Findings Of Fact During early 1982, Petitioner submitted an application for licensure as an Advanced Registered Nurse Practitioner in the category of Midwifery. Petitioner's application was reviewed by the Respondent, Board of Nursing, on July 21, 1982. By letter of that date, Petitioner was advised that her application for certification as an Advanced Registered Nurse Practitioner did not meet the criteria for certification as set forth and defined in Section 464.012(1), Florida Statutes. Specifically, Petitioner was advised that: The midwifery training that she completed in 1962 in England was note post-basic. Enrollment as a midwife on the Central Midwife's Board has not been recognized as an "an appropriate" specialty board for certifi- cation as an Advanced Registered Nurse Practitioner, and The master's degree preparation that Petitioner acquired is not from a program leading to a master's degree in a nursing clinical specialty area. (Petitioner holds a master's degree in Education) Petitioner was further advised that she had one other means of being certified. I.e., that "registered nurses who have received their midwifery training outside the United States may be certified if they have completed an American college of nurse midwifery approved refresher program and the registered nurse is deemed eligible to take the ACNM examination. [Rule 210-11.23(2)(c), Florida Administrative Code] (Petitioner's Exhibits 2 and 3) Petitioner is a currently licensed registered nurse in the State of Florida, having been issued license number 30882-2, on January 1, 1964, by examination. Further, Petitioner was admitted to the Central Midwives' Board (London, England) after successfully completing a one year course of training undertaken by pupils who had previously qualified as state- registered general trained nurses. Petitioner took a three years' course of general nurse training at Bedford General Hospital from 1957 through 1960 and commenced midwifery training on August 1, 1961, as confirmed in the verification of her training and enrollment as a midwife. Debra Fitzgerald, a resident of Atlanta, Georgia, on May 26, 1983, was previously employed by the Respondent, Board of Nursing, from July, 1980 to February, 1983, as a nursing consultant in the educational section dealing primarily with the certification of applicants in the field of ARNP. As part of her duties as an employee of the Respondent, Ms. Fitzgerald reviewed the application of the Petitioner for certification as an ARNP. Upon review of the Petitioner's application, it is determined that the program that the Petitioner attended in midwifery during 1961-1962 in England was not a formal post-basic program equivalent to the standards required of formal post-basic programs in this country. Rule 21D-11.24, Florida Administrative Code. Petitioner was given credit for a total of one hundred four (104) didactic hours and the Board requires a minimum of one hundred twenty (120) didactic hours for proof of the equivalent of a post-basic course requirement in obstetrical nursing. (Testimony of Fitzgerald [by deposition]) Petitioner has not otherwise satisfied the criteria to be certified in keening with Rule 21D-11.23(2)(c)1 or 2, Florida Administrative Code.
The Issue The issue in this case is whether disciplinary action should be taken against the Respondent for violation of statutory provisions regarding the practice of nursing. By Administrative Complaint the Respondent was charged with unprofessional conduct and with being unable to practice nursing with reasonable skill and safety to patients.
Findings Of Fact At all times material hereto, the Respondent has been a licensed practical nurse in the State of Florida, having been issued license number PN 0711261. Respondent was employed at Humana Hospital Cypress in Pompano Beach from on or about October 10, 1988, until on or about March 10, 1989. During her employment at Humana Hospital Cypress, Respondent was absent from her duties without giving notice on four occasions, was absent with notice on one occasion, and was on sick leave on five different occasions. These absences constitute an excessive number of absences. The pattern of the absences also raises concerns as to whether the absences are caused by behavioral problems. During her employment at Humana Hospital Cypress, Respondent was observed while on duty by several Charge Nurses (Dysen, Fabella, and Keough) to be extremely nervous; jumpy; on the verge of tears or crying when asked what was wrong; to be constantly complaining about being tired and hungry; to be frequently looking very tired, taking naps during lunch break, and not waking up in time for duty; to be frequently flailing her arms around, talking verbosely in high volumes, and speaking about subject matter inappropriate at a nurse's station; and exhibiting generally unpredictable and worrisome behavior. Lynn Whitehead, R.N., has been a staff nurse on the Substance Abuse floor of Humana Hospital Cypress for approximately six years. During February of 1989, Nurse Whitehead spoke to Respondent after Respondent had a hysterical crying reaction to learning that she failed the Telemetry Nursing course. During Nurse Whitehead's discussion with Respondent, Respondent admitted to Nurse Whitehead that Respondent used drugs and had been to some rehabilitation group meetings in the past. Respondent's behavior in her discussions with Nurse Whitehead - extreme anxiety, pacing, upset, complaints of hunger and exhaustion - along with Respondent's excessive absences, were consistent with drug abuse behavior based on Nurse Whitehead's knowledge and experience. On or about February 28, 1990, Respondent was asked by Nurse Fabella to submit to a urinalysis based on Fabella's observation of Respondent's erratic and unusual behavior which led Nurse Fabella to suspect that drug use might be involved. Respondent refused to submit to a urinalysis and stated the reason was because she knew marijuana would show in her urine. Nurse Fabella counseled Respondent about her erratic behavior, excessive absences, refusal to submit to a urinalysis, and unprofessional nursing conduct, on or about February 28, 1989. Subsequent to the counseling by Nurse Fabella, Respondent failed to keep an appointment with Nurse Cruickshank to discuss her situation and the decision was made to terminate Respondent. Amy Mursten, Investigative Specialist for the Department of Professional Regulation, interviewed Respondent for the purpose of conducting an investigation into her behavior and suspected drug abuse. Ms. Mursten discussed the Intervention Project for Nurses which could help rehabilitate the Respondent and save her nursing practice, but Respondent refused this help and denied having a problem. On at least two occasion, Respondent failed to act professionally or responsibly towards a patient and would have given inappropriate dosages or types of medications to the patients had someone not intervened. The Respondent's behavior patterns described above constitute a departure from minimal standards of acceptable and prevailing nursing practice. The Respondent's behavior patterns described above demonstrate an inability to practice nursing with reasonable skill and safety to patients by reason of use of drugs or narcotics or as a result of her mental condition.
Recommendation On the basis of all of the foregoing, it is RECOMMENDED that the Board of Nursing enter a final order in this case concluding that Respondent has violated Section 464.018(1)(h), Florida Statutes, by engaging in unprofessional conduct, and has violated Section 464.018(1)(j), Florida Statutes, by being unable to practice nursing with reasonable skill and safety to patients. It is further recommended that the Board's final order suspend Respondent's license until Respondent has demonstrated to the Board that Respondent is able to practice nursing with reasonable skill and safety to patients and, once Respondent has demonstrated her ability to so practice, place Respondent on probation for a period of one year subject to such requirements as may appear to the Board to be necessary to assure that Respondent continues to practice with reasonable skill and safety to patients. DONE and ENTERED in Tallahassee, Leon County, Florida, this 30 day of April 1990. MICHAEL M. PARRISH 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 30 day of April 1990.
The Issue Whether Petitioner, Mary E. Johnson, was discriminated against by her discharge from her position as a Certified Nurse Assistant by Respondent, Ormond Beach Memorial Hospital (Hospital), on November 21, 1991, because of her handicap, clinical depression, in violation of Section 760.10, Florida Statutes.
Findings Of Fact Petitioner worked as an on-call Nurse Assistant for Respondent. On call employees were guaranteed no certain amount of hours and no benefits were provided to them. On call employees were called to work when patient census was high, and were the first to be cancelled when the census was low. Vodenicker, Tr. 29 (1. 20-25) - 30 (1. 1-19); Johnson, Tr. 31 (1. 4-5). On November 21, 1991, Respondent discharged Petitioner from her position as a Certified Nursing Assistant at the Hospital. Hearing Officer's Exhibit 1. Petitioner had been hospitalized the majority of May 1991 for clinical depression. She returned to work at the Hospital following her hospitalization and was not hospitalized again prior to her discharge, although she did continue to have problems with depression. Johnson, Tr. 33 (1. 18-25) - 34 (1. 1-14). Ms. Vodenicker, Vice President of Nursing Services, became aware that Petitioner had been hospitalized for clinical depression during a counseling session on August 20, 1991. Ms. Sally Cole, Nurse Manager of Six North, was also present during this meeting. Johnson, Tr. 53 (1. 23-24); Vodenicker, Tr. 120 (1. 8-16), Tr. 121 (1. 9-17), Tr. 133 (1. 8-11). In early May, Diane McCall, Assistant Director of Nursing, was told by Dorothy Johnson, Petitioner's mother, that Petitioner was depressed and had been hospitalized. McCall, Tr. 78 (1. 23-25) - 79 (1. 1-8). Petitioner never discussed her clinical depression with Ms. McCall. McCall, Tr. 79 (1. 9-14); Johnson, Tr. 51 (1. 5-7). Petitioner's psychiatrist, Dr. Oh, had no conversations with anyone at the Hospital regarding Petitioner's clinical depression. Johnson, Tr. 38 (1. 13-15). As a physician practicing in the area, the nurses and staff were familiar with his specialty, and some of the Petitioner's supervisor's knew Dr. Oh was treating the Petitioner. Petitioner did not inform any members of the Hospital's nursing staff that she was suffering from clinical depression. Johnson, Tr. 50 (1. 19-22). Ms. Burns, one of Petitioner's supervisors, was not aware that Petitioner suffered from clinical depression. Johnson, Tr. 51 (1. 14-16); Burns, Tr. 182 (1. 16-19). Ms. Bowen, Nurse Manager of Six South, had no knowledge that Petitioner suffered from clinical depression. Johnson, Tr. 52 (1. 10-12); Bowen, Tr. 185 (1. 9-17). In her capacity as Team Leader and/or Charge Nurse, Ms. Canelli had occasion to supervise Ms. Johnson's work. Ms. Canelli described Petitioner's performance as "erratically efficient" because sometimes Petitioner was "very good at her job and at other times she was less than adequate". Canelli, Tr. 83 (1. 4-15). In early May 1991, Petitioner was counseled by Ms. Vodenicker regarding her personal interactions with a coworker, Brad Van Buren. Ms. Vodenicker cautioned Petitioner to keep her personal life separate from her business life at the Hospital. Johnson, Tr. 57 (1. 15-25) - 58 (1. 1-15). On July 20th, Ms. Canelli counseled Petitioner regarding the deficient level of care she had provided to a "total-care patient" (i.e., a patient who cannot feed, bathe or move themselves in bed) on July 2nd. Ms. Canelli discovered the patient "lying in a puddle of stool," and located Petitioner sitting at the nurses station holding her pocketbook and waiting to leave for the day, even though there was still 20-25 minutes left until the end of the shift. Ms. Canelli instructed Petitioner to clean up the patient. About ten minutes later, Ms. Canelli went back into the patient's room and discovered that the patient had apparently been wiped off with a dry cloth but had not been bathed. This was evident because there was still stool on the patient's pillow, dressings, and leg. Ms. Canelli summoned another Nurse Assistant, and they cleaned up the patient. Ms. Canelli counseled Petitioner regarding this incident on the next available opportunity she had to work with her, and she also documented the incident. Canelli, Tr. 83 (1. 21-25) - 84 (1. 1-17) - 85 (1. 4-25) -86 (1. 1-23); Respondent's Exhibits 6 and 7. On August 20th, Ms. Vodenicker had a second counseling session with Petitioner concerning Mr. Van Buren, following a complaint by Mr. Van Buren that Petitioner had been following him around in her car and that she had been seen in the Hospital parking lot watching him as he came on duty on the evening of August 19th. Vodenicker, Tr. 118 (1. 10-14). On October 27th, Ms. Canelli counseled Petitioner about Petitioner's absence from her assigned floor when she could not be located by the nursing staff, even after she was paged over the Hospital paging system. Ms. Canelli documented the events surrounding this counseling session on October 28th, to include several prior instances in which the nursing staff had been unable to locate Petitioner on her assigned floor. Canelli, Tr. 88 (1. 2-25) - 89 (1. 1- 8) - 102 (1. 1-25) - 103 (1. 1-3); Respondent's Exhibit 8. Ms. Vodenicker requested that Ms. Cole, Nurse Manager of Six North, escort Petitioner to Ms. Vodenicker's office in order to discuss the situation and to get Petitioner's side of the story. Ms. Cole sat in on the meeting as a witness. Ms. Vodenicker reminded Petitioner of their previous discussion regarding Mr. Van Buren and told Petitioner to keep her business and personal lives separate. Ms. Vodenicker also took this opportunity to discuss other problems with Petitioner's job performance. Vodenicker, Tr. 119 (1. 15-25) - 120 (1. 1-7); Johnson, Tr. 58 (1. 18-25) - 59 (1. 1-10). Because Petitioner's actions were in violation of the directives that Ms. Vodenicker had previously discussed with Petitioner in May, Ms. Vodenicker a wrote a disciplinary report. Johnson, Tr. 121 (1. 20-24). On August 21st, Ms. McCall presented Petitioner with the disciplinary report in the presence of Ms. McCall. Petitioner refused to sign the document, and Ms. Vodenicker made a notation of this fact on the face of the document and forwarded the original to the Hospital's personnel department. Vodenicker, Tr. 121 (1. 25) - 122 (1. 1-23) - 146 (1. 10-25) - 147 (1. 1-3); McCall, Tr. 156 (1. 22-25) - 157 (1. 1-11); Johnson, Tr. 59 (1. 11-25) - 60 (1. 1-4); Respondent's Exhibit 3. Ms. Burns counseled Petitioner after the Petitioner failed to answer a page and could not be found when Ms. Burns undertook a personal search for Petitioner. Petitioner later stated that she had taken a patient to x-ray; however, when Ms. Burns called the x-ray department, no one remembered seeing Petitioner in that area. Ms. Burns counseled Petitioner regarding leaving her assigned floor without notifying proper personnel and documented the incident. Burns, Tr. 176 (1. 4-23) - 177 (1. 22-25) - 178 (1. 1-17) - 179 (1. 3-25) - 180 (1. 1-10) - 181 (1. 14-16) - 182 (1. 9-15). On October 26, 1991, Petitioner was working under Ms. Peterson's supervision. Ms. Peterson observed that, while on a supposed 15-minute break at 8:15 a.m., Petitioner did not return until nearly 9:15 a.m. Ms. Peterson documented the incident after consulting with her supervisor. No one at the Hospital had instructed Ms. Peterson to keep an eye on Petitioner. Peterson, Tr. 172 (1. 12-23) - 173 (1. 18-25) - 174 (1. 1-6) - 175 (1. 1-3); Respondent's Exhibit 17. On November 2, 1991, Ms. McCall counseled Petitioner regarding being absent from her assigned floor, and limiting her breaks to 15 minutes and lunch breaks to one-half hour. Ms. McCall instructed Petitioner not to leave the floor unless directed to do so by the Charge Nurse or Team Leader. Ms. McCall documented her counseling Petitioner in her personnel file. McCall, Tr. 149 (1. 19-25) - 150 (1. 1-18); Respondent's Exhibit 14. On November 10, 1991, Petitioner was assigned to assist patient Joan Cummings. Patient Cummings was an "NPO" patient, meaning that she could not receive any of her fluids and medications by mouth. Petitioner forgot to measure the patient's urine output prior to emptying her bedpan. Canelli, Tr. 92 (1. 18-25). Johnson, Tr. 40 (1. 2-8) - 66 (1. 23-25) - 67 (1. 1-5). After forgetting to measure patient Cummings' urine, Petitioner asked the patient how many times she had urinated. The patient informed her that she had voided three (3) times, and Petitioner multiplied that number by 200 cc's to arrive at a figure of 600 cc's. Petitioner recorded 600 cc's as patient output on the intake/output slip, and which was ultimately recorded on the patient's daily log form located on a clipboard outside the patient's door. The information was later transcribed onto the patient's chart. Johnson, Tr. 40 (1. 10-25) - 42 (1. 4-25) - 43 (1. 1-12). The Nurse Assistant assigned to the patient is responsible for an accurate intake and output measurement as recorded on the patient's intake/output slips and daily log sheets. The information recorded on these Hospital documents are relied upon as accurate by the entire nursing staff. The information is transferred onto the patient's graphic charts by the nurse, or nursing assistant or nursing team leader, depending on who has time. Canelli, Tr. 112 (1. 8-25) - 113 (1. 1-3); Bowen, Tr. 184 (1. 3-8). By substituting 200 cc's in the place of the BRP designation, Petitioner failed to follow the procedures as described to her by Ms. Canelli. Petitioner had never been instructed by anyone at the Hospital to substitute 200 cc's for actual measurement. Johnson, Tr. 44 (1. 21-25) - 45 (1. 1) - 47 (1. 15-25) - 48 (1. 1-19) - 49 (1. 1-6); Canelli, Tr. 99 (1. 2-8). It would not be proper for a nurse or nurse assistant to multiply the number of times a patient had voided by 200 cc's, and use that number as an accurate representation of the amount of urine output by the patient. Canelli, Tr. 91 (1. 9-14). Petitioner's "Nursing Skill Evaluation" form reveals that she received training on the use of intake/output sheets, including the accurate measuring of cleaning of these items, although she cannot recall what instructions she received. Johnson, Tr. 64 (1. 7-25) - 65 (1. 1), (1. 14-17); Respondent's Exhibit 4. An accompanying self-evaluation form also reveals that Petitioner indicated that she felt comfortable with charting elimination of bedpan fluids and with the accurate measuring and cleaning of the graduated pitcher. Johnson, Tr. 67 (1. 12-25) - 68 (1. 1-12); Respondent's Exhibit 5. Ms. Canelli instructed her Nurse Assistants to inform the Team Leader, whenever they had forgotten to measure a patient's urine output and to let their Team Leader know the number of times the patient had voided so that the staff would have some idea that the patient had voided and chart that the urine had not measured. Canelli, Tr. 91 (1. 17-25). Petitioner's substitution of her estimate of urine output was contrary to acceptable charting practice. Petitioner had been instructed by Ms. Canelli, who regularly performed Team Leader and Charge Nurse duties, to document instances in which she had forgotten to measure a patient's output by writing the number of times the patient had voided beside the designation "BRP" (bathroom privileges). Johnson, Tr. 43 (1. 25) - 44 (1. 1-20). On November 10, 1991, patient Cummings reported to Ms. Canelli that Petitioner had dumped her bedpan without measuring the urine output after the Petitioner had left at the end of her shift. Ms. Canelli documented the facts related to her by the patient in a report to her team leader, Ms. Bowen. Canelli, Tr. 94 (1. 22-25) - 95 (1. 1-3); Respondent's Exhibit 9. Petitioner admits that the nurses rely on the information recorded on the intake/output slips and daily logs as being accurate representations of the actual amount of fluids measured by the Nurse Assistants. Johnson, Tr. 43 (1. 13-15). Nurse Bowen was the Team Leader on Six North on November 10, 1991. Ms. Bowen spoke with Ms. Cummings, who advised her that Petitioner had failed to measure her urine output before emptying the bedpan. Ms. Bowen also documented the patient's complaint in a report. Bowen, Tr. 184 (1. 9-19). Nurse McCall was advised of the Cummings incident when she returned to work after the weekend. Ms. McCall brought the incident involving patient Cummings to the attention of Ms. Vodenicker. In reviewing patient Cummings' medical file, Ms. Vodenicker was very concerned about Petitioner's inaccurate recording of patient information. Ms. Vodenicker opined that it was very important that the Hospital be able to trust what its health-care employees tell them and have confidence that the employees have done what they say they have done. Vodenicker, Tr. 123 (1. 9-20) - 124 (1. 7-16). Ms. Vodenicker was already aware of Petitioner's performance, as well as the prior written corrective action which she had given Petitioner. She reviewed Petitioner's personnel file, performance appraisals, and met with Nurse McCall, Petitioner's immediate supervisor, in order to analyze this matter further. Ms. Vodenicker decided in view of the decline in Petitioner's performance, the verbal and written counseling she had received from the supervisory staff, the prior corrective action which had been issued, and the recent incident involving patient Cummings that a decision was required regarding Petitioner's further employment. Vodenicker, Tr. 124 (1. 20-25) - 125 (1. 1-3). Ms. Vodenicker discussed the matter with Nurse McCall and asked that she provide her with a recommendation. Nurse McCall recommended Petitioner's discharge based upon the incident involving patient Cummings and Petitioner's declining work performance. Vodenicker, Tr. 125 (1. 8-18); McCall, Tr. 153 (1. 10-25) - 154 (1. 1-11) - 157 (1. 24-25) - 158 (1. 1); Respondent's Exhibit 13. Petitioner's annual performance evaluation reflected that there had been a demonstrable demise in her overall performance over the course of her first year of employment. McCall, Tr. 155 (1. 4-21). The decision to discharge Petitioner was not communicated to Petitioner until November 21st, mainly because of the time that it took Ms. Vodenicker to conduct her review of the situation and discuss the proposed disciplinary action with her superiors. Petitioner was not called to work due to low patient census on November 15, 18, and 20, 1991. Vodenicker, Tr. 125 (1. 23-25) - 126 (1. 1-18) - 144 (1. 1-6). On November 21, 1991, Ms. Vodenicker met with the Petitioner and reviewed the incident involving patient Cummings with Petitioner. Petitioner admitted to Ms. Vodenicker that she had forgotten to measure the patient's urine output and had documented the output as 600 cc's. Ms. Vodenicker expressed her concern over Petitioner's failure to properly chart patient information, and Petitioner's declining work performance. Ms. Vodenicker then terminated the Petitioner. Vodenicker, Tr. 126 (1. 19-25) - 127 (1. 1-8); Johnson, Tr. 189 (1. 22-25) - 190 (1. 1-19); Hearing Officer Exhibit 1. Petitioner states she does not wish to return to the Hospital as a Nurse Assistant at this time for health reasons. Johnson, Tr. 50 (1. 3-13).
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Commission on Human Relations issue a Final Order finding that Petitioner has failed to prove a violation of Section 760.10, Florida Statutes. DONE AND ENTERED this 17th day of September, 1993, in Tallahassee, Florida. STEPHEN F. DEAN 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 September, 1993 APPENDIX TO RECOMMENDED ORDER, CASE NO. 93-1556 The following constitute specific rulings, pursuant to S120.59(2), F.S., upon the parties' respective proposed findings of fact (PFOF). Respondent's PFOF: 1-7 Adopted. 8-9 Irrelevant. 10-17 Adopted. 18-19 Irrelevant. 20-27 Adopted. 28 Irrelevant. 29-32 Adopted. 33 Rejected as contrary to the best evidence. 34-42 Adopted. 43-44 Subsumed in 24 and other paragraphs. 45-50 Adopted. 51-56 Subsumed in 41. 57 Adopted. Petitioner's PFOF: 1-End Rejected and contrary to the best evidence. COPIES FURNISHED: Sharon Moultry, Clerk Human Relations Commission 325 John Knox Road Building F, Suite 240 Tallahassee, Florida 32303-4149 Dana Baird, Esquire General Counsel Human Relations Commission 325 John Knox Road Building F, Suite 240 Tallahassee, Florida 32303-4149 Ms. Mary E. Johnson c/o Ms. Dorothy Johnson 1807 Golfview Boulevard South Daytona, Florida 32119 Gary E. Thomas, Esquire FISHER & PHILLIPS 1500 Resurgens Plaza 945 East Paces Ferry Road Atlanta, Georgia 30326
Findings Of Fact In October 1978 Bonnie Ray Solomon Crawford, LPN was employed at the West Pasco Hospital, New Port Richey, Florida as a licensed practical nurse provided by Upjohn Company's rent-a-nurse program. On 7 October 1978 Respondent signed out at 10:00 a.m. and 2:00 p.m., and on 8 October 1973 at 8:00 a.m. and 1:00 p.m. for Demerol 75 mg for patient Kleinschmidt (Exhibit 2). Doctor's orders contained in Exhibit 4 shows that Demerol 50 mg was ordered by the doctor to be administered to patient Kleinschmidt as needed. Nurses Notes in Exhibit 4 for October 7, 1978 contains no entry of administration of Demerol at 10:00 a.m. and at 2:00 p.m. shows administration of 50 mg. and Phenergan 25 mg. Exhibit 3, Narcotic Record for Demerol 50 mg contains two entries at 8:15 a.m. on October 7, 1978 and one entry at 12:30 p.m. where Respondent signed out for Demerol 50 mg. for patients King, Zobrist and King in chronological order. Nurses Notes for King, Exhibit 6, and Zobrist, Exhibit 5, contain no entry that Demerol was administered to patient Zobrist at 8:15 a.m. or to patient King at 12:30 p.m. on 7 October 1978. In fact, the record for Zobrist shows that Zobrist was discharged from the hospital on October 5, 1978. Failure to chart the administration of narcotics constitutes a gross error in patient care and is not acceptable nursing practice. Similarly it is not acceptable nursing practice to withdraw narcotics not contained in doctors orders or administer medication not in doctors orders. When confronted by the Nursing Administrator at West Pasco Hospital with these discrepancies in the handling of Demerol, Respondent stated that she failed to check the identity of the patient before administering medication and that she didn't feel she should be giving medications any more. Following this confrontation with the hospital authorities, Respondent was fired for incompetency. No evidence was submitted regarding Respondent's 1975 disciplinary proceedings.
Findings Of Fact The Respondent is a licensed practical nurse holding license number 0688681. At all times pertinent to this proceeding the Respondent was employed as a licensed practical nurse at Leesburg Center Health Care and Nursing Home. The Petitioner is an agency of the state of Florida charged with enforcing the professional practice standards for nurses embodied in Chapter 464, Florida Statutes (1981) and with initiating and prosecuting disciplinary actions against nurses for violations of those standards. On February 7, 1983, the Respondent while working as a nurse or medical technician at the Sumter Correctional Institute was involved in a disturbance with some inmates in the course of which the chemical "mace" was used to quell the disturbance. Later that evening at approximately eleven p.m. he reported for his night shift duty at Leesburg Center Health Care and Nursing Home complaining of a migraine headache. His supervisor, Nurse Cavatello informed him that he could lie down and get some sleep during his "break." During breaktimes, nurses are considered to be "off-duty". Such was the policy at that time at Leesburg Center Health Care and Nursing Home. During his breaktime, while on duty early on the morning of February 8, 1983, at approximately 2:00 a.m., Respondent was asleep on a stretcher some ten to twelve feet from his duty station while on his break. At that time he was observed by Nursing Director, Shirley Gooden, to be asleep and she awakened him. She inquired as to why he was sleeping on duty and he informed her that he was on his break. Nurse Gooden informed the Respondent that he was not considered to be "on break" because he had not "punched out" on a time clock or card before going on his break as required by the employer's nurses handbook, therefore she immediately terminated him from employment. It was accepted policy and practice at that facility for nurses to be able to sleep while on break, especially on late-night shifts such as the Respondent was employed on, on the night in question. It was also the accepted policy and practice that nurses did not have to "clock in or out" when they were merely taking their authorized breaktime as the Respondent was doing. The Respondent's immediate supervisor, Nurse Cavatello, authorized him to sleep during his breaktime and did not require him to "punch out" or make a formal record of his breaktime on the evening in question. Thus, the Respondent, who was admittedly asleep at the time in question, was not on duty, but rather was on his breaktime, during which he was permitted by his supervisor to sleep. On January 1, 1983, the Respondent submitted his employment application for the position of Licensed Practical Nurse at Leesburg Center Health Care and Nursing Home. On that employment application he indicated that he left his last employment as a deputy sheriff for Polk County for the reason that he wished to return to school to further his education. In reality, the Respondent was terminated from his position as deputy sheriff by the Polk County Sheriff's Department for falsifying an official department record, and for "conduct unbecoming an employee" of the Sheriff's Department. This is the first occasion in which the Respondent has been subjected to disciplinary action with regard to his licensure status by the Petitioner. His record as a licensed practical nurse is otherwise unblemished and he displays a high level of skill and compassion in his nursing duties and in his relations with patients while performing those duties.
Recommendation Having considered the foregoing Findings of Fact and Conclusions of Law, the evidence of record, and the candor and demeanor of the witnesses, it is, therefore RECOMMENDED: That a Final Order be entered by the Board of Nursing issuing a formal reprimand to the Respondent, Richard Womack, imposing a period of probation on his licensure status until such time as he completes a continuing education course in the legal aspects of nursing. DONE and ENTERED this 14th day of March, 1984, in Tallahassee, Florida. P. MICHAEL RUFF 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 14th day of March, 1984. COPIES FURNISHED: Julia P. Forrester, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Richard J. Womack 1607 Stafford Road Leesburg, Florida 32758 Helen P. Keefe, Executive Director Board of Nursing Dept. of Professional Regulation 111 East Coastline Drive, Room 504 Jacksonville, Florida 32202 Fred M. Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
Findings Of Fact At all times material, Respondent was a licensed practical nurse in the State of Florida, having been issued license number 32187-1. During November, 1983, Respondent was employed by On Call Medical Service, a nursing agency which provided care for patient Dee Zenrich. Patient Zenrich resided in the home of Respondent, and Respondent was regularly assigned to provide nursing care to patient Zenrich during November, 1983. Respondent normally worked one shift of approximately eight hours per day caring for Zenrich. She relieved another On Call Medical Service nurse at the beginning of her shift and was, in turn, relieved by an On Call nurse at the end of her shift. Patient Zenrich suffers from Amyotrophic Lateral Sclerosis (ALS) and requires twenty-four hour skilled nursing care since she is on a respirator and requires frequent suctioning. Further, the patient is completely immobile and can only communicate by blinking her eyes and through a number board. The testimony of the medical witnesses established that patient Zenrich requires constant observation. Thus, any absence from her bedside by the attending nurse poses some risk. During the week of November 7 to 13, a relieving nurse observed Respondent, while she was the duty nurse, briefly leave Zenrich unattended to visit with a friend in the kitchen and, on another occasion, to take a shower. She also was observed in bed sleeping with the patient while on duty during this period. On November 22, 1983, Zenrich's medical condition required her to be transported by ambulance to the Navy hospital emergency room. Since two nurses were required to transport Zenrich, Respondent was asked to go on duty to transport the patient. Respondent had not been scheduled to go on duty and had been consuming alcohol. However, she continued to drink after she was reminded by an On Call administrator that she was on duty. Although Respondent's close relationship with the patient prompted her to accept the unscheduled assignment, she was nonetheless on duty and should not have continued to consume alcohol. Respondent also behaved in a belligerent manner toward hospital staff at the emergency room but this was apparently out of concern for the rough handling she believed patient Zenrich was receiving. Patient Zenrich was admitted to the hospital in late November, 1983. Based upon nutritional studies and her continuing problem of ingesting sufficient food, a physician recommended insertion of a gastrostomy tube. While on duty as a nurse and in the presence of the patient, Respondent angrily questioned the physician's recommendation and was verbally abusive about the physician. Again, however, this questionable conduct was at least well motivated and arose from Respondent's sincere concern for the patient. In addition to the November 22 incident discussed above, an On Call Medical Services nurse observed Respondent drinking while on duty during the week of November 7-13, 1983, and on duty while under the apparent influence of alcohol on November 17 and 23, 1983. On these two occasions, Respondent smelled of alcohol, exhibited slurred speech, bloodshot eyes and staggering. Respondent admits that she does drink alcohol prior to going on duty, but contends that the quantities are limited. She denies any on-duty drinking (except as noted below) and believes that she is never under the influence of alcohol when on duty. Respondent concedes that she did drink on November 22, the day patient Zenrich was taken to the hospital, but points out that she was not the primary care nurse and thought she was merely accompanying the patient as a friend. She did not recall receiving any pay for her services that day and did not believe she was officially on duty at the time. The testimony of both Petitioner's and Respondent's witnesses established that Respondent is an exceptionally caring nurse with respect to patient Zenrich, and enjoys the complete trust of the patient and her family. Petitioner's witnesses attested to several instances where Respondent spoke out angrily in patient Zenrich's presence and thus, in their view, upset the patient. However, these outbursts did not disturb the patient and must be attributed to Respondent's sometimes abrupt demeanor, rather than loss of emotional control.
Recommendation From the foregoing, it is RECOMMENDED that Petitioner enter a Final Order suspending Respondent from the practice of nursing until she demonstrates that she has submitted to psychiatric evaluation and/or treatment for alcohol abuse and is found capable of safely caring for medical patients by the evaluating or treating physician. DONE and ORDERED this 2nd day of January, 1985 in Tallahassee, Florida. R. T. CARPENTER 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 2nd day of January, 1985.
The Issue Whether the Respondent committed the offenses set forth in the Administrative Complaint and , if so, what disciplinary action should be taken.
Findings Of Fact Respondent, Dalia V. Gonzalez, was at all times material hereto, licensed as a registered nurse in the State of Florida, having been issued license number RN 88664-2. On August 16, 1988, Respondent was employed as a charge nurse for the skilled unit portion of a floor at Coral Gables Convalescent Center. The remaining portion of the floor was a long term intermediate care unit with a licensed practical nurse, Ms. Jane Reilly Perkins, serving as charge nurse for said unit. During the change of shifts and between 6:30 a.m. and 7:00 a.m. on August 16, 1988, a threatening argument, over the number of personnel assigned to each portion of the floor, arose between Respondent and Ms. Reilly who was accompanied by another licensed practical nurse. Ms. Reilly is a female of physically imposing stature; therefore, Respondent, reasonably fearing her safety, locked herself in her office and called her supervisor to ask for assistance. Respondent remained locked in her office for approximately two hours awaiting the arrival of her supervisor. During this time, Respondent was in constant contact with the other medical personnel on her floor. Although she was the only registered nurse present, her personal service as a registered nurse was not required at the time nor was she prohibited from giving it had the necessity arisen. When Respondent's supervisor, a registered nurse, arrived, they discussed the situation with Ms. Reilly. During this discussion, Respondent gave her first notice of intent to leave her position. After being informed that if she left, she would lose her position at Coral Gables Convalescent Center, Respondent handed her keys to her supervisor and left the facility not completing her assigned shift. While Respondent was available to her patients, although locked in her office during her shift, she did leave her nursing assignment without notifying her supervisor of her intent to leave within sufficient time to allow substitute arrangements to be made. Respondent's notice was improper Consequently, Respondent acted with unprofessional conduct.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED the a final order be entered reprimanding Petitioner. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 19 day of June 1989. JANE C. HAYMAN 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 Administrative Hearings this 19 day of June 1989. APPENDIX TO RECOMMENDED ORDER CASE NO. 89-325 Petitioner's proposed findings of fact are addressed as follows: Addressed in paragraph 1. Addressed in paragraph 1. Addressed in paragraph 2. Addressed in paragraph 2. Addressed in paragraph 3. Not necessary to result reached. Addressed in paragraph 2. Addressed in paragraph 3. Addressed in paragraph 3. To the extent supported by competent proof, addressed in paragraph 3. Addressed in paragraph 4. Subordinate to the result reached. Subordinate to the result reached. Addressed in paragraph 6. Not supported by competent and substantial evidence. Addressed in paragraph 5. Not supported by competent and substantial evidence. Not supported by competent and substantial evidence. Addressed in paragraph 6. Addressed in paragraph 6. Addressed in paragraph 5. Not supported by competent and substantial evidence. Not supported by competent and substantial evidence. Not supported by competent and substantial evidence. Addressed in paragraph 6. COPIES FURNISHED: Lisa M. Basset, Esquire Department of Professional Regulation 1940 North Monroe Street Suite 60 Tallahassee, Florida 32399-0729 Santiago Pellegrini, Esquire 1570 Northwest Fourteenth Street Miami, Florida 33125 Judie Ritter Executive Director Board of Nursing 504 Daniel Building 111 East Coastline Drive Jacksonville, Florida 32201 Kenneth E. Easley General Counsel Department of Professional Regulation 1940 North Monroe Street Suite 60 Tallahassee, Florida 32399-0729 =================================================================
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
The Issue The issue posed for decision herein is whether or not the Respondent, based on conduct which will he set forth hereinafter in detail, engaged in acts and/conduct violative of Subsection 464.21(1)(d) and (g), Florida Statutes.
Findings Of Fact Based on my observation of the witnesses and their demeanor while testifying, the arguments of counsel, the documentary evidence received and the entire record compiled herein, the following relevant facts are found. Michael Ray Hernicz, R.N., is a licensed registered nurse who holds license No. 0985972. Additionally, the Respondent has been certified as a Certified Registered Nurse Anesthetist (CRNA) and an Advanced Registered Nurse Practitioner (APNP). By its eight-count Administrative Complaint filed March 14, 1979, the Petitioner, Florida State Board of Nursing, seeks to place on probation, suspend or revoke the Respondent's license to practice nursing based on allegations that: During the week of January 15, 1979, Respondent caused to be advertised in the DeLand Sun News, a newspaper of general circulation the opening of an office in the 4 Towns Shopping Center, Orange City, Florida, for the general practice of medicine and used in connection with his name designation, "M.D." to imply or designate himself as a medical practitioner while not licensed, in violation of Florida Statutes Sec. 458.152(a), (b) and (c). On or about February 9, 1979, in Orange City, Florida, Respondent administered medical treatment to Steven H. Gaffney which action was not within the purview of the Nurse Practice Act, Florida Statutes Chapter 464. On or about February 9, 1979, Respondent practiced medicine as defined by Florida Statutes Sec. 458.13, in that he diagnosed, treated and prescribed medication for Steven Gaffney although not licensed to practice medicine in Florida and without the responsible supervisory control of a licensed physician, in violation of Chapter 453 and the Nurse Practices Act, Chapter 464, Florida Statutes. On or about February 16, 1979, Respondent was arrested by law enforcement officers of the Volusia County Narcotics Task Force at his office in Orange City, Florida, and was found to be in unlawful possession of controlled substances as set forth in Florida Statutes Chapter 893. On or about February, 1979, Respondent, for a fee, treated and prescribed medication for patient, Gladys M. Mossman, which treatments and medications were not prescribed or authorized by a person licensed to practice medicine in Florida. Respondent, for a fee, also treated and administered medications to cardiac patient, Nils Ljunberg, which treatment and medications were not prescribed or authorized by a person licensed in the State to prescribe medications or treatment, in violations of Florida Statutes Chapters 458 and 464. On numerous occasions from January 15, 1979, through February 9, 1979, Respondent unlawfully practiced medicine in violation of Chapter 458 by prescribing medications for various patients and treating said patients when he was not licensed to do so and while he was not acting under the responsible supervisory control of a licensed physician or without the purview of the Nurse Practices Act, Florida Statutes Chapter 464. In conclusory fashion, it is alleged that the Respondent is therefore guilty of engaging in the possession of controlled substances as set forth in Chapter 893, Florida Statutes, in violation of Florida Statutes 464.21(1)(d) and (g). The facts surrounding the allegations in the Administrative Complaint filed herein are not in dispute. What is in dispute, however, is the nature and scope of treatment authorized by nurse practitioners, such as Respondent, in view of the additional acts apparently approved by the Joint Advisory Committee on Advanced Nursing Practices. Section 464.021, Florida Statutes. Respecting the allegations that the Respondent caused to be advertised in the DeLand Sun News, an advertisement to the effect that he was opening an office for the general practice of medicine, Steve Blais, an advertising official of the Deland Sun News, appeared and testified that the day following the advertisement which appeared in the local paper, Respondent telephoned his office to alert the paper's advertising staff that a mistake had been made and that the initials "M.D." should not have followed the designation in his ad as he was not a licensed medical doctor in Florida. Mr. Steve Blais offered Respondent a letter of correction such that he could show to customers or anyone who needed documentation. Mr. Blais testified that the ad with the M.D. format ran on January 13, 14 and 17, and that the change was made on or about January 24 to delete the designation "M.D." from the ad. As stated, the facts surrounding the treatment aspect of the allegations are undisputed. However, Respondent contends that based on the supervisory arrangements and the written protocol that he had with Dr. Randal Whitney, M.D., and the working relationship that he had with Dr. Jeffrey Rudell, he was authorized to do the acts which he is here charged with as being violative of the Nurse Practice Act and Chapters 458 and 893, Florida Statutes. As originally conceived, the Respondent planned to practice with Dr. Jeffrey Rudell, who was then licensed in Alabama and who had applied for licensure by endorsement in Florida. This application by Dr. Rudell for licensure by endorsement was denied and Respondent entered into a supervisory relationship with Dr. Randal Whitney of Daytona Beach, Florida. Dr. Whitney appeared and testified that he had in fact entered into a supervisory relationship with Respondent and that he was consulted by Respondent on the treatment of several patients. Dr. Whitney's testimony is that of these patients about when Respondent consulted with him, he concurred with the method of treatment outlined and/or prescribed by Respondent. Respondent testified that he reached a decision that he could properly treat patients while working under the supervision and control of a licensed medical doctor or other specialized practitioner after considerable reflection on the latitude granted Advanced Registered Nurse Practitioners. In support of this decision, Respondent points to the fact that the Joint Committee, by its official Minutes, pointed out in Section 210-11.03, acts which were proper to be performed by an Advanced Registered Nurse Practitioner. Therein, the Board authorized various categories of functions that Advanced Registered Nurse Practitioners may perform at advanced and special levels which are recognized by the nursing profession and which are currently included in the curricula of advanced nursing education programs by the Board (Petitioner). Additionally, the Board authorized Advanced Registered Nurse Practitioners to perform such additional acts as was recognized by the Advisory Committee created by Florida Statutes Subsection 464.021(2)(a)(4) as proper to be performed by an Advanced Registered Nurse Practitioner. Petitioner requested the minutes from numerous meetings of the Board from 1977 through 1978 and noted that Board Member Charles D. MacIntosh during a meeting with the Board of Nursing advised that the Board of Medical Examiners had met on April 2, 1978, and ratified a new appendix D regarding Advanced Registered Nurse Practitioners. Dr. MacIntosh urged the Board that in light of the ratification by the Board of Medical Examiners, the Joint Advisory Committee should jointly meet to work out a proposed formulary of drugs that would he available to Advanced Registered Nurse Practitioners. The Board thanked Dr. MacIntosh for apprising them of the medical board's actions and Petitioner's counsel stated his opinion that, based upon the interpretations of subject Section 465.031, no conflict would result if the Joint Advisory Committee agreed that prescriptions and medications would be an additional act defined by Florida Statutes 464.021. Page 4 of the minutes indicate that with respect to Advanced Registered Nurse Practitioners, they are authorized to perform those additional acts which are performed within protocols which are jointly established by the Advanced Registered Nurse Practitioner and the M.D., D.O., or D.D.S., or the appropriate medical staff of a healthcare facility. Respondent entered into an arrangement with Dr. Whitney and explained to him the manner in which he expected to treat patients coming to his office and Dr. Whitney agreed to allow him the latitude he envisioned. (TR 259 through 261.) Accordingly, Respondent perceived his actions as falling within the purview of the regulation authorized by the joint committee. (TR 263 through 264.) Additionally, Respondent denied that he represented to anyone in this State that he was a licensed medical doctor. Respondent reiterated his position that he immediately notified the paper and asked them to change the designation to reflect that he was not a medical doctor. (Respondent's Exhibit 17.) On February 16, 1979, Respondent's office was searched by the law enforcement officers of Volusia County Narcotics Task Force in Orange City, Florida, and Respondent was given a list of drugs taken from his office by the law enforcement officers. (Petitioner's Exhibit 5.) No evidence was offered to establish that the Respondent has been found guilty of the unlawful possession of controlled substances as set forth and defined in Florida Statutes Chapter 893.
Conclusions In summation, the Respondent established that he, in addition to being a Registered Nurse, has been further certified as an Advanced Registered Nurse Anesthetist. Dr. Randal Whitney established that he entered a relationship with Respondent under the laws of the State of Florida to be his supervisory or sponsoring physician, to consult with him in the practice, and to call or talk personally with Respondent about problems or cases that might be a potential problem or possibly outside his field of expertise as to what to do about them. A similar arrangement was shown to exist between the Respondent and Dr. Paul Andrews, Additionally, Dr. Rene Almiron, M.D., testified that he agreed to read and interpret EKG's for Respondent. Subsection 464.021(2)(a), Florida Statutes, provides that performance of assessment, diagnosis, counselling and health teaching of the ill are within the definition of professional nursing. It thus appears that all of the acts and/or conduct engaged in by Respondent were permissible acts within the responsible supervisory control of Dr. Randal Whitney or were for medications within the approved formulary for Advanced Registered Nurse Practitioners. Respondent credibly testified that he consulted with Dr. Whitney, who supervised him in the treatment of all of his patients. (TR 261.) Finally, although it was alleged in Count IV of the Administrative Complaint that Respondent was found to be in the unlawful possession of controlled substances in violation of Florida Statutes Chapter 893, the Respondent denies this, and no evidence was offered by Petitioner to counter Respondent's assertion. The record herein reflects that while some of Respondent's acts and/or practices may have been questionable based on the conflicting directions embarked upon by the various joint committees, in view of the latitude granted to Advanced Registered Nurse Practitioners by the Nurse Practices Act and the established working relationship entered into between Respondent and Dr. Randal Whitney, the undersigned concludes that Respondent acted within his authority in his treatment of patients referred to herein. I shall so recommend.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is hereby, RECOMMENDED: That the Administrative Complaint filed herein be DISMISSED IN ITS ENTIRETY. RECOMMENDED this 4th day of December, 1979, in Tallahassee, Florida. JAMES E. BRADWELL, Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675
