The Issue This issue is whether Mr. LaFergola is guilty of misconduct by holding himself as a physician's assistant when he was never licensed as a physician's assistant in the State of Florida and whether he used improper technique in attempting to intubate an infant at Raulerson Memorial Hospital in Okeechobee, Florida, thereby departing from minimal standards of acceptable prevailing nursing practice.
Findings Of Fact Frank LaFergola is licensed as a practical nurse in Florida, holding license 0601421. Mr. LaFergola was employed by Flight Nursing, Inc., an air ambulance company, between September, 1982 and November, 1983. Mr. LaFergola has had no medical training beyond that which he received as a licensed practical nurse. A physician's assistant has a higher level of training than a licensed practical nurse or a registered nurse. Mr. LaFergola has not been trained as a physician's assistant. In April of 1983 Mr. LaFergola represented himself to Dr. Barry D. Chandler as a physician's assistant. He represented to Nancy Northington, a registered nurse, who flew with him for Flight Nursing, Inc. that he was a physician's assistant. Mr. LaFergola represented to Ms. Mary Nara, who is the director of a private technical school and licensed as a licensed practical nurse in Florida, that he was a physician's assistant by presenting her with a certificate from the University of the State of New York showing that Mr. LaFergola held license number 16302 for the biennium ending August 31, 1984 as a registered physician's assistant in New York. These representations were false because Mr. LaFergola has never been licensed as a physician's assistant in Florida or New York. It is dangerous for a licensed practical nurse to misrepresent the status of his training. Mr. LaFergola's representation that he was a physician's assistant caused others engaged in medical practice to permit him to perform actions which they would not have permitted him to perform if they had known the level of his training. On one occasion Nancy Northington, a registered nurse, took an order from Mr. LaFergola concerning intravenous medication for an infant. Mr. LaFergola's instructions were not those which had been given by the attending physician, Dr. Chandler. This change in the instructions endangered the infant. In May, 1983 at Raulerson Memorial Hospital in Okeechobee, Florida, Mr. LaFergola attempted to place an endotracheal tube in a newborn to prepare it for air transportation to another facility. Intubation is a procedure requiring training beyond that of a licensed practical nurse. His attempt to use a laryngoscope during the insertion was incorrect, and he approached the method of insertion of the tube in a manner so wrong that the attending physician stopped him from proceeding with the insertion. Misrepresentation of licensure and training constitutes unprofessional conduct for a nurse. In addition to these cases of misrepresentation to health care providers concerning his status, while employed at Flight Nursing, Inc. Mr. LaFergola signed correspondence on behalf of Flight Nursing, Inc. using the letters "P.A." after his name, representing himself as the "Assistant Flight Medical Director" for Flight Nursing, Inc. Mr. LaFergola was not the Assistant Flight Medical Director of Flight Nursing, Inc. The use of the initials "P.A." after his name was meant to lead those in medical professions who would read the letter to believe that he was a physician's assistant. While at Flight Nursing, Inc., Mr. LaFergola also signed material soliciting business for Flight Nursing, Inc., with the designation "B.S.P.A." after his name. The designation B.S. is commonly recognized as an indication that the person signing the correspondence holds a Bachelor of Science degree. While there is no recognized designation "B.S.P.A", the use of that designation in correspondence would have conveyed to those reading it that Mr. LaFergola held a Bachelor of Science degree and was a physician's assistant. Conspicuously absent from this correspondence is any indication that Mr. LaFergola is a licensed practical nurse. By signing the Flight Nursing, Inc. advertising as he did, Mr. LaFergola intended to mislead other health care personnel regarding his credentials.
Recommendation It is recommended that a final order be entered by the Florida Board of Nursing suspending the license of Frank LaFergola as a licensed practical nurse for one year and fining him $1,000. DONE and ORDERED this 28th day of July, 1987, in Tallahassee, Florida. WILLIAM R. DORSEY, JR. Hearing Officer Division of Administrative Hearings 2009 Apalachee Parkway The Oakland Building Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 28th day of July, 1987. APPENDIX The following are my rulings on the proposed findings of fact submitted by the parties pursuant to Section 120.59(2), Florida Statutes (1985). Rulings on Proposals submitted by the Petitioner Covered in Finding of Fact 1. Covered in Finding of Fact 2. Covered in Finding of Fact 4. Covered in Finding of Fact 3. Covered in Finding of Fact 5. Covered in Findings of Fact 4 and 6. Covered in Finding of Fact 7. Covered in Finding of Fact 8 to the extent it deals with the use of the initials P.A. There is no allegation in the Administrative Complaint of misconduct arising from advertising that Mr. LaFergola was under the direct supervision of Dr. Norman Silverman, and facts concerning that contention are irrelevant. It is inappropriate to use such uncharged misconduct on the issue of the penalty to be imposed because the Respondent had no notice of such charges. Covered in Finding of Fact 9. Rulings on Proposals submitted by the Respondent In general the submission of Mr. LaFergola is in the form of argument rather than findings of fact. The following comments on the proposals can be made. The testimony of Dr. Chandler and Nancy Northington was believable. The suggestion that they should not be believed is rejected. Although the initials B.S.P.A. have no generally accepted meaning, they were intended to have the meaning stated in Finding of Fact 9, which was misleading. Given the Respondent's admission that the signatures on Exhibits 2 and 3 are his, the similarity of the signature on Exhibit 5 to those signatures, as well as identification of the signature on 5 as his by Ms. Nara, is sufficient to admit Exhibit 5. The testimony of Mr. Bovio as corroborated by the deposition testimony of Dr. Fred Brown is sufficient to establish that the intubation attempt made by Mr. LaFergola was improper. The testimony of Ms. Bauman was not based upon the investigative file which was not placed in evidence. There is no reason to strike her testimony. See Transcript page 71. COPIES FURNISHED: Gary D. Beatty, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Mr. Frank LaFergola 177 Doris Avenue Franklin Square, New York 11010 Van Poole, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Joseph A. Sole, General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Judie Ritter, Executive Director Board of Nursing Room 504, 111 East Coastline Drive Jacksonville, Florida 32201
Findings Of Fact Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant facts are found: At all times pertinent to these proceedings, respondent was a licensed practical nurse holding license number 26892-1. The designation of "-1" in the license number is the Board's designation for a licensed practical nurse, and the designation "-2" is for a registered nurse. Respondent is not now and has never been a licensed registered nurse in the State of Florida. In June of 1974, respondent went to the nursing director's office of the Bryan Cameron Community Hospital in Bryan, Ohio, and applied for a position as a registered nurse in the operating room. Respondent could not substantiate that he was a licensed registered nurse. On the day that respondent was to report to work, the hospital administrator, Mr. Rusty O. Brunicardi, told respondent that he was having a problem verifying his registry and asked respondent if he would fill out a form saying that he was a registered nurse. Respondent then filled out and signed a form, witnessed by two persons, certifying that he was a licensed registered nurse in the State of Florida and that, his license number is 26892-1. Mr. Brunicardi also informed respondent that he should contact the Florida State Board of Nursing and have them call him and that, upon Brunicardi's receipt of a call from the Board, respondent could start to work. Respondent indicated to Brunicardi that there was some kind of mixup in the Board's files and that he would straighten it out. Respondent then left and Brunicardi never heard from him again. Respondent began his employment with the Manhattan Convalescent Center in Tampa, Florida, on October 17, 1975. As a part of the orientation procedure for new employees, respondent was made aware of the Center's policy or procedure with respect to patient trust funds. The policy was that when patients with money in their possession are admitted to the Center, the money was to be taken by the admitting nurse to the business office and put into a trust fund account for the patient. After the money had been turned in, the nurse would give the patient a receipt. The business office kept a ledger card for each patient. when a patient requested money, the nurse was to write it down in the trust fund book on the station, take it to the office and deliver the money requested to the patient on the following day. On or about November 20, 1975, Gloria Elizabeth Adams was admitted as a patient to the Manhattan Convalescent Center having in her possession $44.00 in cash. She gave $35.00 of this amount to her admitting nurse, respondent herein, for the purpose of putting it into a trust fund for her. Respondent wrote in his nursing notes on Adams' admission that she had brought money in and that it had been put in her trust fund. A day or two thereafter, respondent asked her to write a check for the trust fund. She asked respondent what had happened to the $35.00 she had previously given him and, not receiving a satisfactory answer, she refused to give him a check. Ms. Adams then went to the desk and asked to withdraw $5.00 from her account. She was told she would receive it the following day. She then saw respondent, who again asked her to write a check for $35.00 for the trust fund. She again refused and told him she had asked to withdraw $5.00 from her account. He then brought her $5.00, and she never saw him again. About a week after Ms. Adams was admitted, the Director of Nursing at the Center, Phyllis Hereford, learned that there was a problem with Ms. Adams' trust fund. Since respondent was Adams' admitting nurse, Ms. Hereford spoke to him about it. He at first told her that he had put the money in an envelope and put the envelope in a narcotic book for Sister Edna Mae, the next nurse coming on duty. Ms. Hereford suggested that he call Sister to see if she remembered. He did so and Sister was very adamant that she did not receive an envelope with money in it in the narcotic book, and that, had the envelope been there, she would have seen it when she was counting drugs. Director Hereford told respondent that since he had mishandled Ms. Adams' money, he was responsible for it and should pay it back. He indicated that he would do so, but he did not return to work more than one day thereafter. The administrator of the Center determined that the missing $30.00 would be deducted from respondent's pay check and placed into the Adams' trust fund. The ledger card for Ms. Adams reveals that on December 9, 1975, a deposit was made for $30.00 "to cover mishandled monies on Station 2." There was nothing on the ledger to indicate that an earlier deposit had ever been made. Ms. Hereford learned that another patient, Doris Clark, had $10.00 mishandled by respondent and the Center deducted $10.00 from respondent's paycheck and reimbursed Clark's trust fund by such amount. No objection or complaint was received by the Center from respondent concerning the $40.00 deduction from his salary.
Recommendation Based upon the findings of fact and conclusions of law recited above, it is recommended that the Board dismiss that charge relating to the monies of Doris Clark; find respondent guilty of unprofessional conduct in his actions surrounding the monies of Ms. Adams; and find respondent guilty of willfully violating F.S. ss. 464.081(1) and 464.24(1)(d) in his actions surrounding his attempt at employment with the Bryan Cameron Community Hospital. It is further recommended that, for such offenses, the Board suspend respondent's license number 26892-1 for a period of one (1) year. Respectfully submitted and entered this 5th day of August, 1976, in Tallahassee, Florida. DIANE D. TREMOR, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Mr. Danny L. Pressler 3 Seashore Drive Ormand Beach, Florida Mr. Danny L. Pressler 307 Southeast Avenue Montpelier, Ohio 43543 Ms. Geraldine Johnson Florida State Board of Nursing 6501 Arlington Expressway Jacksonville, Florida 32211 Julius Finegold 1130 American Heritage Life Building Jacksonville, Florida 32202
The Issue The issue for consideration in this case is whether the Respondent's license as a licensed practical nurse in Florida should be disciplined because of the misconduct alleged in the Administrative Complaint filed herein.
Findings Of Fact At all times pertinent to the allegations herein, the Petitioner, Board of Nursing, was the state agency responsible for the licensing of registered and practical nurses and the regulation of the nursing profession in this state. The Respondent, Virginia Ellen Wright, was a licensed practical nurse employed at Gulf Coast Center, (GCC), an institution for the training and rehabilitation of mentally retarded adults located in Ft. Myers, Florida. On the morning of January 29, 1990, Respondent, who was working the 6:30 AM to 3:00 PM shift in Buchanan and Adams Cottages at GCC, was called to come to the District VIII headquarters to see David Sherwin, the District VIII Inspector General regarding a letter she had written to the parents of a resident, and others. Ms. Wright left GCC at approximately 9:30 AM. At approximately 12:00 noon, Glenn Green, the Registered Nurse in Adams cottage, who had been assigned to complete the Respondent's 12:00 noon medications, found that certain medications for some of the residents were missing and had apparently been administered. There was, however, no indication on the Medication Administration Record, (MAR), that these medications had been given or wasted. When Eleise Paquette, the registered nurse in Buchanan cottage that day, who had been given the responsibility to complete the Respondent's 12:00 noon medications in that location, started to do so, she also found that some medications were missing and were neither shown on the MAR as administered nor wasted. Because she was not sure what had been done with the medications, and not wanting to overdose any resident, Ms. Paquette did not administer the noon medications that were not recorded. It was safer for the resident to miss one medication dose than to be overdosed. Ms. Pauley, the LPN in Buchanan cottage on the 2:30 PM to 11:00 PM shift also discovered that some of the medications due to be administered at 4:00 PM were missing and found that there was no MAR entry to show them administered or wasted. She reported this matter to her supervisor, Mr. Stonham who called the Respondent at home to see if she had administered them. Because she had been gone since 9:30 AM and felt, therefore, that his question was silly since she could not have administered them in a timely manner, she sarcastically answered his question in the affirmative. Respondent now categorically denies having administered any of the noon or 4:00 PM medications that day. On the day in question, Ms. Wright claims, she got the key to the medications at the infirmary and went to Monroe cottage to pass the medications due. She went there first because some of the residents there are school children who need their insulin. When she was finished there, she went to Buchanan and was passing medications there when she was called by Mrs. Blake who advised her she had to be at the District VIII office by 10:00 AM. Before leaving, she then went to Adams to pass medications there and then left. She claims that all medications she gave that day were for the 7:00 to 8:00 AM dosage. When she went down to the District office she took the medication keys with her because she believed she'd be back in time to administer the noon medications. She was relieved of duty at GCC by the Inspector General, however, and immediately barred from the facility. Medications at GCC are generally kept under lock and key on a medication cart which is kept in a locked room when not being used. According to Ms. Wright, the locks on the medication carts and the storage room in the units are universal. One key fits all. This was not contradicted by the Department. The key for the cart and the room is kept by the LPN charged with the responsibility for administering them. Only the pharmacy is supposed to have the other key to that room. However, according to Mr. Stonham, the keys to the medication carts were, at that time, being stored in a key box at the other end of the hall from the infirmary - not in the same room with the attendant. They were not signed out when taken, and Mr. Stoneham, who worked in the infirmary, would not necessarily see someone taking a key and would not know if a key had been taken unless he looked in that key box. He had not looked that day. When medications are not being used, they are supposedly kept in a cabinet in the infirmary. The medications in issue here are not the sort of drug that would have a street value on the illegal market. Ms. Wright was called to the Inspector General's office to discuss a letter she admits to sending out to the parents of a resident and to several state officials that that resident was being sexually abused at GCC. Ms. Wright admits to writing and sending the letters and, in fact, in Circuit Court, pleaded nolo contendere to, and was found guilty of, a charge of knowingly and wilfully making a false report of child abuse. She admits to exercising extremely poor judgement in doing so. Both individuals who testified for Respondent had prior experience working with her in health care. Both witnesses found Respondent to be very trustworthy and competent. The one witness who recalls Respondent having responsibility for the passing of medications, a registered nurse herself, saw no indication of any difficulty in that regard. In fact, she claims the Respondent is one of the best clinical nurses she has ever seen in many years of nursing practice. Both the allegation regarding the medications and that regarding the false report, if proven, would constitute failure to conform to the minimal standards of acceptable and prevailing nursing practice.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is, therefore recommended that a Final Order be issued in this case placing the Respondent, Virginia Ellen Wright's, license on probation for a period of one year under such terms and conditions as are prescribed by the Board of Nursing. RECOMMENDED this 24th day of May, 1991, in Tallahassee, Florida. ARNOLD H. POLLOCK, 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 24th day of May, 1991. APPENDIX TO RECOMMENDED ORDER, CASE NO. 90-7812 The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on all of the Proposed Findings of Fact submitted by the parties to this case. FOR THE PETITIONER: 1. & 2. Accepted and incorporated herein. 3. & 4. Accepted and incorporated herein. 5. - 7. Accepted and incorporated herein. 8. - 11. Accepted and incorporated herein. - 15. Accepted and incorporated herein. Accepted and incorporated herein with additional information added. Rejected as contra to the weight of the evidence. - 23. Accepted and incorporated herein. FOR THE RESPONDENT: No Proposed Findings of Fact submitted. Counsel's Final Argument, submitted subsequent to the hearing, was fully considered in the preparation of this Recommended Order. COPIES FURNISHED: Tracey S. Hartman, Esquire Department of Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-0792 Joseph Hoffman, Esquire 4388 Palm Beach Blvd. Ft. Myers, Florida 33905 Jack McRay General Counsel Department of Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-0792 Judie Ritter Executive Director Board of Nursing 504 Daniel Building 111 East Coastline Drive Jacksonville, Florida 32202
The Issue The issue is whether respondent's license as a practical nurse should be disciplined for the reasons cited in the administrative complaint.
Findings Of Fact Based upon the entire record, the following findings of fact are determined: Background At all times relevant hereto, respondent, Lorrie Neumann Dupuis (Dupuis or respondent), was licensed as a practical nurse and held license number PN 0766491 issued by petitioner, Department of Professional Regulation, Board of Nursing (Board). When the events herein occurred in 1990, respondent was known as Lorrie Neumann. She has since changed her name to Lorrie Neumann Dupuis. Counts I and II At hearing respondent admitted that the charges in Counts I and II are true. The admitted allegations which underpin these counts are briefly as follows. On July 23, 1990, respondent applied for employment with Upjohn Health Services (Upjohn). On her application, Dupuis indicated that she was a registered nurse when in fact she was a licensed practical nurse. In addition, respondent submitted to Upjohn an altered nursing license which had been changed to indicate the designation "RN" and title "Registered Professional Nurse". Finally, respondent gave Upjohn a resume indicating the designation "RN" after her name. Accordingly, it is found that respondent (a) engaged in unprofessional conduct by improperly using the name or title Registered Nurse and (b) knowingly violated a statutory provision that prohibits any person from assuming the title of registered nurse or using the abbreviation "R.N." without being so licensed. There is no evidence, and the Board has not alleged, that any unlawful practice as a registered nurse occurred as the result of the application nor that respondent was subjected to criminal prosecution for this act. Count III Respondent is charged in Count III with "making or filing a false report or record which the licensee knows to be false". This charge stems from a factual allegation that, while employed by Consolidated Staffing Services (CSS), respondent altered a time verification form by increasing the number of hours she had allegedly worked on July 26, 1990, from four to nine. Respondent was employed as a licensed practical nurse (LPN) by CSS from April through July 1990. CSS, which is a for-profit division of St. Vincent's Hospital in Jacksonville, has agreements with various clients in the Jacksonville area to supply nurses to the clients on a supplemental staff basis. One such agreement was with the Jacksonville Naval Air Station (NAS) and called for CSS to furnish nurses to the NAS emergency room. During her tenure with CSS, respondent worked on various occasions as a LPN at the NAS emergency room. On Tuesday, July 24, 1990, Dupuis worked an eight hour shift at the NAS. Based on erroneous advice received from a CSS employee, respondent was under the impression she was to work again at the NAS on Thursday morning, July She accordingly reported to duty that day at 6:45 a.m. However, Dupuis was not actually scheduled to work that day since the emergency room already had a full complement of nurses on duty. After realizing that the emergency room had more persons on duty than was customary, the emergency room nursing manager contacted CSS and verified that respondent was not scheduled to work that day. Accordingly, around 10:45 a.m., the manager advised respondent that she must leave but that she would be paid for the four hours she had worked that morning. Just before leaving the premises, respondent filled out a CSS time verification form. The form is made up of four pages, an original and three copies, and the CSS nurse is instructed to leave one copy with the client, retain one copy for herself, and to return the original and one copy to CSS offices. On the form, respondent noted she had worked from 6:45 a.m. to 10:45 a.m., or a total of four hours. After she departed the NAS, respondent noted that the time sheet reflected a date of July 25 when in fact the correct date was July 26. She accordingly altered the three copies of the form still in her possession to reflect the correct date. The copy left with the NAS still carries the incorrect date of July 25. In accordance with her normal procedure, respondent accumulated her time verification forms from the week and turned them all in at one time to CSS on Sunday afternoon, July 29. She did so by placing them in an envelope and sliding the envelope under the locked doors of CSS's offices. Such a procedure was acceptable with her employer. When the envelope was opened by CSS the next day and sent to accounting for computation of pay, CSS personnel noted that on respondent's July 26 time verification form the number "4" had been altered to read "9" so that it appeared respondent had worked nine hours at the NAS. Also, the "time finished" column, which is the time Dupuis finished her stint of duty, reflected that "10:45" had been altered to read "15:45", which is the military time for 3:45 p.m. CSS then had the NAS fax its copy of the form to CSS. This form had not been altered and correctly reflected that Dupuis worked only four hours. When Dupuis would not agree to meet with CSS management to discuss the altered form, respondent was terminated from employment and the matter was turned over to the Board. Except for changing the date on the form from July 25 to July 26, respondent denied that she had altered any other numbers. She suggested at hearing that someone at CSS may have altered the copies after she turned them in on Sunday, July 29. She also suggested that the nurse manager at the NAS emergency room disliked her and may have set her up. However, these contentions are not deemed to be credible. Accordingly, it is found that respondent made a report which she knew to be false. Mitigation There is no evidence that respondent has ever been disciplined by the Board. In addition, there is no evidence that her actions endangered the public or resulted in actual damages of any nature, or that she engaged in any other similar misconduct. Finally, there are no complaints of record regarding the quality of work performed by respondent as a LPN.
Recommendation Based upon the foregoing findings of facts and conclusions of law, it is recommended that respondent be found guilty of violating Subsections 464.018(1)(f),(h), and (l), Florida Statutes (1989), and that her nursing license be suspended for thirty days. RECOMMENDED this 26th day of September, 1991, in Tallahassee, Florida. DONALD R. ALEXANDER 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 26th day of September, 1991. COPIES FURNISHED: Tracey S. Hartman, Esquire 1940 North Monroe Street, Suite 60 Tallahassee, Florida 32399-0792 Lorrie Neumann Dupuis 4156 Piney Branch Court Jacksonville, FL 32257 Jack L. McRay, Esquire 1940 North Monroe Street, Suite 60 Tallahassee, Florida 32399-0792 Judie Ritter, Executive Director Board of Nursing 504 Daniel Building 111 East Coastline Drive Jacksonville, FL 32202
Findings Of Fact Margie Leverson, petitioner, was registered with the Florida State Board of Nursing in 1978 as a licensed practical nurse holding license number 13107-1. On the evening of March 9, 1978, petitioner was assigned to work the 11 p.m. through 7 a.m. shift in the critical care unit of Palm Springs General Hospital, Homestead, Florida. An audit of administration records at the Hospital disclosed that petitioner failed to properly chart medications administered to a number of patients, that she failed to complete the nurses' notes of patients under her care, and that she did not sign the medication administration profile sheets or nurses' notes for any of the patients under her care during the time at issue. The importance of conforming to these requirements is to assure that all medications have been given when scheduled and to assure continuity in evaluating a patient's illness. With critically ill patients, it is necessary to be able to ascertain when a condition or problem was noted and how it was treated. Otherwise, continuity is lost, and it is possible that decisions as to treatment may not be accurately made, and the nurse in charge cannot in every case be identified unless her signature appears on the documents. Failure to chart medications administered to patients. On two occasions, petitioner failed to chart medications administered to patients. Specifically, Juan Pinera was to receive 2 million units of penicillin intravenously every four hours, including twice during the time he was in petitioner's care. However, the prescribed medication was not charted as having been given to the patient during this time. Another patient, Peter L. Garcia, was scheduled to receive ampycillin 500 mg. at midnight and 6 a.m., and garamycin 40 mg. at midnight. Such administrations, if given, were not charted by petitioner. Failure to adequately and properly chart the nurses' notes of patients in the nurse's care. In the case of four patients under the care of petitioner, no nurses' notes were kept. (Exhibit Nos. 1, 2, 5, & 6). For the other three patients, the notes were of minimal, if any, value because they did not provide any evaluation or explanation of the problems noted. (Exhibit Nos. 3, 4 & 7). Petitioner herself acknowledged that the words were written in her hand writing and were of no value to anyone attempting to determine the patient's condition. Failure to sign medication administration profile sheets and nurses' notes. The petitioner failed to sign the medication administration profile sheets and nurses' notes for any of the patients under her care during the time at Issue. In mitigation, petitioner had earlier completed a 3 p.m. through 11 p.m. shift at another hospital on the same date. She arrived on duty at the Hospital around 11:30 p.m. Because of an argument with a co-worker, she was transferred by her supervisor to another unit around 1:00 a.m. and claims she cannot be held accountable for the failures as to the seven patients who were under her care. Petitioner stated she ultimately left the hospital on leave around 3:00 a.m. due to a pinched nerve in her back.
Recommendation Based upon the foregoing findings of fact and conclusions of law, it is RECOMMENDED the application of Margie Leverson for reinstatement of her license as a licensed practical nurse be granted subject to the conditions set forth in conclusion 14 above. DONALD R. ALEXANDER Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675 COPIES FURNISHED: Ms. Margie Leverson 4030 Northwest 190th Street Opa Locka, Florida 33055 Frank A. Vickory, Esquire Assistant Attorney General The Capitol Tallahassee, Florida 32301
Findings Of Fact Respondent, Ann Claycomb (Claycomb), was at all times material hereto a licensed practical nurse in the State of Florida, having been issued license number 39853-1. On December 24, 1987, Claycomb was employed as an agency nurse by Alpha Health Care, Inc., and was on assignment to Health South Rehabilitation, a skilled nursing and rehabilitation facility in Miami, Florida. While at the facility on that date, Claycomb worked the morning shift 7:00 a.m. to 3:30 p.m., and was assigned to the skilled nursing floor. The skilled nursing floor contained 20-25 elderly, though mostly alert patients. At the commencement of Claycomb's shift, it was her responsibility to administer medications to these patients which conformed with that prescribed by their medication administration record (MAR). Shortly after Claycomb began her rounds, Elaine Wood, the Unit Manager at Health South Rehabilitation, began to receive complaints from patients for what they perceived to be errors in the medicinal drugs administered or attempted to be administered to them by Claycomb. Upon investigation, the following medication errors were discovered. Claycomb administered what she believed to be two Tylenol tablets to patient H.B. Following administration, the patient became lethargic and her vital signs deteriorated but later returned to normal. Lethargy is not a side effect of Tylenol. Although the MAR prescribed two Slow K tablets at 9:00 a.m., and Lilbrax as needed, Claycomb recorded having administered one Slow K tablet and Atarax to patient H.R. Claycomb dispensed Atarax to patient A.J. at 9:00 a.m. when the MAR prescribed dose to be given at 1:00 p.m. Patient refused medication because given at the wrong time. In committing the foregoing medication errors Claycomb's practice fell below the minimal standards of acceptable and prevailing nursing practice in the administration of medicinal drugs. Verification of other complaints received by Ms. Wood could not be verified because, contrary to accepted and prevailing nursing practice, Claycomb did not annotate some patients' MAR upon dispensing medications.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that a final order be entered suspending the license of respondent, Ann Claycomb, until such time as she submits proof satisfactory to the Board of Nursing that she can practice nursing safely. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 27th day of December, 1988. WILLIAM J. KENDRICK 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 27th day of December, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 88-3603 Petitioner's proposed findings of fact are addressed as follows: 1. Addressed in paragraph 1. 2-4. Addressed in paragraphs 2 and 3. 5 & 6. Addressed in paragraphs 46. Addressed in paragraph 4c. Subordinate or not necessary to result reached. Not necessary to result reached. Not necessary to result reached. To the extent supported by competent proof addressed in paragraph 4. Proposed findings 11a and 11d are based on hearsay which does not supplement or explain any competent proof. 12-15. Not pertinent nor necessary to result reached. COPIES FURNISHED: Michael A. Mone', Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Ms. Ann Claycomb 4175 South West 98th Avenue Miami, Florida 33165 Lawrence M. Shoot, Esquire 6011 West 16th Avenue Hialeah, Florida 33012 Judie Ritter, Executive Director Board of Nursing 504 Daniel Building 111 East Coastline Drive Jacksonville, Florida 32201 Bruce D. Lamb, Esquire General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
The Issue At issue is whether Respondent committed the offenses set forth in the Second Amended Administrative Complaint and, if so, what penalty should be imposed.
Findings Of Fact Stipulated Facts The Petitioner is the State Agency charged with the regulation of the practice of nursing pursuant to Chapters 20,456 (formerly Chapter 455, Part II; see Chapter 2000-160, Laws of Florida) and 464, Florida Statutes. Pursuant to the authority of Section 20.43(3)(g), Florida Statutes, the Petitioner has contracted with the Agency for Health Care Administration to provide consumer complaint, investigative and prosecutorial services required by the Division of Medical Quality Assurance, councils or boards, as appropriate, including the issuance of emergency orders of suspension or restriction. Respondent is Cynthia Chance. Respondent is a Licensed Practical Nurse in the State of Florida, having been issued license No. PN 0855441. On or between March 1997-May 1997, Respondent was employed by Health Force, a nurse-staffing agency. In or about March 1997, Respondent was assigned to work various shifts at Baptist Medical Center-Beaches. In or about March 1997, Respondent submitted time slips to Health Force alleging that she had worked an eight-hour shift on March 18, 1997. In or about March 1997, Respondent submitted time-slips to Health Force alleging that she had worked an eight-hour shift on March 21, 1997. Findings of fact based on the evidence of record Missing Drugs On May 13, 1997, Health Force received a "late call" from Cathedral Gerontology Center (Cathedral) needing a "stat" nurse because one of their nurses had not come to work. Tresa Streeter (now Calfee), administrator for Health Force, called Respondent who reported to Cathedral at 6:50 p.m. Kim Harrell, R.N., a supervisor at Cathedral, was the nurse who stayed until Respondent arrived. Also at 6:50 p.m. on May 13, 1997, Barbara Kelley, R.N., received and signed for a delivery of medications for residents from American Pharmaceutical Services. Included in that delivery was an order of Alprazolam (Xanax) and an order of Diazepam (Valium) for two residents on the floor where Respondent was working that evening. The delivery came with a separate medication or narcotics card for each medication. There were two floors of residents at Cathedral. Each floor had its own medication cart and its own nurse assigned to the floor. Controlled medications have a separate box in the medication cart with a separate key. The nurse on each floor had a key to her own medication cart but did not have a key to the medication cart of the other floor. The Director of Nursing (DON) also had a key to both medication carts in the event of an emergency such as a lost key. After receiving and signing for these drugs, Nurse Kelley locked the medications that belonged to her medication cart in it and inserted the narcotic cards for those medications into the notebook that corresponded to her cart. She then gave the medications and control sheets that belonged to Respondent's medication cart to Respondent, placing them in Respondent's hand. Nurse Kelley told Respondent that these were controlled drugs and instructed Respondent to lock up the medications in Respondent's medicine cart. There is conflicting testimony as to what happened next. Respondent admits to receiving the medications and the control cards. However, Respondent maintains that she placed the medications in the locked drawer of the medication cart and inserted the cards into the notebook in front of Nurse Kelley, whereas Nurse Kelley maintains that she walked away immediately after giving the drugs and cards to Respondent and did not see her place the drugs in the controlled drug lock box or the cards in the notebook. It was a policy at Cathedral for the out-going nurse to count controlled drugs with the on-coming nurse. When Respondent arrived on the night in question, she counted the controlled medications with Nurse Harrell. The narcotics count for both narcotics cards and actual doses was 16. At the end of her shift, Respondent counted the controlled medications with the on- coming nurse, Pamela Schiesser. The number of narcotics cards and tablets or doses was 16, the same as when Respondent came on duty. Nurse Schiesser was scheduled to work a double shift, 11 to 7 and 7 to 3. During the 11 to 7 shift, Nurse Schiesser was the only nurse for both floors of residents and she, therefore, had the key to both medication carts. Sometime during the 7 to 3 shift on May 14, 1997, Nurse Schiesser called the pharmacy to find out about a medication order she had placed for two residents so they would not run out. She was informed by the pharmacy that the drugs had been delivered the evening before and that they had been signed for by Nurse Kelley. She checked the delivery sheets and confirmed that Nurse Kelley had signed for the medications. After determining that there were no cards for the missing drugs and the drugs were not in the cart, she then reported to her supervisor, Kim Harrell, that the medication had been delivered but could not be located. Nurse Schiesser and Nurse Harrell checked the entire medication cart, the medication cart for the other floor and the medication room but did not find the missing medications. Nurse Harrell then notified the Assistant Director of Nursing (ADON), Lu Apostol, and the Director of Nursing (DON), Fely Cunanan, regarding the missing medications. The ADON began an investigation and secured written statements from all of the nurses on her staff who had access to the drugs: Nurses Kelley, Harrell, and Schiesser. She called Nurse Kelley to confirm that she had received the medications from the pharmacy and confirmed that the two missing medications, Alprazolam (Xanax) and Diazepam (Valium), were given by Nurse Kelley to Respondent. The ADON also called Tresa Streeter (now Calfee), the administrator of Health Force for whom Respondent worked to notify her of the missing medications. On May 14, 1997, Ms. Streeter (Calfee) called Respondent and informed her about the missing drugs. On May 15,2000, Ms. Streeter and Respondent went to Cathedral for a meeting. They were informed that the two missing drugs had not been located and they were shown the written statements of the other nurses. Respondent admitted that the drugs had been given to her the night before by Nurse Kelley, but stated that she had locked the drugs in her cart. She denied any further knowledge about the drugs. At Ms. Streeter's suggestion, Respondent took a blood test on May 15, 2000.1 The drug test result was negative thus indicating that the drugs were not in her blood at the time of the test, which was two days after the drugs were missing. No competent evidence was presented as to how long it takes for these drugs to leave the bloodstream. Cathedral had a policy that required that all controlled substances be properly accounted for and secured by each nurse responsible for the drugs. This policy was verbally communicated from the off-going nurse to the oncoming nurse. When Nurse Kelley gave the drugs and drug cards in question to Respondent, she specifically instructed Respondent to lock up the drugs in the narcotics drawer. Respondent maintains that other people had keys to her medication cart and could have taken the drugs after she put them in the locked narcotics box. This testimony is not persuasive. Every witness from Cathedral testified unequivocally that there was only one key in the facility for each medication cart and that key was in the possession of the nurse assigned to that cart. The only other key, which was in the possession of the Director of Nursing, was not requested or given to anyone at anytime material to these events. The persuasive testimony is that Respondent was the only person during her shift with a key to her medication cart. That key was passed to Nurse Schiesser who discovered that the drugs and narcotics cards were not in the medication cart or notebook. The count of the drugs and the cards on hand did not show that anything was missing at the change of shift from Respondent to Nurse Schiesser as the count was 16, the same as when Respondent came on the shift. If Respondent had put the drugs and corresponding cards in the medication cart, the count should have been 18. The only logical inference is that Respondent did not put the drugs or cards in the cart. In the opinion of the two witnesses accepted as experts in nursing and nursing standards, Respondent's failure to properly secure the narcotics and to document the receipt of these controlled drugs constitutes practice below the minimal acceptable standards of nursing practice. Time-Slips While employed by Health Force as an agency nurse, Respondent was assigned at various times to work at Baptist Medical Center-Beaches (Beaches). Respondent submitted time cards or slips for each shift she worked to Health Force so that she would be paid for the work. Respondent submitted time-slips for working at Beaches on March 18 and 21, 1997. When Health Force billed Beaches for these two dates, Anne Hollander, the Executive Director of Patient Services, the person responsible for all operations at Beaches since 1989, determined that Respondent had not worked on either March 18 or 21, 1997. Ms. Hollander faxed the time-slips back to Health Force for verification. She advised Health Force that Respondent was not on the schedule as having worked on either of those dates. She also advised Health Force that the supervisor's signatures on the two time-slips did not match anyone who worked at Beaches. Ms. Hollander is intimately familiar with the signatures of all the supervisors who are authorized to sign time-slips at Beaches and none of them have a signature like the signatures on the two time-slips. Health Force did an investigation and ended up paying Respondent for the two days, but did not further invoice Beaches. Health Force was never able to determine whose signatures were on the time-slips. Health Force did have Respondent scheduled to work at Beaches on March 21, 1997, but not on March 18, 1997. Beaches keeps a staffing sheet for every day and every shift. The supervisors are responsible for completion of the staffing schedules to ensure that the necessary staff is scheduled to work on each shift. These staffing sheets are used for both scheduling and doing the payroll. According to Ms. Hollander, it is not possible that Respondent's name was just left off the staffing sheets. The staffing sheets are the working sheets. If a person works who is not originally on the staffing sheet, the supervisor writes that person's name into the correct column at the time they come to work. Ms. Hollander has been familiar with these staffing sheets for 12 years and does not recall any time when someone's name has been left off the staffing sheet when he or she had worked. The two supervisors who testified, Erlinda Serna and Carol Lee, are equally clear that in their many years of experience as supervisors at Beaches, no one has worked and not been on the staff schedules. Anybody who worked would show up on the schedule. Every shift and every day should be on the staffing schedules. Ms. Serna is unaware of any time in her 10 years at Beaches that someone's name was left completely off the schedules, but that person actually worked. Respondent's name was on the staffing schedule for March 21, 1997, but it was crossed out and marked as cancelled. When agency nurses are scheduled at Beaches, but are not needed, they are cancelled with the agency. If the agency fails to timely notify the nurse and the nurse shows up for work, the agency must pay her for two hours. If the hospital fails to notify the agency timely and the nurse shows up for work, then the hospital must pay the nurse for two hours. In no event is a nurse who is cancelled paid for more than two hours. There are times when a nurse is cancelled and shows up for work, but the hospital has a need for the nurse either as a nurse or in another capacity such as a Certified Nursing Assistant (CNA). If that happens, the nurse's name is again written into the nursing unit staffing schedule. For March 18, 1997, Respondent's name is not on the schedule for Beaches. She did not work in any capacity on March 18, 1997. For March 21, 1997, Respondent's name was on the schedule, but she was cancelled. Even if she had not been timely notified that she was cancelled and she showed up for work, the most she could have billed for was two hours. If she had stayed and worked in a different capacity, her name would have been rewritten into the staffing schedule. Beaches is very strict and follows a specific protocol. No one except the supervisors is allowed to sign time cards. The signatures on these two time cards do not belong to any supervisor at Beaches. Therefore, it can only be concluded that Respondent did not work on March 18 or 21, 1997, at Beaches and that she submitted false time-slips for work she did not do on March 18 and 21, 1997. In June 1997, Respondent was also working as an agency nurse for Maxim Healthcare Services (Maxim). On June 8, 1997, Respondent submitted a time ticket to Maxim and to Beaches indicating that she had worked eight-hour shifts at Beaches on June 2, 3, 4, and 5, 1997. All four days were on the same time ticket and purported to bear the initials and signature of Carol Lee. This time ticket was brought to Ms. Hollander's attention because Beaches had a strict policy that only one shift could appear on each time slip. Even if a nurse worked a double shift, she would have to complete two separate time tickets, one for each shift. Under Beaches policy, no time ticket would ever have more than one shift on it. The time tickets are submitted to Ms. Hollander's office daily with the staffing schedules that correspond. Therefore, a time ticket for a person who is not on the staffing schedule would immediately stand out. When Ms. Hollander was given the time ticket for June 2-5, 1997, she investigated and reviewed the staffing sheets for those days. Respondent was not listed on any of the staffing schedules. Ms. Hollander then showed the time ticket to Erlinda Serna, who was the nursing supervisor on the 3 to 11 shift. Nurse Serna verified that Respondent had not worked on the shift any of those days. Ms. Hollander then showed the time-slip to Carol Lee, the 11 to 7 nursing supervisor. Carol Lee verified that she had not initialed or signed the time ticket and that the initials and signature were a forgery. Nurse Lee would not have signed a time ticket with more than one shift per time ticket because she was well aware of the policy prohibiting more than one shift per time ticket. Nurse Lee verified that Respondent had not been scheduled to work any of those days and that Respondent had not worked on June 3, 4, or 5, 1997. These inquiries to Nurse Serna and Nurse Lee took place within a few days after the dates for which Respondent had submitted this time ticket. Therefore, the matter was fresh in the minds of both nursing supervisors. Both are certain that Respondent was neither scheduled nor worked on June 2-5, 1997. Only nursing supervisors at Beaches are authorized to sign time tickets. Maxim Healthcare has a policy of never working a nurse in excess of 40 hours in one week. The same policy was in effect in 1997. Susan Ranson, the records custodian who also staffs for Maxim on the weekends and assists in their billing, indicated that Respondent was paid by Maxim for working at another facility the same week as June 2-5, 1997. June 2-5, 1997, are a Monday through Thursday. Specifically, Respondent submitted a time ticket to Maxim for another facility showing that she worked 12 hours on Saturday, June 7, 1997, and 13 hours on Sunday, June 8, 1997. Maxim pays from Monday through Sunday. If Respondent had worked 32 hours at Beaches on Monday through Thursday and then 25 hours at another facility on Saturday and Sunday, she would have worked more than 40 hours in one week, which would have violated their policy and would have required Maxim to pay overtime. When Maxim gets a request for a nurse and has no one to send who would not exceed 40 hours in one week, rather than exceed 40 hours, the agency does not staff the job. In the disciplinary document from Health Force dated June 18, 1997, Health Force advised Respondent that it would not be scheduling her based on the complaints they received regarding false billing, the missing drugs at Cathedral, and another incident at Beaches that occurred during this same time. Taken in its totality, the testimony of Respondent is not credible. Respondent's explanation of the discrepancy in the count of drugs and corresponding cards is that during her shift "there was [sic] one or two cards that only had one or two pills on them, so you just throw them away. And that's what made it back to 16." This explanation is unpersuasive. If there had been any pills left in the drawer from cards that Respondent threw away, the count would have been off at the change of shift. Moreover, several witnesses testified as to the care that is taken to carefully account for all narcotics. Respondent's assertion that narcotic pills were simply thrown away is not credible. Nurse Schiesser clearly remembered that there were no cards for the medications in question and there were no medications from this delivery in the medication cart. Respondent has been previously disciplined by the Board of Nursing in the Board's case No. 98-20122.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law set forth herein, it is RECOMMENDED: That the Respondent be found guilty of one count of violating Section 464.018(1)(h), Florida Statutes, by failing to secure and document receipt of the drugs at Cathedral Gerontology Center; That the Respondent be found guilty of one count of violating Section 464.018(1)(h), Florida Statutes, and of violating Rule 64B9-8.005(1), Florida Administrative Code, by falsifying employment and time records on multiple occasions; and That a penalty be imposed consisting of a fine of $1000 and payment of costs associated with probation, together with a reprimand and a three-year suspension of license to be followed by a two-year probation with conditions as deemed appropriate by the Board of Nursing. Reinstatement of Respondent's license after the term of the suspension shall require compliance with all terms and conditions of the previous Board Order and her appearance before the Board to demonstrate her present ability to engage in the safe practice of nursing, which shall include a demonstration of at least three years of documented compliance with the Intervention Project for Nurses. DONE AND ENTERED this 29th day of December, 2000, in Tallahassee, Leon County, Florida. BARBARA J. STAROS Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 29th day of December, 2000.
The Issue The issues in this case are whether, before applying for licensure as a registered nurse in Florida, Petitioner had suffered the denial of an application for licensure as a practical nurse in the state of Virginia, and, if so, whether Petitioner's failure to disclose that fact in her Florida application was a knowing misrepresentation; finally, if either or both of the forgoing questions are answered in the affirmative, whether Respondent has grounds to deny Petitioner's pending application for a nursing license.
Findings Of Fact On October 15, 2012, Petitioner Yolette Tema ("Tema") signed an application for licensure as a registered nurse, which she mailed to the Department of Health for review by Respondent Board of Nursing (the "Board"). Item No. 9 of the application sought information about the applicant's disciplinary history. Four subparts (lettered A through D) asked questions that called for a "yes" or "no" answer, which the applicant was to give by marking the applicable check box. The first question ("9A") was: Have you ever been denied or is there now any proceeding to deny your application for any healthcare license to practice in Florida or any other state, jurisdiction or country? Tema answered, "No." In Item No. 10 of the application, there appeared above the signature line the following declarations: I recognize that providing false information may result in disciplinary action against my license or criminal penalties pursuant to Sections 456.067, 775.083, and 775.084, Florida Statutes. I have carefully read the questions in the foregoing application and have answered them completely, without reservations of any kind. Should I furnish any false information in this application, I hereby agree that such act shall constitute cause for denial, suspension or revocation of my license to practice as a Registered Nurse or Licensed Practical Nurse in the State of Florida. Tema's signature manifested her agreement with the foregoing declarations. Despite having acknowledged the hard consequences of deceit, Tema's negative answer to the question of whether she ever had suffered the denial of an application for licensure was false. In fact, in June 2011, the Virginia Board of Nursing had denied Tema's application for licensure as a practical nurse, on the ground that she had provided false information in an effort to obtain a license by fraud, deceit, or material omission. Tema had received timely, contemporaneous notice of the Virginia Board of Nursing's final decision, and she was fully aware of that disposition at all times relevant to this case. When she completed the Florida application in October 2012, therefore, Tema knew that her response to question 9A was false. Because the information Tema failed to disclose obviously would have hurt her chances of obtaining a license in Florida, the undersigned disbelieves Tema's explanation for the material omission, which was that she simply made a mistake.1/ Instead, the undersigned infers that Tema intentionally omitted the damaging fact of the Virginia denial in hopes that the Board would not discover it.2/ The Board did, however, discover the Virginia decision while reviewing Tema's application. Based on that past denial and Tema's present failure to disclose it, the Board determined that Tema's Florida application should be denied. The Board's preliminary decision was communicated to Tema through a Notice of Intent to Deny dated February 11, 2014. Determinations of Ultimate Fact Tema is guilty of having an application for a license to practice nursing denied by the licensing authority of another state, which is a disciplinable offense under section 464.018(1)(b), Florida Statutes.3/ Tema is guilty of attempting to procure a license to practice nursing by knowing misrepresentation, which is a disciplinable offense under section 464.018(1)(a).
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Nursing enter a final order denying Tema's application for licensure as a registered nurse. DONE AND ENTERED this 10th day of September, 2014, in Tallahassee, Leon County, Florida. S JOHN G. VAN LANINGHAM Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 10th day of September, 2014.
The Issue Whether the license of Respondent should be suspended, revoked, or whether the Respondent should be otherwise disciplined.
Findings Of Fact Upon consideration of the evidence introduced and the testimony elicited, the following facts are found: Am administrative complaint was filed against Respondent Ponte by the Petitioner, Florida State Board of Nursing, on May 26, 1978 seeking to place on probation, suspend or revoke the LPN License No. 38103-1 held by Respondent Beverly Ceraldi Ponte. The complaint was amended at the public hearing to delete allegation number 5. "Respondent, while being searched at the women's annex of the jail, was found to be in possession of one glass vial of promethazine, a prescription drug." The complaint alleged that the Respondent, on several occasions, signed out for controlled narcotics for patients in her care and failed to properly account for the disposition of said narcotics; that Respondent converted a narcotic controlled substance to her own use and admitted to Dade County Police officers the theft of the drug; and that Respondent had in her possession at the time of her arrest a large quantity of syringes (tubex of from 50-75 milligrams of demerol) consisting of a total of 24, of which 7 were empty. The Respondent Beverly Ponte, a Licensed Practical Nurse, was employed at the Miami Heart Institute on January 16, 1978. On that date she signed out for a controlled narcotic, demerol, the generic term being meperedine, for four patients in her care. The medication sheets for the four patients failed to show that demerol or meperedine had been administered to the patients, and no disposition of the narcotics was shown by Respondent. On or about April 7, 1978 Beverly Ponte, the Respondent, was employed at Palmetto General Hospital in Hialeah, Florida. The evening supervisor, a Registered Nurse, was called at about 10:30 p.m. by one of the staff nurses to examine a narcotic sheet kept for patients under the care of the Respondent Ponte, the medication nurse on the shift that evening. The Vice President and Director of Nursing Service was then called and the police were notified that there was an apparent narcotic problem on the floor of the hospital. The police and the director questioned the Respondent. She was searched and on her person was found 24 syringes (tubexes or pre-loaded syringes) of the type used by the hospital. Respondent admitted that she had taken drugs that evening and could not tell the director which of the patients under her care had had medication. The Respondent was arrested and handcuffed. Thereafter an information was filed in the Eleventh Judicial Circuit Court in and for Dade County, Florida charging Respondent with possession of a controlled substance (meperedine) and charged with a count of petit larceny. The Respondent entered a plea of nolo contendre and was found guilty of possession of controlled substance and petit theft and was placed on probation for a period of eighteen months, beginning May 2, 1978, with a special condition that the Respondent not seek employment where she personally had access to narcotic drugs and to also complete the outreach program which is a drug rehabilitation program. The proposed order of the Respondent has been considered and each proposed fact treated herein. Evidence as to the adherence to the condition of probation, the present employment of Respondent, and whether Respondent should be allowed to sit for nursing license examination is insufficient and no finding is made in regard thereto. No memorandum or proposed order was submitted by the Petitioner.
Recommendation Suspend the license of Respondent Ponte. DONE and ORDERED this 21st day of November, 1978, in Tallahassee, Florida. DELPHENE C. STRICKLAND Hearing Officer Division of Administrative Hearings 530 Carlton Building Tallahassee, Florida 32304 COPIES FURNISHED: Julius Finegold, Esquire 1107 Blackstone Building Jacksonville, Florida 32202 Carl L. Masztal, Esquire Suite 806 Concord Building 66 W. Flagler Street Miami, Florida Norman Malinski, Esquire 2825 South Miami Avenue Miami, Florida Geraldine B. Johnson, R.N. Investigation and Licensing Coordinator State Board of Nursing 6501 Arlington Expressway, Building B. Jacksonville, Florida 32211 ================================================================= AGENCY FINAL ORDER ================================================================= BEFORE THE FLORIDA STATE BOARD OF NURSING IN THE MATTER OF: Beverly A. Ceraldi Ponte 3500 S. W. 47th Avenue CASE NO. 78-1142 West Hollywood, Florida 33023 As a Licensed Practical Nurse License Number 38103-1 /
Findings Of Fact At all times pertinent to the issues contained herein, Respondent. ROYCE S. McCALL, was licensed by the State of Florida as a licensed practical nurse, the license initially issued on December 4, 1978 and renewed thereafter until the present. His license number is 0500981. On July 11, 1984, Respondent was employed as a licensed practical nurse with the Walton County Convalescent Center (WCCC) in DeFuniak Springs, Florida. Late that evening, at approximately 4 or 5 a.m., Respondent, as charge nurse on one of the Center's units, along with Rachiel Infinger and Corene Fondren, was about to change a bladder catheter on one of the Center's residents, a Mrs. Rourke. Before doing so, however, he discovered that Mrs. Rourke had fouled herself and he refused to do the procedure then instructing Mrs. Rourke's aides to clean her up. He then went to the room occupied by Mrs. Harper, an elderly, completely bedridden patient between 80 and 90 years old, who rarely talks and can hardly move her arms and legs. Mrs. Harper also required a bladder catheter change and Respondent, along with another nurse, was attempting to do it. Since apparently Mrs. Harper was resisting somewhat, Respondent asked Ms. Infinger to help. During the course of the procedure, Mrs. Harper brought her hand down into the area where Respondent was working in an attempt to stop him. It was obvious that the procedure was somewhat painful to her and in the opinion of Ms. Infinger, Respondent was being less than gentle. When Mrs. Harper brought her hand down, Respondent grabbed it and moved it out of the way telling her at the time to, "Move your damned hand." This comment was heard by both Ms. Infinger and Ms. Fondren. When Respondent moved Mrs. Harper's hand, it collided with the bed rail which broke the skin causing it to bleed. Ms. Infinger noticed this and mentioned it to Respondent. He said he would take care of it and Ms. Infinger went some place else to do something. When she came back some 30 to 45 minutes later, she found that Respondent had still not dressed the skin break on Mrs. Harper's hand. Ms. Infinger thinks Respondent was too rough with Mrs. Harper. She believes it was not necessary for him to throw the elderly woman's hand off as he did. There were two aides present who could have, had they been asked, moved the hand and held it out of the way. There is some divergence in the testimony of Ms. Infinger and Ms. Fondren as to whether Respondent threw Mrs. Harper's hand or pushed it with the former contending it was a throw and the latter contending it was merely a push. Even Ms. Fondren, however, who believes this rough action was a reflex action by Respondent who had been in a bad mood all evening, agrees that since someone was there to help him, he should have asked for help rather than reacting on his own. If either witness is to be believed, however, Respondent acted unprofessionally. On the other hand, however, Ms. Stubbs, Ms. Blocker, and Ms. Fields, all of whom had worked with Respondent for several months, knew him from their repeated observations of him at work never to be abusive or rough with his patients. He is generally very kind to his patients, taking the time to explain what he is doing and exhibiting patience and understanding. His patience is somewhat less with the aides who in his opinion, do not do what they should on duty. Mrs. Harper has had several other skin tears both before and after the one in issue here. She is an old woman who bruises easily and whose skin can be broken easily. While not a difficult patient, she is somewhat confused and tends to try to interfere at times with the ministrations of those trying to help her and her hands often get in the way. Here, it is obvious that Respondent was in a bad mood late at night when he went to treat Mrs. Harper. He had just come from another patient who had not been properly cared for by the aides responsible for her and he was clearly annoyed. No doubt Mrs. Harper, not through spite or even consciously, attempted to stop him from doing what was no doubt a painful procedure and he reacted unprofessionally. This is not to say he consciously intended to harm her, but his reaction was less than it should have been in this situation. When Ms. Infinger came back and found that Respondent had not tended to Mrs. Harpers wound, she immediately reported this fact to Barbara Jean Miller, a licensed practical nurse working on another unit that evening who quickly treated and dressed the skin tear. When she left duty the next morning, she reported what she had seen and done and what Ms. Infinger had told her to the Assistant Director of Nursing who she saw outside in the parking lot. This lady reported it to the Director of Nursing, Mrs. Harwell, who conducted her own investigation. Mrs. Harwell interviewed Respondent who after first denying that the incident had taken place, admitted that he did yank Mrs. Harper's arm but stated he did not know it had hit the bed rail. He also initially denied knowing there was an injury but then admitted he had been told there was and that he had said he would fix it. He admitted that he was upset that evening. In the catheter procedure that Respondent was accomplishing, it is never appropriate to handle a patient so forcefully that it results in an injury even though it may be necessary to restrain or move the patient in some fashion. In Mrs. Harwell's opinion, Respondent's handling of Mrs. Harper in this instance was below minimum standards for the nursing profession. After talking with all the witnesses and securing pictures of the injury, based on her investigation and her discussions with Respondent, she terminated his employment with WCCC that day not only because in this instance his performance was below standards and unprofessional but also because this was the second incident of substandard performance on his record. She had previously chastised him for speaking improperly to or about another patient several weeks previously. Consequently, it is clear that Respondent moved Mrs. Harper's hand in such a manner that resulted in injury to her which is unprofessional conduct on his part compounded by his failure to return to treat the wound once he was made aware of it.
