The Issue The issue for determination is whether Respondent committed the offenses set forth in the administrative complaint and, if so, what action should be taken.
Findings Of Fact At all times material hereto, Herbert Richard Slavin (Respondent) was a licensed physician in the State of Florida having been issued license number ME 0036889. On April 21, 1995, the Agency for Health Care Administration, Board of Medicine (Petitioner) filed its Final Order in Case No. 91-05473, DOAH Case No. 93-3931, in which an administrative complaint had been filed against Respondent. Petitioner concluded in the Final Order that Respondent had violated Chapter 458, Florida Statutes, and as penalty, among other things, placed Respondent on probation for one (1) year, with conditions, including the limitation that Respondent could practice medicine only under the indirect supervision of a licensed physician who was approved by Petitioner or its Probationer's Committee as Respondent's monitoring physician. The Final Order was effective April 21, 1995. Respondent appealed the Final Order. On July 19, 1995, Petitioner granted Respondent a stay of its Final Order during the pendency of Respondent's appeal. On March 1, 1996, the appellate court issued its Mandate commanding compliance with its opinion. Although the appellate court's opinion was not entered into evidence and neither party offered testimony regarding the substance of the opinion, neither party disputes that the appellate court affirmed Petitioner's Final Order. Consequently, an inference is drawn and a finding is made that the appellate court's opinion affirmed Petitioner's Final Order. Commensurate with the Mandate, Petitioner's disciplinary action against Respondent, previously imposed by the Final Order, became effective. On April 19, 1996, Respondent obtained temporary approval of his monitoring physician, with formal approval to be subsequently made by Petitioner's Probationers Committee. On May 23, 1996, Petitioner's Probationers Committee approved the monitoring physician. At all times material hereto, Respondent was employed by the Institute of Advanced Medicine (Institute) as its Medical Director. As Medical Director of the Institute, Respondent's responsibilities include overseeing the activities of the Institute, supervising the Institute's nurse practitioner, and interpreting blood work. On April 8, 1996, three patients, R. G., F. S., and C. B., presented to the Institute. R. G., a male patient, had been receiving treatment from Respondent for approximately two years. He presented to Respondent's office for his regular physical examination. R.G. was examined by a nurse, including taking his blood pressure, and blood was drawn. Respondent was not present at the office. R. G. was not seen by any other physician. F. S., a 91 year old male patient, regularly presents to Respondent's office for blood work and presented on April 8, 1996, for that same purpose. Respondent was not present at his office. F. S. was not seen by any other physician. C. B., a male patient, had been receiving treatment from Respondent for approximately two and one-half years. He presented to Respondent's office for a regular blood analysis. Blood was drawn by a nurse. Respondent was not present at his office. C. B. was not seen by any other physician. On April 8, 1996, the nurse practitioner was present at Respondent's office. The nurse practitioner treated and diagnosed the patients and reviewed the results of blood work. On April 8, 1996, even though Respondent was not present at the Institute, he had the responsibility of supervising the nurse practitioner; however, another physician was available at the time, to supervise the nurse practitioner.2 On April 8, 1996, Respondent did not order any blood work, review lab results, or consult with the nurse practitioner.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Medicine enter a final order dismissing the administrative complaint against Herbert Richard Slavin, M.D. DONE AND ENTERED this 11th day of June, 1997, in Tallahassee, Florida. ERROL H. POWELL Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (904) 488-9675 SUNCOM 278-9675 Fax Filing (904) 921-6847 Filed with the Clerk of the Division of Administrative Hearings this 11th day of June, 1997.
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 At all times relevant hereto Respondent was licensed as a licensed practical nursing in Florida and was employed at the Lake Wales Convalescent Center. On the evening of December 29, 1983, Respondent was called into patient Allen's room by the nurses aide because Allen had refused to get into his pajamas as requested and was verbally abusing the aide. Respondent approached Allen, who began swearing at her, whereupon Respondent rolled up a towel and struck Allen several times on the left arm causing some bleeding and bruises which were visible to another witness two days later. Respondent does not deny striking Allen with the towel but contends Allen picked up a pitcher and called her a nigger before she picked up the towel. Respondent denies any intent to hurt the patient and testified she has worked as a licensed practical nurse for 15 years and has never before struck a patient. Allen is senile, often verbally abusive, but has never been violent while a patient at Lake Wales Convalescent Center. He does not bruise as easily as do many elderly patients. It is below the minimal standards of acceptable and prevailing nursing practice to strike a patient and, especially, a senile patient who is not violent.
