Findings Of Fact Maurice Hedge, M.D., is licensed by the Board of Medical Examiners of the State of Florida as a medical doctor and was so licensed at all times relevant hereto. Mrs. Renate Hall was a patient of Respondent from late 1977 until early 1979 during which time she saw him approximately bi-monthly. During this period Mrs. Hall, who was born in Germany and came to America as the wife of a U.S. serviceman, was widowed, out of work, and in poor financial circumstances. Respondent was very gallant, often kissed Mrs. Hall's hand and stroked her arm or hair when she came to his office. Several times he offered to take her to dinner, which offer she did not accept. He did not bill her for the visits. Her last visit to Respondent's office was to have her son's flu virus treated. After examining Mrs. Hall's son, Respondent came out of the examining room and told Mrs. Hall to come into his office while he wrote a prescription. He closed the door to the office, came close to Mrs. Hall, grabbed her breasts and made moaning and groaning sounds. She pushed him away and departed the office, very upset; never to return. No evidence was presented that Respondent is or was in any way mentally impaired. During the period 6-29-79 through 4-17-80 Respondent called in 12 prescriptions to Walgreen's Drug Store, Cocoa, for Class IV controlled substances, Fastin, Talwin, Valium and Premarin for patient Mabel DeVoe (Exhibit 6). A lady known at Walgreen's as Mabel DeVoe picked up these prescriptions. Mabel DeVoe and Geneveive Hodge, the wife of Respondent, are the one and the same person. Exhibit 20 is a list of prescriptions written by Respondent for his wife for controlled substances, primarily Fastin and Talwin, during the first nine months of 1980. These prescriptions were filled at Campbell's Pharmacy, Rockledge, Florida. In the affidavit of Mabel DeVoe (Exhibit 7) she states that she works for Dr. and Mrs. Hodge, and picked up prescriptions made out to Mabel DeVoe and turned the drugs over to Mrs. Hodge. The fact that Respondent was writing prescriptions for Fastin and Talwin for Geneveive Hodge at the same time he was calling in prescriptions for Fastin to be issued to Mabel DeVoe, either a fictitious person or an alias for Mrs. Hodge, shows an intent to deceive by Respondent while participating in this charade. During an audit of Respondent's controlled substances record by the Federal Drug Administration inspectors some two thousand tablets of controlled substances dispensed by Respondent were unaccounted for. Respondent stated to the inspector that most of these unaccounted-for drugs had been dispensed by him rather than administered. When advised of the shortages Respondent made no effort to show that these drugs had been administered, by providing the patients' records to whom he may have administered the drugs. In view of Respondent's admission that these drugs had been dispensed by him, his argument at the hearing that these missing drugs may have been administered and the inspector would have so found had he reviewed all of Respondent's patient records, is without merit. Linda Lomax has been known in police circles in Cocoa and the vicinity for the past ten years or longer as a drug abuser. At various times until late 1980 she was addicted to Demerol. She was successful many times in going to the emergency rooms of hospitals complaining of back pain, earache, and other problems and getting prescriptions for Demerol and other controlled substances. She has a criminal record for assault with a deadly weapon and forgery of prescriptions. In July 1980 Ms. Lomax was apprehended by the police in Rockledge on the basis of a warrant issued in Melbourne for the offense of using forged prescriptions. She was accosted in a drug store while attempting to get drugs on a forged prescription. When the policeman identified himself as such she immediately asked to leave the drug store to "talk". Without ever being placed under arrest by the police, without promises of leniency, of police dropping of charges or other inducement Ms. Lomax asked if the police were interested in learning who committed recent drug related robberies and when the policeman said "Yes" proceeded to tell him about prior unsolved robberies in the area and of a forthcoming planned robbery. The information given by Ms. Lomax proved reliable. She also knew the drug abusers who were getting drugs from which doctor and agreed to assist in getting evidence against these doctors. Ms. Lomax subsequently was introduced to John Spanogle, an investigator for Petitioner, and agreed to assist in getting evidence against Respondent. She had gone to Respondent's office in mid-June 1980 and had obtained Demerol without a physical examination and without a medical reason for having the drug. She had received information from other drug abusers that she could get Demerol from Respondent. When Respondent asked her during the June visit who sent her to him she told him Karen Schaffer and Karen Pritchard. After giving her a prescription for Demerol, Respondent told her to come back. On this visit she stole some blank prescription pads from Respondent's office. Ms. Lomax's next visit to Respondent was in mid-July 1980 and on this visit she presented him with a prescription for 50 Demerol she had forged on one of the blanks she had stolen and told him the pharmacist would not fill it. Respondent tore up that prescription and issued her a valid one for 50 Demerol. During these visits Respondent kissed Ms. Lomax and called her "Baby". When Ms. Lomax told Spanogle the substance of her visit to Respondent he asked if she would return with a "bugging" device on her person, to which she agreed. On July 30, 1980, Ms. Lomax visited Respondent's office carrying a radio transmitter in her purse which was monitored and recorded by Spanogle and the police. At this visit Ms. Lomax told Respondent's nurse that she had an earache. When she met Respondent in the examining room he greeted her with a kiss on the mouth. She told him she didn't have an earache but wanted something for sleep. He asked if Valium would be okay. She said "Yes". When he asked if she wanted 24 or 30 she replied "30". After the greeting kiss Respondent unzipped the front of her dress and played with her breasts. She showed him bruises on her leg and he lifted her dress and remarked that she had sexy underwear and good-looking legs. Her testimony of the events that transpired on this July 30 visit is corroborated by the transcript of the tape of the conversation between Respondent and Ms. Lomax (Exhibit 13). Respondent again agreed to take care of the prescription she had forged from the stolen prescription pad. She made an appointment to return 5 August and left with the prescription. At a prearranged meeting place she turned over prescriptions for 30 Valium, 5 mg. and 24 Dalwane, 30 mg. (Exhibit 8) to Spanogle. On 5 August 1980 Ms. Lomax again visited Respondent's office carrying a "bugging" device. During this visit she was kissed several times by Respondent. They discussed his sexual exploits, or rumors thereof, with other patients. Respondent unzipped his pants to expose his penis and asked Ms. Lomax to look at it and touch it, and he kissed and fondled her breasts. No other physical examination was performed. Ms. Lomax told Respondent she wanted something to help her sleep. While in the office Respondent gave her a Valium injection and upon her departure he gave her prescriptions for 60 Librium, 10 mg. and 24 Nodular, 300 mg. These prescriptions were delivered to law enforcement officers by Ms. Lomax and were admitted into evidence as Exhibit 9. On 12 August 1980 Ms. Lomax made a final visit to Respondent's office again carrying a "bugging" device through which their conversation could be monitored and recorded. During this visit Respondent again fondled and kissed Ms. Lomax's breasts, unzipped his pants and requested oral sex from Ms. Lomax, which she declined. She complained that some of the drugs he gave her last time were ineffective and that she wanted something stronger. Also, she wanted something to keep her awake for the night job she was going to start and sleeping pills so she could sleep during the daytime. She stated she preferred Valium over Librium. When she left the office she had prescriptions for 50 Talwin, 50 mg.; 50 Valium, 5 mg.; 30 Ionamin, 30 mg.; and 50 Dalmane, 30 mg., which she delivered to law enforcement officers (Exhibit 10). On none of these visits was she billed by Respondent for medical services.
The Issue Whether Petitioner, Palm Beach County School Board, has just cause to suspend and terminate the employment of Respondent, Carla J. Holmes, for violations of school board policies resulting from her refusal to take a reasonable suspicion drug test on January 7, 2013.
Findings Of Fact The Board is the duly-constituted school board charged with the duty to operate, control, and supervise all free public schools within the School District of Palm Beach County, Florida (the District), pursuant to Article IX, Florida Constitution, and section 1001.32, Florida Statutes. From 2006 until her termination, Respondent was employed by the District as a food service assistant assigned to Palm Springs Elementary School. The District has a Drug and Alcohol Free Workplace Policy (the Policy) that prohibits staff from coming to work under the influence of alcohol or illegal drugs and provides for the District to undertake "reasonable suspicion" drug testing when warranted by certain circumstances. On January 7, 2013, a cafeteria worker, Rose Niva-Joseph (Niva-Joseph), heard the bell for the cafeteria door ring. When she opened the door, Respondent stumbled into the kitchen. Respondent sat in a chair, fell, and dropped her bag. According to Niva-Joseph, Respondent smelled like alcohol. Niva-Joseph reported her observations to the cafeteria manager, Lisa Rosenthal (Rosenthal). Rosenthal observed that Respondent had fallen and sprayed water all over the floor. Rosenthal went to assistant Principal Andrew Kline (Kline) and reported that Respondent was acting very unusual. She told Kline that Respondent fell and sprayed water all over the kitchen floor. Kline went to the kitchen to investigate. Kline observed that Respondent was swaying back and forth, slurring her speech and had alcohol on her breath. Kline directed Respondent to return with him to his office. Kline contacted Human Resources Manager Britoni Garson (Garson) in the District’s Professional Standards Office to report Respondent's unusual behavior. Garson directed Kline to fill out an Observable Behaviors Checklist (Checklist). On this Checklist, Kline noted that Respondent was argumentative, her speech was slurred, she appeared restless, and had an unsteady gait. Kline also noted that Respondent had an odor of alcohol on her breath, she fell, and appeared agitated and nervous. Kline faxed the Checklist back to Garson who determined reasonable suspicion existed to suspect Respondent was under the influence of alcohol or drugs. Garson contacted the testing technicians to go to the school and collect a specimen for a drug and alcohol test on Respondent. While in Kline's office, Respondent was agitated and belligerent. Because this was not the first time Kline had observed Respondent acting in this manner, he asked for the school district police to send an officer. Kline previously observed similar behaviors from Respondent in September 2008 for which Respondent received a written reprimand for a positive drug or alcohol test. As a result of Respondent's aggressive behavior during the 2008 incident, Respondent also received a verbal reprimand with a written notation for her unprofessional behavior displayed in threatening Kline. Commander Terry Moore (Moore) was dispatched on January 7, 2013, and was directed to stand by because a cafeteria worker appeared to be under the influence of alcohol or drugs, and he was to be present to deter any problems. When Moore arrived, Respondent was in the office with Kline, and Kline was trying to explain to Respondent why she was asked to submit to testing. Respondent was aggressive, resistant, and accused Kline of being a racist. Moore smelled the strong odor of alcohol on Respondent's breath from three to four feet away. Principal Kathy Harris (Harris) was starting her first day at Palm Springs Elementary School on the morning of January 7, 2013. She heard yelling from Kline's office, and she looked in to see what was going on. Respondent was talking to Kline in a very argumentative tone. When Harris looked in the office, Kline was on the telephone. He came out to speak to Harris and told Harris that Respondent exhibited unusual behaviors including slurred speech and an unsteady gait. Harris personally observed Respondent being argumentative, belligerent, talking with slurred speech, and not making any sense. She believed these behaviors warranted a drug test. When the technician arrived to take Respondent's specimen, Respondent refused. Harris and Kline told Respondent that refusing to take a drug test constitutes an automatic positive test pursuant to the Board's policies. Harris had not previously met Respondent, and she was unaware that Respondent had a prior positive drug or alcohol test. Kline explained to Respondent that if she refused to take the drug test, she could lose her job. Respondent refused to take the test and walked out of the school. Moore followed Respondent to make sure that she was safe and that she did not drive. Moore observed Respondent boarding a public transit bus. Several days later, the lab sent the District a report indicating that Respondent refused to provide a sample for a drug test. Board Policy 3.96 provides that refusal to take a reasonable suspicion drug test constitutes a positive test and that the appropriate discipline for a positive drug test shall be in conformance with the applicable collective bargaining agreement. Pursuant to notice dated January 28, 2013, Respondent was informed that the District was undertaking an investigation into her actions and that she was scheduled for pre-determination meeting for February 1, 2013. Respondent attended this meeting and offered no explanation for her behavior on January 7, 2013, including her refusal to take the drug test. Respondent denied spraying water on the kitchen floor and stated that, if Kline wanted her to submit to a drug test, everyone else in the kitchen would need to be drug tested because they were using drugs. She denied that she had an odor of alcohol or demonstrated any risky behavior, slurred speech, or increased loud talking. Significantly, prior to January 7, 2013, Respondent never reported to anyone her belief that her co-workers were using drugs or alcohol while at work. No other member of the cafeteria staff was observed engaging in behavior that would suggest that they were under the influence of drugs or alcohol at work. Respondent signed a Drug and Alcohol Free Workplace Acknowledgment form on January 11, 2007, verifying her receipt and understanding of Board Policy 3.96 and that violation of the Policy would result in disciplinary action up to, and including, termination. Respondent signed the Code of Ethics Acknowledgment Receipt on April 24, 2010. The applicable collective bargaining agreement requires progressive discipline, and the District's policy and practice since 2008 has been that every employee who has a second positive drug or alcohol test was terminated for that offense. On August 7, 2013, the Board voted to terminate Respondent's employment effective August 23, 2013, for violation of Board Policy 3.96(2)(v) and (4)(f), Drug and Alcohol Free Workplace Policy; Board Policy 3.02(4)(a), (4)(f) and (4)(h), Code of Ethics; Board Policy 3.10(6), Conditions of Employment; and Board Policy 1.013(1), Responsibilities of School District Personnel and Staff. No evidence was introduced at the final hearing to substantiate Respondent's contention that the request for her to take a drug and alcohol test on January 7, 2013, was the result of a "conspiracy" against her, racism on the part of Kline, or that she was being singled out for testing when other co-workers were allegedly using drugs. Determination of Ultimate Facts The Board demonstrated by a preponderance of the evidence that reasonable suspicion existed on January 7, 2013, to require Respondent to submit to a drug and alcohol test. Respondent's refusal to take such test was not justified and constituted a "second offense" for purposes of the Policy. Accordingly, "just cause" existed to suspend and terminate Respondent's employment.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a final order be entered by the Palm Beach County School Board, sustaining Respondent's suspension without pay and terminating her employment. DONE AND ENTERED this 23rd day of July, 2014, in Tallahassee, Leon County, Florida. S MARY LI CREASY Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 23rd day of July, 2014. COPIES FURNISHED: Jean Marie Middleton, Esquire School District of Palm Beach County Office of General Counsel Post Office Box 19239 West Palm Beach, Florida 33416-9239 Carla J. Holmes 615 Mango Drive, Apartment 117 West Palm Beach, Florida 33415 E. Wayne Gent, Superintendent Palm Beach County School Board Suite C-316 3300 Forest Hill Boulevard West Palm Beach, Florida 33406 Matthew Carson, General Counsel Department of Education Turlington Building, Suite 1244 325 West Gaines Street Tallahassee, Florida 32399-0400 Pam Stewart, Commissioner Department of Education Turlington Building, Suite 1514 325 West Gaines Street Tallahassee, Florida 32399-0400
The Issue The issue for determination is whether Petitioner's request for exemption should be granted.
Findings Of Fact Petitioner seeks an exemption for employment in a position for which a security background check is required pursuant to Sections 435.03 and 435.04, Florida Statutes. 1/ Petitioner seeks employment in a position caring for children. On September 1, 1987, Petitioner pled guilty to trafficking in cocaine, a first degree felony under Section 893.135(1)(b)(1). Petitioner also pled guilty to possession of cocaine, within the meaning of Section 893.03(2)(a)(4). The court fined Petitioner $50,000, imposed court costs of $2,500, and sentenced Petitioner to 15 years imprisonment. The sentence was to be served by three years imprisonment and by 12 years probation. Petitioner served three years imprisonment, is currently completing her probation, and is paying the fine and court costs over time. The terms of probation, in relevant part, require Petitioner to submit to drug testing and to remain free of all drugs. On November 9, 1995, Petitioner tested positive for marijuana. Petitioner failed to show by clear and convincing evidence that she is no longer a threat to those with whom she would interact if exempted. Petitioner failed to show by clear and convincing evidence that she has been rehabilitated.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that Respondent enter a Final Order and therein DENY Petitioner's request for exemption. RECOMMENDED this 3rd day of June, 1996, in Tallahassee, Florida. DANIEL S. MANRY, 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 3rd day of June, 1996.
The Issue Should the Board of Nursing (the Board) impose discipline on Respondent's nursing license for violating Section 464.018(1)(n), Florida Statutes (2003)?
Findings Of Fact Stipulated Facts At all times material to this Complaint, Respondent was a registered nurse (R.N.) within the state of Florida, having been issued license number RN 2055672. Respondent's address of record is Rt. 22, Box 2347, Lake City, Florida 32024. On or about April 21, 2004, Respondent submitted to a pre-employment drug screen. The drug screen returned on or about April 24, 2004, indicating a positive test result for cannabinoids - tetrahydrocannabinol, the principal active component of Marijuana. Marijuana is a schedule I controlled substance pursuant to Section 893.03(1)(c)35., Florida Statutes. A substance in Schedule I has a high potential for abuse and has no currently accepted medical use in treatment in the United States and its use under medical supervision does not meet acceptable safety standards. Respondent did not have a lawful prescription or a legitimate medical reason for using Marijuana, or any other substance that might test positive for cannabinoids - tetrahydrocannabinol. Specimen Submission On April 21, 2004, when Respondent underwent a pre- employment drug screen, it was by providing a urine specimen. As the donor she signed a form with the following language: I certify that I provided my urine specimen to the collector: that I have not adulterated it in any manner: each specimen bottle used was sealed with a tamper evidence seal in my presence and that the information provided on this form and on the label affixed to each specimen bottle is correct. It was specimen ID number 190920 to be submitted for drug testing at Doctors Laboratory, Inc. (Doctors Laboratory) in Valdosta, Georgia. The reason Respondent provided the urine specimen was in relation to a job application with Shands, Lake Shore, Live Oak and Starke (Shands) whose business address is in Gainesville, Florida. Respondent was tested for drugs in accordance with the Florida Drug Free Work Place Program that is part of the pre-employment process for the prospective employer. The urine specimen was tested for the presence of amphetamines, cannabinoids, cocaine, opiates, phencyclidine, barbiturates, benzodiazepines and methaqualone. Respondent's urine specimen was packaged and shipped to Doctors Laboratory in Valdosta, Georgia, where it was received on April 22, 2004, for testing. The test designed to detect cannabinoids is referred to as "9 CARBOXY-THC." The laboratory test performed on Respondent's urine specimen returned as positive for the presence of cannabinoids, outside what would be considered an acceptable range. On April 23, 2004, Doctors Laboratory released Respondent's test results to the Occupational Health Services Unit within Shands, which was received by that unit on the same date as evidenced by a stamp found on the laboratory test information copy. On April 26, 2004, nurse Denise Cannon signed a document that is headed "Shands Healthcare Occupational Health Services Positive/Abnormal Drug Screen." It pertains to Respondent. It mentions the prospective hiring of the Respondent to work at Lakeshore in the position of R.N./ICU. It notes of the positive drug screen for: 9 CARBOXY-THC-Marijuana. It notes that nurse Cannon notified Respondent of the results on April 26, 2004. Part of the notification was to verify Respondent's identity by social security and date of birth and to advise Respondent of Shands Drug Free Work Place Policy, as well as rights/responsibility under the Florida Drug Free Work Place Act of 1988. The form indicates that Respondent requested a consultation with the MRO, short for Medical Review Officer. It comments that the Respondent was not hired. The comment section states that Respondent "would like to contest the drug screen." On April 28, 2004, a MRO Verification Worksheet was completed in relation to the Respondent and specimen ID 190920, which shows that a positive result was received on April 27, 2004. On April 28, 2004, the worksheet was signed by Dr. Ku-Lang Chang M.D., M.R.O. According to the MRO Verification Worksheet, an attempt was made to call Respondent on April 27, 2004. On April 28, 2004, as the worksheet describes, a message was left "LM with husband." The Verification Worksheet goes on to describe that on April 28, 2004, an interview was conducted in which the "applicant decided not to pursue this." This is understood to refer to Respondent as the applicant. In the April 28, 2004, conversation Respondent was informed of the test results. The MRO Verification Worksheet has a notation that "reported to IPN 5/3/04" IPN is read to refer to the intervention project for nurses. In conclusion, the MRO Verification Worksheet made a verification decision: positive for 9 CARBOXY-THC. On April 28, 2004, Dr. Ku-Lang Chang notified N. Denise Cannon, R.N., Occupational Health Unit within Shands, of the positive drug screen. On May 10, 2004, nurse Cannon executed a form provided by the Department reporting on Respondent's positive drug screen. On June 10, 2004, nurse Cannon wrote Ms. Julie Weeks, of the Department, outlining the drug screen process, notification of the results on April 26, 2004, and the advice to Respondent to contact IPN. The June 10, 2004, correspondence refers to Respondent's request that the results of the drug screen be turned over to Dr. Ku-Lang Chang, Medical Review Officer (MRO). The June 10, 2004, correspondence from nurse Cannon to Ms. Weeks speaks of the intervention project, the IPN, Intake Case Manager Pat Falke and Respondent's failure to follow through with the recommendations of IPN. As a consequence, Nurse Cannon corresponded with the Department to undertake an investigation. On May 28, 2004, Pat Falke, had written nurse Cannon indicating that efforts at gaining Respondent's participation with IPN had not succeeded and reminding nurse Cannon to proceed with the execution of the uniform complaint on the Department's form. Laboratory Analysis Doctors Laboratory where Respondent's urine specimen was analyzed is a clinical reference laboratory that serves Florida, among other states. Its affiliation with Florida is in relation to the Florida Drug Free Work Place Program in providing forensic urine drug testing for employment screening. Richard Earl Struempler, B.S., M.T., (ASCP), MS, MA, NRCC is the Director of Operations and the Director of Toxicology for Doctors Laboratory. As such, he is responsible for the day-to- day operations of the forensic urine drug testing laboratory pertaining to procedures and protocols, in the interest of making certain that the procedures followed in the laboratory comply with rules, regulations, and certification standards for the Florida Drug Free Work Place Program employment drug testing, among other affiliations. By stipulation, Mr. Struempler was accepted as an expert in toxicology and drug testing for purposes of his testimony. On April 22, 2004, Doctors Laboratory received Respondent's urine specimen for drug testing. Tests were performed to detect the class of drugs that have been described. Within that grouping was Marijuana which is also known as THC. THC stands for tetrahydrocannabinol, with delta nine tetrahydrocannabinol being the main psychoactive ingredient found in Marijuana. The test conducted on the urine specimen was designed to look for the metabolite of this substance in the carboxylic acid form. Respondent's urine specimen was collected in Gainesville and taken by carrier to Doctors Laboratory in Valdosta, Georgia. When it arrived by carrier, it was placed in the accessioning area within the laboratory for immediate transfer to the drug testing area within the laboratory. The accessioning area is a secured facility within the laboratory with limited access, access only to the individual(s) who would need to work with the specimen. Shipping containers are opened in the accessioning area and the individual specimens are removed with an interest in discovering any damage or tampering that may have occurred during shipment. The sample is assigned an accessioning number and is marked as being received in the drug testing laboratory accessioning area. Nothing about Respondent's sample indicated that there were signs of tampering or damage. It was specifically indicated that the primary seal bottle for the urine specimen was intact upon arrival. The accessioning number for Respondent's drug specimen was 07163062. That number was utilized in tracking the urine specimen through activities associated with the urine specimen while in the laboratory. Two tests were employed to analyze Respondent's urine specimen in Doctors Laboratory. The first test, referred to as an initial test, was the immunoassay test designed to identify categories of drugs, to include cannabinoids. It is an antibody antigen reaction test to reveal a color associated with a given drug. At this stage the laboratory also does specimen validity testing, looking for the presence of any indicators that might show that the specimen was tampered with. These steps in the process were utilized in analyzing Respondent's urine specimen. The initial test was by use of an aliquot of the urine specimen. The immunoassay test is accepted in the scientific community and is contemplated as a protocol related to the Florida Drug Free Workplace Program. Respondent's results show the presence of cannabinoids at the cut-off level of 15 nanograms per milliliter or greater. Being within that range, it was considered to be a positive test. Recognizing the positive results, the laboratory staff tested the urine specimen further through what is referred to as confirmation testing. When the confirmation test was performed, a fresh aliquot was obtained from the urine specimen bottle. The confirmation test is designed to extract from the urine, delta 9 tetrahydrocannabinol or delta 9 THC carboxylic acid. The extracted material is concentrated in a small vial and derivatized or converted into a form that allows it to be analyzed by an instrument known as a gas chromatograph/mass spectrometer, also referred to as GC/MS. This step in the process is designed to separate THC from other things found in the urine specimen, breaking it down into molecular components. The components are measured as to size, weight, and amount. The GC/MS test is considered within the scientific community to be accurate and reliable. The results of the test on Respondent's urine specimen revealed the presence of delta 9 THC carboxylic acid at 57.5 nanograms per milliliter, a significant amount confirming the presence of the drug. The immunoassay and GC/MS test equipment was properly calibrated before performing the test on Respondent's urine specimen. The tests were properly performed. The chain of custody from the collection point through the testing regimen was not breached and is well documented. The chain of custody was maintained in accordance with standards required at Doctors Laboratory. Respondent's urine specimen that remained following the laboratory test was retained for at least a year, the period required for retention. During that time, no request was made to make the specimen available for independent testing outside the laboratory. As an expert, Dr. Struempler offered his professional opinion that Respondent's urine specimen was collected and submitted to the Doctors Laboratory in accordance with standard operating procedures, that the test and handling of the specimen was in accordance with standard operating procedures, and that the results of the tests reported on April 23, 2004, as being positive for the presence of cannabinoids, THC, was a true and accurate reflection of the nature of the substance found. No administrative or technical errors in the handling and testing occurred. Dr. Struempler expressed the opinion that the Respondent, donor, would have had to have consumed Marijuana or a Marijuana THC containing product one to four days prior to submission of the specimen or as long as 10 days prior to the submission under extreme circumstances. Dr. Struempler's expert opinion is accepted.
Recommendation Upon consideration of the facts found and the conclusions of law reached, it is RECOMMENDED: That a final order be entered finding Respondent in violation of Section 464.018(1)(n), Florida Statutes (2003), for failing to meet the minimal standards of acceptable and prevailing nursing practices through a violation of Florida Administrative Code Rule 64B9-8.005(2)(k) and that Respondent be fined $250, subject to IPN evaluation and placed on a period of probation for one year, in accordance with the disciplinary guidelines provision set forth in Florida Administrative Code Rule 64B9-8.006(2)(vv). DONE AND ENTERED this 2nd day of March, 2007, in Tallahassee, Leon County, Florida. S CHARLES C. ADAMS 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 2nd day of March, 2007. COPIES FURNISHED: William F. Miller, Esquire Ellen Simon, Esquire Department of Health 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Duncan Alden Jones, Esquire 330 Southwest Fourth Avenue High Springs, Florida 32643 Rick Garcia, Executive Director Board of Nursing Department of Health 4052 Bald Cypress Way Tallahassee, Florida 32399-1701 Tom Koch, Acting General Counsel Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701
Findings Of Fact Hilda T. Clark, Respondent, is a registered nurse who holds license no. 21750-2. Evidence adduced during the course of the hearing reveals that during 1961, while Respondent was employed as a private duty nurse at Mount Sinai Hospital in Miami, she withdrew a narcotic drug, to wit: Dilaudid, for her patient, Mrs. Fanny Goldblum on approximately thirty occasions, which she administered to herself instead of the patient. Based on an Information for violation of the Florida Uniform Narcotic Drug Act (Chapter 398.19, F.S.) which was filed on March 15, 1961, the Respondent pled guilty and was placed on probation for a term of seven years on March 31, 1961. Thereafter, on January 12, 1977, the Respondent, while employed as a private duty registered nurse at the University of Miami Hospital and Clinic, converted to her own use a narcotic drug, to wit: Demerol. When confronted with this fact, the Respondent admitted to the Head Nurse, M. Francis, R.N., that she had injected herself with the Demerol and that she was addicted to narcotics for many years. The Respondent does not contest the above allegations and in fact admits that she engaged in the conduct that is alleged in the administrative complaint filed herein. However, she urges that the suspension of her license is unwarranted in these circumstances inasmuch as she was undergoing tremendous pressure based on her mother and spouse's poor health. Additionally, she related an incident wherein she was undergoing tremendous pain and was placed on the medication, Demerol for the relief of pain due to severe herpes zoster infection. Evidence and testimony introduced during the course of the hearing reveal that herpes zoster infection causes severe pain and that to control such pain, her physician, Edward E. Goldman, M.D., prescribed oral Tolwen, Demerol and Dilaudid suppositories. There also was evidence introduced during the course of the hearing which indicated that the Respondent is not now suffering from any drug related problems or addiction and that her professional abilities are beyond question. Respecting the most recent incident which occurred on January 12, 1977, evidence reveals that the Respondent was indeed laboring under a great deal of stress and mental pressures which, in her words, forced her to resort to the unlawful withdrawal and injection of the narcotic drug, Demerol. There was no evidence introduced that the Respondent engaged in any unlawful act during the period between the incident which occurred in 1961 and the January, 1977 incident. Nor was there any further evidence of any drug addiction problem by Respondent subsequent to the January, 1977 incident. The unlawful use of and procurement of drugs by nursing professionals is a serious act which should not be condoned without sanction by the Board of Nursing. It goes without saying that such acts and/or conduct constitutes a departure from the minimal standards of acceptable and prevailing nursing practice and in fact constitutes unprofessional conduct. See Chapter 464.21(b), Florida Statutes. Based on evidence received during the course of the hearing, there is substantial and competent evidence from which a finding can be made that the Respondent engaged in conduct violative of the above chapter i.e., Subsection 464.21(b), Florida Statutes. However, there was no evidence introduced on which a finding can be made that the Respondent is guilty of conduct violative of Chapter 464.21(c) and (d), as alleged. Although two instances of unlawful useage of narcotic drugs was alleged which the Respondent admits, in view of the length of time between the two occurrences, the undersigned concludes that the record fails to establish that the Respondent is habitually addicted to the use of controlled substances as provided in Chapter 464.21(c), Florida Statutes. I shall therefore recommend that the remaining two allegations be dismissed. Respecting the finding that the Respondent engaged in unprofessional conduct within the meaning of Chapter 464.21(b), Florida Statutes, I shall bear in mind and give consideration to the lengthy and creditable service that she has given to the nursing profession, a profession in which she desires to continue to practice. Based thereon and the favorable testimonials received into evidence, I shall recommend that the Respondent be placed on probation for a period of two years.
Recommendation Based on the foregoing findings of fact and conclusions of law I hereby recommend that the Respondent be placed on probation for a term of two years. In all other respects, I hereby recommend that the complaint allegations be dismissed. RECOMMENDED this 12th day of September, 1977, in Tallahassee, Florida. JAMES E. BRADWELL Hearing Officer Division of Administrative Hearings 530 Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1005 Blackstone Building Jacksonville, Florida 32202 George A. Kokus, Esquire Cohen and Kokus 500 Roberts Building 28 West Flagler Street Miami, Florida 33130 =================================================================
The Issue The issue is whether Petitioner may terminate Respondent's employment as a teacher.
Findings Of Fact Respondent has been a teacher since 1993. She is a 34- year-old divorced mother of a four-year-old son. Respondent has suffered from a chemical dependency since she was 18 years old. At that time, she completed a 28- day detoxification program at Mt. Sinai Medical Center in Miami. Six or seven years later, Respondent underwent additional inpatient treatment for her addiction to drugs. She submitted to a third detoxification, lasting five to seven days, in 1993 or 1994. Respondent underwent a fourth detoxification ten months later and, in 1996, a fifth detoxification. Respondent admits that she has undergone detoxification several more times since 1996. These detoxifications and Respondent's intermittent participation in Narcotics Anonymous were parts of treatment programs attempting to relieve Respondent from her addiction to cocaine and heroin. Respondent's addiction has spanned her college years through her entire teaching career. The effects of Respondent's illness have, at times, precluded her from reaching her full potential as a classroom teacher. After a brief period of employment by Petitioner as a permanent substitute teacher, Respondent began fulltime employment with Petitioner in August 1994 as a teacher at Oak Grove Elementary School. While at Oak Grove, Respondent was a satisfactory teacher, although her attendance was less than satisfactory. Also, on at least six occasions, evidently starting in her second year, Respondent fell asleep while conducting a reading tutorial session in which the students spent 20 minutes in separate cubicles. Respondent's principal at Oak Grove documented by a memorandum dated December 4, 1995, eleven full-day absences and two half-day absences during the 1995-96 school year and two instances of sleeping while charged with the instruction of a student--both on the same day and both discovered by the principal. Due to these incidents and an earlier incident of sleeping while on duty, the principal administratively referred Respondent to Petitioner's Employee Assistance Program (EAP). The December 4 memorandum documented the actions taken at a conference held the same date involving, among others, Respondent and the principal. Respondent then missed work on December 6 and 7--calling in at 10:06 a.m. on December 7 saying that she had overslept and asking if it was too late to report to work. Respondent missed a considerable amount of work during the 1996-97 school year. Some of the absences, especially from early December through early February, were due to Respondent's chemical dependency. However, some absences, especially during the latter part of the school year, may be attributed to the birth of Respondent's child on July 9, 1997, following a high- risk pregnancy. The record does not disclose much about the 1997-98 school year. However, Respondent missed ten days of work due to sick or personal leave and eleven days of work due to unpaid, but authorized, leave. The absence of additional administrative action against Respondent suggests that she may have improved her attendance and eliminated her sleeping while on duty. For the 1998-99 school year, Respondent transferred to a new school, Linda Lentin Elementary School. Again, Respondent was a satisfactory teacher, except for absenteeism. However, during a nine-day absence from May 20 through June 2, 1999, the principal received a telephone call from someone claiming that Respondent had had a breakdown and was in a "drug rehabilitation hospital." Accordingly, the principal requested that Petitioner's Office of Professional Standards (OPS) monitor Respondent's return to work. On June 8, 1999, Respondent, the principal, Petitioner's OPS Director, and others participated in a Conference for the Record (CFR). Respondent attributed her 21 absences in the 1997-98 school year, as well as 20.5 absences in the 1998-99 school year, to six miscarriages and depression. Petitioner's OPS Director explained the procedures for reasonable-suspicion drug testing. The CFR memorandum concludes by emphasizing that Respondent must report to work when scheduled and on time, obtain medical excuses for all absences, provide lesson plans for substitute teachers, and obtain approval for scheduled leave. At the same time, Petitioner's OPS Director referred Respondent to Petitioner's EAP. Subject to these actions, Petitioner approved Respondent's return to the classroom. However, Respondent's attendance did not improve the following school year, and her behavior became somewhat eccentric early in the school year. At noon on September 27, 1999, Respondent told the principal that she was ill and needed to go home for the remainder of the day and the following day. Respondent went home, but, despite requesting leave and a substitute for the following day, returned to work the following day without calling first. Near the end of the school day, while her students were in a special-area class, Respondent signed out of school and walked down the street, despite the fact that it was raining. The next day, Respondent left the school grounds without permission and, the following day, failed to attend a mandatory teachers' meeting. The situation deteriorated in mid-October 1999. From October 11-14, Respondent telephoned the school each day and reported that she was sick and in the hospital. The following Monday, October 18, Respondent reported to work. However, on October 19, Respondent failed to report to work or call, leaving her class sitting in the hallway. Respondent telephoned the school at mid-day and stated that she had been in a five-car accident. This accident did not take place. On October 20, while driving to school, Respondent was involved in a two-car accident, which resulted in her striking a fire hydrant not far from the school. The accident took place at about 8:45 a.m., which was about 15 minutes after Respondent assumed direct supervision of her students. Respondent arrived at school late, crying and disconcerted. An acquaintance transported Respondent home. The next morning, prior to the start of school, Respondent called the school and stated that she would not be at work. On the following morning, October 22, Respondent reported to work, and her principal ordered her to submit to a reasonable-suspicion drug test. Respondent complied, and the drug test revealed the presence of cocaine and morphine. The drug test accurately detected the presence of these substances because Respondent had used crack cocaine and heroin within the period for which the drug test is sensitive. By memorandum dated October 29, 1999, Respondent's principal asked Petitioner's OPS to monitor Respondent's return to work. By memorandum dated November 1, 1999, Petitioner's OPS informed Respondent that she would require a clearance from OPS before returning to work. On November 8, 1999, Respondent requested a leave of absence without pay to extend from October 22, 1999, through June 16, 2000. Petitioner granted this request. Shortly after starting her leave from work, Respondent was first seen by Dr. John Eustace. Dr. Eustace is Board-certified in internal medicine and is also certified in the treatment of addictions. He is the medical director of the Addiction Treatment Program at Mt. Sinai Medical Center. He is also an assistant professor of psychiatry at the University of Miami medical school. In the last ten years, Dr. Eustace has performed 2000 evaluations of professionals to assess whether they can return to practice with the requisite skill and safety. During his career, Dr. Eustace has diagnosed and treated over 10,000 patients for addictions. Dr. Eustace admitted Respondent as an in-patient at Mt. Sinai for, among other things, a four- or five-day detoxification program. He found that Respondent was in the late middle stage of addiction to heroin and cocaine and that her illness was active. When releasing Respondent from the detoxification program, Dr. Eustace recommended that Respondent enter a twelve- step program to better prepare Respondent for the difficult recovery process, which requires, among other things, gaining insight into the consequences of the addiction. Following the detoxification process, Dr. Eustace opined that Respondent had an even chance of avoiding another relapse. However, this prognosis improves with time. After the first five years without relapse, the relapse rate is only ten percent. Also, after a second treatment, the recovery rate is over 90 percent. Of the 2000 professionals whom Dr. Eustace has treated, over 90 percent have recovered. Unfortunately, Respondent relapsed after her 1999 detoxification and treatment by Dr. Eustace. Despite her return to active use of illegal drugs, Respondent chose to restart the process by which she could return to the classroom. Petitioner's OPS informed Respondent that she would need OPS clearance before returning to work. Reacting to Respondent's request for a clearance, OPS scheduled a CFR with Respondent and others to take place on July 28, 2000. At the July 28 CFR, Respondent signed an Employee Acknowledgement Form concerning Petitioner's drug-free workplace policy. The form states: "Before returning to duty, I must undergo a return-to-duty . . . controlled substances test with verified negative results." At the CFR, Respondent admitted that she had had a chemical dependency, but represented that she was now clean and sober. Apparently, Respondent did not anticipate that she would be required to take a drug test at the July 28 CFR. However, with the new school year imminent, it is difficult to understand exactly when Respondent thought she would be required to take the drug test. If she were going to teach the next school year, her principal needed more than a few days' notice. In any event, Respondent took the test on July 28, and the test revealed the presence of morphine, although not cocaine. By memorandum dated September 6, 2000, from Petitioner's OPS Director to Respondent, Petitioner advised Respondent that it was reviewing its options after receiving the results of the July 28 drug test. By letter dated October 6, 2000, to Respondent, Petitioner's Superintendent advised Respondent that Petitioner was suspending her and initiating dismissal proceedings due to just cause, including incompetency, misconduct in office, gross insubordination, excessive absences, and violation of Petitioner's Rules 6Gx13-4-105 (drug-free workplace) and 6Gx13-4A-1.21 (responsibilities and duties). By letter dated October 12, 2000, and revised October 17, 2000, Petitioner's board took the action recommended by the Superintendent. The contract between Petitioner and the United Teachers of Dade (Contract) provides in Article XXI, Section 1.B.1.a, that "[a]ny member of the instructional staff may be suspended or dismissed at any time during the school year, provided that the charges against him/her are based upon Florida Statutes." Article XXI, Section 2.G, sets forth the Drug-Free Workplace General Policy Statement. Section 2.G.b provides the policy statement on illegal drugs, Section 2.G.c provides the policy statement on alcohol and prescription drugs, and Section 2.G.d provides the policy statement on employee drug screening. Under employee drug screening, Section 2.G.d.5 states: [Petitioner] recognizes that chemical dependency is an illness that can be successfully treated. It is the policy of [Petitioner], where possible, to seek rehabilitation of employees with a self- admitted or detected drug problem. Disciplinary action may be instituted against employees who the Board believes will not be assisted by rehabilitation or who have negatively impacted students and/or staff. Employees who have previously been referred for assistance or employees unwilling or unable to rehabilitate may be subject to appropriate action, pursuant to Board Policy, applicable Florida Statutes, State Board Rules, and applicable provisions of collective bargaining agreements. Petitioner has invoked two of its rules in this case. Rule 6Gx13-4A-1.21, which is a statement of "Responsibilities and Duties," requires, at Section 1, all employees "to conduct themselves, both in their employment and in the community, in a manner that will reflect credit upon themselves and the school system." It is unnecessary to determine whether the Contract incorporates this rule, or whether Petitioner may otherwise rely on this rule to dismiss an instructional employee during the school year. Rule 6Gx13-4-1.05 (Rule), which is the "Drug-Free Workplace General Policy Statement," is a restatement of the Drug-Free Workplace General Policy Statement contained in the Contract. The prominent role of the Drug-Free Workplace General Policy Statement in the Contract, as well as its provision for the dismissal of employees, justifies Petitioner’s reliance upon a violation of the Rule as a basis for dismissing an instructional employee during the school year, notwithstanding the provision of the Contract otherwise requiring that all such dismissals be based on violations of Florida Statutes. In most respects, the Drug-Free Workplace General Policy Statement is the same in the Rule and the Contract. The Rule provides for "disciplinary sanctions" against employees who have violated the "standards of conduct" set forth within the Rule. Like the Contract, the Rule contains three "policy statements," which supply most of the operative provisions of the Rule. For illegal drugs, the policy statement, as set forth in the Rule, provides: "Employees are expected to conduct themselves in a manner consistent with the following provisions: Employees on duty or on School Board property will not manufacture, distribute, dispense, possess or use illegal drugs, nor will they be under the influence of such drugs. Employees on or off duty will not influence students to use illegal or abuse legal drugs. An employee convicted, adjudicated guilty, or who has entered a plea of guilty for an criminal drug statute violation occurring in the workplace shall notify [Petitioner] within 48 hours after final judgment. Paragraphs A and C are limited to acts and conditions that take place while an employee is on Petitioner's property or on duty. Paragraph B is limited to acts of the employee directed toward students. The evidence does not suggest that Respondent violated any of these provisions of the Rule. Petitioner failed to serve that the incidents involving Respondent sleeping while in charge of students appear not to have been due to her cocaine or heroin intoxication; it is at least as likely that the sleeping resulted from fatigue following the use of one or both of these drugs the preceding night. The distinction between intoxicating levels of these drugs and nonintoxicating trace amounts is explicitly dismissed by the Rule's treatment of alcohol, as to which employees must be "free of measurable . . . concentrations." After the policy statements on illegal drugs and alcohol and prescription drugs, the Rule sets forth the policy statement on employee drug screening. Although this part of the Rule fails to provide explicitly that a positive drug screen is a violation of the Rule, the introductory paragraph of the Rule acknowledges that Petitioner and the United Teachers of Dade are jointly committed "to create and maintain a drug-free work environment." Paragraph D within the drug-screening policy statement restates this purpose. Also, the disciplinary sanctions provided by the Rule clearly state that a refusal to submit to a drug test or a second violation of the Rule constitutes an inability to be assisted by rehabilitation; if a refusal to submit to a drug test is a violation, a failed drug test must also be a violation. These statements are therefore sufficient to provide that the presence in employees of even nonintoxicating amounts of illegal drugs, while on duty, constitute a violation of the Rule. In two respects, the Drug-Free Workplace General Policy Statement, as described in the Rule, is materially different from the Drug-Free Workplace General Policy Statement, as described in the Contract. First, the Rule adds another objective: To communicate that persons who violate the standards of conduct cited in this rule and who refuse or cannot be assisted by rehabilitation or who have negatively impacted students and/or staff shall be dismissed. Second, the Rule provides disciplinary sanctions for any violation--not just for violations of the drug-screening policy statement, as provided by the Contract--of the Drug-Free Workplace General Policy Statement. The Rule also adds two presumptive conditions for determining when an employee is unable to be assisted by rehabilitation. The Rule states: Employees who violate the standards of conduct cited it this rule and who the Board determines will not be assisted by rehabilitation or who have negatively impacted students and/or staff shall be dismissed. A refusal to submit to a drug test or a second violation of the Drug-Free Workplace Policy shall constitute an inability to be assisted by rehabilitation. . . . This case turns on whether Petitioner has proved that Respondent would not be assisted by rehabilitation because Petitioner has produced little detailed evidence of any negative impact upon Respondent's students. The record lacks detail of Respondent's specific teaching duties, the specific impact of her sleeping incidents or absences, and the academic achievements of her students during the periods in which these shortcomings took place. Notwithstanding the marked shortcomings in Respondent's performance as a teacher, Petitioner did not dismiss her until first giving her a chance to rehabilitate herself. The most likely inference is that Petitioner's administrative employees found that the situation did not satisfy the first criterion for dismissal--negatively impacting students. The basic issue, then, is whether Petitioner could reasonably have determined, from July to October 2000, that Respondent would not be assisted by rehabilitation. Petitioner could choose to show rehabilitation would be futile by relying on one of the two presumptions contained in the Rule. However, Respondent never refused to submit to a drug test, and difficult questions of her employment status in July 2000 obscure the determination as to whether her failure of the July 2000 drug test constitutes a second violation of the Rule. In this case, though, Petitioner may satisfy its standard of proof without regard to either of the presumptions in the Rule. After a display of considerable patience and good faith by Petitioner, Respondent, in July 2000, misrepresented to Petitioner that she was clean and sober and prematurely requested permission to return to teaching duties despite her knowledge that she was still abusing drugs and not ready to return to the classroom. These facts support the finding that, as of July or October 2000, Respondent would not be assisted by rehabilitation. This finding of the futility of rehabilitation, as of July or October 2000, is difficult due to the fact that subsequent events suggest that Respondent may finally be rehabilitating herself. After Petitioner dismissed her, Respondent underwent detoxification and then began treatment at St. Luke's Addiction Recovery Center, which is sponsored by Catholic Charities of the Archdiocese of Miami, Inc. She was in intensive residential treatment from November 6, 2000, through January 24, 2001. She later underwent nine urinalyses, through June 1, 2001--a day after the end of the hearing in this case-- and all of them were negative. Respondent is successfully participating in the St. Luke's aftercare program, where she takes weekly drug tests. She is proud of the fact that she has turned her life over to God and has achieved the longest period of sobriety that she has experienced in many years. After regaining sobriety, Respondent substituted for awhile and then found a job teaching a third-grade class at a private school in the Miami area. At the time of the hearing, Respondent had been so employed for six weeks, she had not been late or missed a day of school, and the school had invited her to teach again for the 2001-02 school year. Dr. Eustace opines that Respondent's prognosis is much improved from the prognosis of September 2000.
Recommendation It is RECOMMENDED that Petitioner enter a final order dismissing Respondent from employment. DONE AND ENTERED this 5th day of November, 2001, in Tallahassee, Leon County, Florida. ROBERT E. MEALE 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 5th day of November, 2001. COPIES FURNISHED: Roger C. Cuevas, Superintendent Miami-Dade County School Board 1450 N. E. Second Avenue Room 912 Miami, Florida 33132-1308 Luis M. Garcia Attorney's Office School Board of Miami-Dade County 1450 Northeast Second Avenue Suite 400 Miami, Florida 33132 Richard Baron Baron and Cliff 11077 Biscayne Boulevard, Suite 307 Miami, Florida 33161 Honorable Charlie Crist Department of Education The Capitol, Plaza Level 08 Tallahassee, Florida 32399-0400 James A. Robinson, General Counsel Department of Education The Capitol, Suite 1701 Tallahassee, Florida 32399-0400
The Issue Whether respondent committed the acts alleged in the Administrative Complaint, and, if so, whether respondent's license should be revoked or suspended, or whether other discipline should be imposed.
Findings Of Fact Respondent is a licensed pharmacist in the State of Florida, having been issued license number 005517, and was so licensed at all times material to the Administrative Complaint. The respondent is engaged in the practice of pharmacy at Interbay Discount Drugs, 4332 South Manhattan, Tampa, Florida, where he is the proprietor and the sole pharmacist. On April 23, 1986, Ms. Beth Christie, investigation specialist for the Department of Professional Regulation, conducted a pharmacy inspection of Interbay Discount Drugs. During the pharmacy inspection, Ms. Christie reviewed certain documents, including the Certified Exempt Narcotic Record of Retail Sales maintained by Interbay Discount Drugs. This record, or log, is required to be maintained by a pharmacist to reflect the pharmacist's dispensing of Schedule V drugs. The log must show to whom the Schedule V drug was dispensed, the date it was dispensed, and identify the dispensing pharmacist. The log is used to ensure that certain amounts of exempt drugs are not dispensed to the same customer within a 48-hour period. Since respondent was the sole pharmacist at Interbay Drugs, all the log entries are followed by his initials. Ms. Christie initially reviewed the log while conducting her inspection at Interbay Discount Drugs. She noticed the same names appearing over and over again throughout the log which covered approximately a two-year period. Subsequently, Ms. Christie reviewed the log more extensively and prepared a patient profile for Cynthia D. Anderson and Vester L. McDaniel based on the information contained in the log. The patient profiles contained the date the drug was dispensed to the patient, the drug dispensed, and the quantity. The patient profile revealed that Vester L. McDaniel received Robitussin AC, 2 oz., on the following dates in the 1 1/2-year period from November 30, 1984, through April 21, 1986: 11-30-84 04-25-85 08-20-85 11-21-85 02-08-86 12-04-84 04-27-85 08-22-85 11-23-85 02-10-86 12-11-84 05-02-85 08-24-85 11-26-85 02-12-86 12-15-84 05-07-85 08-27-85 11-30-85 02-14-86 12-20-84 05-11-85 08-29-85 12-03-85 02-17-86 12-22-84 05-16-85 09-02-85 12-04-85 02-18-86 12-27-84 05-21-85 09-05-85 12-07-85 02-21-86 12-31-84 05-25-85 09-07-85 12-10-85 02-24-86 01-05-85 05-27-85 09-10-85 12-12-85 02-26-86 01-10-85 05-29-85 09-12-85 12-14-85 02-28-86 01-15-85 06-03-85 09-14-85 12-17-85 03-03-86 01-22-85 06-07-85 09-17-85 12-19-85 03-10-86 01-29-85 06-11-85 09-21-85 12-21-85 03-12-86 02-02-85 06-15-85 09-26-85 12-23-85 03-14-86 02-06-85 06-18-85 10-01-85 12-26-85 03-17-86 02-09-85 06-22-85 10-03-85 12-28-85 03-19-86 02-12-85 06-28-85 10-08-85 12-31-85 03-21-86 02-16-85 07-02-85 10-10-85 01-02-86 03-24-86 02-18-85 07-06-85 10-12-85 01-04-86 03-26-86 02-21-85 07-09-85 10-14-85 01-06-86 03-28-86 02-23-85 07-13-85 10-15-85 01-08-86 03-31-86 02-26-85 07-16-85 10-22-85 01-11-86 04-02-86 03-01-85 07-18-85 10-24-85 01-14-86 04-04-86 03-05-85 07-20-85 10-26-85 01-16-86 04-06-86 03-08-85 07-23-85 10-29-85 01-18-86 04-09-86 03-14-85 07-30-85 10-31-85 01-20-86 04-11-86 03-18-85 08-01-85 11-02-85 01-22-86 04-14-86 03-23-85 08-03-85 11-05-85 01-24-86 04-17-86 04-04-85 08-06-85 11-07-85 01-27-86 04-19-86 04-06-85 08-08-85 11-09-85 01-29-86 04-21-86 04-10-85 08-10-85 11-14-85 01-31-86 04-18-85 08-13-85 11-16-85 02-03-86 04-20-85 08-17-85 11-19-85 02-06-86 In addition to the above, Mr. McDaniel received Terpin Hydrate with Codeine on September 19, 1985, and November 12, 1985. The record reveals that Mr. McDaniel received Robitussin AC, 2 oz., on October 14 and 15, 1985, and on December 3 and 4, 1985. The quantity of codeine contained in the Robitussin AC dispensed to Mr. McDaniel by respondent within the 48-hour period from 10-14-85 to 10-15-85 and the 48-hour period from 12-3-85 to 12-4-85 exceeded 120 milligrams. The patient profile of Cynthia D. Anderson revealed that Ms. Anderson received Robitussin AC, 2 oz. on February 24, 1984, and received Novahistine DH, 2 oz., on the following dates in the 2-year period from April 14, 1984, to April 23, 1986: 04-25-85 09-04-85 12-09-85 02-21-86 04-14-84 04-29-85 09-06-85 12-11-85 02-24-86 04-20-84 06-29-85 09-09-85 12-13-85 02-26-86 05-04-84 07-02-85 09-11-85 12-16-85 02-28-86 07-31-84 07-06-85 09-13-85 12-21-85 03-03-86 08-23-84 07-09-85 09-16-85 12-23-85 03-05-86 09-05-84 07-11-85 09-18-85 12-30-85 03-07-86 09-08-84 07-13-85 09-20-85 01-01-86 03-10-86 10-11-84 07-15-85 09-23-85 01-03-86 03-12-86 10-13-84 07-17-85 09-30-85 01-07-86 03-14-86 10-16-84 07-22-85 10-02-85 01-10-86 03-17-86 10-23-84 07-24-85 10-04-85 01-13-86 03-19-86 11-01-84 07-26-85 10-07-85 01-14-86 03-21-86 11-15-84 07-29-85 10-09-85 01-16-86 03-24-86 11-17-84 07-31-85 10-11-85 01-20-86 03-26-86 12-07-84 08-02-85 10-15-85 01-22-86 03-28-86 12-27-84 08-07-85 10-17-85 01-24-86 03-31-86 01-28-85 08-09-85 10-21-85 01-27-86 04-02-86 01-30-85 08-12-85 10-23-85 01-29-86 04-04-86 02-06-85 08-14-85 10-25-85 01-31-86 04-06-86 02-12-85 08-16-85 10-29-85 02-03-86 04-08-86 02-15-85 08-20-85 10-31-85 02-05-86 04-10-86 02-18-85 08-22-85 11-18-85 02-07-86 04-14-86 02-21-85 08-24-85 11-22-85 02-10-86 04-14-86 04-06-85 08-26-85 11-27-85 02-12-86 04-18-86 04-09-85 08-28-85 12-02-85 02-14-86 04-21-86 04-11-85 08-30-85 12-04-85 02-17-86 04-23-86 04-23-85 09-02-85 12-06-85 02-19-86 As the above shows, respondent dispensed Novahistine DH, 2 oz., to Ms. Anderson twice on April 14, 1986. 2/ The quantity of codeine contained in the Novahistine DH dispensed to Ms. Anderson on April 14, 1986, exceeded 120 milligrams. Ms. Christie asked respondent about the repeated dispensing of Robitusin AC and Novahistine DH to Mr. McDaniel and Ms. Anderson, and respondent stated that both complained of a chronic cough. However, Ms. Christie observed Ms. Anderson, who happened to purchase Novahistine DH while Ms. Christie was performing her inspection, and Ms. Anderson did not cough at all while she was in the store. Respondent also told Ms. Christie that he continued to provide the drugs to Ms. Anderson and Mr. McDaniel because "they were regular customers and purchased other items in his store [and] it would be awkward for him to refuse to sell the exempt narcotics to them." [T-30] Codeine is a very potent narcotic, and it can be addictive. Approximately 60 milligrams of codeine are contained in one ounce of Robitusin AC, Novahistine DH, and Terpin Hydrate with Codeine. Robitusin AC, Novahistine DH, and Terpin Hydrate with Codeine, in two ounce quantities, are Schedule V controlled substances. No more than two ounces of these drugs can be dispensed by a pharmacist to the same person within a 48-hour period without a prescription. Although Robitusin AC, Novahistine DH, and Terpin Hydrate with Codeine are cough depressants, there are much better things for people with chronic coughs than cough depressants that contain narcotics. A pharmacist who is presented with a request for Robitusin AC, 2 oz., by the same customer every two or three days should be very concerned and cautious. First, the pharmacist should be concerned about the health of the customer. A chronic coughing problem over a period of time should be treated professionally by a physician, not a pharmacist. A pharmacist should advise the customer to see a physician and refuse to sell the customer any more of the drug. Second, the pharmacist should be cautious because of the potential for abuse of the drug. It would be prudent for a pharmacist to refuse to dispense the drug after about three requests within a short period of time. To dispense Robitusin AC regularly over a two-year period cannot be considered dispensing the drug in good faith as a medicine. Any pharmacist dispensing the drug in good faith as a medicine would cease such regular dispensing of the drug long before two years had elapsed. The dispensing of Robitusin AC, 2 oz., and Terpin Hydrate with Codeine to Mr. McDaniel from November 30, 1984, to April 21, 1986, was not in good faith as a medicine. Novahistine DH is a essentially the same drug as Robitusin AC but made by a different company. The dispensing of Novahistine DH to Ms. Anderson from April 14, 1984, to April 23, 1986, was not in good faith as a medicine. Respondent admitted that he used poor judgement in dispensing the drugs to Mr. McDaniel and Ms. Anderson, but he denied that he dispensed the drugs not in good faith as a medicine. Mr. McDaniel was a heavy smoker and had a chronic cough. Respondent stated that he was just not aware that Mr. McDaniel had been receiving Robitusin AC for the period of time that he had. Respondent stated that Ms. Anderson had a family history of chronic bronchitis and respondent felt the medication was needed. Respondent also stated that he did not sell more than two ounces of either Robitusin AC or Novahistine DH to Ms. Anderson or Mr. McDaniel within a 48-hour period, although he admitted that his log reflected that such had occurred. Respondent contended that the customers had written in the wrong dates.
Recommendation Based upon the foregoing findings of fact and conclusions of law it is RECOMMENDED that the Board of Pharmacy enter a final order finding respondent committed those acts set forth in Counts I, II, III, and IV of the Administrative Complaint, imposing an administrative fine of $200 for each of the four counts, for a total fine of $800, and placing the respondent on probation for a period of one year under such terms and conditions as the Board may deem appropriate. DONE and ORDERED this 17th day of April 1987, in Tallahassee, Florida. DIANE A. GRUBBS 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 17th day of April 1987.
The Issue The issue to be resolved in this proceeding concerns whether the Respondent committed the violations charged in the Administrative Complaint, involving possessing and introducing onto the grounds of a state correctional institution, certain controlled substances and, if so, what if any penalty is warranted.
Findings Of Fact The Respondent, Erlene Stewart, has been employed as a correctional officer at Union Correctional Institution (UCI). She was so employed on February 1, 1999, and had been employed there for almost five years at that time. The Respondent was working on Saturday, January 30, 1999. On that day, officers at UCI examined employees coming to work by conducting an "Ion Scan" of employees to attempt to detect any drug or drug residues on or about their persons when they entered the institution to go on duty. The Respondent was subjected to such an Ion Scan and successfully passed it. Thus, she was aware that a drug detection effort was being conducted on Saturday, January 30, 1999, at UCI. February 1, 1999, was the Monday after that Saturday. The Respondent was working that day in tower number five of UCI. She had driven to work that day in the black Pontiac Grand Am in question, which is registered in her name. She was working on the 8:00 a.m. to 4:00 p.m., shift on that Monday. It was very unusual for a drug detection operation to be conducted on that Monday, immediately succeeding the Ion Scan drug detection operation which had been conducted on Saturday, two days before. Such a drug detection operation was conducted in the parking lot of UCI on Monday, February 1, 1999, however, using a drug detection dog. It was very unusual for a drug detection dog to be used so soon after an Ion Scan drug detection operation and also unusual for the dog to be used at 12:30 in the afternoon. The Respondent was surprised to find that a drug detection dog was being used in the parking lot of UCI on February 1, 1999. When the Respondent came to work on that day she locked her car leaving the windows slightly cracked and went inside to go on duty. Later that day, at approximately 12:30 p.m., a drug detection dog, handled by Sergeant Box of UCI, was examining vehicles in the parking lot and "alerted" to the presence or odor of narcotics inside or on the Respondent's vehicle. The dog had been trained and certified to be capable of passively alerting to the odors of four narcotics: marijuana, powdered cocaine, crack cocaine and heroin. After the dog alerted to the presence of contraband drugs in or on the Respondent's vehicle, the Respondent, who was then working in tower number five, was relieved of duty and summoned to her vehicle in the parking lot on the grounds of UCI. When she arrived in the vicinity of her vehicle, she was informed that a drug detection dog had alerted to her vehicle. She provided a written consent, to the officers present, to a search of her vehicle. The Respondent had to unlock her vehicle in order for the drug detection officers to begin their search of its interior. Upon gaining access to the interior of the Respondent's vehicle, Sergeant Mobley of Hamilton Correctional Institution, discovered an aluminum foil package containing a white powder suspected to be cocaine, on the passenger's side of her vehicle. Sergeant Mobley turned that package over to the custody of Inspector Bailey. Sergeant Dugger found what appeared to be marijuana on the driver's side of the Respondent's vehicle. Prior to his entry into the vehicle, Sergeant Dugger and Inspector Bailey had observed through the window what appeared to be marijuana and marijuana seeds on and about the driver's seat. The Respondent is familiar with the appearance of marijuana and cocaine. Moreover, she is aware that cocaine is commonly wrapped in aluminum foil. Her former husband had been known to use cocaine according to the Respondent's testimony. Inspector Bailey took custody of the suspected cocaine and marijuana and conducted two tests on both substances. The results of his field test and Ion Scan test were positive for marijuana and cocaine. The evidence was then turned over to Inspector Yaw who conducted another Ion Scan test on the white powder confirming it as cocaine. Sergeant Dale Pfalzgraf of the Union County Sheriff's Office, was summoned to UCI on that day, after the suspected drugs were located in the Respondent's vehicle. Inspector Yaw turned over to him a sealed plastic bag containing what appeared to be marijuana and a tin-foil package of what appeared to be cocaine. Deputy Pfalzgraf placed the Respondent under arrest and transported her and the evidence to the Sheriff's office. He placed the evidence into a secure locker with the evidence custodian, pending its transportation to the Florida Department of Law Enforcement (FDLE) laboratory. Deputy Tomlinson of the Union County Sheriff's Office was given the evidence that was seized from the Respondent's vehicle by the evidence custodian and transported it to the FDLE laboratory in Jacksonville, Florida, for testing. At the FDLE laboratory, Allison Harms received the evidence from Deputy Tomlinson. The evidence bag remained sealed until testing was performed by Ms. Somera, the FDLE chemistry analyst. Ms. Somera tested the substances contained within the bag and positively identified them as cannibis and cocaine. The Respondent maintains in her testimony that her former husband had access to her vehicle and had used it in the last several days with some of his friends. She contends that he is a known illicit drug user (cocaine). She also states that she left the windows to her car slightly cracked for ventilation when she parked it in the parking lot on the day in question to go to work. She states, in essence, that either the illicit drug materials found in her car were placed there without her knowledge by her former husband or his friends or, alternatively, that the correctional officers involved in the investigation planted the drug materials in her car in order to remove her from employment and/or licensure as retaliation for past employment-related friction she states she had with prison authorities. She also contends that another prison employee told her in private that she was being "framed" but that that person refused to testify on her behalf because of fear of potential loss of his job. In any event, her self-serving testimony is not corroborated by any other witness or exhibit and is not credited.
Recommendation Having considered the foregoing Findings of Fact, Conclusions of Law, the evidence of record and the candor and demeanor of the witnesses, and the pleadings and arguments of the parties, it is, therefore, RECOMMENDED: That the Respondent be found guilty of failure to maintain good moral character as defined by the above-cited legal authority and that her certification be suspended for a period of two years. DONE AND ENTERED this 2nd day of April, 2001, in Tallahassee, Leon County, Florida. P. MICHAEL RUFF 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 2nd day of April, 2001. COPIES FURNISHED: Gabrielle Taylor, Esquire Florida Department of Law Enforcement Post Office Box 1489 Tallahassee, Florida 32302-1489 Erlene Stewart Route 1, Box 52 Sanderson, Florida 32087 A. Leon Lowry, II Program Director Division of Criminal Justice Professionalism Services Post Office Box 1489 Tallahassee, Florida 32302 Michael Ramage, General Counsel Department of Law Enforcement Post Office Box 1489 Tallahassee, Florida 32302
Findings Of Fact The Respondent, Marshall Mounger is a licensed pharmacist holding license number 8778, and Dor Mar, Inc., is a pharmacy holding permit number 7310. The Respondents held these licenses at all times material to this proceeding. On or about January 9, 1980, Edward G. Bludworth, an investigator employed by the Petitioner, and Eugene F. O'Neill, a detective with the Okeechobee Police Department, conducted an audit of a variety of the Respondent's scheduled drugs. The audit period covered drug dispensation from March 1, 1979, through January 9, 1980. The drug categories chosen for audit were determined from the utilization of information acquired by Detective O'Neill concerning certain allegations of impropriety taking place at the Respondent's pharmacy. The target drugs in which shortages were discovered are as follows, together with the amounts of these shortages: DRUG Preludin SHORTAGE 0 SHORTAGE BY PERCENTAGE 0 Percocet 5 mg. 65 5 Eskatrol 10 5 Valium 5 mg. 1,968 46 Valium 10 mg. 629 39 Librium 10 mg. 820 39 Ionamin 30 mg. 850 26 Meprobamate 250 8 In conducting the audit, the Respondents were given all due benefit, as the initial inventory employed by Mr. Bludworth was zero; therefore, any drugs that may have been on hand at the beginning of the audit would have provided additional credit toward the final totals. Investigator Bludworth's qualifications to conduct a valid audit are unrefuted. He has had some twenty years experience in this field of expertise. The Respondents assert that the audit results are subject to question, as Detective O'Neill participated in the audit process without training as an auditor or pharmacist. However, Mr. Bludworth reviewed everything material to the integrity of the audit process, realizing that Detective O'Neill was inexperienced. In any event, Detective O'Neill's only assignment was to review some prescription forms and record the contents therein. This requires the ability to read and to count, and Detective O'Neill is qualified to perform these basic functions. The Respondent, Marshall Mounger, presented an audit performed by his wife, Dorothy Mounger, which still indicated substantial shortages in four of the target drug categories. The Respondent offered no credible and convincing evidence as to the inaccuracy of the initial audit, other than the contention that Detective O'Neill was not qualified to simply read the names and numbers on prescription forms. There was a subsequent audit performed at the Respondent's pharmacy which indicated further shortages. However, by the admission of the Petitioner's own witness, this audit was not properly conducted in that the Respondent was not given credit for the generic drugs he had on hand at the time of the second audit. Therefore, the results of this audit have been disregarded.
Recommendation Based upon the foregoing findings of fact and conclusions of law, it is RECOMMENDED that the Board of Pharmacy impose a single administrative fine on the Respondents, Marshall Mounger and Dor Mar, Inc., in the amount of $1,000. THIS RECOMMENDED ORDER entered this 26th day of May, 1982, in Tallahassee, Florida. WILLIAM B. THOMAS Hearing Officer Division of Administrative Hearings Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 27th day of May, 1982. COPIES FURNISHED: W. Douglas Moody, Jr., Esquire 119 North Monroe Street Tallahassee, Florida 32301 Mr. Marshall Mounger and Dor Mar, Inc. 107 South Parrott Avenue Okeechobee, Florida 33472 William L. Grossenbacher, Esquire Post Office Drawer 1140, Tallahassee, Florida 32302 ================================================================= AGENCY FINAL ORDER ================================================================= STATE OF FLORIDA DEPARTMENT OF PROFESSIONAL REGULATION BOARD OF PHARMACY DEPARTMENT OF PROFESSIONAL REGULATION, BOARD OF PHARMACY, CASE NOS. 82-062 82-063 Petitioner, 0018258 vs. 0019995 MARSHALL MOUNGER, Respondent. / DEPARTMENT OF PROFESSIONAL REGULATION, BOARD OF PHARMACY, Petitioner, vs. DOR MAR, INC., d/b/a MOUNGER PHARMACY, AND MARSHALL MOUNGER, owner/operator, Respondent. /
