Findings Of Fact Respondent is now and at all relevant times has been a licensed registered nurse in Florida under license number 1074052. She is currently on active status. Her latest license renewal expires on March 31, 1989. Respondent was hired in April, 1986, as a charge nurse at John Knox Village Medical Center in Tampa. John Knox Village Medical Center is a long- term care facility divided into two wings. The wing to which Respondent was assigned houses between 24 and 32 patients requiring skilled nursing care. For the first three weeks on the job, Respondent performed her duties quite well. She learned the names of all of the long-term patients. She was a good manager and motivator of her employees. She was not absent from work. After about three weeks on the job, Respondent began to exhibit minor lapses of memory. Her hands began shaking. Her face became puffy and pale. She often became withdrawn and subject to mood swings. Occasionally, she could not be located for short periods of time by her nurse's aides, who required her supervision. A coworker smelled what was clearly alcohol on Respondent's breath one evening while Respondent was on duty. Shortly thereafter, on or about May 21, 1987, Respondent admitted to the Director of Nursing, Cary Boylan, that Respondent was an alcoholic. Respondent agreed, at Ms. Boylan's urging, to enter an alcohol treatment program sponsored by Alcohol Community Treatment Services, Inc. ("ACTS"). Respondent had been working at John Knox Village Medical Center for about six weeks at the time of her departure to enter the ACTS Program. Respondent underwent extensive residential treatment in the ACTS program from June 9, 1986 through July 7, 1986. She received counseling seven days a week. On July 14, 1986, Respondent successfully completed the intensive phase of the ACTS program and returned to work. She was rehired on that date, but was no longer the charge nurse. For the first few weeks after her return, Respondent was compliant, exhibited no signs of alcohol consumption, and generally performed her duties quite well. Respondent subsequently began a pattern of absenteeism starting at the end of August, 1986. At first, Respondent would notify her supervisors in advance of her absence. By September, it was "no call, no show." At one point, she missed six working days during a two-week period. About ten absences were unexplained. Others were accompanied by a doctor's excuse. By this time, the hand tremors had returned. Respondent's failure to show up for work or even alert her supervisor in advance of her absence left the floor short-handed. Other nurses were suddenly required to work overtime or report to work early. Sometimes a temporary nurse had to be called in. Respondent evaded Ms. Boylan's attempts to discuss Respondent's behavior. Generally, she avoided Ms. Boylan's telephone calls. When Ms. Boylan terminated Respondent from employment, Respondent's face had the pale and puffy look that it had prior to her entering the ACTS program. There were no charting or care problems with Respondent while she was employed at John Knox Village Medical Center. Ms. Barbara Burhop, a nurse responsible for the orientation of new employees at John Knox Village Medical Center, testified affirmatively to this fact. Also, Respondent was preoccupied at the time with the hospitalization of her father who was suffering from an illness that later claimed his life on November 14, 1986. However, Ms. Boylan and Rosemary Myers, a licensed practical nurse who worked with Respondent at John Knox Village Medical Center, both opined that Respondent could not practice nursing safely while at John Knox Village Medical Center, before and after the ACTS treatment, due to alcohol use. After leaving John Knox Village Medical Center, Respondent worked for six or seven months for a temporary nurse pool. On November 2, 1987, Respondent was hired to work as a staff curse at Centro Espanol Memorial Hospital in Tampa. She was assigned to the med-surg unit, but was first required to undertake two weeks of orientation and employee training. Respondent never completed the orientation training program. On the first day, she fell asleep while another nurse was training Respondent in a one- on-one session. Other times, Respondent appeared to be nodding off while on duty; often, she appeared to be trying hard to stay awake. Other nurses detected the odor of alcohol on Respondent's breath. Respondent frequently left her nurse's station for short periods of time for no apparent reason and during which she could not be found. There was no competent evidence of any charting or care problems during Respondent's short term of employment at Centro Espanol Memorial Hospital. In one instance, Respondent failed to release an in-going catheter, but Respondent's unrebutted testimony was that she told the nurse who followed her on the next shift about the unreleased catheter. Her chart entries were difficult to read, but "made sense" and were not illegible in the strict sense of the word. However, Ms. Gloria Carper, who is Assistant Director of Nursing at Centro Espanol Memorial Hospital, opined that Respondent was impaired due to alcoholism. Respondent admits that she is an alcoholic and has been for 2 1/2 to 3 years. She admits that she does not abstain from alcohol consumption. She testified that she did not drink while on duty. On days that she felt that she could not adequately care for a patient, Respondent stated that she would not report to work. She has attended various alcoholic treatment groups, including Alcoholics Anonymous, but has not successfully completed her recent treatment programs. On February 19, 1987, the Impaired Nurses Program ("INP") found Respondent noncompliant in her treatment program. On March 17, 1987, her noncompliance necessitated an extension of her INP two-year monitoring to February 4, 1989. Respondent was again found noncompliant by INP by letter dated May 11, 1987. Respondent was dismissed for noncompliance from Petitioner's Intervention Project by letter dated May 22, 1987. By letter dated June 25, 1987, Respondent was also unfavorably terminated from the post- residential, out-patient counseling phase of the ACTS program. Her ACTS counselor noted Respondent's sporadic attendance, closed attitude, and insistence upon her alcohol and drug-free status, which insistence was belied upon her uncooperative behavior. Although there is no direct, clear and convincing evidence of alcohol intoxication or even consumption while on duty, the evidence is clear and convincing that Respondent consumed alcohol during the terms of her employment at John Knox Village Medical Center and Centro Espanol Memorial Hospital. The most reasonable inference is that she consumed alcohol excessively the night before work. As a result, Respondent was either so tired and sick the next morning that she was unable to work or, if not quite so tired and sick, she would report to work and doze off.
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 The Florida State Board of Nursing filed an Administrative Complaint against Respondent, William Scott Brewer, who holds licensed practical nurse license number 33305-1, seeking to place on probation, suspend or revoke Respondent's license for the following reasons: On or about January 11, 1978, Respondent uttered forged prescriptions at Maitland Rexall 145 South Orlando Avenue, Maitland, Florida, for controlled substances, to-wit: Quaalude (Methaqualone) and Demerol (Meperedime), and received said controlled substances from the pharmacist. On or about January 16, 1978, Respondent uttered a forged prescription at Walgreen Drug Store, Castleberry, Florida, for a controlled substance, to-wit: Percodan (Oxycodone Hydrochloride). On or about January 25, 1978, Respondent uttered a forged prescription at the Liggett Rexall Drug Store located at 4434 Curry Ford Road, Orlando, Florida, and received a controlled substance from the pharmacist to- wit: Quaalude. On the same date and place as alleged in paragraph C, Respondent uttered a forged prescription for a controlled substance, to-wit: Demerol. Respondent requested this administrative hearing, contending that the Administrative Complaint contained disputed issues of material fact. Based upon the evidence presented and the admissions made by Respondent, it is found that on or about January 11, 1978, the Respondent presented to James A. Robinson, a pharmacist, two prescriptions, one for Demerol and one for Quaalude purportedly signed by Lawrence a Bilotta, M.D. Dr. Bilotta denied signing the prescriptions and the Respondent admitted signing Dr. Bilotta's name thereto. Respondent admitted securing the drugs for himself and his friends. Based upon the evidence presented and the admissions made by Respondent, it is found that on or about January 25, 1978, Respondent presented to Fred Martini, a pharmacist, two prescriptions, one for Quaalude and one for Demerol. Said prescriptions were purportedly signed by Lawrence A. Bilotta M.D. Dr. Bilotta denied signing the prescriptions and the Respondent admitted signing Dr. Bilotta's name thereto. The pharmacist filled the prescription for the controlled drug Quaalude, but did not fill the prescription for controlled drug Demerol. The Respondent admitted securing the Quaalude for use for himself and his friends. After the Respondent left the store with the Quaalude the pharmacist notified the authorities. An information was filed against Respondent in the Circuit Court for Orange County, Florida, charging him with violation of Section 893.13(3)(a)(1) , F.S., charging him with the obtaining of a controlled substance by misrepresentation, fraud, forgery, deception or subterfuge. Respondent pleaded guilty to the crime and the court withheld adjudication of guilt and ordered a pre-sentence investigation by the Florida Parole and Probation Commission and a report to the Circuit Judge. Said report, if any, was not filed in evidence. The allegations contained in allegation B, regarding a forged prescription for a controlled substance, Percodan, was not proved. Respondent, William Scott Brewer, testified, that he has not used drugs since January of 1978, and does not intend to again use drugs. This testimony was not refuted by the Petitioner.
Recommendation Suspend the license of Respondent for a period of not more than three (3) years. DONE AND ENTERED this 10th day of August, 1978, in Tallahassee, Florida. DELPHENE C. STRICKLAND Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1005 Blackstone Building Jacksonville, Florida 32201 William Scott Brewer Post Office Box 176 Nacotee, Florida 33864 ================================================================= AGENCY FINAL ORDER ================================================================= BEFORE STATE OF FLORIDA BOARD OF NURSING IN THE MATTER OF: William Scott Brewer Box 176Street Nacotee, Florida 33864 CASE NO. 78-778 As a Licensed Practical Nurse License Number 33305-1 /
Recommendation Based upon the forgoing facts presented in mitigation, the Hearing Officer would recommend that the State Board of Nursing revoke the license of Paul Bryce as a Licensed Practical Nurse with consideration of his reapplication upon the expiration of his probation in the absence of any adverse information obtained from Bryce's counselor. DONE and ORDERED this 30th day of October, 1978, in Tallahassee, Florida. STEPHEN F. DEAN, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Paul J. Bryce 1010 North 25th Avenue Hollywood, Florida 33020 Julius Finegold, Esquire 1005 Blackstone Building Jacksonville, Florida 32201 Geraldine Johnson, R.N. State Board of Nursing 6501 Arlington Expressway - Bldg. B Jacksonville, Florida 32211
The Issue The amended Administrative complaint, forwarded to the Division of Administrative Hearings on January 20, 1987, alleges that Respondent is unable to practice medicine with reasonable skill and safety to patients by reason of alcohol and substance abuse; that Respondent attempted to treat patients while under the influence of alcohol, constituting gross or repeated malpractice or failure to practice medicine with the level of care recognized by a reasonably prudent similar physician as acceptable under similar conditions and circumstances; and that Respondent failed to fulfill a statutory or legal obligation placed upon a licensed physician. After lengthy discovery and negotiations and Respondent's submittal to an inpatient mental and physical examination, the parties filed a stipulation substantially limiting the issue to the conditions under which Respondent should be allowed to return to the practice of medicine and appropriate monitoring once he returns to practice. At the final hearing, DPR presented the testimony of two witnesses: Lynn Hankes, M. D., qualified as expert in addictionology without objection, treated Dr. Pigg for alcoholism in 1985 and examined him as an inpatient in January, 1988. Robert A. Goetz, M. D., qualified without objection as an expert in the field of impaired physicians, has been the director of Florida's Physicians' Recovery Network since February 1988, and has known Dr. Pigg since shortly after that time. Respondent's sole witness was Milton R. Burglass, M.D., qualified without objection as an expert in psychiatry and in addiction treatment. Dr. Burglass reviewed Dr. Pigg's records and files and interviewed him on April 7, 1988, in anticipation of this hearing. After the hearing the transcript was filed and both parties submitted proposed recommended orders. Specific rulings on the proposed findings of fact are found in the attached appendix.
Findings Of Fact William Larry Pigg is, and has been at all time material, a licensed physician in the State of Florida, having been issued license number ME 0040625. The parties in their prehearing stipulation filed on February 15, 1988, agree to the following: Peitioner, the Department of Professional Regulation, is the state agency charged with regulating the practice of medicine pursuant to Section 20.30, Florida Statutes; Chapter 455, Florida Statutes; and Chapter 458, Florida Statutes. Since at least the summer of 1984, Respondent has had a problem with alcohol abuse. On or about June 13, 1985, Respondent entered the Impaired Physician's Program. Respondent completed an alcohol treatment program in Miami, Florida. Thereafter, Respondent also completed an extended program in Mississippi. On or about December 17, 1985, Respondent was granted staff privileges at Holmes Regional Medical Center in Melbourne, Florida. In order to obtain staff privileges, Respondent signed a statement agreeing to do the following: to abide by the Aftercare Con- tract of the Mississippi State Medical Association Impaired Physician's Program; and to submit to blood alcohol levels [sic] at any time at the request of any physician on the staff of Holmes Regional Medical Center. In or about April 1986, Respondent began to abuse alcohol again. On or about April 12, 1986, Respondent was attempting to perform a right hip reduction on a patient at Holmes Regional Medical Center. The patient in question was legally intoxicated and a large muscular man. Respondent, in attempting to relax the patient, ordered a large dose of narcotics, including Demerol and Nubain, as well as Phenergan and Valium. On or about the evening of April 12, 1986 or the morning of April 13, 1986, Respondent left the emergency room, took a Phenergan tablet and went home. Phenergan is the brand name for prometnazine Hydrochloride. Phenergan can cause drowsiness or impair the mental and/or physical abilities of the individual taking the drug. Later on the same evening, the Emergency Department Physician, Dr. Wagner, spoke with Dr. Pigg by telephone in reference to two patients with fractures that required orthopedic intervention. Respondent agreed to come and resume care for the patients. However, Respondent never came to the medical center and could not be located by police. On or about April 16, 1986, Respondent's wife contacted the Melbourne Police Department because her husband had come home intoxicated. On or about June 7, 1986, Respondent was arrested for driving while under the influence of alcohol and reckless driving. On or about June 30, 1986, the Director of the Florida Medical Foundation Committee on Impaired Physicians, Roger A. Goetz, M.D., advised the Petitioner, by letter, that Respondent was not progressing satisfactorily with the program and had not complied with all aspects of his aftercare contract. Respondent is and has been at all times alleged in the above stipulated facts, unable to practice medicine with reasonable skill and safety to patients by reason of alcohol abuse. No evidence was presented as to substance abuse, other than alcohol. Nor was there evidence that Dr. Pigg suffers from a mental condition. Although his records reflect some prior diagnosis of a passive/aggressive personality disorder, the prevailing thought in the addictionology community is that psychiatric diagnoses are invalid until an individual has been sober long enough to assure that the problem is not solely the alcohol's effect on the individual. There is no evidence that Dr. Pigg has had this requisite period of sobriety since 1984, and particularly the time that he was examined by Dr. Burglass, the only psychiatrist to testify in this proceeding. Of the experts who testified, Dr. Hankes is most familiar with Dr. Pigg, having been his primary treating physician in the past, and having examined him recently over several days as an inpatient. Dr. Hankes found that Dr. Pigg progressed from the mid stage of alcoholism to the early late stage of this disease between 1985 and 1988. In addition to Dr. Hankes' program at South Miami Hospital, Dr. Pigg has undergone primary treatment at a series of facilities in Georgia, Mississippi and Florida, all of which have an excellent reputation. At this point, in Dr. Hankes' opinion, he is a treatment failure. He has, at various times in his treatment experience also undergone detoxification at a Myers Act facility, attempted Antabuse therapy, and tried and rejected Alcoholics Anonymous. In spite of the past failures, the experts concurred that Dr. Pigg, like other alcoholics, is capable of recovery and that once recovered, Dr. Pigg would be capable of practicing medicine safely. All concurred that the recovery must be verified prior to Dr. Pigg's return to practice, and that thereafter the recovery must be monitored for an unforeseeable period of time. Dr. Hankes' advice, based on his concern as Dr. Pigg's treatment provider and primary therapist, is a six-part program: that addiction therapy continue on an outpatient basis, at least weekly, by a certified alcohol or addiction professional; that Dr. Pigg engage in psychotherapy with a qualified psychiatrist knowledgeable about addictive disease, the frequency to be determined by the psychiatrist; that a primary internist or family general practitioner monitor his physical well-being, especially his liver dysfunction; that Dr. Pigg participate in Alcoholics Anonymous, with a lay individual sponsor, as well as engage in International Doctors in Alcoholics Anonymous with a recovering physician sponsor; that Dr. Pigg be assigned a monitoring physician, knowledgeable in addictive disease, who has the authority to require random, unannounced surprise testing of blood or urine and that personal contact be made every two weeks and telephone contact in the alternate weeks; that the treating and monitoring individuals report on a quarterly basis to Dr. Roger Goetz, the Recovery Network director and that at the end of a two-year period Dr. Pigg be examined again by Dr. Hankes who would make his recommendation to Dr. Goetz. Dr. Pigg would also have the right to go to another AMA approved treatment provider for a second opinion. Dr. Hankes distinguishes between the state of being "dry" or free from alcohol use for a period, and recovery from alcoholism which requires a personal transformation with some undefined indicators. Dr. Hankes is convinced that the latter state is essential for real recovery and that Alcoholics Anonymous is the most effective, though not exclusive, route to that state. Although Dr. Hankes recommends a two year period during which Dr. Pigg would not be permitted to practice, he concedes that recovery could be effective in less time and that he would readily endorse his return to practice if the recovery were completed sooner. He describes Dr. Pigg as a "very competent physician", a "very bright guy", a "multi-talented individual, who flies airplanes and does wonderful things in his life." None can predict the time required for recovery, but each of the three experts recommends a period of one to two years of verified sobriety prior to the return to practice. Dr. Burglass recommends neither Alcoholics Anonymous participation nor the multi-part program outlined by Dr. Hankes. Since Alcoholics Anonymous and the other treatment/recovery models have been unsuccessful, Dr. Burglass suggests that Dr. Pigg be allowed to devise his own method of achieving recovery; he emphasizes that the goal, and not the route to that goal, is the concern here. He recommends that sobriety be verified for a period of one year and thereafter Dr. Pigg be allowed to return to practice with monitoring for approximately three years. The evidence, weighed and considered as a whole, fails to establish that an absolute two-year suspension from medical practice is necessary or that involvement in Alcoholics Anonymous is essential.
Recommendation Based on the foregoing, it is, hereby RECOMMENDED: That William Larry Pigg, M.D. be suspended from the practice of medicine for an indefinite period, provided that he be given an opportunity to appear before the Board at twelve month intervals to demonstrate that he can resume the competent practice of medicine with reasonable skill and safety to patients. That demonstration should include, as a minimum: a ) That he has totally abstained from the use of alcohol for a period of twelve months, as evidenced by frequent unannounced random collection of blood samples by an agent designated by the Board. That he has been under the continuous care and supervision of a physician qualified to provide addiction therapy and that, if recommended by that individual after a necessary period of sobriety, he has also undergone a psychiatric evaluation to determine the existence of mental disease or disorder. If detected, the disease or disorder must be treated. That he has been evaluated successfully participated in Alcoholics Anonymous or other similar peer support group program. Successful participation means frequent regular attendance at meetings and the association with a qualified sponsor from the program. That he has been evaluated and recommended for return to practice by Dr. Hankes or other treatment professional designated by the Board. However, if the recommendation is negative, Dr. Pigg should be permitted to obtain a second opinion independent of the Board's designated evaluator, from an individual other than that described in b), above, who is also qualified in the field of addictionology. The length and type of monitoring necessary once Dr. Pigg returns to practice should be determined at that time, based on recommendations of the professionals responsible for assisting in his recovery. DONE and RECOMMENDED this 4th day of August, 1988, in Tallahassee, Florida. MARY CLARK 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 4th day of August, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 87-0225 The following constitute specific rulings on the findings of fact proposed by the parties. Petitioner's Proposed Findings Adopted in paragraph 2. Adopted in paragraph 1. 3-13. Adopted in paragraph 2, incorporating the parties pre-hearing stipulation. 14. Adopted in paragraph 7. Respondent's Proposed Findings 1-4. Incorporated in Issues and Background statement. 5. Adopted in paragraph 2, incorporating the parties' prehearing stipulation. 6-8. Included in Background Statement. 9-12. Rejected as unnecessary restatement of the witnesses' testimony. Adopted in substance in paragraph 3. Included in Background Statement. 15-16. Adopted in substance in paragraph 4. Adopted in paragraph 6. Adopted in paragraph 9. 19-20. Adopted in paragraph 7. Adopted in paragraph 8. Adopted in paragraph 9. 23-24. Incorporated in substance in the Background statement. 25-28. Adopted in substance in paragraph 11, otherwise rejected as cumulative and unnecessary. 29. Adopted by implication in paragraph 12. 30-31. Rejected as cumulative and unnecessary. Adopted in paragraph 12. Rejected as a conclusion of law. Rejected as contrary to the evidence. Abstinence alone is insufficient. Adopted in substance in paragraphs 3, 11, and 12. Rejected as unnecessary. COPIES FURNISHED: John Namey, Esquire 22 East Pine Street Orlando, Florida 32801 Deborah J. Miller, Esquire One Biscayne Tower, Suite 2400 Two South Biscayne Boulevard Miami, Florida 33131 Dorothy Faircloth Executive Director Board of Medicine Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 William O'Neil, Esquire General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
Findings Of Fact Jane Ruth Burch Harrison, the Licensee, is a registered nurse in this state and holds license no. 18473-2. On or about October 15, 1976, Elsie McGuigan, an L.P.N. employed by Division Hospital in Lake City, Florida observed the Licensee on duty and appearing to be intoxicated to the extent that she was unable to carry out her duties as a registered nurse. Specifically, Ms. McGuigan observed the Respondent attempting to chart while she was in a daze. She attempted to get some assistance from the Licensee due to the heavy patient load on the three to eleven shift but the Licensee was unable to assist her due to her condition. Ms. McGuigan thereafter summoned Mary E. DePew, the Director of Nursing for the Division Hospital, and advised her of the Licensee's inability to function and the concern she had of the patient's well being. In so doing, she observed one patient who was receiving cardiac treatment and felt that the services of a doctor were necessary to check the patient's condition. Mrs. Ann Gurtler, an R.N. for approximately 34 years and an employee at Division Hospital, was also summoned on October 15, 1976 to assist with the patient load due to the Licensee's inability to function. She testified that one patient, Elsie Hilliard was suffering from asthma and breathing difficulties and required oxygen treatment to stabilize her condition. Trixie Mitchell, a nurses aide, while on duty on October 15, 1976 spoke to Respondent who was seen crying. She attempted to calm the Licensee down and told her that her problems should not be regarded as insurmountable. Mrs. DePew summoned a taxi to the hospital to take the Licensee home inasmuch as she was under the influence of alcohol. Shortly thereafter, the Respondent admitted herself for treatment at an alcoholic rehabilitation center at the Lake City Alcoholic Center and was confined for a period of one week. Upon her release, she was put on antabuse by Dr. John Philpot and returned to work at the Division Hospital. On May 10, 1977, while on duty, Respondent became intoxicated to the extent that she was unable to function as a nurse and was terminated from her employment by Ms. Depew. The Respondent admitted that she reported to work while under the influence of alcohol and/or drugs. She testified that she did so based on the numerous matrimonial problems that she was having. She testified that her divorce had recently become final and that she had suffered a traumatic episode shortly after her divorce became final. She testified that her son recently became addicted to drugs and while driving in her car had an accident and critically injured a passenger. Licensee acknowledge the seriousness of the problems and the conduct in which she engaged in by reporting to work on October 15 and on May 10, 1977 in an intoxicated state. She testified that these were isolated incidents which should not overshadow her total performance which had been adequate and resulted in no injury to patients. She is presently undergoing alcoholic treatment at the local alcoholic rehabilitation center and feels that she has put her alcoholic and drug problems behind her. Based on the foregoing facts, the undersigned concludes that the Licensee has engaged in conduct violative of Chapter 464.21, Florida Statutes, as alleged. In view of the creditable testimony that the Licensee has submitted to treatment to cure her problems which she admitted, I shall recommend that the Licensee be placed on probation for a period of two years. In so doing, consideration was given to the fact that the Licensee recognized the seriousness of the problem which she is now suffering from and her voluntary submission to treatment at the local alcoholic rehabilitation center.
Recommendation Based on the foregoing findings of fact and conclusions of law, I hereby recommend that the Licensee be placed on probation for a period of two years. RECOMMENDED THIS 3rd day of August, 1977, in Tallahassee Florida. JAMES E. BRADWELL, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1005 Blackstone Building Jacksonville, Florida 32201 Jane Ruth Burch Harrison 2620 South Marion Street M4 Lake City, Florida 32055
