The Issue Should professional discipline be imposed on Respondent for allegedly striking a patient under his care?
Findings Of Fact David W. Brown is a registered nurse. He holds license No. 85273-2, issued by the Florida Board of Nursing. He has been licensed for six years. For one and one-half years Respondent was employed as a nurse at the St. Johns River Hospital, an acute care psychiatric facility. On August 18, 1980 Mr. Brown was the charge nurse on the east wing of the hospital during the 11:00 p.m. to 7:00 a.m. shift. At an unspecified time during the course of that shift three juvenile patients were brought to the east wing, which contains a secure unit, because they were being boisterous and disturbing the other patients. Upon their arrival on the east wing they continued to create a commotion and to be rebellious toward the staff. At one time the patients were striking matches and throwing them on the floors and on the beds of the room where they were confined. After numerous warnings to the patients that their behavior was intolerable and contrary to hospital rules, Mr. Brown, as the charge nurse for the unit, decided to medicate the most uncontrollable of the three patients, Steven Burke, according to a P.R.N. prescription. Steven Burke was fifteen years old at the time. He was 5 feet 7 inches high and weighed approximately 130 pounds. By comparison Mr. Brown had a height of 5 feet 7 1/2 inches and weighed approximately 160 pounds. The patient Burke had a reputation for being foul-mouthed and potentially violent. He had a hostile rebellious attitude toward the hospital staff and generally presented a management problem. When Mr. Brown decided to medicate Steven Burke there were two staff members available to assist him. They were Mr. W. Harden Addy and Ms. Joan Ann Bender, both mental health assistants at the hospital. After drawing the P.R.N. medication Mr. Brown, Ms. Bender and Mr. Addy went to the room where the juveniles were still in an uproar. When the staff members entered the room Steven Burke yelled that no one was going to medicate him. He was most profane in his use of expletives. As Mr. Brown entered the room Steven Burke advanced toward him with his arms raised in a threatening manner. Mr. Brown restrained him around the arms in order to lie him across a bed and administer the medication intramuscularly. The patient appeared to agree to accept the medication. However, as soon as Mr. Brown released him the patient again became agitated and threatening. Mr. Brown again restrained the patient from behind, but Steven Burke managed to keep one arm free. With that arm he elbowed Mr. Brown several times in the face. At that point Mr. Brown used his hand to strike the patient on the back of the head just above the neck. The blow caused the patient to begin sobbing and to accept the medication which was given. There is no evidence of any physical damage to Mr. Brown as the result of Steven Burke's resistance. There is similarly no evidence of physical damage to the patient from the blow which he received from Mr. Brown. During the melee Mr. Casteel who was temporarily assigned to another ward appeared at the door of the room to see what was causing the commotion. Mr. Casteel's testimony presented at the final hearing concerning the nature of the confrontation between Steven Burke and Mr. Brown is not accepted as credible. He was shown to have a bias against Respondent and his testimony conflicted with credible testimony of other witnesses. When Mr. Brown was struggling with the patient Mr. Addy assisted to some degree by restraining the patient's legs. Ms. Bender was occupied during that time with with other two patients in the room to insure that they did not join the struggle. During his struggle with Steven Burke, Mr. Brown was not in danger of serious bodily injury. He had the choice of breaking contact with the patient at anytime. Striking a patient under the circumstances of this case is a deviation from the minimal acceptable and prevailing nursing practices in Florida. While the behavior of Steven Burke was obnoxious and he had a reputation for being physically violent there was no justification for Mr. Brown's striking him. Mr. Brown's attempt to administer intramuscular medication to a resisting patient with insufficient assistance from other hospital staff created a dangerous situation. At a minimum, the room where the patient Steven Burke was being confined should have been cleared of the other two juveniles in order to allow the staff present to concentrate on Steven Burke. On the morning subsequent to his confrontation with Steven Burke, Mr. Brown admitted to the Director of Nursing, Ms. Joyce Starnes, that, "He was quite concerned because he lost it and hit a patient." Ms. Starnes, who was Mr. Brown's supervisor, considered him to be very knowledgeable and qualified to be a nurse.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED: That the Board of Nursing enter a Final Order suspending the license of David W. Brown to practice nursing for a period of one month. DONE and RECOMMENDED this 27th day of August, 1982, in Tallahassee, Florida. MICHAEL PEARCE DODSON Hearing Officer Department of Administrative Division of Administrative Hearings Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 27 day of August, 1982.
The Issue The issue is whether Respondent's license to practice nursing should be revoked, suspended, or otherwise disciplined under the facts and circumstances of this case.
Findings Of Fact Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant findings of fact are made: At all times material to this proceeding, Respondent Rita Flint (Flint) was a licensed practical nurse in the State of Florida, holding license number PN0655201. Flint's last known address is 6494 South West 8th Place, North Lauderdale, Florida 33068. At all times material to this proceeding Flint was employed by North Broward Medical Center (NBMC) located in Pompano Beach, Florida, as a practical nurse. On August 3, 1990, Flint was assigned to care for patients J. C. and J. K. including administering their medications and charting same on their Medication Administration Record (MAR). On August 3, 1990, J. C.'s physician prescribed one (1) nitroglycerine patch each day. Flint failed to administer the patch on this date. On August 3, 1990, J. C.'s physician prescribed 100 mg. of Norpace every six (6) hours. Flint failed to administer the 2:00 p.m. dosage of Norpace to J. C. On August 3, 1990, J. C.'s physician prescribed 120 mg. of Inderal each day. Flint failed to administer the 9:00 a.m. dosage of Inderal until 1:30 p.m. without noting any explanation on J. C.'s MAR. On August 3, 1990, Flint failed to document the administration of J. K's own medications on the MAR. On August 3, 1990, Flint failed to sign the MARs for J. C. and J. K. as required by hospital policy. On August 15, 1990, Flint left an intravenous bag with an exposed needle hanging at the bedside of a patient. On August 29, 1990, Flint was assigned to care for patient R. R. including administering his medications. Flint failed to administer the following medications leaving all of them at R. R.'s bedside: (a) Timolo (9:00 a.m. and 2:00 p.m. doses); (b) Mixide (9:00 a.m. dose); (c) Zantac (9:00 a.m. and 4:00 p.m. doses); (d) Lasix (9:00 a.m. dose); and, (e) Entozyme (8:00 a.m. and 12:00 noon doses). On August 30, 1990, NBMC terminated Flint's employment as a result of the aforementioned conduct. There is no evidence that any patient suffered any actual harm as a result of Flint's errors. In September of 1990, NBMC referred Flint to the Intervention Project for Nurses. At all times relevant to this proceeding, Flint's job performance was adversely affected by long work schedules necessitated by severe financial problems. During the week of August 3, 1990, Flint worked a ninety-two-hour week. The acute financial stress was due to domestic problems including the breakup of her twenty-two-year-old marriage. Flint had no problems involving substance abuse. Flint attended individual therapy sessions with a clinical psychologist, Priscilla Marotta, Ph.D., and participated in group therapy designed primarily for persons with substance abuse problems. Flint attended weekly therapy sessions for approximately one month after which she could no longer afford treatment. Even though Flint was financially unable to continue treatment with Dr. Marotta or any other counseling program recommended by the Intervention Program for Nurses, she diligently undertook a self-help program to educate herself on stress management techniques, to develop self-reliance, and to improve self-esteem. Flint's effort to participate in therapy, to the extent financially possible, and to rehabilitate herself shows a strong commitment to her profession. Flint has been licensed to practice nursing since May 31, 1982. There is no evidence of any disciplinary action against her license prior to or after the incidents herein described. Flint is currently employed as a nurse in a hospice. Her recent performance appraisal reports indicate that, on an average, she fully meets all job requirements.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is, therefore recommended that the Board of Nursing enter a Final Order finding Respondent guilty of violating Section 464.018(h), Florida Statutes (1989), as defined in Rule 210-10.005(1)(e)1 and Rule 210-10.005(1)(e)2, Florida Administrative Code, and not guilty of violating Section 464.018(1)(j), Florida Statutes. It is further recommended that the Board's final order: (1) place the Respondent on probation for one year subject to such requirements as the Board may require; and (2) require the Respondent to pay an administrative fine in the amount of two hundred fifty dollars ($250). DONE AND ENTERED in Tallahassee, Leon County, Florida, this 21st day of November 1994. SUZANNE F. HOOD, Hearing Officer 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 21st day of November 1994. APPENDIX TO RECOMMENDED ORDER IN CASE NO. 93-2715 The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on all of the Proposed Findings of Fact submitted by the parties to this case. FOR THE PETITIONER: Incorporated into Findings of Fact 1. Incorporated into Findings of Fact 2 and 11. Incorporated into Findings of Fact 4. Incorporated into Findings of Fact 5. Incorporated into Findings of Fact 6. Incorporated into Findings of Fact 7. Incorporated into Findings of Fact 8. Incorporated into Findings of Fact 9. Incorporated into Findings of Fact 10. The first sentence is incorporated into Findings of Fact 13. The remaining portion of this proposed fact is not supported by competent substantial evidence. Furthermore, Respondent's Exhibit 3, as it relates to a diagnosis of a mental condition, is hearsay which does not supplement or explain any other psychological or medical evidence. Thus, any reference in Exhibit R3 to a generalized anxiety disorder is insufficient to support Petitioner's proposed finding. Unsupported by competent substantial evidence. Unsupported by competent substantial evidence. See number 10 above. FOR THE RESPONDENT: 1. Respondent did file proposed findings of fact or conclusions of law. COPIES FURNISHED: Laura Gaffney, Esquire Natalie Duguid, Esquire Agency for Health Care Administration 1940 North Monroe Street Tallahassee, Florida 32399-0792 Rita Flint 3313 South East Second Street Pompano, Florida 33063 Judie Ritter Executive Director Board of Nursing AHCA 504 Daniel Building 111 East Coastline Drive Jacksonville, Florida 32202 Harold D. Lewis General Counsel The Atrium, Suite 301 325 John Knox Road Tallahassee, Florida 32303
