The Issue Whether Respondent committed the offenses set forth in the Second Amended Administrative Complaint and, if so, the penalties that should be imposed.
Findings Of Fact At all times relevant hereto, Respondent, Diahann James, held license numbered 1266532 as a registered nurse (RN) and held license numbered 36309-1 as a practical nurse (PN). Both of these licenses had been issued to Respondent by Petitioner and entitled Respondent to engage in the practice of nursing within the scope of her licensure in the State of Florida. Respondent's RN license was, at the time of the formal hearing, suspended following Petitioner's order of suspension entered December 13, 1990. This suspension was based on Respondent's alleged failure to comply with the terms of her previously established probation. Respondent's PN license has been on an inactive status since April 1, 1983. Respondent has until April 1, 1993, to seek reactivation of her PN license pursuant to Rule 210-14.005(1), Florida Administrative Code. Unless reactivated, her PN license will permanently expire after April 1, 1993. On February 15, 1985, Respondent's RN license was suspended pursuant to an order entered by the Board of Nursing (Board) as the disposition of the Department of Professional Regulation's (DPR) Administrative Complaint Number 0051651. On June 23, 1986, Respondent's RN license was conditionally reinstated pursuant to an order of the board, contingent upon Respondent's submission of a favorable psychological evaluation. On August 11, 1986, Respondent submitted a satisfactory psychological evaluation and her license was reinstated effective August 27, 1986. Upon reinstatement, Respondent's RN license was placed on probation for a period of two years subject to specific terms and conditions. Respondent did not submit the quarterly reports required by the terms of her probation and the Board filed a complaint with DPR against Respondent on April 22, 1988, based on her failure to comply with the terms of her probation. On October 18, 1988, DPR filed Administrative Complaint 0098524 against Respondent based on the complaint the Board had filed on April 22, 1988. On April 1, 1989, Respondent's RN license 1266532 became inactive due to Respondent's failure to apply for renewal. In May 1989, Respondent applied for reactivation of her RN license. Accompanying this application was an affidavit that Respondent had executed on April 3, 1989. This affidavit affirmed that she had earned the continuing education hours during 1987-89 to meet the requirements set by DPR for renewal of her license. At the Board's request, Respondent submitted copies of continuing education certificates from Psycho- Awareness Continuing Education Provider as documentation that she had met the continuing education requirements as represented by her affidavit dated April 3, 1989. The continuing education certificates submitted by Respondent had been altered to reflect her participation and attendance at these continuing education programs in 1988. Respondent attended these programs not in 1988 (which would have met the continuing education requirements), but in 1986 (which would not meet the continuing education requirements). The affidavit Respondent signed on April 3, 1988, was false, and the certificates she submitted in support of that affidavit were altered. Respondent's submitted continuing education certificates were deemed to be forgeries by the Board. On June 23, 1989, Respondent was advised that her continuing education certificates were unacceptable, that her license remained on an inactive status, and that she was not entitled to work as a nurse. In July 1989, Respondent worked as a registered nurse at Cedars Medical Center, Miami, Florida. Respondent did not inform the Board's probation supervisor of her employment at Cedars Medical Center, even though the terms of her probation required her to do so. Respondent answered "no" on the Cedars Medical Center employment application to the question of whether her license had ever been revoked, suspended, or placed on probation. At no time during the term of her employment at Cedars Medical Center did she reveal that her licensure was on an inactive status and on probation. During the course of her employment at Cedars Medical Center on July 11-12, 1989, and on July 25-26, 1989, (these events occurred during the night shift) Respondent wrote telephone orders, allegedly from physicians, for various medications for several different patients. Respondent signed at least two of said telephone orders with the name of "L. Hemingway", a coworker. Respondent submitted these telephone orders to the pharmacy and obtained various medications, including controlled substances. The physicians named by Respondent on the telephone orders denied giving Respondent authorization to order those medications on the dates specified, and none of said orders were an existing part of the patients' records. On July 28, 1989, Respondent was confronted by her superiors regarding the numerous discrepancies that had been discovered through the pharmacy regarding her deviation from the normal procedure for obtaining and administering medications. Respondent denied any diversion of drugs and further denied writing the fraudulent telephone orders. Respondent was then asked to submit to a urine test, and she submitted a urine sample under controlled conditions. The urine sample was thereafter tested using appropriate methodology and equipment. Her urine tested positive for cocaine, meperidine (Demerol, a schedule II controlled substance, and pentazocine (Talwin, a schedule IV controlled substance). Respondent did not produce any valid prescriptions to account for the positive results of her urinalysis. On August 1, 1989, Respondent's employment at Cedars Medical Center was terminated. On July 28, 1989, the Board filed a Final Order in DPR case 0098524, the case DPR had filed against Respondent's RN license on October 18, 1988. This Final Order extended Respondent's existing probation for a period of two years and imposed conditions of probation similar to those initially imposed on August 27, 1986. On August 27, 1989, Respondent's RN license, which had been on an inactive status since April 1, 1989, was reactivated, but remained on probationary status. In December 1989, Respondent was employed at Doctors Hospital, Coral Gables, Florida, as a registered nurse. Respondent failed to inform her probation supervisor of her employment as a nurse, though she was required to do so by the terms of her probation. On December 4-5, 1989, Respondent worked the 11 p.m. to 7 a.m. shift at Doctors Hospital. The narcotic records on which Respondent signed out for narcotics for patients under her care and the medication record on which she charted the medication for these patients were falsified to reflect that these patients had received more narcotics than had actually been administered to them. These false records, for which Respondent was responsible, permitted Respondent to obtain excess narcotics from the hospital's pharmacy. On January 18, 1990, Respondent rendered a urine specimen for drug analysis pursuant to the terms of her probation. The subsequent analysis tested positive for propoxyphene (Darvone, a schedule IV controlled substance). Respondent provided no valid prescription to account for the positive result of her urinalysis. On March 1-2, 1990, Respondent was employed at Coral Gables Hospital, Coral Gables, Florida. Respondent failed to inform her probation supervisor of her employment, although she was required to do so by the terms of her probation. While working the 11 p.m. to 7 a.m. shift at Coral Gables Hospital, on March 1, 1990, Respondent admitted to her nursing supervisor that she had self-administered 150 mg. of Demerol. Respondent was accompanied to the Emergency Room where she received medical assistance. The nursing supervisor immediately began a review of Respondent's patients' charts. From this review, it was established that Respondent had obtained 250 mg. of Demerol, and that the patients for whom Respondent had signed out the narcotics did not possess physicians' orders for same. Respondent falsely charted on the medical records of two patients the administration of Demerol. On March 8, 1990, Respondent rendered a serum sample for drug analysis at the request of Coral Gables Hospital. Said specimen subsequently tested positive for the presence of Demerol. On July 15, 1990, Respondent rendered a urine specimen for drug analysis, pursuant to the terms of her probation. The preliminary results of that testing detected the presence of certain controlled substances and were classified as presumptive positive. The specimen Respondent had given was not of sufficient quantity to permit the completion of testing, and the preliminary findings were not confirmed. On December 13, 1990, Respondent's R.N. license was suspended due to her failure to comply with the terms of her probation. Based on the expert testimony presented at the formal hearing, it is found that Respondent is an impaired individual suffering from chemical dependency; that Respondent's practice of nursing is below the minimum standard of safe patient care for the State of Florida; and that Respondent is unable to practice nursing with reasonable skill and safety to patients because of her chemical dependency.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered which revokes Respondent, Diahann James's license as a registered nurse (number 1266532) and which revokes her license as a practical nurse (number 36309-1). DONE AND ORDERED in Tallahassee, Leon County, Florida, this 18th day of July, 1991. CLAUDE B. ARRINGTON 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 18th day of July, 1991. APPENDIX The proposed findings of fact submitted on behalf of the Petitioner are adopted in material part by the Recommended Order. The only post-hearing submittals by Respondent were in the form of two brief letters addressed to the undersigned, one filed May 8, 1991, and the other filed May 30, 1991. To the extent that either letter is construed to contain proposed findings of fact, those proposed findings are rejected as being either irrelevant, unsupported by the record, or contrary to the findings made. COPIES FURNISHED: Tracey S. Hartman, Esquire Roberta Fenner, Esquire Department of Professional Regulation 1940 North Monroe Street, Suite 60 Tallahassee, Florida 32399-0792 Diahann L. James 676 N.W. 48th Street, No. 4 Miami, Florida 33127 Judie Ritter, Executive Director 504 Daniel Building 111 East Coastline Drive Jacksonville, Florida 32202 Jack McRay, General Counsel Department of Professional Regulation 1940 North Monroe Street, Suite 60 Tallahassee, Florida 32399-0792
The Issue The issue in this case is whether Respondent is guilty of violating Rule 59S-8.005(1)(e)2, Florida Administrative Code, for administering medications or treatments in a negligent manner and subject to discipline for unprofessional conduct under Section 464.018(1)(h), Florida Statutes. If so, another issue is what penalty should be imposed.
Findings Of Fact In June 1994 Respondent was licensed as a registered nurse, holding license number RN 2740932. Respondent had been licensed as a registered nurse since 1993 and as a licensed practical nurse since 1987. Respondent's license as a registered nurse became inactive June 21, 1995 after she failed to renew it. In the fall of 1993 East Pointe Hospital hired Respondent as a charge nurse in the transitional care unit, which had recently been started. Although Respondent had only recently become licensed as a registered nurse, the hospital hired her based partly on her current licensing and partly on her previous experience as a licensed practical nurse and respiratory therapist. During the weekend of June 24-26, 1994 Respondent worked the 7:00 pm to 7:00 am shift. As a charge nurse Respondent supervised several other nurses, typically licensed practical nurses. The charge nurse and nurses whom the charge nurse supervised sometimes divided up the patients in the unit, but the charge nurse retained supervisory authority over the other nurses and always remained directly responsible for patients with more complex problems. Patient C. P. had recently been transferred to the transitional care unit from the acute care unit. On the evenings in question, C.P. was among the patients for whom Respondent was directly responsible. Several IVs were being administered the evening of June 24 and early morning of June 25. One patient was having problems with an IV pump and his veins. Respondent asked another nurse, who was under Respondent's supervision, to do the accuchecks on the other patients, including C. P. Accuchecks are finger stick glucose monitors. As was the case with C. P., physicians typically order accuchecks every six hours for patients receiving their total nutrition intravenously. The purpose of the accucheck is to ensure that the patient receiving all his nutrition intravenously does not develop low or high blood sugar, which could have very serious implications. The other nurse failed to perform the accuchecks for midnight at the start of June 25 and 6:00 am on June 25. Respondent failed to follow up to ensure that they were done. Respondent's failure to perform the required accuchecks or to check to make sure that the other nurse performed them constitutes the negligent treatment of a patient. A physician had also ordered that C. P. receive antibiotics intravenously every eight hours, at about 6:00 am, 2:00 pm, and 10:00 pm. Petitioner alleges that Respondent failed to administer two consecutive doses. However, nothing in the nurses' notes documents what would have been a material omission, and no one on the nursing staff bothered to contact the physician who had ordered the antibiotics. There is also a reasonable possibility that IV bags bearing dates and times were mixed up so as to preclude a determination of which registered nurse failed to administer IV medication, if in fact two doses of antibiotics were missed. Respondent later admitted not performing the accuchecks, but never admitted failing to administer the IV antibiotics. Petitioner has failed to prove that Respondent failed to administer the IV medications as ordered. The hospital terminated Respondent's employment shortly after the incidents involving C. P. Respondent has since held two temporary nursing jobs and has applied unsuccessfully for 12 other nursing jobs. She now lives with her mother in Virginia where she earns $100-$200 weekly in employment unrelated to nursing. C. P. suffered no injury as a result of the failure to conduct ordered accuchecks and the failure, if any, to administer the prescribed IV. Respondent has not previously been disciplined as a licensed practical nurse or registered nurse.
Recommendation It is RECOMMENDED that the Board of Nursing enter a final order finding Respondent guilty of violating Rule 59S-8.005(1)(e), Florida Administrative Code, and Section 464.018(1)(h), Florida Statutes, for her failure to perform two accuchecks or make sure that another nurse had performed them and issuing a reprimand to Respondent. ENTERED on December 21, 1995, in Tallahassee, Florida. ROBERT E. MEALE 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 December, 1995. APPENDIX Rulings on Petitioner's Proposed Findings 1-4: adopted or adopted in substance. 5: rejected as irrelevant. 6-12 (first sentence): adopted or adopted in substance. 12 (second sentence): rejected as subordinate and irrelevant. 13-15: rejected as subordinate. 16: rejected as subordinate and irrelevant. 17-18: adopted or adopted in substance. 19-21: rejected as subordinate and recitation of testimony. 22-23: rejected as irrelevant and subordinate. 24: rejected as subordinate. 25: rejected as subordinate and irrelevant. 26-28: adopted or adopted in substance. 29: rejected as irrelevant. Rulings on Respondent's Proposed Findings 1-3 (first sentence): adopted or adopted in substance. 3 (first sentence)-4: rejected as subordinate and irrelevant. 5-6: adopted or adopted in substance, although not as to the identify of the other nurse. 7: adopted or adopted in substance, except that the failure either to perform the accuchecks or ensure that the other nurse did is negligence. 8-14: rejected as subordinate. 15-18: adopted or adopted in substance. COPIES FURNISHED: Laura P. Gaffney, Senior Attorney Agency for Health Care Administration General Counsel's Office Department of Business and Professional Regulation 1940 North Monroe Street, Suite 60 Tallahassee, FL 32399-0792 Robert E. Tardif, Jr. Duncan & Tardif, P.A. P.O. Drawer 249 Ft. Myers, FL 33902 Linda Goodgame, General Counsel Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-0792 Judie Ritter, Executive Director Board of Nursing Daniel Building, Room 50 111 East Coastline Drive Jacksonville, FL 32202
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 one or more of the following penalties should be imposed on Elizabeth Worden: revocation or suspension of the Ms. Worden's practice, imposition of an administrative fine, and/or any other relief that the Board of Nursing deems appropriate?
Findings Of Fact Elizabeth Worden is, and has been at all times material hereto, a licensed practical nurse in the State of Florida. Ms. Worden holds State of Florida license number 0739611. Her license lapsed on April 1, 1987, and remained lapsed at least through September 20, 1988. On September 11, 1985, Ms. Worden was arrested and charged with one count of driving under the influence (hereinafter referred to as "DUI") and five counts of possession of controlled substance. On February 24, 1986, Ms. Worden was found guilty of DUI. Additionally, an Order Withholding Adjudication of Guilt and Placing Defendant on Probation was entered based upon a plea of nolo contendere by Ms. Worden to the five counts of possession of controlled substance. Ms. Worden was placed on three years probation for the charge of possession of controlled substance and was placed on a year of probation (to run concurrently with the sentence for possession of controlled substance), ordered to pay a fine, perform community service and had her drivers license suspended for six months for the charge of DUI. During at least part of 1986 and 1987, Ms. Worden was employed as a licensed practical nurse at the Ocala Geriatrics Center (hereinafter referred to as the "Center"). Ms. Worden was one of three licensed practical nurses at the facility during the 11:00 p.m. to 7:00 a.m. shift and was in charge of the patients on one floor of the facility. While on duty at the Center Ms. Worden retired to room 5 in the east wing of the Center almost every night to sleep. She generally went to the room at about 2:00 a.m. and remained in the room until approximately 6:00 a.m. While Ms. Worden slept, she left the certified nurses aides in charge of patient care and assigned duties to the aides which should have been conducted by a licensed nurse. Ms. Worden told the aides to wake her only if a patient needed medication, if another nurse appeared on her floor, and at 6:00 a.m. On three occasions Ms. Worden left the Center while she should have been on duty, leaving certified nurses aides in charge of patient care. On these occasions Ms. Worden was gone from fifteen to thirty minutes carrying out personal errands. Ms. Worden admitted on one occasion to a certified nurses aide that she had consumed a couple of beers before coming to work. Ms. Worden's breath often smelled of alcohol and the room in which she slept also smelled of beer on occasion. During 1987, Ms. Worden entered the Intervention Project for Nurses. She was dismissed from the program in August, 1987, for noncompliance with the program's requirements. On May 18, 1987, Ms. Worden was arrested and charged with DUI and resisting arrest without violence. She was adjudicated guilty of both offenses on July 13, 1987.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that Elizabeth Worden be found guilty of having violated Sections 464.018(1)(c) and (g), Florida Statutes, as alleged in Count One and Count Three of the Administrative Complaint. It is further RECOMMENDED that the portion of the Administrative Complaint alleging that Ms. Worden is guilty of having violated Sections 464.018(1)(f) and (h), Florida Statutes, as alleged in the second Count One and Count Three of the Administrative Complaint be dismissed. It is further RECOMMENDED that Ms. Worden's license as a practical nurse be suspended until the later of the end of a five (5) year period from the date of the final order issued in this case or the date that Ms. Worden provides proof acceptable to the Petitioner of her successful completion of a rehabilitation program acceptable to the Petitioner. DONE and ENTERED this 18th day of November, 1988, in Tallahassee, Florida. LARRY J. SARTIN 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 18th day of November, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 88-2548 The Petitioner has submitted proposed findings of fact. It has been noted below which proposed findings of fact have been generally accepted and the paragraph number(s) in the Recommended Order where they have been accepted, if any. Those proposed findings of fact which have been rejected and the reason for their rejection have also been noted. The Petitioner's Proposed Findings of Fact Proposed Finding Paragraph Number in Recommended Order of Fact Number of Acceptance or Reason for Rejection 1 1. 2 3. 3-4 2. 5 3-4. 6 5. 7 7. 8 9. 9 10. 10 10-11. COPIES FURNISHED: Michael A. Mone' Staff Attorney Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Elizabeth Worden 412-A Clark Street St. Charles, Missouri 63301 Bruce D. Lamb General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Lawrence A. Gonzalez Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Judie Ritter Executive Director Department of Professional Regulation Room 504, 111 East Coastline Drive Jacksonville, Florida 32201
Findings Of Fact Having reviewed the entire record before it, the Board finds that the Findings of Fact as contained in the Hearing Officer's Recommended Order are adequately supported by competent, substantial evidence and hereby adopts those Findings of Fact as its own.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that Petitioner's application for licensure by examination be GRANTED and that Ann Mary McKay be authorized to take the licensed practical nurse examination. DONE and ENTERED this 9th day of March, 1982, in Tallahassee, Florida. DONALD R. ALEXANDER Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 9th day of March, 1982.
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
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 At all times material to this proceeding, the Respondent has been a licensed practical nurse in the State of Florida, having been issued license number PN 0695621. Before 1987, the Respondent practiced nursing for approximately 30 years, including some time for the United States Marine Corps, without any occasion for license discipline. During 1987, through August 2,1987, the Respondent was employed as a licensed practical nurse at Haines City Health Care Center. During 1987, the Respondent's performance at work at the nursing home was adversely affected by situational depression caused in part by the pain probably caused by an arthritic condition that involved the temporomandibular joint and in part by a reaction to the medication prescribed to alleviate the pain On many occasions while the Respondent was working at the Haines City Health Care Center in 1987, the Respondent experienced dramatic mood changes.. She would act normal, even very happy, one minute, and become very depressed, even crying, the next. In February, 1987, the Respondent signed the medication administration record indicating that she had performed a dressing change on a patient when she in fact had not performed the dressing change. On July 31, 1987, the Respondent charted in the medication administration record the administration of procardia to a patient when she in fact had not administered the medication. On August 2, 1987, the Respondent had the assignment, among other things, to clean out some medicine carts. She accumulated 14 assorted pills but could not dispose of them because another nurse was required to be there to verify the proper disposition of the pills. She put the pills in a souffle cup and covered them with a plastic cup, planning to dispose of them properly when another nurse was available to watch her. Time went by, and the Respondent got busy doing other things, and she forgot to dispose of the pills. She did not realize her error until she got home after her shift was over. She telephoned to ask the nurse on the next shift to dispose of the pills in the presence of another nurse. She also asked the nurse not to report her error to their supervisor. The incidents described in Findings 4 through 6, above, constitute unprofessional conduct which departs from, or fails to conform to , the minimal standards of acceptable and prevailing nursing practice. There was no evidence that any of the incidents described in Findings 3 through 6, above, resulted in any physical harm or injury to a patient (although failure to administer prescribed procardia could have endangered the health of the patient under some circumstances.) Thinking that the Respondent's performance deficiencies and mood changes may have been evidence of a chemical dependency of some kind, the staff at the Haines City Health Care Center recommended that the Respondent submit to an evaluation and treatment, if necessary, by the Intervention Project for Nurses (IPN). The Respondent agreed and enrolled on September 23, 1987. Testing convinced the professional working for the IPN that the Respondent had no chemical dependencies but indicated to them that she may benefit from psychiatric evaluation and treatment for depression. The Respondent considered some of the suggestion to be cost-prohibitive for her means, but she did see visit her medical doctor, who prescribed an antidepressant. Her doctor advised her to discontinue the medication when the Respondent noticed undesirable side- effects. By not completing the recommended psychiatric evaluation and treatment and not filing required status reports, the Respondent did not comply with the requirements of the IPN, and was dismissed from the program without having completed it. When the Respondent returned to the Haines City Health Care Center, she was not given back her job. She then sought and was given employment as an LPN at another facility, the Ridge Convalescent Center, Inc., and has been a satisfactory employee from February 15, 1988, through the date of the final hearing, December 9, 1988.
Recommendation Based on the foregoing Findings Of Fact and Conclusion Of Law, it is recommended that the Board of Nursing enter a final order finding the Respondent, Gloria A. Williams, guilty of three separate violations of Section 464.018(1)(f), Florida Statutes (1987), and placing her on probation for one year conditioned on her submission for reevaluation of her mental and emotional stability by a psychiatrist or psychologist approved by the IPN, on her completion of any recommended follow-up treatment, and on her submission of quarterly progress reports while on probation. RECOMMENDED this 13 day of January, Tallahassee, Florida. J. LAWRENCE JOHNSTON 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 13 day of January, 1989. APPENDIX TO RECOMMENDED ORDER CASE NO. 88-4411 To comply with the requirements of Section 120.59(2), Florida Statutes (1987), the following rulings are made on the Petitioner's proposed findings of fact: Accepted and incorporated. Rejected, but only because the Respondent's employment at Ridge Convalescent Center, In., between February 15 and at least December 9, 1988, is relevant to the alleged violation of Section 464.018(1)(h), Florida Statutes (1987); otherwise, accepted and incorporated. 3.-12. Accepted and incorporated to the extent necessary and not subordinate. COPIES FURNISHED: Michael A. Mone', Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Gloria A. Williams 2900 Powerline Road, Lot 88 Haines City, Florida 33844 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
