Findings Of Fact At all material times, the Respondent held license number 282 which was issued by the Department effective September 1, 1981, and expired August 31, 1982. On or about September 1, 1981, the Respondent purchased the nursing home facility from Ramsey Nursing Facilities, Inc., which was owned and operated by Ethel G. Miller. Roberto Villaescusa became administrator of Eden on or about September 1, 1981. He replaced the previous administrator, Ethel G. Miller. On March 15, 1982, the Department mailed an application for license renewal to the facility by certified mail, return receipt requested. The envelope was addressed to "Ms. Ethel G. Miller, Ashley Manor Care Center, 8785 N.W. 32nd Avenue, Miami, Florida 33147." On March 18, 1982, the license renewal was received by Jesse Brooks, office manager of Eden, who forwarded the letter to D.I.S.C. Corporation, the agent and accountant for Ms. Miller. Mr. Brooks did not open the letter since he believed it was personal mail because it was addressed specifically to Ms. Miller. The letter and other mail were subsequently returned by D.I.S.C. to the Respondent together with instructions that the mail be delivered to Manny Garcia, the son of Ms. Miller, who was then deceased. Shortly after the receipt of the letter from D.I.S.C. and before forwarding it to Garcia, Roberto Villaescusa, Eden's administrator, contacted William Garrett, acting director of licensure for the Department, to inquire regarding license renewal procedures. Garrett advised Villaescusa that the official renewal form had been revised and that such form could only be obtained from Jacksonville. The revised license renewal form was shipped from Jacksonville to Miami where it was obtained by Eden. Within two days of receipt, the new, revised form was completed and mailed back to Jacksonville. It was received in Jacksonville on July 26, 1982, fifty-two days past the renewal date. It is the long standing policy of the Departments office of Licensure in Jacksonville to annually send to nursing facilities licensure notices and application forms in sufficient time for them to be completed and returned ninety days prior to the expiration date stated on their licenses. Nursing home operators and administrators have come to rely upon receiving such notification from Jacksonville.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED: That the Department of Health and Rehabilitative Services enter a Final Order assessing a late fee of $5,000 against the Petitioner, for failing to timely renew its license to operate a skilled nursing facility. DONE and RECOMMENDED this 3rd day of June, 1983, in Tallahassee, Florida. SHARYN L. SMITH, Hearing Officer Division of Administrative Hearings 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 3rd day of June, 1983. COPIES FURNISHED: Martha F. Barrera, Esquire 1320 South Dixie Highway Coral Gables, Florida 33146 Charles J. King, Esquire 3037 East Commercial Boulevard Fort Lauderdale, Florida 33308 David H. Pingree, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301
Findings Of Fact At all times material hereto, Respondent has been a licensed registered nurse in the State of Florida, with license number 78035-2. He has been licensed in Florida for a total of approximately seven years. Additionally, he has been a licensed registered nurse in New York, California and Texas for fifteen, seven and seven years, respectively. With the exception of this case, Respondent has not been the subject of license disciplinary proceedings in Florida, or any other state of licensure. On August 16, 1984 Respondent was employed as a licensed registered nurse at Harborside Hospital in St. Petersburg, Florida on the medical-surgical floor. He reported for duty at 7:00 a.m. on that day and was responsible for the medication cart, and dispensing medication to patients on the floor. A patient, known as W. H., was on the medical-surgical floor on August 16, 1984. W. H. had previously been a psychiatric patient at Harborside Hospital and while on the medical-surgical floor during this admission, W. H. had been assigned a psychiatric counsellor, Cecil North, who provided counselling and group therapy. Respondent knew that Cecil North had been assigned to W. H., and also that W. H. had attempted suicide sometime prior to this admission. While W. H. was walking back to his room on the medical-surgical floor on August 16, 1984, accompanied by Cecil North, Respondent heard W. H. tapping on the hallway wall. At the time W. H. was approximately twelve feet from Respondent, who was standing by the medication cart in the hallway. Respondent admits he looked up from the medication cart, saw W. H. and North, and said, "Here come the crazies." North, who was walking next to W. H., heard the comment. There is no evidence that W. H. heard the comment. Respondent testified that this comment was not a derogatory remark directed to W. H., but was said to himself as a reaction to W. H.'s tapping on the wall. Respondent had earlier been discussing movies with W. H., and specifically the movie "Escape From New York" in which the phrase, "Here come the crazies," was used in response to tapping sounds made by certain characters in that movie. Respondent stated that since the movie was on his mind, he just spontaneously made this comment to himself when he heard the tapping sounds. After considering Respondent's explanation as well as the expert testimony of Dr. Frank, it is specifically found that his comment, "Here come the crazies," was inappropriate and unprofessional, regardless whether W. H. heard it or not. It was said in a manner which allowed this comment to be overheard by North and other nursing staff, and can reasonably be interpreted as a derogatory comment about the patient, W. H. As such, Respondent disregarded his duty to W. H., a patient on his floor, by jeopardizing the patient's self esteem and possibly supporting his suicidal tendency. Later on August 16, 1984, Respondent was overheard talking with W. H. about filming a person committing suicide by fire. Respondent testified he was only talking about movie stunt techniques. However, in view of W. H.'s prior suicide attempt, of which Respondent was aware, this was an inappropriate and unprofessional, as well as potentially dangerous, discussion with W. H.
Recommendation Based upon the foregoing, it is recommended that the Board of Nursing enter a Final Order finding that Michael James Hanly has violated Section 464.018(1)(f), Florida Statutes, and therefore imposing a reprimand based upon this violation. DONE AND ENTERED this 17th day of August, 1987, in Tallahassee, Florida. DONALD D. CONN 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 17th day of August, 1987. APPENDIX DOAH Case No. 86-5025 Rulings on Petitioner's Proposed Findings of Fact: 1. Adopted in Finding of Fact 1. 2,3 Adopted in Finding of Fact 3. 4 Adopted in Finding of Fact 4. Adopted in Findings of Fact 4, 5. Adopted in Finding of Fact 4. Adopted in Finding of Fact 5. 8,9 Adopted in Findings of Fact 4, 6. Adopted in Findings of Fact 6, 8. Adopted in Finding of Fact 8. Adopted in Finding of Fact 9. 13,14 Adopted in Finding of Fact 8. 15 Adopted in Finding of Fact 9. 16-18 Adopted in Findings of Fact 8, 9. COPIES FURNISHED: Michael A. Mone', Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Michael James Hanly P. O. Box 1472 Boynton Beach, Florida 33425 Judie Ritter Executive Director Board of Nursing Department of Professional Regulation Room 504, 111 East Coastline Drive Jacksonville, Florida 32201 Van Poole, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Joseph A. Sole, Esquire General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 =================================================================
Findings Of Fact The Respondent Tobianna W. Huddleston is a registered nurse licensed in Florida, having been issued license number 140220-2. The Respondent's license to practice nursing in the State of New York was revoked on or about December 24, 1982, effective January 3, 1983, by the Commissioner of Education for the State of New York. The Commissioner's revocation was based on a Report of the Regents Review Committee which reviewed a Recommendation of a Hearing Panel which found that the Respondent was incapable of practicing her profession competently and, therefore, constituted a threat to the public.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED: That a Final Order be entered by the Board of Nursing revoking the nursing license of the Respondent Tobianna W. Huddleston. DONE and ENTERED this 28th day of October, 1983, in Tallahassee, Florida. SHARYN L. SMITH, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 28th day of October, 1983. COPIES FURNISHED: Julia P. Forrester, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Tobianna W. Huddleston Post Office Box 1124 Danville, Kentucky 40422 Helen P. Keefe, Executive Director Florida Board of Nursing Room 504, 111 East Coastline Drive Jacksonville, Florida 32202 Frederick Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
The Issue Should discipline be imposed by Petitioner against Respondent's license to practice as a licensed practical nurse (L.P.N.)?
Findings Of Fact Findings Established by Request for Admissions: Petitioner is the State of Florida department charged with regulating the practice of nursing pursuant to Section 20.43, Florida Statutes, Chapter 456, Florida Statutes, and Chapter 464, Florida Statutes. Respondent is and has been at all time material to the complaint a L.P.N. in the State of Florida, having been issued license number 9246217. Respondent's address of record is Post Office Box 99, High Springs, Florida 32655-0099. At all times material to this case, Respondent was employed as a L.P.N. by Suwannee Home Care and Medical Personnel, a staffing agency. At all times material to this case, Respondent was assigned to work as a L.P.N. at Alachua Nursing and Rehabilitation in Gainesville, Florida (Alachua). At all times material to this case, Alachua in Gainesville, was a licensed rehabilitation facility as defined in Section 400.021(13), Florida Statutes. At all times material to this case, Patient E.D. was admitted to Alachua (having been admitted) on June 20, 2003, with a diagnosis of status post CVA (stroke). On or about June 21, 2003, Respondent was assigned to care for E.D. on the 3 to 11 p.m. shift, and at the end of the shift, Respondent reported to the oncoming nurse that he assisted with the care of E.D. and that E.D. was okay and in no acute distress. Respondent's nurse's notes regarding the care he provided to patient E.D. do not mention whether he suctioned the tracheostomy care being provided; and do not contain any physical assessment of the patient. Respondent should have performed and documented tracheostomy care, including but not limited to frequency of suctioning, amount of color of sputum suctioned, cleaning of the tracheostomy device, oral hygiene, and method of communication with the patient. Respondent should have performed and documented a physical assessment of the patient that included respiratory rate and effort, color, pulse rate, and exertional level. Respondent should have monitored and followed up on patient E.D.'s vital signs. Additional Facts: Alice Bostick, is a Medical Malpractice Investigator for Petitioner. She was involved in the investigation leading to the drafting of the Administrative Complaint. As part of the process she attempted to notify Respondent of the allegations made against him. On July 15, 2003, she sent a letter of notification to Respondent at an address obtained from a printout of license information associated with Respondent. That address was 13134 North 22nd Street, Apartment 109, Tampa, Florida 33612. The information sent to Respondent was a Uniform Complaint Form and a Nursing Home Adverse Incident Report. The information sent to Respondent was returned as undeliverable and not subject to forwarding, absent a forwarding request made from Respondent to the U.S. Postal Service. Having failed to notify Respondent at the Tampa address, Ms. Bostick took advantage of access which the Petitioner has to the Florida Department of Highway Safety and Motor Vehicles records to locate Respondent's address maintained by the other state agency. The address provided by the other agency was Post Office Box 99, High Springs, Florida 32655-0099. This was the proper address. Utilizing the new address, the same information was dispatched a second time from Petitioner to Respondent. This time it was not returned as undelivered. Instead Respondent contacted Petitioner's office in person and by his remarks made it known that he received the communication from Petitioner concerning the investigation. At times relevant to this case Respondent worked for the Suwannee Valley Nursing Agency. That agency assigned him to work on a shift at Alachua, now the Manor of Gainesville. On June 21, 2003, Respondent worked the 3:00 p.m., to 11:00 p.m., shift at Alachua. One of the resident's in his care at that time was E.D. Resident E.D. was born on May 18, 1920. She had been released from the hospital on June 20, 2003, and transferred to Alachua. She was receiving oxygen. Physician's orders called for tracheostomy care (trach care) to be administered "Q 6 hours." She had a catheter which was last changed on the date of her release from the hospital. The order indicated that the catheter should be changed every Friday beyond that point. The resident was being fed by tube. As Respondent describes it, E.D. was among 30 patients in his care on the shift. Other residents included persons with G-tubes and insulin-dependent diabetics. Respondent was very busy during his shift helping the residents. Another staff member at the nursing home reminded the Respondent that he needed to suction E.D's trach. At some point in time Respondent and the other staff member suctioned the trach. When this function was performed during the shift is not established in the nursing home record pertaining to resident E.D., as that record was presented at the hearing. Therefore it was not shown an entry was made in the resident's record for care confirming the suctioning of the trach. The only reference to patient E.D. made in writing by Respondent presented at hearing, was from nursing notes related to resident E.D. In the nurse's note Respondent made an entry at the end of his shift as to vital signs for the resident, pulse rate 92, respiration rate 24 and a notation that Respondent "Assisted e-care no acute distress noted." Contrary to the nurse's note made by Respondent, resident E.D. was in distress as discovered by Gloria Brown, L.P.N., who came on shift to work from 11:00 p.m. June 21, 2003, until 7:00 a.m. June 22, 2003. Ms. Brown was familiar with the need to suction a trach and to make appropriate entry in the nursing notes in caring for a trach patient. Notes are also made in relation to oxygen saturation for that resident if a doctor's order calls for that entry. Ms. Brown properly expected the prior shift nurse to notify her concerning the resident's condition as to the number of liters of O2 provided the resident and if the resident had a fever. If the resident had a Foley catheter placed reference would be made to that circumstance. Generally if the resident was experiencing a problem, Ms. Brown would expect the outgoing nurse to mention that fact. On June 21, 2003, at 11:45 p.m., as Ms. Brown described in the nursing notes, "On first rounds observed resident E.D. with shallow breathing, skin color grayish, O2 on a 2 liter per trach mask. Attempt to suction, felt resistance. Sat. 24. O2 increased to three liters. Able to palpate pulse. 911 was called. Transported to Shands at UF via 911. Respiratory distress." Resident E.D. was transported to Shands Hospital at 12:00 midnight. When resident E.D. was transported to the hospital she was experiencing respiratory distress. She had a baseline level of consciousness in the alert range. Petitioner presented an expert to comment on Respondent's care rendered resident E.D. in the context of the allegations set forth in the Administrative Complaint. That expert was Meiko D. Mills, R.N., M.N.S., A.R.N.P. Ms. Mills is licensed to practice nursing in Florida. She has a business that involves the preparation for graduates of L.P.N. schools and R.N. schools to take the National Licensing Examination for those fields. Ms. Mills is familiar with trach care. She has had occasion to write nursing notes pertaining to trach care. She is generally familiar with the requirements for nursing notes in the patient record concerning any form of patient care rendered by the nurse practitioner. She was recognized in this case as an expert in the field of nursing related to patient care and L.P.N.s. In providing trach care, Ms. Mills refers to the need for a sterile environment and the part of the trach device that she refers to as a tube, requires a lot of cleaning because of secretions from the patient. She describes the fact that the trach device will form a crust. As a result the center portion of the device sometimes has to be taken out and soaked in sterile water to clean it. The suctioning process associated with trach care involves the use of a suctioning machine in which all the encrustations and saliva are removed. It is possible for a hard mucus plug to form if suctioning is not done appropriately, according to Ms. Mills. Ms. Mills expressed her opinion concerning Respondent's care provided resident E.D., as to a reasonable degree of certainty and whether Respondent met the minimal standards for acceptable and prevailing care and treatment of E.D. She described that care as lacking. Ms. Mills comments that the nursing note that was made by Respondent at the end of his shift was inadequate in describing the kind of care provided to the resident. In particular she describes the lack of reference to the trach issue and the oxygen saturation issue. She perceives that E.D. required considerable attention and that attention is not reflected in the nursing note. As a person responsible for providing care to E.D., who had a trach, Ms. Mills refers to the need for the Respondent to establish a baseline at the beginning of the shift. That baseline is constituted of vital signs and oxygen saturation, as well as a basic assessment of the resident. There was the need to compare the vital signs assessment to the shift before Respondent came on duty to gain an impression of any trends. The observations by Respondent should have been documented in nursing notes beginning with the baseline as to vital signs, oxygen saturation, reference to the condition of the trach, respiratory effort and so forth, and there was the need to go back and reassess over time. As Ms. Mills explains the resident's condition was reaching an abnormal state on the shift before. Without entries concerning the resident's condition, the assumption is made by Ms. Mills, that the patient care and in particular trach care was not performed by Respondent. Ms. Mills refers to a normal pulse rate as 80 to 100, but Ms. Mills cautions her students that a pulse rate close to 100 bears watching. A respiration rate approaching the highest normal demands attention. Anything above that creates concern. Higher readings tend to manifest themselves with shallower breathing by patient at more frequent intervals, given the body's attempt to compensate for a lack of oxygen. To address this condition a baseline oxygen saturation should be established at the beginning of a shift to help set a plan of care. A resident such as E.D. with a pulse rate of 97 and respiration rate of 24 is a person who needs to be closely monitored. There was no record by Respondent reflecting the establishment of monitoring to address these circumstances. The resident's progress should have been noted as to pulse rate and respiration rate several times during Respondent's shift, as Ms. Mills perceives it. Respondent should have also notified the oncoming nurse for the following shift that the patient was not doing well. This was not done. Overall, Ms. Mills feels that Respondent was deficient in his documentation concerning resident E.D. through the nursing notes. The general comment by Respondent that he assisted with care is not sufficient to establish that trach care was performed in Ms. Mills opinion. According to Ms. Mills, some of the vital signs reflected in the resident's record would create the possibility that they were in relation to a mucus plug in the trach. When the Resident E.D. was transported from the nursing home on June 21, 2003, at 11:30 the oxygen saturation at that time was 78 percent and her pulse was 159. In Ms. Mills opinion those values represented the fact that the resident was in distress. Ms. Mills believes that Respondent engaged in unprofessional conduct by acts of omission. Ms. Mills compared the nursing notes made by Respondent to those made by nurses on the prior two shifts at the nursing home. The prior notes were described as good notes talking about the care, while Ms. Mills did not get the same feeling about the notes made by Respondent. Ms. Mills compared the circumstances when Respondent came on shift when resident E.D. had a pulse of 100 and respiration rate of 20 and the change from the respiration of 20 to the respiration rate of 24 at the end of the shift, as indicating that the resident had shallow compensatory respiration because of a lack of oxygen. This leads Ms. Mills to the conclusion that the vital signs look worse and the person was significantly compromised over the day. Whether this circumstance was brought about by the formation of a plug due to a lack of trach care, Ms. Mills is not certain, but the vital signs indicate that the resident was sufficiently compromised to alert a health professional to that possibility. Earlier in the day the resident had a respiration rate of 28 and a pulse of 110. The change in those values over time up through the Respondent's shift did not indicate improvement in resident's condition in Ms. Mills' opinion. Ms. Mills' opinions that have been described are accepted. Based upon the facts found and Ms. Mills' expert opinion, Respondent failed to meet minimal standards of acceptable and prevailing nursing practice in the care provided resident E.D.
Recommendation Upon consideration of the facts found and the conclusions of law reached, it is RECOMMENDED: That a final order be entered finding Respondent in violation of those provisions of law set forth in Counts One through Three, calling for a written reprimand for those violations, imposing an administrative fine of $500.00, and placing Respondent on probation for a period of two years. DONE AND ENTERED this 24th day of May, 2005, in Tallahassee, Leon County, Florida. S CHARLES C. ADAMS 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 24th day of May, 2005. COPIES FURNISHED: Judith A. Law, Esquire J. Blake Hunter, Esquire Department of Health 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Harvey J. Price Post Office Box 99 High Springs, Florida 32655 Dan Coble, Executive Director Board of Nursing Department of Health 4052 Bald Cypress Way Tallahassee, Florida 32399-1701 R. S. Power, Agency Clerk Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701
The Issue An administrative complaint dated March 8, 1990, alleges that Respondent violated Section 464.018(1)(h), F.S. by abandoning her nursing shift without notice. The issue in this proceeding is whether that violation occurred, and if so, what discipline is appropriate.
Findings Of Fact Respondent, Rachel Ethel Hibbert, was licensed as a registered nurse in the State of Florida, on March 28, 1988, by examination. Now, and at all relevant times, her license has been current through March 31, 1991. Ms. Hibbert was employed by Largo Medical Center Hospital, Largo, Florida, on December 28, 1988, and was assigned to the Critical Care Unit (CCU). She successfully completed her critical care internship on March 24, 1989. On Saturday, April 1, 1989, Ms. Hibbert was assigned to work a 12-hour shift on the CCU. The unit was overstaffed and another unit, ICVTU, with open heart critical care patients needed help. The practice of "floating" staff between units is common, and each nurse was expected to take his or her turn when the ICVTU needed help. It was Ms. Hibbert's turn on April 1st. However, she told her Supervisor, Danielle Page, that she didn't feel "comfortable" with the ICVTU patients, as she had just finished training. Another nurse was selected to "float". However, Ms. Hibbert was counselled that her turn would come up again soon, and that she was properly trained. The type of patient and care on the ICVTU was explained to her. The following day, April 2, 1989, Ms. Hibbert was again working a 12- hour shift. Around 3:00 p.m., a call came from ICVTU for a "float" nurse. Ms. Hibbert was told it was her turn, and she did not argue or otherwise refuse. She completed her records for the patients on the ICU and left the unit. Danielle Page told the ICVTU Charge Nurse that they had a new nurse coming and she was assured that the patient load would be light, and that experienced nurses could help Ms. Hibbert. About 30-45 minutes later, ICVTU called to ask what happened to the float nurse. A search was made for Ms. Hibbert, and eventually someone checked her time card and found that she had clocked out at 3:12 p.m., shortly after leaving ICU. Jacqueline Tobin, the Nursing Supervisor for Largo Medical Center, attempted to reach Ms. Hibbert by telephone, but was unsuccessful. Ms. Hibbert, or someone on her behalf, called in sick on April 3rd. She was scheduled to be off on the 4th and 5th, and called in sick again on April 6th. Roberta Bischoff, Director of Critical Care Nursing, attempted to reach Ms. Hibbert by phone, but when she identified herself, the person answering the phone hung up. On April 7, 1989, Rachel Hibbert called the personnel office to discuss her check. Roberta Bischoff spoke with her and asked why she left her shift. She replied that she did not feel qualified. Ms. Bischoff explained that this was an extremely serious matter and that she was deemed to have resigned without notice. Ms. Hibbert's employment with Largo Medical Center Hospital was terminated effective April 2, 1989. Diane Gossett, a Medical Quality Assurance Investigator for the Department of Professional Regulation, contacted Ms. Hibbert during the course of her investigation. Ms. Hibbert admitted that she was supposed to go to the ICVTU, but she reiterated that she felt she was not qualified. Notwithstanding Ms. Hibbert's personal misgivings, her abandonment of her shift, leaving without notice, was inexcusable. Petitioner's witnesses, professional women with extensive nursing training and experience, established that such action violates minimal standards of acceptable and prevailing nursing practice.
Recommendation Based on the foregoing, it is hereby, RECOMMENDED That a Final Order be entered finding Rachel Hibbert guilty of violating Section 464.016(1)(h), F.S., and imposing discipline of one year probation, to commence upon her return to the State of Florida, and requiring the successful completion of an approved continuing education course in legal aspects of nursing. DONE AND RECOMMENDED this 29th day of October, 1990, in Tallahassee, Leon County, Florida. MARY CLARK 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 29th day of October, 1990. COPIES FURNISHED: Judie Ritter, Executive Director DPR-Board of Nursing 504 Daniel Building 111 East Coastline Dr. Jacksonville, FL 32202 Kenneth E. Easley, General Counsel DPR-Northwood Centre 1940 N. Monroe St., Suite 60 Tallahassee, FL 32399-0792 Lois B. Lepp Allied Health Legal Section DPR-Northwood Centre 1940 N. Monroe St., Suite 60 Tallahassee, FL 32399-0792 Rachel Hibbert Route 2, Box 486 Mays Landing, NJ 08330
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law the Hearing Officer would recommend that the license of Mary Stella Ghansah be revoked. DONE and ORDERED this 17th day of April, 1979, in Tallahassee, Leon County, Florida. STEPHEN F. DEAN, Hearing Officer 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 Joyce H. Knox, Esquire 825 NW 7th Street Road Miami, Florida 33136
The Issue Whether one or more of the following penalties should be imposed on Elizabeth Worden: revocation or suspension of the Ms. Worden's practice, imposition of an administrative fine, and/or any other relief that the Board of Nursing deems appropriate?
Findings Of Fact Elizabeth Worden is, and has been at all times material hereto, a licensed practical nurse in the State of Florida. Ms. Worden holds State of Florida license number 0739611. Her license lapsed on April 1, 1987, and remained lapsed at least through September 20, 1988. On September 11, 1985, Ms. Worden was arrested and charged with one count of driving under the influence (hereinafter referred to as "DUI") and five counts of possession of controlled substance. On February 24, 1986, Ms. Worden was found guilty of DUI. Additionally, an Order Withholding Adjudication of Guilt and Placing Defendant on Probation was entered based upon a plea of nolo contendere by Ms. Worden to the five counts of possession of controlled substance. Ms. Worden was placed on three years probation for the charge of possession of controlled substance and was placed on a year of probation (to run concurrently with the sentence for possession of controlled substance), ordered to pay a fine, perform community service and had her drivers license suspended for six months for the charge of DUI. During at least part of 1986 and 1987, Ms. Worden was employed as a licensed practical nurse at the Ocala Geriatrics Center (hereinafter referred to as the "Center"). Ms. Worden was one of three licensed practical nurses at the facility during the 11:00 p.m. to 7:00 a.m. shift and was in charge of the patients on one floor of the facility. While on duty at the Center Ms. Worden retired to room 5 in the east wing of the Center almost every night to sleep. She generally went to the room at about 2:00 a.m. and remained in the room until approximately 6:00 a.m. While Ms. Worden slept, she left the certified nurses aides in charge of patient care and assigned duties to the aides which should have been conducted by a licensed nurse. Ms. Worden told the aides to wake her only if a patient needed medication, if another nurse appeared on her floor, and at 6:00 a.m. On three occasions Ms. Worden left the Center while she should have been on duty, leaving certified nurses aides in charge of patient care. On these occasions Ms. Worden was gone from fifteen to thirty minutes carrying out personal errands. Ms. Worden admitted on one occasion to a certified nurses aide that she had consumed a couple of beers before coming to work. Ms. Worden's breath often smelled of alcohol and the room in which she slept also smelled of beer on occasion. During 1987, Ms. Worden entered the Intervention Project for Nurses. She was dismissed from the program in August, 1987, for noncompliance with the program's requirements. On May 18, 1987, Ms. Worden was arrested and charged with DUI and resisting arrest without violence. She was adjudicated guilty of both offenses on July 13, 1987.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that Elizabeth Worden be found guilty of having violated Sections 464.018(1)(c) and (g), Florida Statutes, as alleged in Count One and Count Three of the Administrative Complaint. It is further RECOMMENDED that the portion of the Administrative Complaint alleging that Ms. Worden is guilty of having violated Sections 464.018(1)(f) and (h), Florida Statutes, as alleged in the second Count One and Count Three of the Administrative Complaint be dismissed. It is further RECOMMENDED that Ms. Worden's license as a practical nurse be suspended until the later of the end of a five (5) year period from the date of the final order issued in this case or the date that Ms. Worden provides proof acceptable to the Petitioner of her successful completion of a rehabilitation program acceptable to the Petitioner. DONE and ENTERED this 18th day of November, 1988, in Tallahassee, Florida. LARRY J. SARTIN Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 18th day of November, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 88-2548 The Petitioner has submitted proposed findings of fact. It has been noted below which proposed findings of fact have been generally accepted and the paragraph number(s) in the Recommended Order where they have been accepted, if any. Those proposed findings of fact which have been rejected and the reason for their rejection have also been noted. The Petitioner's Proposed Findings of Fact Proposed Finding Paragraph Number in Recommended Order of Fact Number of Acceptance or Reason for Rejection 1 1. 2 3. 3-4 2. 5 3-4. 6 5. 7 7. 8 9. 9 10. 10 10-11. COPIES FURNISHED: Michael A. Mone' Staff Attorney Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Elizabeth Worden 412-A Clark Street St. Charles, Missouri 63301 Bruce D. Lamb General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Lawrence A. Gonzalez Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Judie Ritter Executive Director Department of Professional Regulation Room 504, 111 East Coastline Drive Jacksonville, Florida 32201
