The Issue Whether Respondent engaged in unprofessional conduct and, if so, what disciplinary action should be imposed on her nursing license.
Findings Of Fact The Department of Health is the state agency charged with regulating the practice of nursing pursuant to Chapter 464, Florida Statutes. At all times relevant to this proceeding, Respondent was a licensed practical nurse in the State of Florida, holding license no. PN 0986101. Respondent has been so licensed since 1990. At all times relevant to this proceeding, Respondent was employed in the office of Dr. David Flick, M.D., an oncologist. On October 17, 1995, Dr. Flick wrote a prescription for Fiorinal for Katherine Filan, who on that date, was an employee of Dr. Flick. The prescription authorized one refill. On or about January 12, 1996, in response to an inquiry from a pharmacy, Respondent approved a refill of the prescription for Fiorinal for Katherine Filan, without first consulting Dr. Flick. According to Dr. Flick, at all times pertinent to this proceeding, the general policy in his office was that he approved all refills. This policy was unwritten and was not effectively communicated to employees. Respondent and one other licensed practical nurse, formerly employed as a nurse in Dr. Flick's office, provided credible testimony that nurses in Dr. Flick's office were allowed to refill prescriptions, except for narcotics. However, when nurses authorized such refills, the policy was that the refills were to be documented and charted. Respondent believed that her action of authorizing the refill of Ms. Filan's prescription was consistent with the practice and policy of Dr. Flick's office. Moreover, Respondent believed that her approval of the refill was permitted because Dr. Flick had expressly authorized one refill on the original prescription he had written. No evidence was presented that Ms. Filan had refilled the prescription prior to January 12, 1996. After Respondent authorized the refill of the prescription for Ms. Filan, she failed to record the refill authorization on the any medical records. Respondent maintains that her failure to document the refill was inadvertent and was the result of her being extremely busy that day. On the day that Respondent authorized the refill, she was the only chemotherapy nurse on duty, was taking care of patients, and taking incoming nurse's calls. Except for this proceeding, Respondent has never been the subject of a disciplinary proceeding related to her nursing license.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is REOMMENDED that the Department of Health, Board of Nursing, enter a final order dismissing the Administrative Complaint against Respondent. DONE AND ENTERED this 17th day of February, 1999, in Tallahassee, Leon County, Florida. CAROLYN S. HOLIFIELD 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 17th day of February, 1999. COPIES FURNISHED: Sam Power, Agency Clerk Agency of Health Care Administration Fort Knox Building 3, Suite 3431 2727 Mahan Drive Tallahassee, Florida 32308 Paul J. Martin, General Counsel Agency of Health Care Administration Fort Knox Building 3, Suite 3431 2727 Mahan Drive Tallahassee, Florida 32308 Howard M. Bernstein, Esquire Agency for Health Care Administration General Counsel's Office Medical Quality Assistance Allied Health Post Office Box 14229 Tallahassee, Florida 32317-4229 Michele L. Schrembs DeGrolier, pro se 1501 Carlos Avenue Clearwater, Florida 33755
The Issue Petitioner seeks licensure by examination as a registered nurse in the State of Florida. The issue for disposition here is whether her application should be granted.
Findings Of Fact Vergella Joseph Anicet was born in Haiti on July 26, 1957. After high school and university studies she attended the National School of Nursing in Port-Au-Prince, Haiti, from 1982- 1985, and graduated in 1985. Ms. Anicet emigrated to Miami, Florida, in November 1985. After approximately a year she moved to Central Florida and now is residing in Orlando. In 1990, Ms. Anicet applied for licensure as a registered nurse in Florida. Upon her request, the nursing school in Haiti sent a transcript directly to the Board of Nursing. The Board approved her to work as a graduate nurse until she could take the licensing examination. After she failed the examination Ms. Anicet lost her graduate nurse permit but qualified for licensure as a certified nursing assistant. In 1993, she passed the licensed practical nurse (LPN) examination and has been employed as an LPN since then. Ms. Anicet applied again for licensure as a registered nurse by examination in February 1999. As part of the process of that application she requested the nursing school in Haiti to send her transcript to the Board of Nursing. The nursing school sent Ms. Anicet's transcript directly to the Board. However, the transcript sent in 1999 varied in many material aspects from the version that the Board received from the school in 1990. The discrepancies are in the described courses, numbers of hours completed, and in the clinical practice experiences described in the two transcripts. From the record it is impossible to determine which is the correct transcript. In response to a request by Ms. Anicet's attorney, the National School of Nursing in Port-Au- Prince sent a letter to the Board of Nursing in October 1999, in an attempt to explain the two transcripts. As best as can be determined, the school revised its curriculum in November 1997 and somehow readjusted the official transcript to conform to the revisions. However, there is no key to how the adjustments were made. The differences are not attributable to different translations, French to English, of the two documents.¹ There is no evidence of any fraud by Ms. Anicet. The peculiar documents came directly to the Board from the school in Haiti. The Board has had problems verifying the coursework of other applicants who are graduates from this same school. The evidence establishes that Ms. Anicet graduated from nursing school but does not establish the courses or program which she completed.
Recommendation Based on the foregoing, it is hereby RECOMMENDED: That the Board of Nursing enter its final order denying Ms. Anicent's application without prejudice to her right to reapply when she is able to obtain an appropriate credentialing report. DONE AND ENTERED this 18th day of October, 2000, in Tallahassee, Leon County, Florida. MARY CLARK 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 18th day of October, 2000.
The Issue Whether Respondent engaged in unprofessional conduct and, if so, what penalty should be imposed on his nursing license.
Findings Of Fact The Department of Health is the state agency charged with regulating the practice of nursing pursuant to Chapter 464, Florida Statutes. Respondent, Cecil Harold Floyd, was at all times material hereto a licensed practical nurse in the State of Florida, having been issued a license numbered PN 0960631. At all times material hereto, Respondent was employed as a licensed practical nurse by the North Shore Senior Adult Community in St. Petersburg, Florida. At all times material hereto, Respondent was assigned to care for Patient M.F., a patient in the skilled nursing section of the North Shore Senior Adult Community. On February 26-27, 1996, Respondent worked as the charge nurse on the 11:00 p.m. to 7:00 a.m. shift. On February 27, 1996, at approximately 6:00 a.m., Respondent wrote in the nurse's notes that Patient M.F. was lethargic and having difficulty swallowing; that the patient's bottom dentures were out; and that the patient's tongue was over to the right side. In this entry, Respondent also noted "will continue to monitor." After Respondent completed his shift on February 27, 1996, Conchita McClory, LPN, was the charge nurse in the skilled nursing facility at North Shore Senior Adult Community. At about 8:10 a.m., Nurse McClory was called by the CNA who was attempting to wake up Patient M.F. Upon Nurse McClory's entering Patient M.F.'s room, she observed that the patient was sleeping, incontinent, and restless and that the right side of the patient's face was dropping. Based on these observations, Nurse McClory believed that Patient M.F. may have suffered a stroke and she immediately called 911. Following the 911 call, Patent M.F. was taken to Saint Anthony's Hospital in Saint Petersburg, Florida. Prior to coming to this country, Conchita McClory had been trained and worked as a registered nurse in the Philippines. However, Ms. McClory is not licensed as a registered nurse in the State of Florida. Saint Anthony's Hospital's records regarding Patient M.F. indicate that the patient had a history of multiple strokes beginning in 1986. The Department’s Administrative Complaint against Respondent included the following factual allegations, all of which were alleged to have occurred on February 27, 1996: At approximately 6:00 a.m., Respondent recorded in the nurse’s notes that Patient M.F. was lethargic and having difficulty swallowing; the patient's bottom dentures were out; and the patient's tongue was over to the right side. Respondent also noted in the nurses' notes that Patient M.F. should continue to be monitored. Patient M.F.'s roommate told Respondent that she believed that M.F. had suffered a stroke because she could not swallow and her speech was slurred. At about 8:00 a.m., Patient M.F.'s roommate went to the nurses' station and requested that a certified nurse's assistant check on M.F. Patient M.F. was found paralyzed on her left side, soaked in urine and unable to speak. There was no evidence presented to support the factual allegations referenced in paragraph 9b and 9c above and included in the Administrative Complaint.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Health, Board of Nursing, enter a final order dismissing the Administrative Complaint against Respondent. DONE AND ENTERED this 6th day of October, 1999, in Tallahassee, Leon County, Florida. CAROLYN S. HOLIFIELD 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 6th day of October, 1999. COPIES FURNISHED: Howard M. Bernstein, Esquire Agency for Health Care Administration Allied Health - Medical Quality Assistance 2727 Mahan Drive, Building 3 Tallahassee, Florida 32308-5403 Cecil Harold Floyd 1680 25th Avenue, North St. Petersburg, Florida 33713-4444 Ruth Stiehl, Executive Director Board of Nursing Department of Health 4080 Woodcock Drive, Suite 202 Jacksonville, Florida 32207 Angela T. Hall, Agency Clerk Department of Health 2020 Capital Circle, Southeast, Bin A02 Tallahassee, Florida 32399-1701 Pete Peterson, General Counsel Department of Health 2020 Capital Circle, Southeast, Bin A02 Tallahassee, Florida 32399-1701
Findings Of Fact Petitioner has been registered with respondent as a licensed practical nurse since September 25, 1951. She worked as a licensed practical nurse until 1972, which was the last year she paid any annual renewal fee. She assumed that her license was in an inactive status after 1972, although she never made a written request that it be placed on the inactive list. She was unaware of any requirement to pay annual renewal fees after 1972. Petitioner applied for reinstatement of her license in February of 1979. Respondent denied this application on the ground that petitioner "did not complete a program approved by the Board for the preparation of Licensed Practical Nurse." Petitioner's exhibit No. 1. Petitioner has completed an approved 4-year high school course of study. Petitioner's exhibit No. 2. In addition, petitioner has, since early February of 1979, completed 46 1/2 hours of continuing education in a wide range of nursing subjects. Petitioner's exhibit No. 3. Petitioner enjoys the confidence of physicians in her community, one of whom described her as "industrious, conscientious and reliable." Petitioner's exhibit No. 2.
Recommendation Upon consideration of the foregoing, it is RECOMMENDED: That respondent grant petitioner's request for re-registration as a licensed practical nurse. DONE AND ENTERED this 14th day of August, 1979, in Tallahassee, Florida. ROBERT T. BENTON, II Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675 COPIES FURNISHED: Cecil G. Costin, Jr., Esquire 413 Williams Avenue Port St. Joe, Florida 32456 Julius Finegold, Esquire 1107 Blackstone Building Jacksonville, Florida 32202
Findings Of Fact In October 1978 Bonnie Ray Solomon Crawford, LPN was employed at the West Pasco Hospital, New Port Richey, Florida as a licensed practical nurse provided by Upjohn Company's rent-a-nurse program. On 7 October 1978 Respondent signed out at 10:00 a.m. and 2:00 p.m., and on 8 October 1973 at 8:00 a.m. and 1:00 p.m. for Demerol 75 mg for patient Kleinschmidt (Exhibit 2). Doctor's orders contained in Exhibit 4 shows that Demerol 50 mg was ordered by the doctor to be administered to patient Kleinschmidt as needed. Nurses Notes in Exhibit 4 for October 7, 1978 contains no entry of administration of Demerol at 10:00 a.m. and at 2:00 p.m. shows administration of 50 mg. and Phenergan 25 mg. Exhibit 3, Narcotic Record for Demerol 50 mg contains two entries at 8:15 a.m. on October 7, 1978 and one entry at 12:30 p.m. where Respondent signed out for Demerol 50 mg. for patients King, Zobrist and King in chronological order. Nurses Notes for King, Exhibit 6, and Zobrist, Exhibit 5, contain no entry that Demerol was administered to patient Zobrist at 8:15 a.m. or to patient King at 12:30 p.m. on 7 October 1978. In fact, the record for Zobrist shows that Zobrist was discharged from the hospital on October 5, 1978. Failure to chart the administration of narcotics constitutes a gross error in patient care and is not acceptable nursing practice. Similarly it is not acceptable nursing practice to withdraw narcotics not contained in doctors orders or administer medication not in doctors orders. When confronted by the Nursing Administrator at West Pasco Hospital with these discrepancies in the handling of Demerol, Respondent stated that she failed to check the identity of the patient before administering medication and that she didn't feel she should be giving medications any more. Following this confrontation with the hospital authorities, Respondent was fired for incompetency. No evidence was submitted regarding Respondent's 1975 disciplinary proceedings.
The Issue The issue is whether Respondent's license to practice nursing should be revoked, suspended, or otherwise disciplined under the facts and circumstances of this case.
Findings Of Fact Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant findings of fact are made: At all times material to this proceeding, Respondent Rita Flint (Flint) was a licensed practical nurse in the State of Florida, holding license number PN0655201. Flint's last known address is 6494 South West 8th Place, North Lauderdale, Florida 33068. At all times material to this proceeding Flint was employed by North Broward Medical Center (NBMC) located in Pompano Beach, Florida, as a practical nurse. On August 3, 1990, Flint was assigned to care for patients J. C. and J. K. including administering their medications and charting same on their Medication Administration Record (MAR). On August 3, 1990, J. C.'s physician prescribed one (1) nitroglycerine patch each day. Flint failed to administer the patch on this date. On August 3, 1990, J. C.'s physician prescribed 100 mg. of Norpace every six (6) hours. Flint failed to administer the 2:00 p.m. dosage of Norpace to J. C. On August 3, 1990, J. C.'s physician prescribed 120 mg. of Inderal each day. Flint failed to administer the 9:00 a.m. dosage of Inderal until 1:30 p.m. without noting any explanation on J. C.'s MAR. On August 3, 1990, Flint failed to document the administration of J. K's own medications on the MAR. On August 3, 1990, Flint failed to sign the MARs for J. C. and J. K. as required by hospital policy. On August 15, 1990, Flint left an intravenous bag with an exposed needle hanging at the bedside of a patient. On August 29, 1990, Flint was assigned to care for patient R. R. including administering his medications. Flint failed to administer the following medications leaving all of them at R. R.'s bedside: (a) Timolo (9:00 a.m. and 2:00 p.m. doses); (b) Mixide (9:00 a.m. dose); (c) Zantac (9:00 a.m. and 4:00 p.m. doses); (d) Lasix (9:00 a.m. dose); and, (e) Entozyme (8:00 a.m. and 12:00 noon doses). On August 30, 1990, NBMC terminated Flint's employment as a result of the aforementioned conduct. There is no evidence that any patient suffered any actual harm as a result of Flint's errors. In September of 1990, NBMC referred Flint to the Intervention Project for Nurses. At all times relevant to this proceeding, Flint's job performance was adversely affected by long work schedules necessitated by severe financial problems. During the week of August 3, 1990, Flint worked a ninety-two-hour week. The acute financial stress was due to domestic problems including the breakup of her twenty-two-year-old marriage. Flint had no problems involving substance abuse. Flint attended individual therapy sessions with a clinical psychologist, Priscilla Marotta, Ph.D., and participated in group therapy designed primarily for persons with substance abuse problems. Flint attended weekly therapy sessions for approximately one month after which she could no longer afford treatment. Even though Flint was financially unable to continue treatment with Dr. Marotta or any other counseling program recommended by the Intervention Program for Nurses, she diligently undertook a self-help program to educate herself on stress management techniques, to develop self-reliance, and to improve self-esteem. Flint's effort to participate in therapy, to the extent financially possible, and to rehabilitate herself shows a strong commitment to her profession. Flint has been licensed to practice nursing since May 31, 1982. There is no evidence of any disciplinary action against her license prior to or after the incidents herein described. Flint is currently employed as a nurse in a hospice. Her recent performance appraisal reports indicate that, on an average, she fully meets all job requirements.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is, therefore recommended that the Board of Nursing enter a Final Order finding Respondent guilty of violating Section 464.018(h), Florida Statutes (1989), as defined in Rule 210-10.005(1)(e)1 and Rule 210-10.005(1)(e)2, Florida Administrative Code, and not guilty of violating Section 464.018(1)(j), Florida Statutes. It is further recommended that the Board's final order: (1) place the Respondent on probation for one year subject to such requirements as the Board may require; and (2) require the Respondent to pay an administrative fine in the amount of two hundred fifty dollars ($250). DONE AND ENTERED in Tallahassee, Leon County, Florida, this 21st day of November 1994. SUZANNE F. HOOD, Hearing Officer Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 21st day of November 1994. APPENDIX TO RECOMMENDED ORDER IN CASE NO. 93-2715 The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on all of the Proposed Findings of Fact submitted by the parties to this case. FOR THE PETITIONER: Incorporated into Findings of Fact 1. Incorporated into Findings of Fact 2 and 11. Incorporated into Findings of Fact 4. Incorporated into Findings of Fact 5. Incorporated into Findings of Fact 6. Incorporated into Findings of Fact 7. Incorporated into Findings of Fact 8. Incorporated into Findings of Fact 9. Incorporated into Findings of Fact 10. The first sentence is incorporated into Findings of Fact 13. The remaining portion of this proposed fact is not supported by competent substantial evidence. Furthermore, Respondent's Exhibit 3, as it relates to a diagnosis of a mental condition, is hearsay which does not supplement or explain any other psychological or medical evidence. Thus, any reference in Exhibit R3 to a generalized anxiety disorder is insufficient to support Petitioner's proposed finding. Unsupported by competent substantial evidence. Unsupported by competent substantial evidence. See number 10 above. FOR THE RESPONDENT: 1. Respondent did file proposed findings of fact or conclusions of law. COPIES FURNISHED: Laura Gaffney, Esquire Natalie Duguid, Esquire Agency for Health Care Administration 1940 North Monroe Street Tallahassee, Florida 32399-0792 Rita Flint 3313 South East Second Street Pompano, Florida 33063 Judie Ritter Executive Director Board of Nursing AHCA 504 Daniel Building 111 East Coastline Drive Jacksonville, Florida 32202 Harold D. Lewis General Counsel The Atrium, Suite 301 325 John Knox Road Tallahassee, Florida 32303
Findings Of Fact On December 9, 1980, Petitioner was working as a student nurse at University Community Hospital, Tampa, Florida. She was in her next to last quarter as a student in the Registered Nurse Program at Hillsborough Community College. Her supervisor had assigned Petitioner to provide exclusive care to a comatose patient who had both a tracheostomy and a gastrostomy. Attached to the trachea of this patient was a tube into which oxygen and water were added to help patient's respiration and to keep the proper moisture content in his lungs. The hole was covered by a mask which could be slipped aside by the nurse to suction fluids emerging from the lungs. This suctioning around the trachea was required every few minutes, hence the assignment of Petitioner to only one patient during this shift. Petitioner was informed she would get this assignment one or two days prior and had visited the patient's room, read his charts, and studied the nursing required before reporting for duty on 9 December 1980. She was fully aware of the tracheostomy, gastrostomy, and the purpose and function of each. Petitioner reported for work at 6:00 a.m. on December 9, 1980, and was assigned to the comatose patient as noted above. She spent most of the first two hours suctioning and cleaning around the tracheostomy and generally caring for the patient, which included turning the patient. From her observation and study Respondent was aware of the tube into the abdomen of this patient by which he was to be fed. Shortly after 8:00 a.m. on December 9, 1980, Petitioner prepared the bag for liquid feeding of the patient and hung it on the IV pole alongside the patient's bed. She then connected the tube from the feeding bag to the tracheostomy tube. Around 8:45 a.m. James Holly, a respiratory therapy technician, entered the room and saw Petitioner standing alongside the patient's bed with the feeding bag on the IV pole and the tube from the bag leading to the tracheostomy of the patient. He immediately yelled words to the effect that the feeding tube is connected to the treach and ran to the opposite side of the bed from which Petitioner was standing. Petitioner heard a noise, immediately realized what was happening and removed the feeding tube from the trachea. Holly testified the patient coughed once violently; Petitioner testified-the patient did not cough violently. In either, event the patient's lungs were checked immediately with a stethoscope, the supervising nurse was sent for and Petitioner's supervisor was called. The patient received very little, ,if, any, feeding fluid into his lungs and suffered no adverse effects from this incident. Petitioner's supervisor discussed the incident with Petitioner, assisted her in giving the patient his morning feeding and concluded Petitioner was capable of caring for the patient for the rest of the shift. Petitioner remained with the patient throughout the shift and gave the patient his twelve o'clock feeding without assistance or incident. Petitioner's supervisor reported the incident to the Director of Nursing at Hillsborough Community College, who called a meeting of the evaluating committee the following day. At the evaluation hearing Petitioner could give no explanation of why she had connected the feeding tube to the tracheostomy tube rather than the gastrostomy tube, nor could she explain at this hearing why she did it. In Petitioner's words, "If I knew why I did it, it wouldn't have happened." Following the meeting of the evaluating committee Petitioner was dismissed from nursing school and her subsequent application for readmission was denied. Her application to take the licensed practical nurse examination, for which her time as a student nurse qualified for the licensed practical nurse training requirements, was denied by Respondent and Petitioner requested this hearing. Prior to the incident of 9 December 1980 Petitioner was regarded by her supervisors as well motivated, good with patients, and well organized. Petitioner is 37 years old and has wanted to be a nurse for a long time. She readily acknowledges that she knew the patient was to be fed through the gastrostomy tube, that the patient could not be fed through the tracheostomy tube and that it would be very dangerous to attempt to do so. Her inability to give any explanation of why she attached the feeding tube to the tracheostomy was a major factor in the evaluation board's determination to dismiss Petitioner from nursing school. Transmitting liquid into a patient's lungs through a tracheostomy tube constitutes a very dangerous procedure which could prove fatal to the patient either from suffocation (if a sufficient quantity of fluid was injested) or through infection in the lungs from the unsterilized liquid. Committing such act constitutes a failure to conform to minimum standards of acceptable and prevailing nursing practices. Petitioner was sufficiently advanced in her training to know the proper procedures to be followed in such a case, and Petitioner readily acknowledges that she did know the proper procedures to follow and is unable to account for her deviation therefrom.
Findings Of Fact The Respondent, Bonnie Jean Hutcheson, is a licensed practical nurse, who holds License No. 19002-1. In June and July of 1978, the Respondent was employed at The Abbey Nursing Home in St. Petersburg, Florida. On July 4, 1978, the Respondent was terminated from her employment at The Abbey Nursing Home by the Director of Nursing. Respondent Hutcheson was employed as a licensed practical nurse at North Horizon Convalorium in St. Petersburg, Florida in April, 1979. On February 16, 1979, an Administrative Complaint was filed alleging that Respondent Hutcheson was guilty of unprofessional conduct. The Respondent requested an administrative hearing in May of 1979, and a hearing was scheduled for July 25, 1979, but was continued by Motion of the Petitioner. Thereafter, the Administrative Complaint was amended on August 12, 1979, to add additional charges. On June 17, 23 and 24, 1978, while employed at The Abbey, Respondent Hutcheson signed out for Dalmane, a controlled substance, for a patient, Josephine Miracky, and failed to chart the administration of same on the patient's medication record. On July 2, 1978, Respondent reported to work at The Abbey for the 3:00 p.m. to 11:00 p.m. shift. Alice Henderson, a registered nurse who was going off duty at 3:00 p.m., noticed the Respondent and reported to the nursing office that Respondent's speech seemed slurred, that she seemed unsteady on her feet and slow to respond, and that she had counted medications very slowly. On July 4, 1978, the Director of Nursing terminated the employment of Respondent Hutcheson for the reason that she felt the Respondent's performance was unsafe as a practitioner. In April of 1979, while employed at North Horizon Convalarium, Respondent Hutcheson signed out for Tylenol No. 3, a narcotic and controlled substance, at an interval of one hour for a patient, Emma Jackson, when the physician's order for this medication was that it be administered no more frequently than every four (4) hours. On three (3) or four (4) occasions during the month of April, 1979, the Respondent took from the patients' medication stock three (3) or four (4) Tylenol No. 3 tablets and left the facility with them to give to her son at home. Respondent Hutcheson did not deny the allegations in the Administrative Complaint. In defense of her actions she testified that she knew Alice Anderson, the witness for Petitioner, but that she had not worked with her and did not work with her on the same shift. (Ms. Anderson's report is contained in Paragraph 2) Respondent Hutcheson acknowledged that she knew Eris J. Frye, the Director of Nursing at The Abbey Nursing Home, and admitted that she might have made a "common error" by failing in June of 1978, to chart medication on a patient's medication record. She did not know she had been terminated as "an unsafe practitioner." Respondent Hutcheson recalled the day of July 2, 1978, when she came to work, and she stated she had developed a back problem, having a chronic type of arthritis. She stated that she had taken a pain medication prescribed for her by her physician, Dr. Spatapora, which was a medication called Anexsia-D. Respondent stated that at that time she had just learned that her daughter, who was fifteen (15) years of age and unmarried, was pregnant, and that she in fact was exceedingly disturbed over her daughter's condition and could not sleep, and had taken the medication prescribed for her by her physician. She said she had not taken any of the medication at work, but that she was so over-whelmed by her problems she was ready to resign her position at The Abbey at the time she was terminated on July 4, 1978. Respondent Hutcheson stated that in April of 1979, while working at North Horizon Convalarium, she took several tablets of Tylenol No. 3 from the medication supplies to give to her son, who had recently come out of the hospital after having been seriously injured in an automobile accident. She testified that her son was in a great deal of pain, that she had to leave him alone in the house, and that she used the tablets to help him get to sleep for a few nights because she could not get in touch with his physician and could not afford to take him to another physician. She said her son used the nine (9) to eleven (11) tablets only, and was not and is not addicted to drugs. Respondent Hutcheson is not addicted to drugs. Witnesses for the Petitioner Board stated that it was contrary to acceptable and prevailing nursing practice for the Respondent to fail to accurately chart all medications signed out by her, and that it is contrary to acceptable and prevailing nursing practice to take Tylenol No. 3 tablets from the patients' medication supplies. Witnesses for the Respondent testified that she is a good neighbor and a hard-working, conscientious nurse, and that she is a devoted mother to her son and daughter. They stated Respondent is divorced and has the responsibility for her children. Petitioner and Respondent submitted proposed findings of fact and recommended orders. These instruments were considered in the writing of this Order. To the extent the proposed findings of fact have not been adopted in, or are inconsistent with, factual findings in this Order they have been specifically rejected as being irrelevant or not having been supported by the evidence.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, the Hearing Officer recommends that the Respondent, Bonnie Jean Hutcheson, be placed on probation for a period of two (2) years from the date hereof. DONE and ORDERED this 7th day of November, 1979, in Tallahassee, Leon County, Florida. DELPHENE C. STRICKLAND Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1107 Blackstone Building 233 East Bay Street Jacksonville, Florida 32202 Jean M. Flanagan, Esquire Gulfcoast Legal Services, Inc. 641 First Street, South Post Office Box 358 St. Petersburg, Florida 33731 Geraldine B. Johnson, R. N. Board of Nursing 111 Coastline Drive East, Suite 504 Jacksonville, Florida 32202
The Issue The issue is whether Petitioner meets the academic requirements to sit for the practical nursing equivalency examination in Florida.
Findings Of Fact Petitioner attended the registered nursing program at HCC. On or about March 1, 2007, Petitioner applied to sit for the practical nursing licensure examination. By letter dated May 8, 2008, the Board notified Petitioner that additional information was required to complete her application. According to the letter, two submissions were required. First, the director of nursing at HCC needed to submit a letter stating that Petitioner's coursework meets the practical nursing educational equivalency. Second, Petitioner needed to submit verification that she completed coursework in medical-surgical nursing (oxygenation, circulation and hematology). Rise Sandrowitz, program manager of the nursing program at HCC, submitted a letter to the Board. In the letter dated June 8, 2008, Ms. Sandrowitz stated that while Petitioner was a student at HCC, she "twice attempted but was unsuccessful in Adult Health III." The Adult Health Care III course is a 5.5 credit hour course and covers topics of oxygenation, circulation and hematology. Ms. Sandrowitz' letter does not state that the courses Petitioner completed in the professional nursing program at HCC met the requirements for the practical nursing equivalency. Ms. Sandrowitz testified credibly that the intent of her letter was to recommend that Petitioner be allowed to sit for the examination, if the Board determined that Petitioner's coursework met the practical nursing equivalency requirements. The Board determined that Petitioner's failure to successfully complete the course that covered the oxygenation (respiratory), circulation, and hematology systems demonstrated that she did not meet the practical nursing equivalency requirements. Petitioner testified credibly that each time she took the Adult Health Care III course, she attended "all lectures and every clinical," took every test and quiz, and completed all assignments. Nevertheless, Petitioner did not successfully complete the course. Each time Petitioner took the course, she was "just short of the 80%" needed to pass the lecture part of the course. Despite her failure to pass Adult Health Care III, Petitioner argues that she has adequate knowledge in all nursing areas, including those systems covered in that course and, thus, should be allowed to sit for the practical nursing examination.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a final order be entered which denies Petitioner, Angela Sessa's, application to sit for the examination for licensure as a practical nurse in Florida. DONE AND ENTERED this 6th day of June, 2008, in Tallahassee, Leon County, Florida. S CAROLYN S. HOLIFIELD 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 6th day of June, 2008. COPIES FURNISHED: Lee Ann Gustafson, Esquire Office of the Attorney General The Capitol, Plaza Level 01 Tallahassee, Florida 32399-1050 Angela Sessa 3505 Sandburg Loop Plant City, Florida 33566 Rick Garcia, Executive Director Board of Nursing Department of Health 4052 Bald Cypress Way, Bin C-02 Tallahassee, Florida 32399-1701 Dr. Patricia Dittman, Chairman Board of Nursing Department of Health 4052 Bald Cypress Way, Bin C-02 Tallahassee, Florida 32399-1701 Josefina M. Tamayo, General Counsel Department of Health 4052 Bald Cypress Way, Bin A-02 Tallahassee, Florida 32399-1701 R.S. Power, Agency Clerk Department of Health 4052 Bald Cypress Way, Bin A-02 Tallahassee, Florida 32399-1701
