue her application as described above. DONE AND ENTERED this 22nd day of December, 1999, in Tallahassee, Leon County, Florida. MARY CLARK Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 22nd day of December, 1999. COPIES FURNISHED: Lee Ann Gustafson, Esquire Office of the Attorney General The Capitol, Plaza Level 01 Tallahassee, Florida 32399-1050 Sylem May Fearon 7019 Hiawassee Oak Drive Orlando, Florida 32818 Ruth Stiehl, Executive Director Board of Nursing Department of Health 4080 Woodcock Drive, Suite 202 Jacksonville, Florida 32207 Pete Peterson, General Counsel Department of Health Bin A02 2020 Capital Circle, Southeast Tallahassee, Florida 32399-1701 Angela T. Hall, Agency Clerk Department of Health Bin A02 2020 Capital Circle, Southeast Tallahassee, Florida 32399-1701
The Issue Whether Petitioner should be issued a license as a Licensed Practical Nurse, pursuant to Chapter 464, Florida Statutes.
Findings Of Fact Petitioner Mary Ellen Stone Zirkle, Huntington, West Virginia, submitted an application for Licensed Practical Nurse by Endorsement to Respondent Florida State Board of Nursing, dated August 29, 1978. The application was denied by Respondent by letter of September 28, 1978, for the reason that Petitioner had not completed a program approved by the Board for the preparation of Licensed Practical Nurses and had not completed the 12th grade. Petitioner, through her counsel's letter of October 19, 1978, requested an administrative hearing. (Exhibit 1, Case File) Petitioner attended high school in West Virginia for three years from 1940 to 1943. In November, 1958, she received a certificate from the Huntington East High Trades School, Huntington, West Virginia, certifying that she had completed the requirement in practical nursing prescribed in the adult trade extension program sponsored by the Practical Nurses of West Virginia, Inc., District No. II, and the National Association for Practical Nurse Education. The course in practical nursing consisted of 285 hours of classroom work which involved class attendance for two nights a week for approximately one and one- half years. Although the school was not accredited by the West Virginia State Board of Examiners for Practical Nurses until 1961, West Virginia permitted individuals who had engaged in practical nursing for a period of three years to be issued a license as a practical nurse by waiver. It further authorized such individuals who had completed extension courses equal in theory to those for the graduate practical nurses to thereafter take the examination prescribed by the Board and obtain a license without the designation of "waiver" thereon. In this manner, Petitioner obtained her West Virginia license by waiver on November 6, 1958 and, in 1959, she passed the State Board examination. During the time Petitioner attended the extension course at Huntington East High Trades School, she was simultaneously employed at Cabell Huntington Hospital performing the duties of a practical nurse. During the period March - September, 1960, she attended a "post graduate educational program" at the hospital in operating room technique and was awarded a certificate of graduation. She thereafter was employed as a licensed practical nurse at Doctor's Memorial Hospital, Huntington, West Virginia, from 1962 until 1976. Her duties included working in all areas of surgery as well as general central service type functions in the general nursing units. In 1974, she satisfactorily completed a required course of studies in operating room technician refresher program which consisted of 80 hours of classroom work. She was also certified as an Operating Room Technician in 1974. (Exhibits 2-6, 7-8) Petitioner submitted letters from the various physicians familiar with her performance of duty at Doctor's Memorial Hospital who "found her to be reliable and efficient in the Operating Room and seemingly quite knowledgeable as a Staff Nurse in the general nursing departments." Her former supervisor at Doctor's Memorial Hospital also submitted a letter in which she commented favorably on Petitioner's efficiency and reliability. The letter stated in part as follows: When assigned to other areas, she worked with as much efficiency as she did in the Operating Room. It was very evident she had been trained well to function as a L.P.N. Her knowledge of nursing procedures and medications was quite adequate even with long periods of absence from general duty. (Exhibit 7) In determining qualifications for licensure by endorsement, Respondent considers that an applicant's graduation from an "approved school of practical nursing" in another state is acceptable as meeting Florida's requirements and does not inquire into the number of hours of instruction required for such graduation. Its inquiry into Petitioner's qualifications in this respect was caused by the fact that the West Virginia State Board of Examiners for Practical Nurses indicated on Respondent's application form that Petitioner's education had been an extension course. It is a policy of Respondent that the equivalent of a four year high school education is completion of the General Education Development Test (GED). Petitioner has not taken such a test. (Testimony of Johnson, Zirkle)
Recommendation That Petitioner's application for license to practice practical nursing without examination pursuant to Section 464.121 (2), F.S., be approved. DONE and ENTERED this 21st day of February, 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 1107 Blackstone Building 233 East Bay Street Jacksonville, Florida 32202 Peter S. Penrose, Esquire 3175 South Congress Avenue Suite 103 Lake Worth, Florida 33461 Geraldine Johnson, R.N. Licensing and Investigation Coordinator State Board of Nursing 6501 Arlington Expressway, Bldg B Jacksonville, Florida 32211
The Issue The issue in this proceeding was whether Respondent violated the Nurse Practice Act, Subsections 464.018(d) and (f), Florida Statutes, by making a false record and by abandoning the care of her patient and thereby departing from minimal standards of acceptable and prevailing nursing practice.
Findings Of Fact At all times relevant, Respondent was licensed as a practical nurse with license number 0797251. (Petitioner's Exhibit #1, T-22). Respondent, Sheri Ward, was employed by Bayshore Registry, a private-duty nursing service. (Petitioner's Exhibit #3). On August 3, 1985, Ms. Ward was assigned to Villa Maria Nursing Center, Bon Secours Hospital in Miami, to fill in for the regular LPN who was on leave. (T-26) Her only assigned patient was Estelle Crocoll. (T-10) The patient needed continual care because she remained either comatose or semi-conscious and had to be fed by a tube. She had to be watched to ensure that she didn't regurgitate the feeding. She also had bed sores and muscle contractures and had to be turned every couple of hours. (T-11, 26-28) When she checked in for her shift around 7:00 a.m., Ms. Ward learned that Cleo Bell, the nurse in charge of the unit, was the one who would sign her time sheet. She asked Ms. Bell if she could get off a little early, like around 2:00 p.m. Ms. Bell said okay and asked that she be notified when she (Ms. Ward) left. Ms. Ward's shift was supposed to end at 3:00 p.m. that day. (T-10, 42) Ms. Bell checked on the patient at 11:00 a.m. and around 12 noon but did not see Ms. Ward. (T-l1) Helen Bushey, R.N. is the head nurse on the wing where Ms. Ward was working on August 3, 1985. (T-23) She has thirty years of nursing experience and at the hearing was qualified as an expert to testify regarding nursing standards. (T-24, 26) Among her other duties, Ms. Bushey makes the rounds to check on the patients and to introduce herself to any new private duty nurse assigned to a patient. (T-29) On August 3, 1985, Ms. Bushey checked Estelle Crocoll's room at 8:30 a.m., between 11:00 and 11:30 a.m., and again around 12 noon, but at no time saw Sheri Ward. (T-29, 30) Ms. Ward failed to answer a page and members of the staff told Ms. Bushey they could not recall seeing her after 11:00 a.m. (T-31, 33) Ms. Bushey reviewed the notes on the patient's chart around 1:45 p.m., and found that notations for 3:00 p.m. had been written up already. (Petitioner's Exhibit #3, T-31) She notified Ms. Ward's employer and Ms. Ward was barred from practicing at Villa Marie. (Petitioner's Exhibit #3, T-32) Ms. Ward claimed that she left the patient's room only to help another nurse ("Virginia") move a patient and to get the nurse to come help her move Estelle Crocoll. (T-44) She claimed that the chair in which she sat was obscured from view by a person entering the room. (T-44) She admitted that she left the job no later than 1:25 p.m., and since she could not find Ms. Bell she told "Virginia" to tell Ms. Bell she was leaving. (T-51, 52) Sheri Ward also admitted that she pre-entered notes for 3:00 p.m., having learned that "little bad habit" (her characterization) from working and training in a county hospital where ". . . you are really pressed for time." (T-46, 53) The reason she left early was to go to a wedding. (T-13, 48) It is unnecessary to determine Ms. Ward's whereabouts during the day or the exact time she left her duty; clearly, by her own admissions, Sheri Ward falsified her patient's record and abandoned the care of that patient without proper notification. Ordinary common sense would conclude that, given the uncontroverted circumstances, these actions constitute extremely bad judgement. Competent expert opinion concluded that these actions constitute a departure from minimal standards of acceptable nursing practice. (T-36)
