Findings Of Fact On July 20, 1978, Mary I. Gallagher, the seven to three supervisor at Tampa General Hospital "was called up to 3 South in regard to Mrs. Seaton's actions." (T.6) There she found respondent with a patient. Respondent was confused and smelt of alcohol; her speech was garbled. Mrs. Gallagher did not believe respondent capable of performing her normal duties and sent her home. On August 4, 1977, respondent reported to work at Tampa General Hospital for the eleven to seven shift. As oncoming nurse, she took responsibility for the narcotics from the three to eleven nurse who had custody of the drugs. In doing this, she accepted a count of 25 ampules of morphine sulphate, even though the three to eleven nurse only had 24 ampules of this controlled substance. On September 23, 1977, "Mrs. Johnson, one of the three to eleven supervisors, notified [Joyce Millis, Assistant Director of Nursing at Tampa General] in writing that she had been called to 4 South by one of the staff nurses, Mrs. Sellers, who [reportedly] noticed the odor of alcohol on Mrs. Seaton's breath." (T.14) See petitioner's exhibit No. 2. On October 2, 1977, respondent administered Tuinal to a patient, but signed out for Nembutal rather than for Tuinal. This made the narcotic count incorrect. On October 3, 1977, respondent administered 500 milligrams of Aminophyline intravenously to a patient. A 500 milligram dose of Aminophyline is supposed to be administered slowly; it should take an hour or more. Respondent said she spent only 45 minutes administering the drug on that occasion. On October 27, 1977, according to a contemporaneous report of the incident, respondent told another nurse, Miss Findley, that a patient was "going to code," i.e., had suffered cardiac arrest, and that her blood pressure was 68/30. Miss Findley looked in on the patient, who did not appear to her to be in acute distress, and telephoned Dr. Hampton. When Dr. Hampton arrived, he found the patient's blood pressure to be 188/80. Later, Dr. Hampton telephoned; respondent answered the telephone and said to Miss Findley, "Dr. Hildehand is on the phone . . ." There was a patient named Hildehand on the floor at the time. See petitioner's exhibit No. 3. Physicians order that drugs be administered or that diagnostic tests be done on patients at Tampa General Hospital by specifying the procedure prescribed in writing in a particular place on the patients' charts. A nurse has the duty of examining each patient's chart and transcribing the physician's orders, if any, to a central index. After examining a chart for this purpose, the nurse signs the doctor's orders sheet, even if no orders have been given. In dispensing medications and otherwise carrying out physicians' orders, the nursing staff works from the central index, ordinarily without consulting patients' charts. A Dr. Tyner ordered that an antibiotic, Keflin, be administered to a patient at Tampa General. Although respondent signed off on the patient's chart, she failed to transcribe this order to the central index; as a result, the drug was not administered to the patient on respondent's shift, contrary to Dr. Tyner's order. On another occasion, a doctor ordered K-Lor for a patient but respondent entered K-Lyte on the central index. In anticipation of an operation, a physician prescribed Dalmane for a patient at Tampa General, and ordered that it be given at ten in the morning. Respondent administered this drug at ten the night before, spurning the patient's suggestion that she check the doctor's orders. On another occasion, respondent ordered a liver scan for a 96 year old patient in Tampa General with gastrointestinal bleeding. Curious, another nurse checked the patient's chart and found that no liver scan had been ordered. Still another time, respondent transcribed a physician's orders from a patient's chart to the central index and signed the patient's chart; but failed to transcribe an order for hemoglobin and hematocrit tests every twelve hours. In January of 1978, Ronald C. Baker, R.N., patient care coordinator at Centro Espanol Memorial Hospital, smelt alcohol on respondent's breath while she was on duty as a nurse in the emergency room. On February 13, 1978, respondent's supervisor, a Mrs. Phillips, observed respondent moving carefully and stiltedly, having trouble with her equilibrium. Mrs. Phillips smelt alcohol on respondent's breath and sent her home from El Centro, because she felt respondent was unable to perform her duties.
Recommendation Upon consideration of the foregoing, it is RECOMMENDED: That petitioner suspend respondent's license for two years. DONE and ENTERED this 20th day of April, 1979, in Tallahassee, Florida. ROBERT T. BENTON, II Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Julius Finegold Esquire 1107 Blackstone Building Jacksonville, Florida 32202 Mrs. Nancy A. Seaton 70 Davis Boulevard Apartment 12 Tampa, Florida 33606 ================================================================= AGENCY FINAL ORDER ================================================================= BEFORE THE FLORIDA STATE BOARD OF NURSING IN THE MATTER OF: Nancy Ann Middendorf Seaton As a Registered Nurse 70 Davis Boulevard CASE NO. 78-2316 Apt. No. 12 LICENSE NUMBER 91995-2 Tampa, Florida 33614 /
The Issue The issue in this case is whether Respondent violated Section 464.018(1)(h), Florida Statutes (1997) (hereinafter, "Florida Statues"), and Florida Administrative Code Rules 59S- 8.005(1)(e)1 and 2, by diverting morphine during his care and treatment of two patients and failing to keep accurate nurse's notes. (All references to rules are to rules promulgated in the Florida Administrative Code in effect on the date of this Recommended Order).
Findings Of Fact Petitioner is the state agency responsible for regulating the practice of nursing. Respondent is licensed as a nurse pursuant to license number RN 2185632. Respondent admitted under oath at the hearing that he committed the acts alleged in the Administrative Complaint. Respondent did not overdose any patient, endanger, or neglect any patient. Respondent diverted morphine during his care and treatment of patients J.G. and R.B. at West Volusia Memorial Hospital on March 24 and 26, 1997. Respondent was addicted to morphine and diverted morphine from the two patients for self- administration. Respondent is guilty of negligent administration of morphine. Respondent self-administrated morphine that was not medically necessary. Respondent failed to keep accurate nurse's notes for patient J.G. Respondent inaccurately recorded the amount of morphine administered to patients J.G. and R.B. Respondent has voluntarily sought aggressive care and treatment for his drug addiction. Respondent is in three rehabilitation programs in Georgia. Respondent is in an intervention program for nurses ("IPN") approved by the State of Georgia pursuant to a prosecution conducted by the appropriate state agency in Georgia. He is also in a nurses anonymous program and a follow-up hospital program. Respondent is also under the regular care of a psychiatrist.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board enter a Final Order finding Respondent guilty of violating Section 464.018(1)(h) and Rules 59S-8.005(1)(e)1 and 2, suspending Respondent's license for two years from the date of this Recommended Order, and placing Respondent on probation for two years from the end of the suspension period. The terms of probation shall include a requirement that Respondent successfully complete the IPN program in Georgia and hospital follow-up program. DONE AND ENTERED this 18th day of June, 1998, in Tallahassee, Leon County, Florida. DANIEL MANRY 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 Filed with the Clerk of the Division of Administrative Hearings this 18th day of June, 1998. COPIES FURNISHED: Marilyn Bloss, Executive Director Department of Health Board of Nursing 4080 Woodcock Drive, Suite 202 Jacksonville, Florida 32207 Angela T. Hall, Agency Clerk Department of Health 1317 Winewood Boulevard Building 6, Room 136 Tallahassee, Florida 32399-0700 Joseph S. Garwood, Esquire Agency for Health Care Administration 1580 Waldo Palmer Lane Post Office Box 14229 Tallahassee, Florida 32308-4229 Joseph Webb, pro se 2169 Turner Church Road McDonough, Georgia 30252
