Findings Of Fact The Respondent, Jo Ann Murphy, is a licensed registered nurse in the State of Florida, holding license number 69367-2. The Respondent received her nursing education and training in Albany, Georgia, and became a registered nurse in Florida in 1973. In 1977 she became certified by the American College of Obstetrics and Gynecology as a nurse clinician. In 1981 she was certified as a clinical nurse practitioner in ambulatory gynecology and obstetric care. Until 1979, the Respondent was head nurse of OB/GYN Labor and Delivery, Postpartum Unit, at West Florida Hospital in Pensacola. From 1979 to 1983 she was office nurse and nurse practitioner in the office of Thomas H. Wyatt, M.D., in Pensacola. The Respondent became employed at University Hospital in Pensacola on April 25, 1983, primarily because of her knowledge in the field of Caesarian Sections. She was terminated less than one month later, on May 23, 1983, while still in her probationary period, for unsatisfactory nursing performance. On May 18, 1983, another registered nurse on the morning shift with the Respondent, testified that she smelled alcohol on the Respondent's breath at 7:30 A.M. Although this witness worked with the Respondent each day, this is the only time she contends that she smelled alcohol on her breath, and this witness did not see the Respondent stagger or exhibit any other symptom of alcohol use. This witness testified that the Respondent showed a lack of initiative, but that when the Respondent was told to do something she would do it well, and that she never had any concern regarding the Respondent's ability to function as a nurse. Two other hospital employees, a Licensed Practical Nurse (LPN) and a nurses aide, testified that they smelled alcohol on the Respondent's breath on a date unknown. The nurses aide, however, never saw the Respondent stagger, or exhibit any other sign of intoxication, and she says she only smelled alcohol on the Respondent's breath on one occasion. The LPN testified that she also saw the Respondent sitting at her desk in a daze or stupor, but this symptom was not observed or described by any other witness. Both of these witnesses worked with the Respondent each day, but only claimed to have smelled alcohol on her breath on one occasion. The Respondent denied having any alcohol to drink on or before any shift that she worked while employed at University Hospital. Her husband and her daughter confirmed that the Respondent had not consumed alcohol on the morning of May 18, 1983, before going to work. Another witness, a physician who was in the residency program at University Hospital while the Respondent worked there, had the opportunity to work in close contact with the Respondent on five or six occasions in the labor and delivery suite, and never smelled alcohol on her breath, or saw her stagger or exhibit any other sign of intoxication. This doctor found her to be alert, she performed her functions with no problems, and he had no complaints with her. The nursing director at University Hospital, who conducted the termination interview of the Respondent, observed what she characterized as red, blotchy skim on the Respondent, and the Respondent appeared to be nervous. However, this witness did not smell alcohol on the Respondent's breath, and she saw no other symptoms of alcohol use. Both the Respondent and the physician who employed her for four years confirmed the Respondent's skin blotches, but this is an inherited tendency having nothing to do with medical problems or alcohol use. The nursing director and the patient care coordinator both testified that the Respondent stated at her termination interview that she used to have an alcohol problem, but that she had been rehabilitated. The Respondent denies having made such a statement. Another physician, in addition to the one mentioned in paragraph 7 above, who was in labor and delivery with the Respondent more than ten times, and probably every day she worked at University Hospital, did not smell alcohol on her breath although they worked together closely. This witness found the Respondent's nursing abilities to be competent and very professional. Likewise, the physician who employed the Respondent for four years had no problems with her or her work, he found her prompt and attentive in her duties, and an excellent nurse. On another occasion, not specifically dated, but separate from the instances of the alleged alcohol breath, the Respondent is charged with having "defied an order to stay with a critically ill patient". The evidence is completely devoid of any explicit order given to the Respondent to stay with any patient during the time she worked at University Hospital. Instead, it is contended that the Respondent violated what are characterized as "standing orders" that a nurse should not leave a patient who has been assigned to her. These "standing orders" are supposed to have been set forth in policy manuals given to employees of the hospital, but no such manual was offered in evidence; nor was the nature of the "standing orders" explicitly described by the witnesses. On the one occasion when the Respondent is charged with defying orders to stay with a patient, the patient was being attended also by an LPN when the Respondent left to telephone the patient's physician. In the same general area, but behind the curtains of an adjoining cubicle, another registered nurse was attending a patient there. The patient whom the Respondent and the LPN attended went into deceleration after the Respondent had left to telephone her physician. The LPN needed help with the oxygen and to turn the patient. The other registered nurse in the adjoining cubicle came in and the patient was stabilized. The Respondent returned in a few minutes. It is below minimum standards of acceptable and prevailing nursing practice for a registered nurse to leave a patient, whose condition is considered critical, in the care of an LPN. Yet the patient was not in critical condition when the Respondent left to call the physician, and there was another registered nurse in close proximity who responded when the need for her arose. Thus, there is not sufficient competent evidence to support a finding of fact (1) that the Respondent either had alcohol on her breath or was in a drunken condition while on duty; (2) that the Respondent defied an order to stay with a critically ill patient; or (3) that the Respondent left a patient whose condition is considered critical in the care of an LPN. The competent evidence in the record supports a finding of fact (1) that the Respondent did not have alcohol on her breath at any time while employed at University Hospital; (2) that the Respondent did not defy an order to stay with a critically ill patient; and (3) that the Respondent did not leave a patient whose condition is considered critical in the care of an LPN.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Administrative Complaint against the Respondent, Jo Ann Murphy, be dismissed. THIS RECOMMENDED ORDER entered this 10th day of January, 1985, in Tallahassee, Florida. WILLIAM B. THOMAS 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 10th day of January, 1985. COPIES FURNISHED: Julia P. Forrester, Esquire 130 North Monroe Street Tallahassee, Florida 32301 Thomas C. Staples, Esquire P. O. Box 12786 Pensacola, Florida 32575 Ms. Helen P. Keefe Executive Director, Board of Nursing Department of Professional Regulation Room 504, 111 East Coastline Drive Jacksonville, Florida 32202 Mr. Fred Roche Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
The Issue The issues in this case are whether, before applying for licensure as a registered nurse in Florida, Petitioner had suffered the denial of an application for licensure as a practical nurse in the state of Virginia, and, if so, whether Petitioner's failure to disclose that fact in her Florida application was a knowing misrepresentation; finally, if either or both of the forgoing questions are answered in the affirmative, whether Respondent has grounds to deny Petitioner's pending application for a nursing license.
Findings Of Fact On October 15, 2012, Petitioner Yolette Tema ("Tema") signed an application for licensure as a registered nurse, which she mailed to the Department of Health for review by Respondent Board of Nursing (the "Board"). Item No. 9 of the application sought information about the applicant's disciplinary history. Four subparts (lettered A through D) asked questions that called for a "yes" or "no" answer, which the applicant was to give by marking the applicable check box. The first question ("9A") was: Have you ever been denied or is there now any proceeding to deny your application for any healthcare license to practice in Florida or any other state, jurisdiction or country? Tema answered, "No." In Item No. 10 of the application, there appeared above the signature line the following declarations: I recognize that providing false information may result in disciplinary action against my license or criminal penalties pursuant to Sections 456.067, 775.083, and 775.084, Florida Statutes. I have carefully read the questions in the foregoing application and have answered them completely, without reservations of any kind. Should I furnish any false information in this application, I hereby agree that such act shall constitute cause for denial, suspension or revocation of my license to practice as a Registered Nurse or Licensed Practical Nurse in the State of Florida. Tema's signature manifested her agreement with the foregoing declarations. Despite having acknowledged the hard consequences of deceit, Tema's negative answer to the question of whether she ever had suffered the denial of an application for licensure was false. In fact, in June 2011, the Virginia Board of Nursing had denied Tema's application for licensure as a practical nurse, on the ground that she had provided false information in an effort to obtain a license by fraud, deceit, or material omission. Tema had received timely, contemporaneous notice of the Virginia Board of Nursing's final decision, and she was fully aware of that disposition at all times relevant to this case. When she completed the Florida application in October 2012, therefore, Tema knew that her response to question 9A was false. Because the information Tema failed to disclose obviously would have hurt her chances of obtaining a license in Florida, the undersigned disbelieves Tema's explanation for the material omission, which was that she simply made a mistake.1/ Instead, the undersigned infers that Tema intentionally omitted the damaging fact of the Virginia denial in hopes that the Board would not discover it.2/ The Board did, however, discover the Virginia decision while reviewing Tema's application. Based on that past denial and Tema's present failure to disclose it, the Board determined that Tema's Florida application should be denied. The Board's preliminary decision was communicated to Tema through a Notice of Intent to Deny dated February 11, 2014. Determinations of Ultimate Fact Tema is guilty of having an application for a license to practice nursing denied by the licensing authority of another state, which is a disciplinable offense under section 464.018(1)(b), Florida Statutes.3/ Tema is guilty of attempting to procure a license to practice nursing by knowing misrepresentation, which is a disciplinable offense under section 464.018(1)(a).
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Nursing enter a final order denying Tema's application for licensure as a registered nurse. DONE AND ENTERED this 10th day of September, 2014, in Tallahassee, Leon County, Florida. S JOHN G. VAN LANINGHAM Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 10th day of September, 2014.
Recommendation Based on the foregoing facts and conclusions of law, the Hearing Officer recommends that the Board take no action against the license of Marie Novak, L.P.N. DONE and ORDERED this 16th day of December, 1976 in Tallahassee, Florida. STEPHEN F. DEAN, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 218 East Forsyth Street Jacksonville, Florida 32202 Robert T. Westman, Esquire Post Office Box 1888 Cocoa, Florida 32922
The Issue By its Administrative Complaint, dated October 14, 1980, Use Petitioner seeks to impose an administrative fine in the amount of $1,500.00 upon the Y & S Partnership, Limited, d/b/a Manhattan Convalescent Center for alleged violations of Chapter 400, Part I, Florida Statutes, and Chapter 10D-29, Florida Administrative Code. Specifically, the Petitioner charges the Respondent with allegedly failing to provide patients in its nursing home with adequate care consistent with their right to receive adequate health care in accordance with the established and recognized practice standards in the community and with rules promulgated by the Department pursuant to Section 400.022 (1)(g), Florida Statutes. The Petitioner charges also that the Respondent failed to maintain its premises and equipment and conduct its operations in a safe and sanitary manner as required by Section 400.141(4), Florida Statutes. The Respondent is concomitantly charged with violations of Rules 10D-29.33(4) and 10D-29.38(1), and Rule 10D-29.52(4) Table (36), Florida Administrative Code, in the area of patient health care. A violation of Rule 10D-29.49(1), Florida Administrative Code is alleged on the ground that no effective maintenance plan was promulgated or implemented by the Respondent. The charges at issue relate to an August 22, 1980 complaint investigation and surveillance visit conducted by personnel from the Tampa Office of Licensure and Certification of Petitioner's Department. On that visit it is charged that the Petitioner's personnel observed a patient and her bed linens soiled with fecal material and another patient who had soil accumulations on the right hand and was in need of hand care. Additionally, the Petitioner's personnel allegedly observed nurse paging cords missing or not attached to beds in approximately twelve rooms and observed various fixtures and equipment in need of repair. The issues are thus whether the acts or omissions charged occurred, and whether they constitute violations of the above-cited legal authority and concomitantly, whether an administrative fine is appropriate pursuant to Section 400.102(c) and Section 400.121(2), Florida Statutes. Two witnesses were called by the petitioner and five by the Respondent. Ten exhibits were introduced into evidence. The Respondent moved to dismiss the Administrative Complaint. The Motion to Dismiss will be treated in the Conclusions of Law hereinbelow. The Respondent has filed 248 proposed findings of fact and has requested separate rulings upon each. In that regard, the Hearing Officer has considered all proposed findings of fact, conclusions and supporting arguments of the parties. To the extent that the proposed findings and conclusions submitted by the parties, and the arguments by them, are in accordance with the findings, conclusions and views stated herein they have been accepted, and to the extent that such proposed findings and conclusions of the parties, and such arguments made by the parties, are inconsistent therewith, they have been rejected. Certain proposed findings and conclusions have been omitted as not relevant, dispositive or as not necessary to a proper determination of the material issues presented. To the extent that the testimony of various witnesses is not in accord with the findings and conclusions herein, it is not credited.
Findings Of Fact The Y & S Partnership, Limited, d/b/a Manhattan Convalescent Center, operates a nursing home facility in Tampa, Florida. The Office of Licensure and Certification (OLC), of the Department of Health and Rehabilitative Services (HRS) is responsible for the investigation of complaints about the operation of nursing facilities such as that of the Respondent, which are licensed by HRS. On August 22, 1980 a complaint investigation and surveillance of the Respondent's facility was conducted by O.L.C. employees Joel Montgomery and Muriel Holzberger. These individuals performed an inspection tour of the Respondent's facility accompanied by staff members of the Respondent to generally observe the level of health care accorded patients and the effectiveness of maintenance and repair operations carried out by the Respondent on its facilities and equipment. Ms. Holzberger, a registered nurse and accepted as an expert in the area of proper nursing care standards, personally observed at least 90 percent of the 176 patients resident at the Respondent's facility. In that connection, witness Holzberger observed patient A. W. who was bedridden at the time. This witness observed a brown stain approximately the size of a half dollar on the top sheet of patient A. W.`s bed. The witness described the stain as appearing to be the color of fecal material and it apparently was dry. She did not touch it, but made a determination by its visual appearance only. The stain only consisted of a brown coloration and no fecal material was observed adhering to the stained area. The sheet of this patient was raised by Nurse Holzberger who thereupon observed wet excrement on the patient's buttocks and on a waterproof pad that had been placed under the patient. Ms. Holzberger opined that at this point and time at least, the patient had not been cleaned. No dried excrement material was observed on the patient or on the waterproof pad however. Patient A. W. had a medical history of constant fecal incontinence and other bowel problems consisting generally of frequent impactions, coupled with constant oozing of fecal matter. Proper nursing care for such a patient was established to consist of changing sheets and washing the patient frequently to avoid the danger of skin breakdown in the anal and coccyx area which can be caused by frequent contact with fecal material. This witness, however, was unable to testify that patient A. W. had not been cleaned frequently inasmuch as she had a constant oozing of fecal material due to her inability to achieve sphincter control. The witness was similarly unable to establish that the wet excrement observed on the patient's buttocks and the waterproof pad beneath her had not been disposited there immediately before her observation of the patient. It was not shown that the patient had remained in a soiled condition for a significant period of time and indeed the witness acknowledged that allowing such a patient to remain in a soiled condition for a short period of time would not, on one or two occasions, affect that patient's health and safety. It is inferred that the soiling could just as likely have occurred immediately prior to Ms. Holzberger's observation inasmuch as it was described to be wet. Ms. Holzberger's observed no patients in the nursing home exhibiting skin breakdown or other ill effects caused by contact with excrement. Nurse Holzberger also observed patient C. M. who had severe contractures of the hands. Ms. Holzberger maintained that she observed soil accumulations in the right hand and the fingernails were in need of trimming. This witness described generally accepted hand care for contractured hands as consisting of washing or soaking in warm water at least daily and that if the contracture is severe, causing pain to open the hand, a washcloth should be wrapped on a tongue blade and inserted into the hand to clean it in that fashion. Drying is accomplished in a similar manner followed by insertion of a soft hand roll at least one inch in diameter to prevent indentation of the nails into the hand and to prevent build up of perspiration and to allow air to circulate. The nails should be trimmed as short as possible. Ms. Holzberger concluded, based primarily on the observance of the soil or stain in the hand, that it had been several days since hand care had been performed on this patient. Nurse Holzberger admitted that she knew nothing of the medical history of the patient C. M., a 97-year-old lady who suffers from severe degenerative arthritis and osteoporosis in both hands. The hand in question is so severely contractured as to be "in a ball." The witness acknowledged that no patient at the facility, including patient C. M., had any wounds caused by long nails, and that patient C. M. did have a gauze pad inserted into her hand. Witness Holzberger acknowledged that the brown stain on the patient's hand could have been due to the use of betadine which is a form of disinfectant medication and indeed Nurses Campanillo and Groves who testified for the Respondent, and were similarly accepted as experts, confirmed that the stain on patient C. M.`s hand was not caused by soil accumulation, but rather the betadine medication applied the day before in the course of regular hand care. Witness Holzberger testified that such hand care should be performed once a day and that she did not know whether it had been performed on the day of the inspection or not. The Respondent's witnesses confirmed that it had not been performed on that day at the time of her inspection shortly after 11:00 a.m., but that within the regular schedule of care for patients, it should be and was performed before 12:30 that day. Witness Holzberger admitted that there was no danger to the health and safety of the patient even if the hand was allowed to remain unclean for a reasonable period of time, which it was not. The Respondent thus demonstrated that the hand care was performed daily and that this patient could not tolerate a hand roll under her fingers to retard perspiration and indentation of the nails into the palm because it was extremely painful to even slide a tongue depresser with a washcloth under her fingers. Consequently, hand care was adequately accomplished on a daily basis by inserting a four inch gauze pad beneath her fingers and against her palm soaked with betadine solution and keeping her nails trimmed as short as possible. Witness Joel Montgomery was the hospital consultant on the Department's inspection team. Witness Montgomery observed a leaking air conditioner unit, a broken water closet tank cover, a leaking faucet in a janitor's closet, an inoperative water fountain and a missing baseboard in two of the rooms, as well as the allegation that nurse call cords were missing or not attached to the beds in approximately 12 rooms. The witness conceded that this is a large nursing home and such deficiencies are not unusual for a nursing home of this size and type, and that the staff of this nursing home had made sincere and continuing efforts to make repairs. He has seen improvements in maintenance over conditions existing at previous inspections. The witness was unable to state how many nurse paging cords were severed or missing, but that most of the 12 were simply not attached to the patients' beds. His testimony was not clear as to the existence of a requirement for attaching the paging cords to the beds, but the general tenor of his testimony was that that was the accepted procedure required by the Petitioner in regulating and overseeing patient care in nursing homes. The witness could not recall which, if any, beds were occupied in the rooms where he noticed the call cords were not attached to the beds. The witness also acknowledged that some of the cords were reattached to the beds in his presence, but he did not recall how many. The Respondent has a policy of detaching the cords from the beds when the patients are not in bed in order to change the linen, move the beds or to better allow ingress or egress by the patient from the bed. This witness did not establish that that policy conflicts with any Department policy or rule or constitutes an adverse influence on health care. The Respondent adduced evidence which established that only two call cords were actually inoperative during the inspection and that those were repaired during the inspection. The Respondent's witness to this effect Ann Killeen, the Administrator of the facility, made the inspection tour in the company of witness Montgomery for the Petitioner and corroborated the fact that the cords were clipped to the wall when patients are out of the beds or beds were being changed in order to prevent cords from breaking when the beds are moved, and that she was unaware that this violated any minimum standard promulgated by the Petitioner. The broken toilet tank cover was corrected while the inspector was on the premises, the leaking faucet in the janitor's closet sink was a slight drip causing no standing water inasmuch as the leaking water went down the drain. The leaking air conditioner drip pan was the only one of 89 air conditioners with such a problem. The testimony of this witness, as well as Respondent's witness Robert Cole, the employee of the facility in charge of maintenance, establishes that the inoperative call cords as well as the loose baseboards, the inoperative water fountain and broken water closet tank cover were repaired on the day of the inspection while the inspector was still on the premises with the exception of the air conditioner which was repaired within one week after the inspection and the baseboards which were repaired the day after the inspection. The water fountain was the subject of regular maintenance and had been repaired a number of times and the plumber was summoned to repair it once again after its deficiency was noted by Mr. Montgomery. None of the deficiencies with regard to the nurse call cords, the condensation dripping from the air conditioner, the broken water closet tank cover, the leaking faucet, the inoperative water fountain and the loose baseboards were shown to have been a recurring problem or problem existing for any significant period of time. The Petitioner did not show when these conditions occurred or how long they had been allowed to exist, nor did it show any resultant effect on the health or safety of the patients. The Respondent called Earnest H. Brown as an adverse witness. Mr. Brown is the Supervisor of the Tampa area Office of Licensure and Certification for the Petitioner. This witness admitted that he recommended a fine with regard to witness Holzberger's observance of patient A. W., who was fecally incontinent, because he believed fecal material had been found dried upon that patient's bed sheet. He relied on witness Holzberger's professional judgment in reporting to him. Witness Holzberger's testimony at the hearing, however, does not establish that any dried fecal material was found on patient A. W.`s bed sheet. With regard to his decision to recommend a fine concerning the deficient nurse calling cords, the witness admitted that this was predicated on the other observances of deficient call cords at the Respondent's facility on past inspections. The witness could not recall how many call cords, if any, had been observed to be inoperative or otherwise used improperly on past inspections. It should be noted parenthetically that the Administrative Complaint contains no allegation of such past deficiencies as a predicate to the charge regarding call cords in the Administrative Complaint stemming from the inspection of August 22, 1980 and in support of the fine which the Petitioner seeks to impose for this condition.
Recommendation Having considered the foregoing Findings of Fact and Conclusions of Law, the evidence in the record, the candor and demeanor of the witnesses and the pleadings of the parties, it is RECOMMENDED that the Administrative Complaint filed against the Respondent in this cause should be dismissed. DONE AND ENTERED this 27th of April, 1981, in Tallahassee, Leon County, Florida. P. MICHAEL RUFF 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 27th day of April, 1981. COPIES FURNISHED: Amelia M. Park, Esquire District VI Legal Counsel Department of Health and Rehabilitative Services 4000 West Buffalo Avenue Tampa, Florida 33614 Richard A. Gilbert, Esquire de la Parte & Butler, P.A. 403 Morgan Street, Suite 102 Tampa, Florida 33602 Steven R. Reininger, Esquire Tew, Critchlow, Sonberg, Traum & Friedbauer 10th Floor Flagship Center 777 Brickell Avenue Miami, Florida 33131
The Issue Whether Respondent engaged in unprofessional conduct and, if so, what penalty should be imposed on his nursing license.
Findings Of Fact The Department of Health is the state agency charged with regulating the practice of nursing pursuant to Chapter 464, Florida Statutes. Respondent, Cecil Harold Floyd, was at all times material hereto a licensed practical nurse in the State of Florida, having been issued a license numbered PN 0960631. At all times material hereto, Respondent was employed as a licensed practical nurse by the North Shore Senior Adult Community in St. Petersburg, Florida. At all times material hereto, Respondent was assigned to care for Patient M.F., a patient in the skilled nursing section of the North Shore Senior Adult Community. On February 26-27, 1996, Respondent worked as the charge nurse on the 11:00 p.m. to 7:00 a.m. shift. On February 27, 1996, at approximately 6:00 a.m., Respondent wrote in the nurse's notes that Patient M.F. was lethargic and having difficulty swallowing; that the patient's bottom dentures were out; and that the patient's tongue was over to the right side. In this entry, Respondent also noted "will continue to monitor." After Respondent completed his shift on February 27, 1996, Conchita McClory, LPN, was the charge nurse in the skilled nursing facility at North Shore Senior Adult Community. At about 8:10 a.m., Nurse McClory was called by the CNA who was attempting to wake up Patient M.F. Upon Nurse McClory's entering Patient M.F.'s room, she observed that the patient was sleeping, incontinent, and restless and that the right side of the patient's face was dropping. Based on these observations, Nurse McClory believed that Patient M.F. may have suffered a stroke and she immediately called 911. Following the 911 call, Patent M.F. was taken to Saint Anthony's Hospital in Saint Petersburg, Florida. Prior to coming to this country, Conchita McClory had been trained and worked as a registered nurse in the Philippines. However, Ms. McClory is not licensed as a registered nurse in the State of Florida. Saint Anthony's Hospital's records regarding Patient M.F. indicate that the patient had a history of multiple strokes beginning in 1986. The Department’s Administrative Complaint against Respondent included the following factual allegations, all of which were alleged to have occurred on February 27, 1996: At approximately 6:00 a.m., Respondent recorded in the nurse’s notes that Patient M.F. was lethargic and having difficulty swallowing; the patient's bottom dentures were out; and the patient's tongue was over to the right side. Respondent also noted in the nurses' notes that Patient M.F. should continue to be monitored. Patient M.F.'s roommate told Respondent that she believed that M.F. had suffered a stroke because she could not swallow and her speech was slurred. At about 8:00 a.m., Patient M.F.'s roommate went to the nurses' station and requested that a certified nurse's assistant check on M.F. Patient M.F. was found paralyzed on her left side, soaked in urine and unable to speak. There was no evidence presented to support the factual allegations referenced in paragraph 9b and 9c above and included in the Administrative Complaint.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Health, Board of Nursing, enter a final order dismissing the Administrative Complaint against Respondent. DONE AND ENTERED this 6th day of October, 1999, in Tallahassee, Leon County, Florida. CAROLYN S. HOLIFIELD Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 6th day of October, 1999. COPIES FURNISHED: Howard M. Bernstein, Esquire Agency for Health Care Administration Allied Health - Medical Quality Assistance 2727 Mahan Drive, Building 3 Tallahassee, Florida 32308-5403 Cecil Harold Floyd 1680 25th Avenue, North St. Petersburg, Florida 33713-4444 Ruth Stiehl, Executive Director Board of Nursing Department of Health 4080 Woodcock Drive, Suite 202 Jacksonville, Florida 32207 Angela T. Hall, Agency Clerk Department of Health 2020 Capital Circle, Southeast, Bin A02 Tallahassee, Florida 32399-1701 Pete Peterson, General Counsel Department of Health 2020 Capital Circle, Southeast, Bin A02 Tallahassee, Florida 32399-1701
Findings Of Fact In October 1978 Bonnie Ray Solomon Crawford, LPN was employed at the West Pasco Hospital, New Port Richey, Florida as a licensed practical nurse provided by Upjohn Company's rent-a-nurse program. On 7 October 1978 Respondent signed out at 10:00 a.m. and 2:00 p.m., and on 8 October 1973 at 8:00 a.m. and 1:00 p.m. for Demerol 75 mg for patient Kleinschmidt (Exhibit 2). Doctor's orders contained in Exhibit 4 shows that Demerol 50 mg was ordered by the doctor to be administered to patient Kleinschmidt as needed. Nurses Notes in Exhibit 4 for October 7, 1978 contains no entry of administration of Demerol at 10:00 a.m. and at 2:00 p.m. shows administration of 50 mg. and Phenergan 25 mg. Exhibit 3, Narcotic Record for Demerol 50 mg contains two entries at 8:15 a.m. on October 7, 1978 and one entry at 12:30 p.m. where Respondent signed out for Demerol 50 mg. for patients King, Zobrist and King in chronological order. Nurses Notes for King, Exhibit 6, and Zobrist, Exhibit 5, contain no entry that Demerol was administered to patient Zobrist at 8:15 a.m. or to patient King at 12:30 p.m. on 7 October 1978. In fact, the record for Zobrist shows that Zobrist was discharged from the hospital on October 5, 1978. Failure to chart the administration of narcotics constitutes a gross error in patient care and is not acceptable nursing practice. Similarly it is not acceptable nursing practice to withdraw narcotics not contained in doctors orders or administer medication not in doctors orders. When confronted by the Nursing Administrator at West Pasco Hospital with these discrepancies in the handling of Demerol, Respondent stated that she failed to check the identity of the patient before administering medication and that she didn't feel she should be giving medications any more. Following this confrontation with the hospital authorities, Respondent was fired for incompetency. No evidence was submitted regarding Respondent's 1975 disciplinary proceedings.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law the Hearing Officer recommends that the Respondent, Nancy Drennen, receive a letter of reprimand. In making this recommendation, the Hearing Officer specifically considers the outstanding comments made about the Respondent by her Dr. Roberts and her coworkers, the fact that she has been employed as an OH nurse since January of 1979, performing her duties without complaint or incident, and the fact that the complaint was filed against her so long after the incident that it truly diminished the Respondent's ability to defend herself. DONE and ORDERED this 29th day of May, 1980, In Tallahassee, Leon County, Florida. STEPHEN F. DEAN, Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675
Findings Of Fact The Respondent is a registered nurse who began her employment at South Lake Memorial Hospital on August 29, 1977, and was terminated on April 23, 1980. During her employment, the Respondent received four poor evaluations and/or warnings for her nursing practice. The first warning occurred on August 1, 1979. This warning involved allegations of poor nursing performance by the Respondent. These allegations included the Respondent leaving her unit, failing to properly organize her work, failing to properly restrain a patient, wasting time by running too many EGG strips instead of performing her assigned functions, failing to take vital signs timely when coming onto shift, becoming hostile with the Director of Nursing, and failing to obey the direct order of the Director of Nursing to leave the hospital and go home after an argument on July 12, 1979. Although there was no direct evidence as to most of the allegations, the Respondent admitted to late charting, failing to timely take vital signs, spending time working with ECG strips, and failing to obey a direct order to-go home given by the Director of Nursing. The next evaluation occurred on November 26, 1979. The deficiencies in Respondent's practice as alleged by the Director of Nursing were that the Respondent gave a patient whole blood instead of packed cells as ordered by the physician, failed to verify an error in transcription by the ward clerk which resulted in a patient's x-rays being delayed for a day, and improperly charting when the Respondent noted on the nursing notes that at 9:00 p.m. there was no significant change in a patient's condition, when in fact the patient had left the hospital at 8:30 p.m. The lack of direct evidence of these allegations was compensated for by the Respondent's admissions as she testified concerning the circumstances surrounding why the incidents occurred. The third warning occurred on March 19, 1980. The allegations in the warning concerned the Respondent having shouted at a supervisor, abandoning her patients, allowing two I.V.s to run dry, failing to carry out a doctor's orders, and failing to chart. Again, there was no direct evidence of the allegations, however, the Respondent admitted that she left her duty station because of sickness prior to relief arriving in the unit, failed to properly follow doctor's orders, and failed to chart for the time she was present in the unit prior to her reporting to the emergency room. The fourth and final warning, which resulted in termination, occurred on April 23, 1980. The allegations by the Director of Nursing were that the Respondent hung one-fourth percent normal saline solution rather than the one- half percent normal saline solution ordered by the physician, and that the Respondent failed to administer the 5:00 p.m. medication. Again, the allegations were admitted by the Respondent as she attempted to explain why they occurred. The Director of Nursing testified that during each of these warnings, the Respondent's attitude was that she had done nothing wrong and, therefore, could not improve on her performance. The testimony of the Department's nurse investigator was to the effect that the Respondent's actions failed to meet the minimal standard of acceptable and prevailing nursing practice. The investigator also testified that, in her opinion, a nurse with Respondent's poor attitude could be extremely dangerous in a hospital setting. After many years of difficult and stressful work, many nurses suffer from what is commonly referred to as "burn out" and are no longer useful, and can be dangerous in a high stress area of nursing. Respondent testified in her own behalf and offered an explanation for each allegation presented by Petitioner. Respondent testified that relative to the first warning, even though she only had two patients, she did not have adequate time to do her charting during her shift and, therefore, had to stay two hours late. Respondent further testified that on one occasion she had not timely taken her vital signs because the Director of Nursing had delayed her with a needless confrontation. Respondent testified that she did not leave the facility as ordered on August 12, 1979, because she was afraid that she would be abandoning her patients, and could lose her vacation and sick leave benefits. With respect to the November 26, 1979 evaluation, the Respondent testified that she gave whole blood instead of packed cells because the whole blood was incorrectly labeled as packed cells. Respondent further testified that she became aware of the error after the solution had infused, and that had she looked at the solution earlier she would have been able to see that it was an incorrect blood product, and would have been able to correct the problem. As to the incorrect transcription resulting in a patient's x-rays being delayed, the Respondent stated that it was the ward clerk's responsibility, not hers, to transcribe the doctor's orders. With respect to the 9:00 p.m. nursing notes when the patient had left the facility at 8:30 p.m., the Respondent's response was that she had been aware that the patient was gone, but was summarizing the patient's condition during the entire shift up to the point the patient left. Respondent acknowledge that the nursing notes may have been misleading. As to thee warning of termination on March 19, 1980, the Respondent admitted leaving her unit prior to relief arriving. Her explanation gas that she had been attempting for one hour to get assistance, to no avail. Upon questioning, she admitted that she was-only "a little dizzy" and had diarrhea. On that day she did not chart any nursing care given by her while on duty. The Respondent was caring for twelve patients at that time. With respect to the April 23, 1980 termination, Respondent admitted that she hung the incorrect percentage saline solution, but that she did so because a prior nurse obtained the incorrect solution from a supply room. The Respondent then also admitted failing to give out the 5:00 p.m. medication as ordered, but stated the reason for her failure to administer the medication was her inability to obtain help from her supervisor which was necessary because she was overworked. Respondent also testified that during this time period, she went on rounds with a doctor, and also went to dinner. The Respondent testified that she felt she was a good and qualified nurse. Respondent also testified that she had been fired previously from Leesburg General Hospital. The Respondent believes her attitude to be good and indicated that the hospital was overreacting to a few isolated incidents.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED: That the Respondent's license to practice nursing in the State of Florida, license number 39108-2, be suspended indefinitely. If the Respondent seeks reinstatement, it will be her responsibility to undergo counseling with a psychologist or psychiatrist, for an in-depth evaluation and treatment, the results of which shall be submitted to the Board of Nursing if and when the Respondent wishes to apply for reinstatement of her nursing license. If the Respondent applies for reinstatement of her license, it shall be her responsibility to demonstrate to the Board that she is able to engage in the practice of nursing in a safe, professional, proficient and legal manner. This demonstration shall include but not be limited to a report by her psychologist or psychiatrist, along with a recommendation from him that she be reinstated to the practice of nursing. 1/ DONE and ORDERED this 8th day of January, 1982, in Tallahassee, Florida. SHARYN L. SMITH, 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 8th day of January, 1982.
