Findings Of Fact Petitioner, Richard W. Merritt, D.C. is a chiropractic physician licensed under Chapter 460, Florida Statutes, and is actively practicing chiropractic in the State of Florida. By this action Petitioner challenges the validity of Rule 61F2- 17.007(6)(a), F.A.C.. The pertinent portions of the challenged Rule purport to define several terms to be utilized by the peer Review Committee in evaluation of chiropractor performance as brought before it. Specifically in issue are provisions of Rule 61F2-17.007: (6)(a) "Appropriate medical treatment" as used in Section 460.4104, Florida Statutes, is defined as a determination made of treatment and other services performed, which by virtue of a substantiated and properly diagnosed condition, appears to be of a type consistent with that diagnosis as reviewed by the peer review committee. "Properly utilized services" as used in Section 460.4104, Florida Statutes, means a determination made of appropriate medical treatment services rendered including frequency and duration which are substantiated as being necessary and reasonable by clinical records and reports of the provider as reviewed by the peer review committee. "Appropriate costs" as used in Section 460.4104, Florida Statutes, mean a determination made of charges submitted for properly utilized services performed which appear to be necessary and reasonable charges for similar provider services in the judgement of the peer review committee. As a licensed chiropractic physician subject to Chapter 460, Florida Statutes, Petitioner is substantially affected by the challenged rule because: he is a "health care provider" as defined by Section 460.403(5), Florida Statutes, and as used in Section 460.4104, the specific authority for and statute implemented by the challenged rule; the challenged rule expressly applies to health care providers and establishes definitions of statutory standards applicable to the peer review of the practice of chiropractic by chiropractic physicians including Petitioner; and the rule, when applied in conjunction with Section 460.4104, Florida Statutes, may subject chiropractic physicians, including Petitioner, to potential penal sanctions for the practice of chiropractic which violates the definitions incorporated in the challenged rule applied consistent with the statutory standard. The Respondent, Department of Business and Professional Regulation, (now Agency for Health Care Administration), Board of Chiropractic, (Board), promulgated the challenged rule and has the responsibility for implementing it as well as the whole of Chapter 460, Florida Statutes and Chapter 61F2, F.A.C..
The Issue Whether the Respondent is guilty of unprofessional conduct. Whether her license as a registered nurse, certificate no. 8829 should be suspended or revoked or whether Respondent should be put on probation.
Findings Of Fact The Respondent, Christine Richter, who holds license no. 88294-2 was employed as a registered nurse at Tallahassee Memorial Hospital, Tallahassee, Florida, during the month of February, 1977. She worked as a certified nurse and anesthetist under Ann Marie Connors, the chief nurse anesthetist. The chief nurse anesthetist reported to the Associate Executive Director April 11, 1977, that there were gross discrepancies in the narcotics record kept by the Respondent and at that time she presented him with some of the records. On April 12, 1977, Respondent was requested by the Associate Executive Director to report to his office for a conference. Nurse Connors, the chief nurse anesthetist, was also called to be present at that conference. At the conference the Associate Executive Director asked Respondent for an explanation as to the discrepancies between the narcotic and barbiturate administration record and the patient records. In reply the Respondent stated that she needed a hysterectomy and could not afford it. Upon the insistance of the Associate Executive Director that she give an explanation for the discrepancy in the hospital records, she indicated that she needed to improve her charting. She gave no explanation for discrepancies in the narcotics chart which she signed, and indicated that she would resign. The Director stated that he would accept her resignation and she left the conference. The Respondent mailed her written resignation to the Tallahassee Memorial Hospital the following day. The Accreditation Manual for Hospitals, 1976 edition, published by the Joint Commission on Accreditation of Hospitals "Anesthesia Services" pages 59 through 64 is used as the standard for anesthetic procedure. A department standard book approved by the American Hospital Association and the joint commission on the accreditation of hospitals is required to be read by each employee of the Tallahassee Memorial Hospital as it pertains to the department in which the work is to be performed. The instructions in the department standards book are the same as in the Accreditation Manual for Hospitals as far as anesthesia services is concerned. Medical records of eight patients were introduced into evidence together with Narcotic and Barbiturate Record no. 081291. This shows the date, time, patient's name, room number, doseage, attending physician and administering nurse. The doseage of drugs secured by and signed for by the Respondent, Christine Richter, was more than the records show was administered to the various patients. No accounting was made for the difference between the amounts of drugs secured and the amounts, if any, administered to the patients, although it is the duty of the nurse checking out drugs to account for its use in writing on a form provided for that purpose. The Respondent offered no verbal explanation for the missing drugs when given the opportunity to explain her actions by the Associate Executive Director at Tallahassee Memorial Hospital and her immediate supervisor, Ann Marie Connors, chief nurse anesthetist.
Recommendation Revoke the license of Christine Richter. DONE AND ENTERED this 12th day of December, 1977, in Tallahassee, Florida. DELPENE C. STRICKLAND Hearing Officer Division of Administrative Hearings 530 Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1005 Blackstone Building 233 East Bay Street Jacksonville, Florida 32202 Rivers Buford, Jr., Esquire Post Office Box 647 Tallahassee, Florida 32302
Findings Of Fact The Respondent, Wendy Laurie Entelis Deutsch, holds registered nurse license No. 80859-2. During the time pertinent to this hearing the Respondent was employed as a registered nurse at Variety Children's Hospital in Miami, Florida. On June 13, 1979, an Administrative Complaint was Filed against the Respondent, alleging that she was guilty of unprofessional conduct based upon the factual allegations contained in the Administrative Complaint. Respondent requested a formal hearing. At the commencement of the formal hearing, Counsel for the Petitioner moved to withdraw allegation 1(b) contained in the Administrative Complaint, and to amend allegation 1(e) to make it read, "On or about November 18, 1978, at approximately 4:00 a.m., signing out for two (2) tablets of Tylenol No. 3 for the patient, Robert Kemp, and Respondent failed to properly chart both the Tylenol No. 3 tablets signed out by her for said patient." Petitioner also moved to amend paragraph 1(f) to read, "Wasting Demerol and failing to describe the reason for the wastage as required by hospital rules and regulations." Said motions to amend were granted without objection on the part of the Respondent. Respondent Deutsch admitted all of the allegations contained in the Administrative Complaint as amended. Petitioner then rested in view of the stipulated admissions to the allegations as amended. The Hearing Officer finds the Respondent guilty of the following accusations found in the Administrative Complaint filed June 13, 1979, pertaining to Respondent's employment at Variety Children's Hospital during November of 1978: Signing out for Demerol (Meperidine) for patients and failing to properly chart the administration of same; Signing out for Demerol on the narcotic control record and indicating times out of sequence with other entries on the record; Signing out for Tylenol No. 3 (with Codeine) a controlled substance, for a patient, George Melendez, and failing to properly chart the administration of same; On or about November 18, 1978, at approximately 4:00 a.m., signing out for two (2) tablets of Tylenol No. 3 for a patient, Robert Kemp, and failing to properly chart both tablets of Tylenol No. 3 signed out by her for said patient; "Wasting" Demerol and failing to describe the reason for the wastage as required by the hospital's rules and regulations; and Signing out for Demerol for a patient, Rhonda Haile, at an interval more frequent than ordered by the patient's physician The evidence showed as follows: That no physical damage or other damage to the patients resulted from the improper charting and failure to follow physicians' orders; That the violation occurred on or about November of 1978, and that no complaints have been filed against Respondent either prior to or following November of 1978; That the Respondent graduated from nursing school in 1975; That the Respondent is self-supporting, as she has separated from her husband and depends on nursing for her livelihood; That the Respondent has made an effort to rehabilitate herself by taking a medication course and by improving her charting; and That other mitigating factors include that the Respondent had never administered narcotics to children previously, and none of the supervisory personnel at her place of employment reviewed her charting with her but instead told her that "she was doing a good job." Both parties submitted proposed recommended orders. These instruments were considered in the writing of this order. To the extent the proposed findings of fact have not been adopted in, or are inconsistent with, factual findings in this order they have been specifically rejected as being irrelevant or not having been supported by the evidence.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, the Hearing Officer recommends that the Respondent, Wendy Laurie Entelis Deutsch, be reprimanded. DONE and ORDERED this 20th day of December, 1979, in Tallahassee, Leon County, Florida. DELPHENE C. STRICKLAND Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1107 Blackstone Building 233 East Bay Street Jacksonville, Florida 32202 Mary Ellen Shoemaker, Esquire Suite 504, Courthouse Square Building 200 Southeast Sixth Street Fort Lauderdale, Florida 33302 Geraldine B. Johnson, R. N. Board of Nursing 111 Coastline Drive East, Suite 504 Jacksonville, Florida 32202 ================================================================= AGENCY FINAL ORDER ================================================================= STATE OF FLORIDA DEPARTMENT OF PROFESSIONAL REGULATION BOARD OF NURSING DEPARTMENT OF PROFESSIONAL REGULATION, Petitioner, vs. CASE NO. 33148 DOAH CASE NO. 79-1745 WENDY L. DEUTSCH, Respondent. /
