The Issue Whether the license of Respondent Judith M. H. Bandlow Gioia, R.N. #26105- 2 should be suspended or revoked, or whether Respondent should be put on probation or otherwise disciplined.
Findings Of Fact During the period of time from March 1, 1978 through March 13, 1978, while employed as a Registered Nurse at Wuesthoff Memorial Hospital, Cocoa, Florida, Respondent converted to her own use on numerous occasions, a controlled narcotic drug, to wit: Demerol (meperidine) and injected herself with said narcotic on a daily basis. Respondent altered the narcotic control record in order to hide the taking of said drugs noted in the foregoing paragraph and, in some instances, failed to chart the narcotic on the patient's medication sheet or nurses notes. On or about March 13, 1978, on being confronted with the facts stated in the foregoing paragraphs 2 and 3 by the Director of Nurses, Nelda C. Mitchell, R.N., Respondent admitted her guilt and at that time gave Ms. Mitchell four ampules of Demerol 100 mg. which she had in her uniform pocket. Respondent was thereupon discharged from her position on March 13, 1978. The Petitioner, State Board of Nursing, filed an administrative complaint against Respondent on March 27, 1978 charging Respondent with unprofessional conduct and with engaging in the possession of controlled substances contrary to Chapter 464 Florida Statutes. Respondent was notified that unless she requested an administrative hearing the Board would either place the license of Respondent on probation or suspend or revoke her license as a Registered Nurse. Petitioner requested an administrative hearing. Respondent at the hearing admitted allegations one to four (4) of the administrative complaint and conceded such conduct was in violation of Section 464.21(1)(b) and 464.21(1)(d) The Respondent through her attorney, and personally, testified that she requested the hearing, not to refute the allegations of the complaint but to mitigate the action pending by the State Board of Nursing. A deposition entered into evidence by Respondent, without objection from the Petitioner, was taken on behalf of the Respondent. The witness was Cynthia H. Clowes, the therapist of Respondent when she was admitted to the Palm Beach Institute on March 16, 1978. Ms. Clowes stated that if the Respondent were to undergo therapy by a person qualified in giving therapy in addiction that at the end of two years, more or less, Respondent would be ready to be exposed to access to drugs. She did not recommend that Respondent be exposed to drugs at the time of the deposition on August 7, 1978. Ms. Clowes recommended that Respondent regularly attend Alcoholics Anonymous meetings. It was Ms. Clowes' opinion that Respondent Gioia had the capability to resume her duties as a nurse on a part-time, but not a full-time basis. The parties agreed that Michelle E. Vollard, Out-patient Therapist Substance Abuse Services, Brevard County Mental Health Center, Inc. would submit a statement to the Hearing Officer subsequent to the hearing. The letter was received December 1, 1978 in the office of the Hearing Officer and was signed by Michelle Vollard, Out-patient Therapist Substance Abuse Services and Rene S. Turla, M.D., Team Psychiatrist. The statement recommends that Ms. Gioia continue individual counselling for a period of at least a year and recommended that her access to narcotic drugs be limited, if not totally eliminated, while she is undergoing therapy. It was recommended that the Respondent attend an alcoholic orientation (education group), and an ongoing alcohol group. The Hearing Officer further finds: Subsequent to her discharge from Wuesthoff Memorial Hospital Respondent voluntarily placed herself in the Palm Beach Institute for a period of six weeks. The purpose was to seek treatment for an apparent addiction to Demerol and to alcoholic substances. After leaving the Palm Beach Institute as an impatient she returned on several occasions to consult with her therapist as an outpatient. She has attended meetings of Alcoholics Anonymous in Brevard County and has sought aid of the Brevard County Mental Health Center. Respondent is at present under stress and may take narcotic drugs without a prescrip- tion, and may also drink alcoholic beverages to excess. She should continue treatment to control alcohol consumption. Respondent should have no access to drugs prescribed for patients.
Recommendation Suspend the license of Respondent for a period of no less than two years. DONE and ENTERED this 18th day of December, 1978, in Tallahassee, Florida. DELPHENE C. STRICKLAND Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675 COPIES FURNISHED: Richard A. Gescheidt, Esquire Amdur Building - Suite 2-D 40 Southeast First Avenue Boca Raton, Florida 33432 Julius Finegold, Esquire 1107 Blackstone Building 233 East Bay Street Jacksonville, Florida 32202 Geraldine B. Johnson, R.N. Investigation & Licensing Coordinator State Board of Nursing 6501 Arlington Expressway Building B. Jacksonville, Florida 32211
Findings Of Fact Jane Ruth Burch Harrison, the Licensee, is a registered nurse in this state and holds license no. 18473-2. On or about October 15, 1976, Elsie McGuigan, an L.P.N. employed by Division Hospital in Lake City, Florida observed the Licensee on duty and appearing to be intoxicated to the extent that she was unable to carry out her duties as a registered nurse. Specifically, Ms. McGuigan observed the Respondent attempting to chart while she was in a daze. She attempted to get some assistance from the Licensee due to the heavy patient load on the three to eleven shift but the Licensee was unable to assist her due to her condition. Ms. McGuigan thereafter summoned Mary E. DePew, the Director of Nursing for the Division Hospital, and advised her of the Licensee's inability to function and the concern she had of the patient's well being. In so doing, she observed one patient who was receiving cardiac treatment and felt that the services of a doctor were necessary to check the patient's condition. Mrs. Ann Gurtler, an R.N. for approximately 34 years and an employee at Division Hospital, was also summoned on October 15, 1976 to assist with the patient load due to the Licensee's inability to function. She testified that one patient, Elsie Hilliard was suffering from asthma and breathing difficulties and required oxygen treatment to stabilize her condition. Trixie Mitchell, a nurses aide, while on duty on October 15, 1976 spoke to Respondent who was seen crying. She attempted to calm the Licensee down and told her that her problems should not be regarded as insurmountable. Mrs. DePew summoned a taxi to the hospital to take the Licensee home inasmuch as she was under the influence of alcohol. Shortly thereafter, the Respondent admitted herself for treatment at an alcoholic rehabilitation center at the Lake City Alcoholic Center and was confined for a period of one week. Upon her release, she was put on antabuse by Dr. John Philpot and returned to work at the Division Hospital. On May 10, 1977, while on duty, Respondent became intoxicated to the extent that she was unable to function as a nurse and was terminated from her employment by Ms. Depew. The Respondent admitted that she reported to work while under the influence of alcohol and/or drugs. She testified that she did so based on the numerous matrimonial problems that she was having. She testified that her divorce had recently become final and that she had suffered a traumatic episode shortly after her divorce became final. She testified that her son recently became addicted to drugs and while driving in her car had an accident and critically injured a passenger. Licensee acknowledge the seriousness of the problems and the conduct in which she engaged in by reporting to work on October 15 and on May 10, 1977 in an intoxicated state. She testified that these were isolated incidents which should not overshadow her total performance which had been adequate and resulted in no injury to patients. She is presently undergoing alcoholic treatment at the local alcoholic rehabilitation center and feels that she has put her alcoholic and drug problems behind her. Based on the foregoing facts, the undersigned concludes that the Licensee has engaged in conduct violative of Chapter 464.21, Florida Statutes, as alleged. In view of the creditable testimony that the Licensee has submitted to treatment to cure her problems which she admitted, I shall recommend that the Licensee be placed on probation for a period of two years. In so doing, consideration was given to the fact that the Licensee recognized the seriousness of the problem which she is now suffering from and her voluntary submission to treatment at the local alcoholic rehabilitation center.
Recommendation Based on the foregoing findings of fact and conclusions of law, I hereby recommend that the Licensee be placed on probation for a period of two years. RECOMMENDED THIS 3rd day of August, 1977, in Tallahassee Florida. JAMES E. BRADWELL, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1005 Blackstone Building Jacksonville, Florida 32201 Jane Ruth Burch Harrison 2620 South Marion Street M4 Lake City, Florida 32055
Conclusions THIS CAUSE came on for consideration before the Agency for Health Care Administration (“the Agency”), which finds and concludes as follows: 1. The Agency issued the Respondent (“the Applicant”) the attached Notice of Intent to Deny Application for licensure (Ex. 1), The parties entered into the attached Settlement Agreement (Ex. 2), which is adopted and incorporated by reference. 2. The parties shall comply with the terms of the Settlement Agreement. If the Agency has not already completed its review of the application, it shall resume its review of the application. 3. Any requests for an administrative hearing are withdrawn. The parties shall bear their own costs and attorney’s fees. This matter is closed. DONE and ORDERED in Tallahassee, Florida, on this_/f day of eat 0. Thomas W. Afyold, Secretary Agency for Heath Care Administration
Other Judicial Opinions A party that is adversely affected by this Final Order is entitled to seek judicial review which shall be instituted by filing one copy of a notice of appeal with the agency clerk of AHCA, and a second copy, along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district where the agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The notice of appeal must be filed within 30 days of rendition of the order to be reviewed. CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of this Final Order was served on the below- named persons/entities by the method designated on this ; Z ay of -eeg Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308-5403 Telephone (850) 922-5873 Jan Mills Facilities Intake Unit _ Agency for Health Care Administration (Interoffice Mail) Roger Bell, Unit Manager Health Care Clinic Unit Agency for Health Care Administration (Interoffice Mail) Dwight O. Slater, Asst. General Counsel Office of the General Counsel Agency for Health Care Administration (Interoffice Mail) Gus Suarez, P.A. 5201 Blue Lagoon Drive, Suite #270 Miami, Florida 33126 (U.S. Mail) Claude B. Arrington Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (U.S. Mail)
Findings Of Fact Cirilo Alvarez, at all times pertinent to the allegations in the complaint, operated an adult congregate living facility in Lake City, Columbia County, Florida, Briar's Haven Adult Care Center, under license number 03-12- 0128-BPS, issued by the Florida Department of Health and Rehabilitative Services. In late July or early August, 1982, Respondent, who is a psychiatric nurse specialist and who works full time at North Florida State Mental Hospital (Hospital) at Macclenny, Florida, took Woodrow Harrison, an elderly patient at that institution, into his home, Briar's Haven Adult Care Center, on pass status from the Hospital for periodic short visits. Ultimately, on July 30, 1982, Harrison was released from Macclenny and began living full time at Respondent's facility. On August 3, 1982, Sharon Stucky, a registered nurse case manager for the North Florida Mental Health Center (Center) in Lake City, Florida, did an intake interview with Harrison, who had just been released from the Hospital and who was living at Respondent's facility. Mr. Harrison was brought into the Center by Respondent's wife. Records from the Hospital pertaining to Harrison, which came to the Center, reflected that he suffered from a seizure disorder and a diabetic condition. His medication consisted of 300 mg. of Dilantin daily and 30 mg. of phenobarbital daily, and he was to receive a daily insulin injection. At the time of his release from the Hospital, he was furnished with a thirty-day supply of these medications. On the afternoon of August 13, 1982, Mr. Alvarez went into the Center with Mr. Harrison and asked to see Ms. Stucky. Respondent indicated that Mr. Harrison was having many physical problems. Earlier in the day, he had taken Harrison back to Macclenny to have him readmitted for seizures, incontinence, etc., even though he was taking his medications, but officials at the Hospital refused to admit him. Mr. Alvarez wanted him admitted to some facility in Lake City. Stucky, indicating she would have to talk with Harrison before taking any action, did so and felt she could see no change in his condition since her first interview of him on August 3, and she decided she could not justify having him recommitted to the mental hospital. Since Stucky wanted to find out if the seizures were the result of a physical problem, and she could not do a physical herself, she requested that Respondent take Harrison to a doctor for an examination. The Respondent again demanded that Harrison be admitted and, when Ms. Stucky refused, stated he would take Harrison to the hospital and leave him. Ms. Stucky talked with her supervisor to see if there was any way that Harrison could be readmitted to Macclenny, and it was determined there was not. When the information was related to Mr. Alvarez, he departed with Mr. Harrison. Respondent then took Harrison to the emergency room at Lake City's Lake Shore Hospital. After a chart was prepared on Harrison, Alvarez departed, leaving Harrison there without his medications. When Alvarez first took Harrison in, he was told there would be an hour wait before Harrison could be seen. Alvarez asked if Harrison could sit there and wait, and the person on duty said, "Yes." Once that was arranged, Respondent left without Harrison. According to a report of the doctor on duty, Harrison was confused and incapable of giving a complaint or history. As a result, evaluation of him was difficult, and his well-being was compromised. Respondent subsequently made no effort to get Harrison's drugs to him by delivering them to Ms. Stuckv, nor did he inquire where Harrison was. Respondent's actions in dropping Mr. Harrison off at the Lake Shore Hospital unsupervised, and only calling to check on his status somewhat later, constitute an intentional abandonment which could have seriously affected Harrison's health, safety, and welfare. Somewhat later the same day, Respondent called Lake Shore Hospital to find out what Harrison's status was, but Harrison had already been placed in another adult care facility by Ms. Stucky when the hospital called her and told her of Harrison's situation. Respondent did not make any other calls. Ms. Stucky visited Harrison daily at this new facility and administered his insulin shot. He appeared to be doing well there and wanted to remain, but on August 17, 1982, he was readmitted to Macclenny, where he currently resides. Harrison is incapable of taking care of himself. He has a poor memory and is somewhat retarded and childlike, according to Stucky. He has no concept of time and could not administer his medicines to himself. He could not understand the need to take his medicine or remember to take it if he could. Since Mr. Harrison was dropped off at Lake Shore without either his medicines or a change of clothing, Stucky made several telephone calls to the Respondent to retrieve them. Mr. Alvarez was always out when she called, and Stucky talked with several different females who answered the phone and with whom she left messages requesting him to call her back. Alvarez did not return any of the calls, but he states he never received them. This is rossible since, he says, neither his mother nor his wife, two of the people at home who may have received the original calls from Stucky, speaks much English. Respondent provided Mr. Harrison with all the clothes he had except those he was wearing when he came from Macclenny. Upon the advice of individuals at Macclenny who he could not remember to identify, Respondent applied for Social Security benefits to support Harrison while he was at Respondent's facility. Because Harrison had no family, Respondent sought the counsel of the legal aid office in Lake City to see if he could be appointed Harrison's legal guardian and was told he could not. In late January or early February, 1983, Respondent received one Social Security check in the amount of $1,900 made out to Harrison and Mrs. Alvarez. This check was not cashed because Harrison was no longer with the Respondent, but was returned to the Social Security Office. Harrison's medicines that were in Respondent's possession when Harrison was taken to the hospital were discarded. Respondent worked with Harrison at Macclenny for about a year before taking him to his own facility. During that time to his knowledge, Harrison never had any seizures. Respondent gave him his medications at Macclenny and knew he needed drugs. When he took Harrison to his facility, he took Harrison's drugs as well.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED: That the Secretary of the Department of Health and Rehabilitative Services enter a final order revoking the Adult Congregate Living Facility License of Cirilo Alvarez, doing business as Briar's Haven Adult Care Center. RECOMMENDED this 1st day of April, 1983 in Tallahassee, Florida. ARNOLD H. POLLOCK 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 1st day of April, 1983. COPIES FURNISHED: James A. Sawyer, Jr., Esquire District III Legal Counsel Department of Health and Rehabilitative Services 2002 NW 13th Street, 4th Floor Gainesville, Florida 32601 Mr. Cirilo Alvarez Post Office Box 2392 Lake City, Florida 32055 Mr. David H. Pingree Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32301
Conclusions THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The parties are directed to comply with the terms of the attached settlement agreement, attached hereto and incorporated herein as Exhibit “1.” Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the GE. day of ach , 2015, in Tallahassee, Florida. Led ELIZABETH DUDEK, SECRETARY Agency for Health Care Administration Final Order Engagement Nos. NH11-039L - NH11-044L Page 3 of 5 A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Andy Page 2501 Blue Ridge Road, Suite 500 Raleigh, North Carolina 27607 (Via U.S. Mail) Bureau of Health Quality Assurance Agency for Health Care Administration (Interoffice Mail) Stuart Williams, General Counsel Agency for Health Care Administration (Interoffice Mail) Shena Grantham, Chief Medicaid FFS Counsel Agency for Health Care Administration (Interoffice Mail) Agency for Health Care Administration Bureau of Finance and Accounting (Interoffice Mail) Zainab Day, Medicaid Audit Services Agency for Health Care Administration (Interoffice Mail) Kristin Bigham Assistant Attorney General Office of the Attorney General (Via Interoffice Mail) State of Florida, Division of Administrative Hearings The Desoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (Via U.S. Mail) Final Order Engagement Nos. NH11-039L - NH11-044L Page 4 of 5 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to orl the above named addressees by U.S. Mail on this the Fin of VA YA re £ , 2015. Richard J. Shoop, Esquire” Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 Final Order Engagement Nos. NH11-039L - NH11-044L Page 5 of 5
Findings Of Fact Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant facts are found: Dr. Maxine Rowland (formerly Maxine Moody) was licensed to practice medicine in the State of Florida under license No. ME0013726, issued on August 30, 1968, by the State Board of Medical Examiners of Florida after graduation from medical school at the University of Florida on June 18, 1967, and an internship at Cincinnati General Hospital from June 28, 1967, to June 28, 1968. Dr. Rowland was married to another physician, John Henry Rowland, Jr., in Pompano Beach, Florida, on June 14, 1969, and does not appear to have practiced medicine, thereafter choosing instead to pursue a career as wife and mother. Her license subsequently went inactive on December 31, 1978. In 1981, she requested her license to be reactivated; and at the time of the hearing, her license was in full force and effect. Respondent's husband died in 1975, leaving her with three children whom she continued to rear until she was overcome by extreme fear and depression arising out of a delayed reaction to her husband's death. As a result, she began to drink alcoholic drinks excessively and ultimately placed herself in the hands of a psychiatrist who, in the course of treatment, prescribed drugs for her. The combination of drugs and alcohol reacted adversely on her. She was admitted to the St. Johns River Hospital on five different occasions between May, 1981, and February, 1982. In addition, she was involuntarily committed to the impaired Physician's Program at South Miami Hospital in November, 1981, and was also treated involuntarily at Ridgeview Clinic in Georgia in February, 1982. Both admissions were for psychiatric disorders due to alcohol or drug abuse. She was diagnosed as suffering from a schizophrenic reaction (acute and chronic) which manifested itself in a lack of insight, poor judgment, suspicion, and alleged violent behavior, while admitted to Ridgeview. During the course of her treatment at the St. Johns River Hospital during the period May, 1981, through February, 1982, Dr. David W. Cheshire, a board eligible psychiatrist, worked with her and concluded that Dr. Rowland suffered from a depressive reaction and alcoholism, as well as a manic- depressive psychosis and symptoms of acute, chronic, schizophrenic reaction. She was paranoid, delusional, and her ability to function had deteriorated, as had her personal hygiene. She was agitated, anxious, and confused. Though Dr. Cheshire did not file a formal complaint with the Department of Professional Regulation concerning Dr. Rowland; during the course of a conversation with a Department of Professional Regulation representative about another matter, he indicated that before she was permitted to return to the practice of medicine, she should be evaluated further because she was mentally ill and incapable of practicing medicine. On December 23, 1982, at the direction of the Secretary of the Department of Professional Regulation, Dr. Rowland was evaluated by Dr. Ernest C. Miller, a psychiatrist on the staff of the University Hospital of Jacksonville. Dr. Miller concluded, after examination, that she currently exhibits a hypomanic mood with verbal pressure, some hostility, and defensiveness as a result of this proceeding and a trend, short of being delusional, toward persecutory ideation. This constitutes an atypical, bipolar disorder which, he feels, should not, alone, deprive her of her medical license. He recommends that she be permitted to work as a physician under Supervision conditioned upon her receiving continued psychiatric counseling. In Dr. Miller's opinion, Dr. Rowland has the potential for positive contribution in the field of medicine; and with a successful combination of a structured medical environment and treatment, she can be rehabilitated. Dr. Rowland alleges she has not had any alcohol for at least nine months, and this allegation was repeated to Dr. Miller. There is no evidence to the contrary. Dr. Rowland further alleges that during her illness, her children and her funds were taken from her by her father under a power of attorney she gave him at the time. Using that power, he converted all of her funds to the names of her children, and she is presently without funds. Dr. Rowland indicates she has been quite active over the past few months in drug and alcohol abuse work on a voluntary basis and has also felt totally well since she is no longer under the care of psychiatrists whom she blames primarily for her condition. She intends, when able to do so, to undergo another residency to prepare herself to enter the practice of medicine as an emergency room physician.
Recommendation Based upon the Findings of Fact and Conclusions of Law recited herein, it is RECOMMENDED THAT: The Respondent be found subject to disciplinary action under Florida Statutes Section 458.331(1)(s). The license of the Respondent, Maxine Moody Rowland, to practice medicine in the State of Florida be restricted and limited to practice while under the supervision of a licensed physician and with the further proviso that she receive continued psychiatric counseling as deemed necessary by her treating physician. The restrictions and limitations continue until such time and under such terms and conditions as the Hoard of Medical Examiners determines is necessary to insure protection of the Respondent's patients and her ability to practice medicine with reasonable skill and safety. RECOMMENDED this 1st day of February, 1983, in Tallahassee, Florida. ARNOLD H. POLLOCK, 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 1st day of February, 1983. COPIES FURNISHED: Charlie L. Adams, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Maxine Rowland, M.D. 4904 Empire Avenue Jacksonville, Florida 32207 Ms. Dorothy Faircloth Executive Director Board of Medical Examiners Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Mr. Fred Roche Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 ================================================================= AGENCY FINAL ORDER ================================================================= STATE OF FLORIDA BEFORE THE BOARD OF MEDICAL EXAMINERS DEPARTMENT OF PROFESSIONAL REGULATION, BOARD OF MEDICAL EXAMINERS, Petitioner, CASE NO: 82-1954 vs. MAXINE ROWLAND, M.D., License Number: 13726, Respondent. /
