IN THE MATTER OF § BEFORE THE ELIGIBILITY § PERMANENT CERTIFICATE § AND DISCIPLINARY § NUMBER 581753 § COMMITTEE § ISSUED TO § OF THE TEXAS § ALMA CAMPOS RICE § BOARD OF NURSING ORDER OF THE BOARD TO: Alma Campos Rice 807 Flicker Ln. Dyersburg, TN 38024 During open meeting held in Austin, Texas, on November 12, 2008, the Eligibility and Disciplinary Committee (hereinafter "Committee") heard the above-styled case. This case was heard, and based on the failure of the Respondent to appear as required by 22 TEX. ADMIN. CODE Ch.213. The Committee of the Texas Board of Nursing finds that notice of the facts or conduct alleged to warrant disciplinary action has been provided to Respondent in accordance with Texas Government Code § 200 1.054( c) and Respondent has been given an opportunity to show compliance with all the requirements of the Nursing Practice Act, Chapter 301 of the Texas Occupations Code, for retention of Respondent's license to practice professional nursing in the State of Texas. The Committee finds that the Formal Charges were properly initiated and filed in accordance with section 301.458, Texas Occupations Code. The Committee finds that after proper and timely Notice regarding the violations alleged in the Formal Charges was given to Respondent in this matter, Respondent has failed to appear in accordance with 22 TEX. ADMIN. CODE Ch. 213. The Committee finds that the Board is authorized to enter a default order pursuant to Texas Government Code § 2001.056. The Eligibility and Disciplinary Committee, after review and due consideration, adopts the proposed findings offact and conclusions oflaw as stated in the Formal Charges which are attached hereto and incorporated by reference for all purposes and the Staffs recommended sanction of revocation by default. This Order will be properly served on all parties and all parties will be given an opportunity to file a motion for rehearing (22 TEX. ADMIN. CODE § 213.2(j)). All parties have a right to judicial review of this Order. All proposed findings of fact and conclusions of law filed by any party not specifically adopted herein are hereby denied. NOW, THEREFORE, IT IS ORDERED that Permanent Certificate Number 581753, previously issued to ALMA CAMPOS RICE, to practice professional nursing in the State of Texas be, and the same is hereby, REVOKED. IT IS FURTHER ORDERED that Permanent Certificate Number 581753, previously issued to ALMA CAMPOS RICE, upon receipt of this Order, be immediately delivered to the office ofthe Texas Board of Nursing. IT IS FURTHER ORDERED that this Order SHALL be applicable to Respondent's multi- state privilege, if any, to practice professional nursing in the State of Texas. Entered this 12th day of November ,2008. TEXAS BOARD OF NURSING BY: ~ c.~ KATHRINE A. THOMAS, MN, RN EXECUTNE DIRECTOR ON BEHALF OF SAID BOARD Re: Pennanent Certificate Number 5.81753 Issued to ALMA CAMPOS RICE DEFAULT ORDER -REVOKE CERTIFICATE OF SERVICE I hereby certify that on the Jl day of NWI/m 4q- , 20 fli, a true and correct copy of the foregoing DEFAULT ORDER was served by placement in the U.S. Mail via certified mail, and addressed to the following person(s): Alma Campos Rice 807 Flicker Ln. Dyersburg, TN 38024 BY: KATHERINE A. THOMAS, MN, RN EXECUTNE DIRECTOR ON BEHALF OF SAID BOARD In the Matter of Permanent License Number 581753, Issued to ALMA CAMPOS RICE, Respondent § § § BEFORE THE TEXAS BOARD OF NURSING FORMAL CHARGES This is a disciplinary proceeding under Section 30 1.452(b), Texas Occupations Code. Respondent, ALMA CAMPOS RICE, is a Registered Nurse holding license number 581753, which is in invalid status at the time of this pleading. Written notice of the facts and conduct alleged to warrant adverse licensure action was sent to Respondent at Respondent's address of record and Respondent was given opportunity to show compliance with all requirements of the law for retention of the license prior to commencement of this proceeding. CHARGE I. On or about June 10, 2008, Respondent's license to practice professional nursing in the State of Tennessee was Revoked by the Tennessee Board of Nursing, Nashville, Tennessee. A copy of the Findings of Fact, Conclusions of Law, Reasons for the Decision, and Agreed Order, dated June 10, 2008, is attached and incorporated, by reference, as part of this pleading. The above action constitutes grounds for disciplinary action in accordance with Section 301.452(b)(8),Texas Occupations Code. NOTICE IS GWEN that staff will present evidence in support of the recommended disposition of revocation of Respondent's license to practice nursing in the State of Texas pursuant to the Board's rules, 22 TEX. ADMIN. CODE §§ 213.27 - 213.33. Additionally, staff will seek to impose on Respondent the administrative costs of the proceeding pursuant to § 301.461, TEX. Occ. CODE ANN. The cost of proceedings shaH include, but is not limited to, the cost paid by the board to the State Office of Administrative Hearings and the Office of the AttomeyGeneral or other Board counsel for legal and investigative services, the cost of a court reporter and witnesses, reproduction of records, board staff time, travel, and expenses. These shall be in an amount of at least one thousand two hundred dollars ($1200.00). NOTICE IS GIVEN that all statutes and rules cited in these Charges are incorporated as part ofthis pleading and can be found at the Board's website, www.bon.state.tx.us. NOTICE IS GIVEN that to the extent applicable, based on the Formal Charges, the Board will rely on Adopted Disciplinary Sanction Policies for Nurses with Substance Abuse, Misuse, Substance Dependency, or other Substance Use Disorder, Lying and Falsification, and Fraud, Theft & Deception which can be found at the Board's website, www.bon.state.tx.us. NOTICE IS ALSO GIVEN that Respondent's past disciplinary history, as set out below and described in the Orders which are attached and incorporated by reference as part of these charges, will be offered in support of the disposition recommended by staff: Texas Board of Nursing Agreed Order dated October 18, 2007, and Tennessee Board of Nursing Agreed order dated June 10, 2008. Filed this ?klt. dayof ~ ,20 ~8. TEXAS BOARD OF NURSING ~<:.<--<-=r~ . Johnston, General Counsel Board Certified - Administrative Law Texas Board of Legal Specialization State Bar No. 10838300 Victoria Cox North, Assistant General Counsel State Bar No. 00789585 John F. Legris, Assistant General Counsel State Bar No. 00785533 TEXAS BOARD OF NURSING 333 Guadalupe, Tower ill, Suite 460 Austin, Texas 78701 P: (512) 305-6824 F: (512) 305-8101 or (512)305-7401 Attachments: Texas Board of Nursing Agreed Order dated October 18, 2007, and Tennessee Board of Nursing Agreed Order dated June 10, 2008. 0999/0 2 RESPONDENT STATE OF TENNESSEE DEPARTMENT OF HEALTH ) ) ) ) ) ) ) BEFORE THE BOARD OF NURSING DOCKET NO. 17.19-098248A AGREED ORDER This matter came to be heard before the Board of Nursing (hereinafter "Board'') on the 1 day of Jun~, 2008, pursuant to a. notice of charges filed by the Tennessee Department of Health (hereinafter "State") and upon consent and agreement of the parties. The State was represented by S. Alexa Whittemore, Assistant General Counsel. The Respondent is represented by counsel, Charles R. Kelly. Neither Respondent nor her counsel were present by agreement of the parties. After consideration of the agreement of the parties as evidenced herein, the Board finds as follows: 1. The Respondent agrees that presentation to and consideration of this Agreed Order by the Board for ratification and all matters divulged during that process shall not constitute unfair disclosure such that the Board or any of its members shall be prejudiced to the extent that requires their disqualification from hearing this matter should this Order not be ratified. Likewise, all matters, admissions and statements disclosed or exchanged during the attempted ratification process shall not be used against the Respondent in any subsequent proceedings unless offered into evidence upon a basis other than the Respondent disclosed it to cmmsel andlor the Board during the formal presentation of this order to the Board. Q 'f' I ()~ DATE Cl I' L \.. I C RTIFY HIS TO BE A TRUE COpy OF THE RECORDS ON FILE WITH THE TENNESSEE BOARD SIGNED _ " ' 2. Respondent understands the nature of the charges herein alleged and that if proved at hearing, such charges and allegations would constitute_cause for imposing discipline upon Respondent's license issued by the Board. 3. Respondent is aware of each of Respondent's rights, including the right to a hearing on the charges and allegations, the right to appear personally and by counsel, the right to confront and cross-examine witnesses who would testify against Respondent, the right to testify and present evidence on Respondent's own behalf, as well as to the issuance of subpoenas to compel the attendance of witnesses and the production of documents, the right to contest the charges and allegations, and other rights which are afforded Respondent pursuant to the Administrative Procedures Act and other applicable laws, including the right to seek reconsideration, review by the Chancery Court, and appellate review. 4. In order to avoid the expense and uncertainty of a hearing, Respondent freely and voluntarily waives each and every one of these rights set forth above and admits the truth of the allegations herein contained. Respondent agrees that cause exists to discipline her license. 5. Respondent understands that by signing this Agreed Order Respondent is enabling the Board to issue its order without further process. In the event that this Agreed Order is rejected for any reason by the Board, it vvill be of no force or effect for either party. 1. FINDINGS OF FACT The Board makes the following specific findings of fact: 6. Respondent was originally granted a license to practice as a registered nurse in the State of Tennessee by the Board on September 28, 2005, having been granted license number 152224. Respondent's license expires on August 31, 2008. 2 7. Respondent's registered nurse license bears a multistate privilege to practice nursing in states which have e~~e!:~(LiAtQ !1t~I1!~n.;~te NJ,l11)~ Li~~ns1.!fe Compact. ---- -"--'. ---- .. __ . ~." 8. Respondent was employed as a registered nurse by Jackson-Madison County General - r Hospital (JMCGH) in Jackson, Tennessee, from September 11, 2006, until October 25, 2006. 9. On October 23,2006, Respondent wasted a vial of Valium at JMCGH, but did not let the witness view the vial before Respondent dropped it in the Sharps box. 10. The witness reported this to the supervisor, who then opened the Sharps container and found only an empty vial of Vallum. 11. Respondent was requested to submit to a urinary drug screen, however the temperature of the specimen she provided was below the level admissible for a urine drug screen. After a few hours of attempting to provide another urine specimen, Respondent left the facility without providing another specimen, even though she was told she would be terminated if she left without providing another specimen. 12. From March 5, 2007, to March 27, 2007, Respondent was employed as a contract registered nurse with Regional Medical Center in Memphis, Tennessee. 13. On or around March 23, 2007, Respondent withdrew narcotics for patients from the Omnicell system, using another nurse's code. These patients did J;lot have doctors' orders for the narcotics. 14. Respondent also placed three (3) complete patient medical records in the shredding box at Regional Medical Center. These records contained orders that she failed to complete. 15. Respondent admitted that she withdrew these narcotics from the Omnicell system for her personal use. 3 16. Respondent also admitted that she placed the narcotics in her car and had a closed 17. Police were called to Regional Medical Center, and they found various narcotics in the trunk of Respondent's car. 18. Respondent pled no contest in the General Sessions Court of Shelby County~ to three (3) felony counts of possession of a controlled substance with intent to manufacture, sell, or deliver. She also pled no contest to one (1) felony count of obtaining a controlled substance by fraud, deceit, or forgery. Finally, she was placed on pre-trial diversion until May 2008 for possession of a controlled substance. 19. On Ju1y 10, 2007, Respondent was employed as a contract registered nurse at Duke Raleigh Hospital in North Carolina. 20. On or around Ju1y 10, 2007, Duke Raleigh Hospital cancelled Respondent's contract when Respondent failed to pass a competency exam.. Respondent was told of her termination with the Hospital and was asked to leave. 21. Respondent was found later that evening, on the fourth floor of Duke Raleigh Hospital, attempting to access narcotics from the Pyxis system. 22. When Respondent was questioned by the fourth floor nurse, she misrepresented herself as a float nurse scheduled to work the fourth floor. The fourth floor nurse left to contact her supervisor, and when she returned the Respondent was gone. 23. Respondent was later found in the hospital's emergency room attempting to access narcotics from the Pyxis system. 24. Respondent was escorted out of the hospital by security and the police were called. 25. The Raleigh police found narcotics in Respondent's motel room. 4 " ' 26. On July 31, 2007, Respondent was convicted in the Superior Court of Wake County, North Carolina on one (1) felony count of possession of a schedule n controlled -.-' -'-'--" .- ----- -- -.-~.---, .. __ .. -._-------- ------~-. ----. .. -.. - --- substance and one (1) felony count of embezzling a controlled substance from her employer. 27. On August 23, 2006, an Order was filed which disciplined Respondent's multi-state privilege or license to practice nursing in Texas by placing her on probation for two (2) years. Specifically, Respondent was disciplined for, among other things, failing to appropriately document the administration of, medicati<:>llS, failing to document the administration of medications, administering controlled substances without a physician's order, misappropriation of controlled substances, removing medications in excess of physicians' orders, changing patients' medication orders without doctor authorization. ll. CONCLUSIONS OF LAW The facts as stated in Section I of this Order are sufficient to establish that the Respondent has violated the provisions of the Tennessee Code Annotated Section (hereinafter "T.CA. §") 63-7-115 et seq. including, but not limited to, the following provisions: 28. T.e.A. § 63-7-115. Grmmds for denial, revocation or suspension of certificate or license. - (a)(l) The board has the power to deny, revoke or suspend any certificate or license to practice nursing or to otherwise discipline a licensee upon proof that the person: (B) Is guilty of a crime; (C) Is unfit or incompetent by reason of negligence, habits or other cause; (D) Is addicted to alcohol or drugs to the degree of interfering with nursing duties; (F) Is guilty of unprofessional conduct; and 5 i (G) Has violated or attempted to violate, directly or indirectly, or assisted in or abetted the violation of, or conspired to violate, any provision of this chapter or any - -- -_.--- ------, .... - ------_ ... -------- ----" --- - --.- -_._---_._-------------- ".-- -- --------" -_ .. lawful order of the board issued pursuant thereto. _ ••• ____ ._~ ________ ._. ___ • ______ • _____________ ." __ •• _. __ " _____ •• _... ~. __ " _. ___ ••• - ______ - - _______ •• _. __ ._ ~. ___ •• __ • __ .0" 29. Rule 1000-1-.13. Unprofessional Conduct and Negligence, Habits or Other Canse. - (1) Unprofessional. conduct, unfitness, or incompetency by reasons of negligence, habits or other causes, as those terms are used in the statute, is defined as, but not limited to, the following: (c) Abandoning or neglecting a patient requiring nursing care; (d) Making false or materially incorrect, inconsistent or unintelligible entries in any. patient records or in the records of any health care facility, school, institution or other work place location pertainiiIg to the obtaining, possessing or administration of any controlled substance as defined in the Federal Controlled Sub~ce Act; (e) Unauthorized use or removal of narcotics, drugs, supplies, or equipment from any health care facility, school, institution or other work place location; (h) Impersonating another licensed practitioner; CD Revocation, suspension, probation or other discipline of a license to practice nursing by another state or territory of the United States for any act or omission which would constitute grounds for the revocation, suspension, probation or other discipline of a license in this state; and (w) Engaging in acts of dishonesty which relate to the practice of nursing. III. REASONS FOR THE DECISION 30. The Tennessee Board of Nursing is responsible for the regulation and supervision oftbe practice of nursing in the State of Tennessee. T.C.A. Section 63-7-101 et seq. 6 31. It is the duty and responsibility of the Board of Nursing to enforce the Nurse Practice Act in such a manner as to insure that nurses use their licenses to promote and J>rotect th~ --.--------.----~-- .. __ .... _--_._------_.-._- --- .-_' ------------------_ .. -- public health, safety and welfare. ••• _. _________ ••• __ h __ " __ "_ --- ---~.----------- ... --- 32. It is the policy of the Tennessee Board of Nursing to require strict compliance with the laws of this State and to apply the laws so as to preserve the. quality of nursing care provided in Tennessee. 33. It is the duty and responsibility of the Tennessee Board of Nursing to promote the public health, safety and welfare by disciplining nurses who violate the provisions of Tennessee Code Annotated Section 63-7-101 et seq. THEREFORE, in view of the above FINDINGS OF FACT, CONCLUSIONS OF LAW, and REASONS FOR THE DECISION. it is hereby ORDERED as follows: 34. Respondent's consent to the terms and conditions ofthls order is accepted. 35. The license of Respondent to practice as a registered nurse in Tennessee pursuant to the authority vested in the Board under T.C.A. §§ 63-7-115 and 116 shall be and is hereby REVOKED for one (1) year, effective immediately upon ratification of this Order by the Board. 36. This REVOCATION is a formal disciplinary action and will be reported to the Health Integrity and Protection Data Bank (HIPDB). 37. Respondent shall pay the costs ofthls action pursuant to T.C.A. §§ 63-7-115(d) and 63-1- 144, and Rule 1000-1-.04(11) of the Official Compilation Rules and Regulations of the State of Tennessee for The Tennessee Board of Nursing (hereinafter "Rule"). These costs will be established by an Affidavit of Costs prepared by Counsel for the Department and will not exceed five hundred dollars ($500.00). Costs are due and payable within two (2) years of the date the Affidavit of Costs is mailed to Respondent. 7 38. Cost payments shall be paid by means of a certified check, cashier's check, or money order- pa-yable-to-the-State---of--'l'ennessee-which-shall- be-mailed'-.-Of- delivered-to:--- ---- --- Disciplinary Coordinator, Tennessee Department of Health, Heritage Place MetroCenter, -------- ----------- - ----------------------------------------------- ------------------ --- 227 French Landing, Suite 201, Nashville, Tennessee 37243. A notation shall be placed on said check that it is payable for the costs of Alma Rice, Case No Nos. 200700858, 200700859,200701546,200701988, and 200702115. 39. A violation of this Order shall constitute a separate violation of the Nurse Practice Act, T.C.A. § 63-7-1 1 5 (a)(1)(G), and is grounds for further disciplinary action by the Board. This AGREED ORDER approved by a majority of a quorum of the Board at a public meeting and signed thisS '7'-ty of June, 2008._ FOR THE TENNESSEE BOARD OF NURSING: Approved for entry by: Alina Rice, RN., No. 152224 Re~ Charles S. Kelly, Esq. Attorney for Respondent 8 Prepared for entry by: --].-ATiti-~-------- ._- -S:-Aiexa-Wbittemore;ftPR-Nrr.-t>2t219- - -- - Assistant General Counsel Tennessee Department of Health Office of General Counsel 220 Athens Way, Suite 210 Nashville, Tennessee 37243 (615) 741-1611 CERTIFICATE OF FILING This Order- was received fOf filing in the Offir~the Secretary of State,- Administrative Procedures Division, and became effective on th~ day of June, 2008. ~ Jl Ei>vfJ.M tift Thomas G. Stovall, Director Administrative Procedures Division 9 CERTIFICATE OF SERVICE HH ______________ The UIldersig!l~d _ does hereby ceq:ify that a true and correct copy_QLth~Jru:eguing------ document has been served upon Respondent, Alma Rice, by and through counsel, Charles S. --Kelly, 802-Troy,P.O ,- Bo*S07-,Dyersburg, Tennessee-38025-,-bydelivering-same--in-the-United-- -- -- - States mail, first class, with sufficient postage thereon to reach its destination. This II day of June, 2008. 10 ~.A~w~ S. Alexa Whittemore Assistant General Counsel ,I . BEFORE THE BOARD OF NURSE EXAMINERS FOR THE STATE OF TEXAS *********************************************** In the Matter of Registered Nurse License Number 581753 issued to ALMA CAMPOS RlCE § § § AGREED ORDER On this day the Board of Nurse Examiners for the State of Texas, hereinafter referred to as the Board, considered the matter of ALMA CAMPOS RICE, Registered Nurse License Number 581753, hereinafter referred to as Respondent. . Information received by the Board produced evidence that Respondent may have violated Section 301.452(b)(9). (10). (12) & (13), Texas Occupations Code. Respondent waived informal conference, notice and hearing, and agreed to the entry ofthis Order offered on July 16, 2007, by Katherine A. Thomas, MN, RN, Executive Director, subject to ratification by the Board. FINDINGS OF FACT 1. Prior to the institution of Agency proceedings; notice of the matters specified below in these Findings of Fact was served on Respondent and Respondent was given an opportunity to show compliance with all requirements of the law for retention ofthe license. 2. Respondent waived informal conference, notice and hearing, and agreed to the entry of this Order. 3. Respondent's license to practice professional nursing in the State of Texas became invalid on April 17, 2006. 4. Respondent received a Baccalaureate Degr-ee in Nursing from Angelo State University, San Angelo, Texas, on May 15, 1992. Respondent was licensed to practice professional nursing in the State of Texas on August 31, 1992. 5. Respondent's professional nursing employment history includes: September 1992 - January 1995 581753:101 RN Shannon Medical Center San Angelo, Texas CIO Respondent's professional nursing employment history continued: February 1995 - May 1995 June 1995 - January 2005 January 2005 - May 2005 June 2005 - Present Unknown RN Midland Memorial Hospital Midland, Texas RN Trinity Medical Center Carrollton, Texas Unknown 6. At the time of the initial incident, Respondent was employed as a Registered Nurse with Trinity Medical Center, Carrollton, Texas, and had been in this position for two (2) months. 7. On or about November 27, 20Q1, Respondent plead No Contest to the offense "Theft of Property >= $50 < $500," a Class B Misdemeanor, in the Midland County Court at Law, Midland, Texas, Cause Number CR90515. An adjudication of guilt was deferred, and Respondent was placed on probation for a period of six (6) months. Respondent was assessed a fine and court costs in the total amount of four hundred sixty-five dollars ($465.00). 8. On or About December 27, 2004, Respondent submitted an employment application to Trinity Medical Center, Carrollton, Texas, in which she provided false, deceptive, andlor misleading infonnation, in that she answered "no" to the following question: "Have you ever been convicted of, been given probation or deferred adjudication in lieu of sentencing, or pled no contest, for any offense other than a minor traffic violation?" On or about November 27, 2001, Respondent plead No Contest to the offense "Theft of Property >= $50 < $500," a Class B Misdemeanor, in the Midland County Court at Law, Midland, Texas, Cause Number CR90515. 9. On or about March 24, 2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent removed Ativan 2mg from the Omnicell medication dispensing system for Patient Medical Record Number 177130 without a valid physician's order. Respondent's conduct was likely to injure the patient in that the administration of Ativan without a physician's order could result in the patient suffering from adverse reactions. 581753:101 - 2 - C10 10. On or about March 24, 2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent removed Ativan 2mg from the Omnicell medication dispensing syst~m for Patient Medical Record Number 177130 but failed to accurately document the administration in the patient's medical record. Respondent's conduct was likely to injure the patient in that subsequent care givers would rely on her documentation to further medicate the patient which could result in an overdose. 11. On or about Match 24, 2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent removed Ativan 2mg from the Omnicell medication dispensing system for Patient Medical Record Number 177130 but failed to follow policy and procedure in place for the wastage of medication. Respondent's conduct was likely to deceive the hospital pharmacy and placed them in violation of Chapter 481 of the Texas Health and Safety Code (Controlled Substances Act). 12. On or about March 24, 2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent misappropriated Ativan belonging to the facility and its patients thereof. Respondent's conduct Was likely to defraud the facility and patients of the cost of the medication. 13. On or about April 15, 2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent removed Versed 5mg and Fentanyl 5m1 from the Omnicell medication dispensing system for Patient Medical Record Number 217661 without a valid physician's order.. Respondent's conduct was likely to injure the patient iJ;t that the administration of Versed and Fentanyl without a physician's order could result in the patient suffering from adverse reactions. 14. On or about April 15, 2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent removed Versed Smg and Fentanyl 5ml from the Omnicell medication dispensing system for Patient Medical Record Number 217661 but failed to accurately document the administration in the patient's medical records. Respondent's conduct was likely to injure the patient in that subsequent care givers would rely on her documentation to further medicate the patient which could result in an overdose. 15. On or about April 15, 2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent administered Versed Smg to Patient Medical Record Number 217661 without a physician's order. Respondent's conduct was likely tQ injure the patient in that the administration of Versed without aphysicianisorder could result in the pa tientsufferingfrom adverse reactions. 16. On or about April 15 ,2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent removed Versed Smg and Fentanyl Sml from the Omnicell medication dispensing system for Patient Medical Record Number 217661 but failed to follow the policy and procedure in place for the wastage of medications. Respondent's conduct was likely to 581753:101 - 3 - CI0 deceive the hospital phannacy and placed them in violation of Chapter 481 of the Texas Health and Safety Code (Controlled Substances Act). 17. On or about April 15, 2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent misappropriated Versed and Fentanyl belOIiiing to the facility and its patients thereof. Respondent's conduct was likely to defraud the facility and patients of the cost of the medications. . 18. On or about April 28, 2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent withdrew Morphine 4mg from the Omnicell medication dispensing system for Patient Medical Record Number 210840 which was in excess of physician's order. The physician's order was for Morphine 2mg. Respondent's conduct was likely to injure the patient in that failure to administer medications as ordered by the physician could have resulted in nonefficacious treatment. 19. On or about April 28, 2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent changed a physician's one time order for Morphine 2mg. without authorization, for Patient Medical Record Number 210840. Respondent's change indicated an. increased :frequency of Morphine 2mg over what was actually ordered by the physician. Respondent's conduct was likely. to injure the patient in that the administration of Morphine in· excess frequencyandlor dosage ofthe physician's order could result in the patient suffering from adverse reactions. 20, On or about May 2,2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent removed Ativan 2J;ng from the Omnicell medication dispensing system for Patient Medical Record Number 143664 without a valid physician's order. Respondent's conduct was likely to injure the patient in that the administration of Ativan without a physician's order could result in the patient suffering from adverse reactions. 21. On or about May 2, 2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent removed Ativan 2mg from the Omnicel1 medication dispensing system for Patient Medical Record Number 143664 but failed to accurately document the administration of the medication in the patient's medical records. Respondent's conduct was likely to injure the patient in that subsequent care givers would rely on her documentation to further medicate the patient which could result in an overdose. 22. On or about May 2,2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent removed Ativan 2mg from the Omnicell medication dispensing system for Patient Medical Record Number 143664 but failed to follow the policy and procedure in place for the wastage. Respondent's conduct was likely to deceive the hospital phannacy and placed them in violation of Chapter 481 of the Texas Health and Safety Code (Controlled Substances Act). 581753: 101 - 4 - CIO 23. On or about May 2, 2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent misappropriated Ativan belonging to the facility and patients thereof. Respondent's conduct was likely to defraud the facility and patients of the cost of the medications. 24. On or about May 3, 2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent lacked fitness to practice professional nursing in that she was observed to be unfocused and tired. Respondent was also overheard saying she had not been gettiI;J.g enough sleep. Respondent's conduct could have affected her ability to recognize . subtle signs, symptoms or changes in patients' conditions, and could have affected her ability to make rational, accurate, and appropriate assessments, judgments, and decisions regarding patient care, thereby placing the patients in potential danger. 25. On or about May 3, 2005, while employed with Trinity Medical Center, Carrollton, Texas, Respondent engaged in the intemperate use of Morphine, Demerol and Fentanyl in that she produced a specimen for a drug screen which resulted positive for Morphine, Demerol and Fentanyl. Possession of Morphine, Demerol and Fentanyl is prohibited by Chapter 481 of the Texas Health and Safety Code (Controlled Substances Act). The use of Morphine, Demerol and Fentanyl by a Registered Nurse, while subject to call or duty, could impair the nurse's ability to recognize subtle signs, symptoIlls or changes in the patient's condition, and could impair the nurse's ability to make rational accurate, and appropriate assessments, judgments, and decisions regarding patient care, thereby placing the patietit potential danger. 26. On December 14,2006, Respondent submitted to a forensic psychological evaluation with a chemical dependency component conducted by Rafael F. Otero, Ph.D. Dr. Otero's conclusion and recommendation are as follows: "Results from the present psychological indicate that it is still doubtful that (Respondent) will be able to consistently behave in accordance with the requirements of Rules 213.27-213.29 at 22 Administrative Code, as well as the minimum standards set by the Hoard's Rules 217,11 at 22 TAC and generally accepted nursing standards. Given these results it is NOT entirely clear that (Respondent) win be able to consistently avoid behaviors identified by the Board as constituting unprofessional conduct. It is recommended that this individual be asked to enter into therapy. A second psychological evaluation will then be required. Random drug testing should also be added to the therapy." 27. The Board finds that there exists serious risks to public health and safety as a result of impaired nursing care due to intemperate use of controlled substances or chemical dependency. 28. Formal Charges were filed on August 23, 2006. 29. Fonnal Charges were mailed to Respondent on August 28, 2006. 581753:101 - 5 - CIO QONCLUSIONS OF LAW. 1. Pursuant to Texas Occupations Code, Sections 301.451-301.555, the Board has jurisdiction over this matter. 2. Notice was served in accordance with law. 3. The evidence received is sufficient to prove violations of Section 301.452(b)(9), (10), (12) & (l3), Texas Occupations Code, 22 TEX. ADMIN. CODE §§217.ll(1)(C)(D)(effective September 28, 2004), and 217. 12(1)(effectiveto September 28, 2004) and217.12(1)(A)(B), (4), (5), (6)(G)(H)(I), (8), (lO)(A)(B)(C){D) & (11)(B)(effective September 28,2004). 4. The evidence received is sufficient cause pursuantto Section 30 1.452(b), Texas Occupations Code, to take disciplinary action against Registered Nurse License Number 581753, heretofore issued to ALMA CAMPOS RICE, including revocation ofRespo~dent's license to practice professional nursing iIi the State of Texas. . QRDER IT IS THEREFORE AGREED and ORDERED, subject to ratification by the Board of Nurse Examiners, that Registered Nurse License Number 581753, previously issued to ALMA CAMPOS RICE, to practice professional nursing in Texas is hereby SUSPENDED with the suspension STAYED and Respondent is hereby placed on PROBATION for two (2) years with the following agreed tenus of probation: IT IS FURTHER AGREED and ORDERED that this Order SHALL be applicable to Respondent's multistate privilege, if any, to practice professional nursing in the State of Texas. IT IS FURTHER AGREED and ORDERED that while Respondent's license is encumbered by this order the Respondent may not work outside the State of Texas pursuant to a multistate licensure privilege without the written pennission ofthe State of Texas and the Board of 581753:[01 - 6 - CIO J . :;, j 1 .I Nursing in the party state where Respondent wishes to work. (1) RESPONDENT SHALL comply in all respects with the Nursing Practice Act, Revised Civil Statutes of Texas as amended, Texas Occupations Code, §§301.001 et seq., the Rules and Regulations Relating to Nurse Education, Licensure and Practice, 22 TEX. ADMlN. CODE §211.01 et seq. and this Order. (2) RESPONDENT SHALL deliver the wallet-sized license issued to ALMA CAMPOS RICE, to the office of the Board of Nurse Examiners within ten (10) days of the date of this Order for appropriate notation. (3) RESPONDENT SHALL, within one (l) year of entry of this Order, successfully complete a course in Texas nursingjurisprudence and ethics. RESPONDENT SHALL obtain Board approval of the course prior to enrollment only if the course is n~t being offered by a pre-approved provider. Home study courses and video programs will not be approved. In order for the course to be approved, the target audience shall include nurses. It shall be a minimum of six (6) contact hours in length. The course's content shaH include the Nursing Practice Act, standards of practice, documentation of care, principles of nursing ethics, confidentiality, professional boundaries, and the Board's Disciplinary Sanction Policies regarding Sexual Misconduct, Fraud, Theft and Deception, Nurses with Chemical Dependency, and Lying and Falsification. Courses focusing on malpractice issues will not be accepted. RESPONDENT SHALL CAUSE the sponsoring institution to submit a Verification of Course Completion fonn, provided by the Board, to the Office of the Board to verify RESPONDENT's successful completion ofthe course. This course shall be taken in addition to any other courses stipulated in this Order, if any, and in addition to any continuing education requirements the Board has for relicensure. Board-approved courses may be found at the following 581753:10l - 7 ~ CtO Board website address: http://www.bne.state.tx.uslaboutlstipscourses.html. (4) RESPONDENT SHALL, within one (1) year of entry of this Order, successfully complete a course in nursing documentation. RESPONDENT SHALL obtain Board approval ofthe course prior to enrollment only if the course is not being offered by a pre-approved provider. Home study courses and video programs will not be approved. The.course shall be a miniInum of six (6) hours in length of classroom time. In order for the course to be approved, the target audience shall include Nurses. The course shall include content on the following: nursing standards related to accurate and complete documentation; legal guidelines for recording; methods and processes of recording; methods of alternative record-keeping; and computerized documentation. RESPONDENT SHALL cause the instructor to submit a Verification of Course Completion Conn, provided by the Board, to the Board's office to verifY.RESPONDENT's successful completion of the course. This course shall be taken in addition to any other courses stipUlated in this Order, if any, and in addition to any continuing education requirements the Board has forrelicensure. Board-approved courses may be found at the following Board website address.: http://www.bne.state.lx.uslaboutlstipscourses.html. IT IS FURTHER AGREED, SHOULD RESPONDENT PRACTICE AS A REGISTERED NURSE IN THE STATE OF TEXAS, RESPONDENT WILL PROVIDE DIRECT PATIENT CARE AND PRACTICE IN A HOSPITAL, NURSING HOME, OR OTHER CLINICAL SETTING AND RESPONDENT MUST WORK IN SUCH SETTING A MINIMUM OF SIXTY-FOUR (64) HOURS PER MONTH UNDER THE FOLLOWING PROBATION CONDITIONS FOR TWO (2) YEARS OF EMPLOYMENT. THE LENGTH OF THE PROBATIONARY PERIOD WILL BE EXTENDED UNTIL BUCH TWENTV- 581753:101 - 8 - CIO FOUR (24) MONTHS HAVE ELAPSED. PERIODS OF UNEMPLOYMENT OR OF EMPLOYMENT THAT DO NOT REQUIRE THE USE OF A REGISTERED NURSE. eRN) LICENSE WILL NOT APPLY TO THIS PROBATIONARY PERIOD: (5) RESPONDENT SHALL notify each present employer in nursing of this Order of the Board and the probation conditions on RESPONDENT's license. RESPONDENT SHALL present a complete copy of this Order and all Proposals for Decision issued by the Administrative Law Judge, if any, to each present employer within five (5) days of receipt of this Order. RESPONDENT SHALL notify all future employers in nursing ofthis Order oithe Board and the probation conditions on RESPONDENT's license~ RESPONDENT SHALL present acompiete copy of this Order and all Proposals for Decision issued by the Administrative Law Judge. if any, to each future employer prior to accepting an offer of employment. (6) RESPONDENT SHALL CAUSE each present empl~yer in n~gto submit the Notification of Employment form, which is provided to the Respondent by the Board, to the Board's office within ten (10) days of receipt of this Order. RESPONDENT SHALL CAUSE each future employer to submit the Notification of Employment [ann, which is provided to the Respondent by the Board, to the Board's office within five (5) days of employment as a nurse. (7) RESPONDENT SHALL be supervised by a Registered Nurse who is on the premises. The supervising nurse is not required to be on the same unit or ward as RESPONDENT, . but should be on the facility grounds and readily available to provide assistance and intervention if necessary. The supervising nurse shall have a minimum of two (2) years experience in the same or similar practice setting to which the Respondent is currently working. RESPONDENT SHALL work only regularly assigned, identified and predetennined unit(s), RESPONDENT SHALL NOT be 581753:10\ - 9 - C\O employed by a nurse registry, temporary nurse employment agency, hospice, or home health agency. RESPONDENT SHALL NOT be self-employed or contract for services. Multiple employers are prohibited. (8) RESPONDENT SHALL CAUSE each employer to submit, on fonns provided to the Respondent by the Board, periodic reports as to RESPONDENT's capability to practice nursing. These reports shall be completed by the Registered Nurse who supervises the RESPONDENT. These reports shall be submitted by the supervising nurse to the office of the Board at the end of each three (3) months fol' two (2) years of employment as a nurse. (9) RESPONDENT SHALL abstain from the consumption of alcohol, Nubain, Stadol, Dalgan, Ultram, or other synthetic opiates, and/or the use of controlled substances, except as prescribed by a licensed practitioner for a legitimate purpose. If prescribed, RESPONDENT SHALL CAUSE the licensed practitioner to submit a written report identifying the medication, dosage and the date the medication was prescribed. The report shall be submitted directly to the office of the Board by the prescribing practitioner, within ten (10) days of the date of the prescription. In the event that prescriptions for controlled substances are required for periods of two (2) weeks or longer, the Board may require and RESPONDENT SHALL submit to an evaluation by a Board approved physician specializing in Pain Management or Psychiatry. The performing evaluator will submit a written report to the Board IS office, including results ofthe evaluation, clinical indications for the prescriptions, and recommendations for on-going treatment within thirty (30) days from the Board's request. (l0) RESPONDENT SHALL submit to random periodic screens for controlled substances, tramadol hydrochloride (Ultram), and alcohol. For the first three (3) month period, 581753:101 - 10- CIO random screens shall be perfonned at least once per week. For the next three (3) month period, random screens shall be performed at least twice per month. For the next six (6) month period, random screens shall be performed at least once per month. For the remainder ofllie probation period, random screens shallbe performed at least once every three (3) months. Specimens shall be screened for at least the following substances: Amphetamines Barbiturates Benzodiazepines Cannabinoids Cocaine Ethanol tramadoI hydrochloride (Ultram) Meperidine Methadone Methaqualone Opiates Phencyclidine Propoxyphene A Board representative may appear at the RESPONDENT's place of employment at any time during the probation period and require RESPONDENT to produce a specimen for screening. All screens shall be properly monitored and produced in accordance with the Board's policy on Random Drug Testing. A complete chain of custody shall be maintained for each . specimen obtained and analyzed. RESPONDENT SHALL be responsible for the costs of all random drug screening during the probation period. Any positive result for which the nurse does not have a valid prescription will be regarded as non-compliance with the tenus of this Order and may subject the nurse to further disciplinary action by this Board. Failure to report for a drug screen may be considered the same as a positive result and may result in further disciplinary action by this Board. (1) RESPONDENT SHALL participate in therapy with a "professional counselor" possessing credentials approved by the Board. RESPONDENT SHALL CAUSE the therapist to submit written reports, on forms provided by the Board, as to the RESPONDENT's progress in 581753:101 - 11 - CIO therapy, rehabilitation and capability to safely practice professional nursing. The report must indicate whether or not the RESPONDENT's stability is sufficient to provide direct patient care safely. Such reports are to be furnished each and every month for three (3) months. If therapy is recommended for beyond three (3) months, the reports shall then be required at the end of each three (3) month period for the durati~n of the probation period, or until RESPONDENT is dismissed from therapy. IT IS FURTHER AGREED, that upon full compliance with the tenns ~fthis Order, RESPONDENT SHALL be issued an unencumbered license and multistate licensure privileges, if any, to practice professional nursing in the State of Texas. BALANCE OF TIllS PAGE INTENTIONALLY LEFT BLANK. CONTINUED ON NEXT PAGE. 58\753:101 - 12 - CtO 09-12-'07 15:06 FROM- +210-479-8452 T-230P002/002 U-866 1U§l:2NPBNTS C!5B'I'IflWtTION I~ tb4It I bIwo the right to tosat cwael prior .. ~tbi$ Ap.d (b;dca:. • I waive ~ \o)y coUDMl. i hue m'iflVed. this Otder. I uithet admit 111«' dfDy tho victlatioaa allr&ed lIaeiI. By my ~ on tis Order, I .. to 1b.c F~ of p~ COQcIuJoDs ottaw, ~ tmd ~C!GBdiii0D$ of said Oldet, to avoid ~&ufpiirwy ~ in 1his 1llII:a'. 1 Wil"Ve jU4icial te'rlcw. of 1.bI& 0t4CL I WlietStad tbIt taD Old« is subject to nti1ladiob by1he Boaftl. WhIn tbis omtil mdJled.. OlctmDB oftbisOr.datbetQIM etrtcttve. aoopywmhe~ to me.. I~ thltiflf4UlO oompIyWilb au Ulm\SIOdODDditicmlofdlil ()rde,r.lwiUbe'AUhj~toimrmti~_~~mo1mJin3~of~liCeUe mpncti~pro&uiotW~m tbcStataofT~M _~ofmy~ . ~ ... ~_~.c.a.. 2.0..2.:1.. "QI1!.!le..C=--- -, ALMACAMPOS .. ~ _ Swom to ImdIlll'mt.nW bctbre me t'bU __ daydf _____ 10_. SEAL GILBREATH LAW F ..,.Z10 419 fl452 · . ~ . WHEREFORE, PREMISES CONSIDERED, the Board.ofNurse Examiners for the State of Texas does hereby ratify and adopt the Agreed Order that was signed on the 29th day of August , 20lrl...-, by ALMA CAMPOS RICE, Registered Nurse License Number 581753, and said Order is final. 581753:101 Effeqtive this 18th day of October ~,~ Katherine A. Thomas, MN, RN Executive Director on behalf of said Board - 14- CIO BEFORE THE NORTH CAROLINA BOARD OF NURSING OF THE STATE OF NORTH CAROLINA I n the matter of ) ) ) Alma Campos Rice, RN ORDER TO REVOKE MULTI-STATE LICENSURE PRIVILEGE Certificate # 152224 Pursuant to the authority vested by Article 9A, Chapter 90 of the General Statutes of North Carolina and Article 3A of Chapter 150B-38 of the General Statutes of North Carolina, the North Carolina Board of Nursing (hereafter referred to as the Board) revokes the Registered Nurse privilege to practice as granted by the Nurse Licensure Compact of Alma Campos Rice for violation of the North Carolina Nursing Practice Act. 1) 2) 3) 4) 5) Rice Alma Campos Rice is the holder of Registered Nurse Certificate # 152224 which was issued by the State of Tennessee. Her license has an expiration date of 08/31/2008. Ms. Rice was assigned to the Duke Raleigh Hospital in Raleigh, North Carolina from Medical Staffing Network, working on her privilege to practice as granted through the Nurse Licensure Compact. By agreeing to work on her privilege to practice as granted through the Nurse Licensure Compact, the licensee agreed to comply with all laws, rules and regulations of practice promulgated by the Boards in the party states in which she choose to practice. On July 12, 2007 Ms. Rice was released from duty at Duke Raleigh Hospital at 12 noon after she.failed to pass her medication test during orientation. At approximately 9:05 pm Ms. Rice was found on the 4th floor of the hospital trying to access the pyxis machine. When she was questioned by one of the staff and asked where she worked in the hospital, she left the Unit. Both the supervisor and hospital security were notified. During their investigation into the matter, it was determined Ms. Rice had also attempted to gain access into the pyxis machine in the Emergency Department at approximately 8:50 pm. She was observed by both a Registered Nurse and a CNA for about 15 minutes. Both of those individuals initially thought she was with the pharmacy. Security was able to locate Ms. Rice as she attempted to leave the hospital and she was detained. The Raleigh Police Department was called and Ms. Rice was escorted from the facility. After Ms. Rice's termination from the Duke Raleigh Hospital she attempted to gain access into the pyxis machine. Ms. Rice's behavior was inappropriate and certainly raised questions regarding what she intended to with the medication she was attempting to access. Ms. Rice was subsequently arrested and convicted on 1 Felony Count of Possession of Schedule II Controlled Substance and 1 Felony Count of Embezzlement of Controlled Substance by Employee of Registrant. For the conviction on August 1,2007, Ms. Rice received a 5 to 6 month sentence which was suspended and was placed on 24 months of supervised probation. Page 1 of 4 BEFORE THE NORTH CAROLINA BOARD OF NURSING OF THE STATE OF NORTH CAROLINA In the matter of ) Alma Campos Rice, RN ORDER TO REVOKE MULTI-STATE Certificate # 152224 LICENSURE PRIVILEGE Additionally, she had to pay cost and fines in the amount of $310.00 and she was ordered not to work as a nurse in North Carolina unless privilege reinstated by the Nursing Board and these convictions must be disclosed to any employer. 6) The investigation determined the licensee has violated G.S. 90-171.37 (2) (6) (7) and (8) and Regulation 21 N.C.A.C. 36.0217(c) (3). 7) Therefore, the privilege to practice as granted through the Nurse Licensure Compact for Alma Campos Rice is hereby REVOKED, and the licensee must immediately CEASE AND DESIST from the practice of nursing in North Carolina. 8) In accordance with Chapter 150B of the General Statutes, the licensee is entitled to a "Show Cause" Hearing before a majority of the members of the Board to determine why the Board should not take further action because of the licensee's failure to comply with the probationary conditions, including imposing further discipline. 9) The licensee is entitled to be represented by counsel and to present evidence and witnesses/testimony on the licensee's behalf. 10) Pursuant to North Carolina General Statute Section 150B-40( d), the licensee may not communicate, directly or indirectly, with any individual member of the Board about this matter. If the licensee or legal representative has questions, they should contact Donna H. Mooney, RN, MBA, Manager for Discipline Proceedings. 11) If the licensee is disputing the fact that the violations as alleged did occur, the licensee must file a written objection with the Board within ten (10) working days of the date of the notice of violations to Alma Campos Rice. The notice must contain with specificity the violations being disputed. 12) When the licensee has properly filed notice of objections with the Board, then the licensee will be notified of the exact date and time for the "Show Cause" Hearing. The Hearing will be held at the next scheduled Board meeting for which appropriate notice can be provided, or scheduled by consent of the parties. 13) Failure to return the written objection within the designated time period will be construed to mean the licensee is not contesting the matter and all further proceedings to which the licensee is otherwise entitled by law are hereby waived. 14) Rice The license will then remain revoked until the licensee requests in writing the opportunity to appear before the Licensure Committee to petition for issuance of a license to practice in North Carolina. This ORDER to REVOKE will be placed in the licensee's file and becomes a public record pursuant to the North Carolina Public Record Statute G.S. Chapter 132 and Board policy. Page 2 of 4 BEFORE THE NORTH CAROLINA BOARD OF NURSING OF THE STATE OF NORTH CAROLINA In the matter of ) Alma Campos Rice, RN ORDER TO REVOKE MULTI-STATE Certificate # 152224 LICENSURE PRIVILEGE 15) By not contesting the violations contained in this ORDER, the licensee is waiving the rights to a "Show Cause" Hearing, to challenge the validity of this ORDER and to any further proceedings to which the licensee may be entitled by law. 16) By contesting the violations contained in this ORDER, the licensee is requesting a "Show Cause" Hearing to be scheduled before a majority of the members of the Board. The licensee understands that a written objection with the specific violations/charges being disputed must be received within 10 business days of the date of this notice. The subject of the "Show Cause' Hearing shall be limited to the specific reasons for which the probationary license was suspended/revoked. When the licensee has properly filed notice of objection with the Board, then the Licensee will be provided a Hearing before the Board at the next scheduled Board meeting for which appropriate notice can be provided, or scheduled by consent of the parties. 17) In accordance with G.S. 90-171.27 (d) and Board policy derived therefrom, a fee may be assessed for disciplinary matters. A "Show Cause" Hearing is considered a discipline matter. FAILURE TO RETURN THE ATTACHED PAGE WITHIN 10 BUSINESS DAYS WILL RESULT IN THE LICENSEE WAIVING ALL RIGHTS TO CHALLENGE THE VALIDITY OF THIS ORDER OR TO ANY OTHER PROCEEDINGS TO WHICH THE LICENSEE MAY OTHERWISE BE ENTITLED BY LAW. This the 12th day of December, 2007 Mary P. Johnson, RN, MSN, FAAN Executive Director North Carolina Board of Nursing Rice Page 3 of 4 BEFORE THE NORTH CAROLINA BOARD OF NURSING OF THE STATE OF NORTH CAROLINA In the matter of Alma Campos Rice, RN ORDER TO REVOKE MUL TI·STATE Certificate # 152224 LICENSURE PRIVILEGE Alma Campos Rice PLEASE RETURN THIS PAGE COMPLETED WITHIN 10 BUSINESS DAYS. Initial the appropriate response, date and sign the document and return to Donna Mooney, RN, ManagerlDiscipline Proceedings LICENSEE'S NAME DATE Rice I do not contest the information reported as violations of the NPA and I do not wish to have a "Show Cause" Hearing. I am requesting a "Show Cause" Hearing. Attached is my written objection with the specific violations/charges I am disputing. The subject of the "Show Cause" Hearing shall be limited to the specific reasons for which the Temporary license was suspended/revoked. Page 4 of 4 STATE OF TENNESSEE DEPARTMENT OF HEALTH IN THE MATTER OF: ) BEFORE THE BOARD OF NURSING ) ALMA RICE, R.N. ) DOCKET NO. 17.19-098248A Dyersburg, Tennessee ) License No. 152224 ) ) RESPONDENT ) ______________________________________________________________________________ AGREED ORDER ______________________________________________________________________________ This matter came to be heard before the Board of Nursing (hereinafter “Board”) on the ______ day of June, 2008, pursuant to a notice of charges filed by the Tennessee Department of Health (hereinafter “State”) and upon consent and agreement of the parties. The State was represented by S. Alexa Whittemore, Assistant General Counsel. The Respondent is represented by counsel, Charles R. Kelly. Neither Respondent nor her counsel were present by agreement of the parties. After consideration of the agreement of the parties as evidenced herein, the Board finds as follows: 1. The Respondent agrees that presentation to and consideration of this Agreed Order by the Board for ratification and all matters divulged during that process shall not constitute unfair disclosure such that the Board or any of its members shall be prejudiced to the extent that requires their disqualification from hearing this matter should this Order not be ratified. Likewise, all matters, admissions and statements disclosed or exchanged during the attempted ratification process shall not be used against the Respondent in any subsequent proceedings unless offered into evidence upon a basis other than the Respondent disclosed it to counsel and/or the Board during the formal presentation of this order to the Board. 2. Respondent understands the nature of the charges herein alleged and that if proved at hearing, such charges and allegations would constitute cause for imposing discipline upon Respondent’s license issued by the Board. 3. Respondent is aware of each of Respondent’s rights, including the right to a hearing on the charges and allegations, the right to appear personally and by counsel, the right to confront and cross-examine witnesses who would testify against Respondent, the right to testify and present evidence on Respondent’s own behalf, as well as to the issuance of subpoenas to compel the attendance of witnesses and the production of documents, the right to contest the charges and allegations, and other rights which are afforded Respondent pursuant to the Administrative Procedures Act and other applicable laws, including the right to seek reconsideration, review by the Chancery Court, and appellate review. 4. In order to avoid the expense and uncertainty of a hearing, Respondent freely and voluntarily waives each and every one of these rights set forth above and admits the truth of the allegations herein contained. Respondent agrees that cause exists to discipline her license. 5. Respondent understands that by signing this Agreed Order Respondent is enabling the Board to issue its order without further process. In the event that this Agreed Order is rejected for any reason by the Board, it will be of no force or effect for either party. ______________________________________________________________________________ I. FINDINGS OF FACT ______________________________________________________________________________ The Board makes the following specific findings of fact: 6. Respondent was originally granted a license to practice as a registered nurse in the State of Tennessee by the Board on September 28, 2005, having been granted license number 152224. Respondent’s license expires on August 31, 2008. 2 7. Respondent’s registered nurse license bears a multistate privilege to practice nursing in states which have entered into the Interstate Nurse Licensure Compact. 8. Respondent was employed as a registered nurse by Jackson-Madison County General Hospital (JMCGH) in Jackson, Tennessee, from September 11, 2006, until October 25, 2006. 9. On October 23, 2006, Respondent wasted a vial of Valium at JMCGH, but did not let the witness view the vial before Respondent dropped it in the Sharps box. 10. The witness reported this to the supervisor, who then opened the Sharps container and found only an empty vial of Valium. 11. Respondent was requested to submit to a urinary drug screen, however the temperature of the specimen she provided was below the level admissible for a urine drug screen. After a few hours of attempting to provide another urine specimen, Respondent left the facility without providing another specimen, even though she was told she would be terminated if she left without providing another specimen. 12. From March 5, 2007, to March 27, 2007, Respondent was employed as a contract registered nurse with Regional Medical Center in Memphis, Tennessee. 13. On or around March 23, 2007, Respondent withdrew narcotics for patients from the Omnicell system, using another nurse’s code. These patients did not have doctors’ orders for the narcotics. 14. Respondent also placed three (3) complete patient medical records in the shredding box at Regional Medical Center. These records contained orders that she failed to complete. 15. Respondent admitted that she withdrew these narcotics from the Omnicell system for her personal use. 3 16. Respondent also admitted that she placed the narcotics in her car and had a closed container of urine on her person. 17. Police were called to Regional Medical Center, and they found various narcotics in the trunk of Respondent’s car. 18. Respondent pled no contest in the General Sessions Court of Shelby County, to three (3) felony counts of possession of a controlled substance with intent to manufacture, sell, or deliver. She also pled no contest to one (1) felony count of obtaining a controlled substance by fraud, deceit, or forgery. Finally, she was placed on pre-trial diversion until May 2008 for possession of a controlled substance. 19. On July 10, 2007, Respondent was employed as a contract registered nurse at Duke Raleigh Hospital in North Carolina. 20. On or around July 10, 2007, Duke Raleigh Hospital cancelled Respondent’s contract when Respondent failed to pass a competency exam. Respondent was told of her termination with the Hospital and was asked to leave. 21. Respondent was found later that evening, on the fourth floor of Duke Raleigh Hospital, attempting to access narcotics from the Pyxis system. 22. When Respondent was questioned by the fourth floor nurse, she misrepresented herself as a float nurse scheduled to work the fourth floor. The fourth floor nurse left to contact her supervisor, and when she returned the Respondent was gone. 23. Respondent was later found in the hospital’s emergency room attempting to access narcotics from the Pyxis system. 24. Respondent was escorted out of the hospital by security and the police were called. 25. The Raleigh police found narcotics in Respondent’s motel room. 4 26. On July 31, 2007, Respondent was convicted in the Superior Court of Wake County, North Carolina on one (1) felony count of possession of a schedule II controlled substance and one (1) felony count of embezzling a controlled substance from her employer. 27. On August 23, 2006, an Order was filed which disciplined Respondent’s multi-state privilege or license to practice nursing in Texas by placing her on probation for two (2) years. Specifically, Respondent was disciplined for, among other things, failing to appropriately document the administration of medications, failing to document the administration of medications, administering controlled substances without a physician’s order, misappropriation of controlled substances, removing medications in excess of physicians’ orders, changing patients’ medication orders without doctor authorization. ______________________________________________________________________________ II. CONCLUSIONS OF LAW The facts as stated in Section I of this Order are sufficient to establish that the Respondent has violated the provisions of the Tennessee Code Annotated Section (hereinafter “T.C.A. §”) 63-7-115 et seq. including, but not limited to, the following provisions: 28. T.C.A. § 63-7-115. Grounds for denial, revocation or suspension of certificate or license. - (a)(1) The board has the power to deny, revoke or suspend any certificate or license to practice nursing or to otherwise discipline a licensee upon proof that the person: (B) Is guilty of a crime; (C) Is unfit or incompetent by reason of negligence, habits or other cause; (D) Is addicted to alcohol or drugs to the degree of interfering with nursing duties; (F) Is guilty of unprofessional conduct; and 5 (G) Has violated or attempted to violate, directly or indirectly, or assisted in or abetted the violation of, or conspired to violate, any provision of this chapter or any lawful order of the board issued pursuant thereto. 29. Rule 1000-1-.13. Unprofessional Conduct and Negligence, Habits or Other Cause. - (1) Unprofessional conduct, unfitness, or incompetency by reasons of negligence, habits or other causes, as those terms are used in the statute, is defined as, but not limited to, the following: (c) Abandoning or neglecting a patient requiring nursing care; (d) Making false or materially incorrect, inconsistent or unintelligible entries in any patient records or in the records of any health care facility, school, institution or other work place location pertaining to the obtaining, possessing or administration of any controlled substance as defined in the Federal Controlled Substance Act; (e) Unauthorized use or removal of narcotics, drugs, supplies, or equipment from any health care facility, school, institution or other work place location; (h) Impersonating another licensed practitioner; (j) Revocation, suspension, probation or other discipline of a license to practice nursing by another state or territory of the United States for any act or omission which would constitute grounds for the revocation, suspension, probation or other discipline of a license in this state; and (w) Engaging in acts of dishonesty which relate to the practice of nursing. ______________________________________________________________________________ III. REASONS FOR THE DECISION ______________________________________________________________________________ 30. The Tennessee Board of Nursing is responsible for the regulation and supervision of the practice of nursing in the State of Tennessee. T.C.A. Section 63-7-101 et seq. 6 31. It is the duty and responsibility of the Board of Nursing to enforce the Nurse Practice Act in such a manner as to insure that nurses use their licenses to promote and protect the public health, safety and welfare. 32. It is the policy of the Tennessee Board of Nursing to require strict compliance with the laws of this State and to apply the laws so as to preserve the quality of nursing care provided in Tennessee. 33. It is the duty and responsibility of the Tennessee Board of Nursing to promote the public health, safety and welfare by disciplining nurses who violate the provisions of Tennessee Code Annotated Section 63-7-101 et seq. THEREFORE, in view of the above FINDINGS OF FACT, CONCLUSIONS OF LAW, and REASONS FOR THE DECISION, it is hereby ORDERED as follows: 34. Respondent's consent to the terms and conditions of this order is accepted. 35. The license of Respondent to practice as a registered nurse in Tennessee pursuant to the authority vested in the Board under T.C.A. §§ 63-7-115 and 116 shall be and is hereby REVOKED for one (1) year, effective immediately upon ratification of this Order by the Board. 36. This REVOCATION is a formal disciplinary action and will be reported to the Health Integrity and Protection Data Bank (HIPDB). 37. Respondent shall pay the costs of this action pursuant to T.C.A. §§ 63-7-115(d) and 63-1- 144, and Rule 1000-1-.04(11) of the Official Compilation Rules and Regulations of the State of Tennessee for The Tennessee Board of Nursing (hereinafter “Rule”). These costs will be established by an Affidavit of Costs prepared by Counsel for the Department and will not exceed five hundred dollars ($500.00). Costs are due and payable within two (2) years of the date the Affidavit of Costs is mailed to Respondent. 7 38. Cost payments shall be paid by means of a certified check, cashier’s check, or money order payable to the State of Tennessee which shall be mailed or delivered to: Disciplinary Coordinator, Tennessee Department of Health, Heritage Place MetroCenter, 227 French Landing, Suite 201, Nashville, Tennessee 37243. A notation shall be placed on said check that it is payable for the costs of Alma Rice, Case No Nos. 200700858, 200700859, 200701546, 200701988, and 200702115. 39. A violation of this Order shall constitute a separate violation of the Nurse Practice Act, T.C.A. § 63-7-115(a)(1)(G), and is grounds for further disciplinary action by the Board. This AGREED ORDER approved by a majority of a quorum of the Board at a public meeting and signed this ____ day of June, 2008. FOR THE TENNESSEE BOARD OF NURSING: Chairperson Approved for entry by: _________________________ _________________________ Alma Rice, R.N., No. 152224 Date Respondent _________________________ _________________________ Charles S. Kelly, Esq. Date Attorney for Respondent 8 Prepared for entry by: ______________________________ S. Alexa Whittemore, BPR No. 021279 Assistant General Counsel Tennessee Department of Health Office of General Counsel 220 Athens Way, Suite 210 Nashville, Tennessee 37243 (615) 741-1611 CERTIFICATE OF FILING This Order was received for filing in the Office of the Secretary of State, Administrative Procedures Division, and became effective on the _____ day of June, 2008. __________________________________ Thomas G. Stovall, Director Administrative Procedures Division 9 10 CERTIFICATE OF SERVICE The undersigned does hereby certify that a true and correct copy of the foregoing document has been served upon Respondent, Alma Rice, by and through counsel, Charles S. Kelly, 802 Troy, P.O. Box 507, Dyersburg, Tennessee 38025, by delivering same in the United States mail, first class, with sufficient postage thereon to reach its destination. This ______ day of June, 2008. ____________________________________ S. Alexa Whittemore Assistant General Counsel January 2008 MULTI-STATE NURSE LICENSURE In 2005, the Ohio Board of Nursing (Board) examined issues and learned about the experience of some Compact states participating in multi-state licensure. Although the Board recognized that multi-state nurse licensure could be advantageous for occupational health nurses, traveling nurses, or employers, the Board discussed that potential risks of harm to the public outweigh the potential benefits. With multi-state licensure, nurses could be practicing in Ohio when they have not been held to the same standards of safe practice that Ohio has deemed important for public safety. For example, Ohio requires criminal records checks for licensure, but not all Compact states have the same requirement. Also, Ohio statute specifies that there are absolute bars to licensure. If an applicant has been convicted of certain crimes such as Murder and Rape, among others, the applicant cannot be considered for licensure in Ohio. The majority of Compact states either do not bar violent felonies, or impose only time-limited, rather than absolute, bars to licensure. Also in 2005, the Board reviewed the actual experience of other states and identified the potential impact of multi-state licensure on public safety. We were advised of nurses with multi- state licenses relocating to states as soon as they find themselves under investigation in their home state. While in theory, the home state would immediately report the investigation to the next state, the reality is neither state may learn of the relocation for a significant period of time. Furthermore, not all states have laws like that in Ohio permitting sharing of investigative information with other governmental entities. In addition, when the nurse moves to another state, the home state does not always continue its investigation. This means that Ohio would not receive vital information unless Ohio attempted to conduct an out-of-state investigation and this is not realistic. In fact, it is unclear whether Ohio would have the ability to compel the production of out-of-state documents or witnesses necessary to prepare a case. These are just some examples of issues that nursing boards across the country are attempting to address. On September 16, 2005, the Board voted to delay action seeking the introduction of interstate compact legislation until such time more information is gathered to assure that the benefits of multi-state licensure outweigh any risks related to public safety. During 2006, the Board discussed multi-state licensure at numerous meetings and also worked at the national level to address Ohio’s concerns. In 2007, the Board continued to be concerned about the differences in licensure standards between states and specifically about criminal convictions. While the Compact states are being encouraged to implement criminal records checks for licensure, Compact states have not been uniformly successful in enacting the requirement. At this time, the Board continues to believe the potential risks of harm to the public outweigh the potential benefits because nurses with multi-state licenses could practice in Ohio without meeting the current statutory and regulatory standards established by the General Assembly and the Board to protect the public. The Board continues to address these issues at the national level through the National Council of State Boards of Nursing. WISCONSIN DEPARTMENT OF REGULATION & LICENSING Wisconsin Department of Regulation & Licensing Access to the Public Records of the Reports of Decisions This Reports of Decisions document was retrieved from the Wisconsin Department of Regulation & Licensing website. These records are open to public view under Wisconsin’s Open Records law, sections 19.31-19.39 Wisconsin Statutes. Please read this agreement prior to viewing the Decision: The Reports of Decisions is designed to contain copies of all orders issued by credentialing authorities within the Department of Regulation and Licensing from November, 1998 to the present. In addition, many but not all orders for the time period between 1977 and November, 1998 are posted. Not all orders issued by a credentialing authority constitute a formal disciplinary action. Reports of Decisions contains information as it exists at a specific point in time in the Department of Regulation and Licensing data base. Because this data base changes constantly, the Department is not responsible for subsequent entries that update, correct or delete data. The Department is not responsible for notifying prior requesters of updates, modifications, corrections or deletions. All users have the responsibility to determine whether information obtained from this site is still accurate, current and complete. There may be discrepancies between the online copies and the original document. Original documents should be consulted as the definitive representation of the order's content. Copies of original orders may be obtained by mailing requests to the Department of Regulation and Licensing, PO Box 8935, Madison, WI 53708-8935. The Department charges copying fees. All requests must cite the case number, the date of the order, and respondent's name as it appears on the order. Reported decisions may have an appeal pending, and discipline may be stayed during the appeal. Information about the current status of a credential issued by the Department of Regulation and Licensing is shown on the Department's Web Site under “License Lookup.” The status of an appeal may be found on court access websites at: http://ccap.courts.state.wi.us/InternetCourtAccess and http://www.courts.state.wi.us/wscca . Records not open to public inspection by statute are not contained on this website. By viewing this document, you have read the above and agree to the use of the Reports of Decisions subject to the above terms, and that you understand the limitations of this on-line database. Correcting information on the DRL website: An individual who believes that information on the website is inaccurate may contact the webmaster at web@drl.state.wi.gov STATE OF WISCONSIN BEFORE THE BOARD OF NURSING ______________________________________________________________________________ IN THE MATTER OF THE DISCIPLINARY : PROCEEDINGS AGAINST : AMENDED : FINAL DECISION AND ORDER CRAIG A. PESKE, R.N., : LS 0901229 NUR RESPONDENT. : ______________________________________________________________________________ [Division of Enforcement Case #’s 07 NUR 388 & 08 NUR 367] The parties to this action for the purposes of Wis. Stat. § 227.53: Craig A. Peske, R.N. 2820 Lime Kiln Road Green Bay, WI 54301 Division of Enforcement Department of Regulation and Licensing 1400 East Washington Avenue P.O. Box 8935 Madison, WI 53708-8935 Wisconsin Board of Nursing Department of Regulation and Licensing 1400 East Washington Avenue P.O. Box 8935 Madison, WI 53708-8935 PROCEDURAL HISTORY The parties in this matter agree to the terms and conditions of the attached Stipulation as the final decision of this matter, subject to the approval of the Board of Nursing. The Board has reviewed this Stipulation and considers it acceptable. Accordingly, the Board in this matter adopts the attached Stipulation and makes the following: FINDINGS OF FACT 1. Craig A. Peske, R.N., Respondent, date of birth June 10, 1974, is licensed by the Wisconsin Board of Nursing as a registered nurse in the state of Wisconsin pursuant to license number 151407, which was first granted July 28, 2005. 2. Respondent's last address reported to the Department of Regulation and Licensing is 2820 Lime Kiln Road, Green Bay, WI 54301. 3. At the time of the events set out below, Respondent was employed as a registered nurse at Aspirus Wausau Hospital, 333 Pine Ridge Boulevard, Wausau, Wisconsin. 4. On June 4, 2007, Respondent began working in Aspirus Hospital’s emergency room. On September 21, 2007, his employment was terminated for unspecified performance issues. 5. After Respondent was terminated, an anomalous usage report revealed that Respondent had withdrawn an extraordinary amount of hydromorphone (Dilaudid) from the Pyxis system. During the period between June 29, 2007 and September 26, 2007, 41 nurses dispensed an average of 28 syringes of hydromorphone. During the same period, Respondent dispensed 245 syringes of hydromorphone. 6. A subsequent audit of Respondent’s use of the hydromorphone revealed that on multiple occasions, Respondent had not dispensed the hydromorphone, nor had he properly wasted the drug. On other occasions, Respondent appeared to have altered prescriptions for the drug. 7. On November 14, 2007, a Wausau police officer interviewed Respondent. The interview was recorded, and Respondent was informed of his “Miranda Rights.” Respondent told police that he used hydromorphone obtained through his work as a registered nurse “whenever the opportunity arose.” He did not believe he was addicted because he never obtained the drug outside of work, and never had withdrawal symptoms. Respondent explained that he could quit when the drug was not available, “but when it’s available that’s a different story.” He admitted that he used whenever the opportunity arose within the course of his work as a nurse. 8. Respondent explained that he obtained the hydromorphone by keeping amounts of the drug that should have been “wasted.” He also admitted that he falsely documented increased dosages in patients’ charts. Respondent stated that he never deprived patients of medication ordered on their behalf. Respondent did not have consent of the patients from whom he diverted medications. 9. Pursuant to Wis. Stat. § 961.16(2)(a)8, hydromorphone is a schedule II controlled substance. 10. On the dates in question, Respondent took hydromorphone without a written prescription from a practitioner, as required by Wis. Stat. § 961.38(1r) and (5). 11. On March 12, 2008, based upon Respondent’s behavior described above, the Marathon County District Attorney, in case number 2008CF227, charged Respondent with six felony counts of possession of narcotic drugs, in violation of Wis. Stat. § 961.43(3g)(am), and six counts of misdemeanor theft, in violation of Wis. Stat. § 943.20(1)(a). A preliminary hearing is scheduled for February 2009. 12. On October 1, 2008, the North Carolina Board of Nursing revoked Respondent’s privilege to practice in that state. According to the Order to Revoke Privilege to Practice (“the Order”), between March 21, 2008, and April 12, 2008, Respondent signed out 6450 mg of meperidine (Demerol) for which there were not physicians’ orders, and for which Respondent failed to document administration or wasting. 13. The Order stated that, on April 18, 2008, Respondent refused to submit to a urine drug screen. 14. Pursuant to Wis. Stat. §§ 961.16(3) and 961.38(1), meperidine is a schedule II controlled substance, for which a written prescription is required. 15. Respondent denies working while impaired. CONCLUSIONS OF LAW 1. The Wisconsin Board of Nursing has jurisdiction over this matter pursuant to Wis. Stat. § 441.07 and authority to enter into this stipulated resolution pursuant to Wis. Stat. § 227.44(5). COUNT ONE 2. Respondent, by engaging in the conduct set out above, has committed negligence as defined by Wis. Adm. Code § NUR 7.03(1)(a), and is subject to discipline pursuant to Wis. Stat. § 441.07(1)(c). COUNT TWO 3. Respondent, by engaging in the conduct set out above, has obtained controlled substances as prohibited by law, which is misconduct as defined by Wis. Adm. Code § NUR 7.04(2), and is subject to discipline pursuant to Wis. Stat. § 441.07(1)(d). COUNT THREE 4. Respondent, by engaging in the conduct set out above, has falsified patient records, which is misconduct as defined by Wis. Adm. Code § NUR 7.04(6), and is subject to discipline pursuant to Wis. Stat. § 441.07(1)(d). COUNT FOUR 5. Respondent, as evidenced by the facts set out above, another jurisdiction has revoked Respondent’s privilege to practice nursing, which is misconduct as defined by Wis. Adm. Code § NUR 7.04(7), and is subject to discipline pursuant to Wis. Stat. § 441.07(1)(d). COUNT FIVE 6. Respondent, by engaging in the conduct set out above, has obtained a thing of value from patients without patient consent, which is misconduct as defined by Wis. Adm. Code § NUR 7.04(12), and is subject to discipline pursuant to Wis. Stat. § 441.07(1)(d). ORDER NOW, THEREFORE, IT IS HEREBY ORDERED: 1. The license of Craig A. Peske, R.N. as a registered nurse in the State of Wisconsin is hereby REVOKED. 2. Pursuant to Wis. Stat. § 441.07(2), Respondent may petition the Board for the reinstatement of his license no earlier than one year following the date of this Order. 3. As a prerequisite to reinstatement, the Board will require at a minimum that Respondent shall have paid to the Department of Regulation and Licensing costs of this proceeding in the amount of $1,380.00 pursuant to Wis. Stat. § 440.22(2). 4. Payment shall be mailed or delivered to: Department Monitor Department of Regulation and Licensing Division of Enforcement 1400 East Washington Avenue P.O. Box 8935 Madison, WI 53708-8935 Fax (608) 266-2264 Telephone (608) 267-3817 5. In the event that Respondent re-applies for Wisconsin licensure as a nurse, the Board may enter an order denying such application unless Respondent provides evidence sufficient to convince the Board that he has been abstinent from unprescribed narcotic drugs for at least one year immediately preceding his application. Such evidence must include at least 56 random drug tests by an approved drug testing program. Respondent hereby expressly waives all rights to a hearing on any resulting application denial. 6. If the Board grants Respondent a nursing license at any time in the future, the terms and conditions of sections A through D below will apply to his license: SUSPENSION A.1. The license of Craig A. Peske, R.N., to practice as a nurse in the State of Wisconsin will be SUSPENDED for an indefinite period immediately upon issuance. A.2. During the pendency of this Order and any subsequent related orders, Respondent may not practice in another state pursuant to the Nurse Licensure Compact under the authority of the Wisconsin license, unless Respondent receives prior written authorization to do so from both the Wisconsin Board of Nursing and the regulatory board in the other state. A.3 Upon a showing by Respondent of continuous, successful compliance for a period of at least five (5) years with the terms of this Order, including at least 600 hours of active nursing for every year the suspension is stayed, the Board may grant a petition by the Respondent under paragraph D.4. for return of full Wisconsin licensure. A.4. The Board may, on its own motion or at the request of the Department Monitor, grant full Wisconsin licensure at any time. STAY OF SUSPENSION B.1. The suspension of Respondent’s Wisconsin nursing license shall be stayed upon Respondent petitioning the Board and providing proof, which is determined by the Board or its designee to be sufficient, that Respondent has been in compliance with the provisions of Sections C and D of this Order for the most recent three (3) consecutive months. B.2. The Board or its designee may, without hearing, remove the stay upon receipt of information that Respondent is in substantial or repeated violation of any provision of Sections C or D of this Order. Repeated violation is defined as the multiple violation of the same provision or violation of more than one provision. The Board may, in conjunction with any removal of any stay, prohibit the Respondent for a specified period of time from seeking a reinstatement of the stay under paragraph B.4. B.3. This suspension becomes reinstated immediately upon notice of the removal of the stay being provided to Respondent either by: (a) Mailing to Respondent’s last-known address provided to the Department of Regulation and Licensing pursuant to Wis. Stat. § 440.11; or (b) Actual notice to Respondent or Respondent's attorney. B.4. The Board or its designee may reinstate the stay, if provided with sufficient information that Respondent is in compliance with the Order and that it is appropriate for the stay to be reinstated. Whether to reinstate the stay shall be wholly in the discretion of the Board or its designee. B.5. If Respondent requests a hearing on the removal of the stay, a hearing shall be held using the procedures set forth in Wis. Admin. Code ch. RL 2. The hearing shall be held in a timely manner with the evidentiary portion of the hearing being completed within 60 days of receipt of Respondent’s request, unless waived by Respondent. Requesting a hearing does not stay the suspension during the pendency of the hearing process. CONDITIONS AND LIMITATIONS Treatment Required C.1. Respondent shall enter into, and shall continue, in a drug and alcohol treatment program at a treatment facility (Treater) acceptable to the Board or its designee. Respondent shall participate in, cooperate with, and follow all treatment recommended by Treater. C.2. Respondent shall immediately provide Treater with a copy of this Final Decision and Order and all other subsequent orders. C.3. Treater shall be responsible for coordinating Respondent's rehabilitation, drug monitoring and treatment program as required under the terms of this Order, and shall immediately report any relapse, violation of any of the terms and conditions of this Order, and any suspected unprofessional conduct, to the Department Monitor (See D.1., below). If Treater is unable or unwilling to serve as Treater, Respondent shall immediately seek approval of a successor Treater by the Board or its designee. C.4. The rehabilitation program shall include individual and/or group therapy sessions at a frequency to be determined by Treater, but not less than twice per month for the first year. Therapy may end only upon a determination by the Board or its designee after receiving a petition for modification as required by D.4., below. C.5. Treater shall submit formal written reports to the Department Monitor on a quarterly basis, as directed by the Department Monitor. These reports shall assess Respondent's progress in the drug and alcohol treatment program. Treater shall report immediately to the Department Monitor any violation or suspected violation of this Order. Releases C.6. Respondent shall provide and keep on file with Treater, all treatment facilities and personnel, laboratories and collections sites current releases complying with state and federal laws. The releases shall allow the Board, its designee, and any employee of the Department of Regulation and Licensing, Division of Enforcement to: (a) obtain all urine, blood and hair specimen screen results and patient health care and treatment records and reports, and (b) discuss the progress of Respondent's treatment and rehabilitation. Copies of these releases shall immediately be filed with the Department Monitor. AA/NA Meetings C.7. Respondent shall attend Narcotics Anonymous and/or Alcoholics Anonymous meetings or an equivalent program for recovering professionals, at the frequency recommended by Treater, but no less than twice per week. Attendance of Respondent at such meetings shall be verified and reported monthly to Treater and the Department Monitor. Sobriety C.8. Respondent shall abstain from all personal use of controlled substances as defined in Wis. Stat. § 961.01(4), except when prescribed, dispensed or administered by a practitioner for a legitimate medical condition. Respondent shall disclose Respondent’s drug and alcohol history and the existence and nature of this Order to the practitioner prior to the practitioner ordering the controlled substance. Respondent shall at the time the controlled substance is ordered immediately sign a release in compliance with state and federal laws authorizing the practitioner to discuss Respondent’s treatment with, and provide copies of treatment records to, Treater and the Board or its designee. C.9. Respondent shall abstain from all use of over-the-counter medications or other substances which may mask consumption of controlled substances or of alcohol, create false positive screening results, or interfere with Respondent's treatment and rehabilitation. C.10. Respondent shall report all medications and drugs, over-the-counter or prescription, taken by Respondent to Treater and the Department Monitor within 24 hours of ingestion or administration, and shall identify the person or persons who prescribed, dispensed, administered or ordered said medications or drugs. If Respondent has not provided a release as required by C.9 above, within 24 hours of a request by Treater or the Board or its designee, Respondent shall provide releases in compliance with state and federal laws. The releases shall authorize the person who prescribed, dispensed, administered or ordered the medication to discuss Respondent’s treatment with, and provide copies of treatment records to, the requester. Drug and Alcohol Screens C.11. Respondent shall enroll and begin participation in a drug and alcohol monitoring program which is approved by the Department pursuant to Wis. Adm. Code § RL 7.11 (“Approved Program”). A list of Approved Programs is available from the Department Monitor. C.12. At the time Respondent enrolls in the Approved Program, Respondent shall review all of the rules and procedures made available by the Approved Program. Failure to comply with all requirements for participation in drug and alcohol monitoring established by the Approved Program is a substantial violation of this Order. The requirements shall include: (a.) Contact with the Approved Program as directed on a daily basis, including vacations, weekends and holidays. (b.) Production of a urine specimen at a collection site designated by the Approved Program within five (5) hours of notification of a test. C.13. The Approved Program shall require the testing of urine specimens at a frequency of not less than 56 times per year, for the first year of this Order. After the first year, the frequency may be reduced only upon a determination by the Board or its designee after receiving a petition for modification as required by D.4., below. C.14. If any urine, blood or hair specimen is positive or suspected positive for any controlled substances or alcohol, Respondent shall promptly submit to additional tests or examinations as the Treater or the Board or its designee shall determine to be appropriate to clarify or confirm the positive or suspected positive test results. C.165. In addition to any requirement of the Approved Program, the Board or its designee may require Respondent to do any or all of the following: (a) submit additional urine specimens, (b) submit blood, hair or breath specimens, (c) furnish any specimen in a directly witnessed manner. C.16. All confirmed positive test results shall be presumed to be valid. Respondent must prove by a preponderance of the evidence an error in collection, testing or other fault in the chain of custody. C.17. The Approved Program shall submit information and reports to the Department Monitor in compliance with the requirements of Wis. Adm. Code § RL 7.11. Practice Limitations C.18. Respondent shall not work as a nurse or other health care provider in a setting in which Respondent has access to controlled substances. C.19. Respondent shall practice only under the direct supervision of a licensed nurse or other licensed health care professional approved by the Board or its designee and only in a work setting pre-approved by the Board or its designee. Respondent may not work in a home health care, hospice, pool nursing, or agency setting. C.20. Respondent shall provide a copy of this Final Decision and Order and all other subsequent orders immediately to supervisory personnel at all settings where Respondent works as a nurse or care giver or provides health care, currently or in the future. C.21. It is Respondent’s responsibility to arrange for written reports from supervisors to be provided to the Department Monitor on a quarterly basis, as directed by the Department Monitor. These reports shall assess Respondent's work performance, and shall include the number of hours of active nursing practice worked during that quarter. C.22. Respondent shall report to the Board any change of employment status, residence, address or telephone number within five (5) days of the date of a change. MISCELLANEOUS Department Monitor D.1 Any requests, petitions, reports and other information required by this Order shall be mailed, e-mailed, faxed or delivered to the Department Monitor at the address indicated above. Required Reporting by Respondent D.2. Respondent is responsible for compliance with all of the terms and conditions of this Order, including the timely submission of reports by others. Respondent shall promptly notify the Department Monitor of any failures of the Treater, treatment facility, Approved Program or collection sites to conform to the terms and conditions of this Order. Respondent shall promptly notify the Department Monitor of any violations of any of the terms and conditions of this Order by Respondent. Additionally, every three (3) months the Respondent shall notify the Department Monitor of the Respondent’s compliance with the terms and conditions of the Order, and shall provide the Department Monitor with a current address and home telephone number. Change of Treater or Approved Program by Board D.3. If the Board or its designee determines the Treater or Approved Program has performed inadequately or has failed to satisfy the terms and conditions of this Order, the Board or its designee may direct that Respondent continue treatment and rehabilitation under the direction of another Treater or Approved Program. Petitions for Modification of Limitations or Termination of Order D.4. Respondent may petition the Board for modification of the terms of this Order or termination, however no such petition for modification shall occur earlier than one year from the date that the initial stay of the suspension goes into effect and no such petition for termination shall occur other than in compliance with paragraph A.3. Any such petition for modification shall be accompanied by a written recommendation from Respondent's Treater expressly supporting the specific modifications sought. Denial of a petition in whole or in part shall not be considered a denial of a license within the meaning of Wis. Stat. § 227.01(3)(a), and Respondent shall not have a right to any further hearings or proceedings on the denial. Costs of Compliance D.5. Respondent shall be responsible for all costs and expenses incurred in conjunction with the monitoring, screening, supervision and any other expenses associated with compliance with the terms of this Order. Being dropped from a program for non-payment is a violation of this Order. Costs of Proceeding D.6. Respondent shall pay costs of $1,380.00 to the Department of Regulation and Licensing before any license is granted to Respondent pursuant to paragraph 3 above. In the event Respondent fails to timely submit any payment of costs, the Respondent's application for a license SHALL BE DENIED, without further notice or hearing. Additional Discipline D.7. In addition to any other action authorized by this Order or law, violation of any term of this Order may be the basis for a separate disciplinary action pursuant to Wis. Stat. § 441.07. 7. This Order is effective on the date it is signed. Wisconsin Board of Nursing By: Marilyn Kaufmann 4/2/09 A Member of the Board Date STATE OF WISCONSIN BEFORE THE BOARD OF NURSING ___________________________________________________________________________ IN THE MATTER OF THE DISCIPLINARY : PROCEEDINGS AGAINST : : STIPULATION CRAIG A. PESKE, R.N., : LS ____________ NUR RESPONDENT. : ___________________________________________________________________________ [Division of Enforcement Case #’s 07 NUR 388 & 08 NUR 367] It is hereby stipulated and agreed, by and between Craig A. Peske, R.N., Respondent; and Sandra L. Nowack, attorney for the Complainant, Department of Regulation and Licensing, Division of Enforcement, as follows: 1. This Stipulation is entered into as a result of pending investigations of Respondent’s licensure by the Division of Enforcement (files 07 NUR 388 & 08 NUR 367). Respondent consents to the resolution of these investigations by stipulation and without the issuance of a formal complaint. 2. Respondent understands that by signing this Stipulation, he voluntarily and knowingly waives his rights, including: the right to a hearing on the allegations against him, at which time the state has the burden of proving those allegations by a preponderance of the evidence; the right to confront and cross-examine the witnesses against him; the right to call witnesses on his behalf and to compel their attendance by subpoena; the right to testify himself; the right to file objections to any proposed decision and to present briefs or oral arguments to the officials who are to render the final decision; the right to petition for rehearing; and all other applicable rights afforded to him under the United States Constitution, the Wisconsin Constitution, the Wisconsin Statutes, the Wisconsin Administrative Code, and any other provisions of state or federal law. 3. Respondent has been provided an opportunity to obtain advice of legal counsel prior to signing this Stipulation. 4. Respondent agrees to the adoption of the attached Final Decision and Order by the Board. The parties to the Stipulation consent to the entry of the attached Final Decision and Order without further notice, pleading, appearance or consent of the parties. Respondent waives all rights to any appeal of the Board's Order, if adopted in the form as attached. 5. If the terms of this Stipulation are not acceptable to the Board, the parties shall not be bound by the contents of this Stipulation, and the matter shall be returned to the Administrative Law Judge for further proceedings. In the event that this Stipulation is not accepted by the Board, the parties agree not to contend that the Board has been prejudiced or biased in any manner by the consideration of this attempted resolution. 6. Attached to this Stipulation are Respondent’s current wall and wallet registration certificates. If the Board does not accept this Stipulation, Respondent's certificates shall be returned to the Respondent with a notice of the Board's decision not to accept the Stipulation. 7. The parties to this Stipulation agree that the attorney or other agent for the Division of Enforcement and any member of the Board ever assigned as a case advisor in this investigation may appear before the Board in open or closed session, without the presence of Respondent or his attorney, if any, for purposes of speaking in support of this agreement and answering questions that any member of the Board may have in connection with the Board’s deliberations on the Stipulation. Additionally, any such case advisor may vote on whether the Board should accept this Stipulation and issue the attached Final Decision and Order. 8. Respondent is informed that should the Board adopt this Stipulation, the Board’s Final Decision and Order is a public record and will be published in accordance with standard Department procedure. 9. The Division of Enforcement joins Respondent in recommending the Board adopt this Stipulation and issue the attached Final Decision and Order. _________________________________ ______________________________ Craig A. Peske, R.N. Date Respondent 2820 Lime Kiln Road Green Bay, WI 54301 _________________________________ ______________________________ Sandra L. Nowack Date Attorney for Complainant Division of Enforcement Department of Regulation and Licensing P.O. Box 8935 Madison, WI 53708-8935 BEFORE THE BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: Case No. 2007-173 DAYNA HICKMAN 940 Catalina Drive, Apt. 12 Livermore, CA 94550 Registered Nurse License No. 658338 Respondent. OAH No. 2007010753 DECISION AND ORDER The attached Stipulated Settlement and Disciplinary Order is hereby adopted by the Board of Registered Nursing, Department of Consumer Affairs, as its Decision in this matter. This Decision shall become effective on _-,J~u_L_,/+-_2_~-=--+I_2._D_"_I_ FOR THE BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFAIRS 2 3 4 5 6 7 8 9 10 11 12 13 14 EDMUND G. BROWN JR. Attorney General of the State of California WILBERT E. BENNETT Supervising Deputy Attorney General SHANA A. BAGLEY, State Bar No. 169423 Deputy Attorney General California Department of Justice ISIS Clay Street, 20th Floor P.O. Box 70550 Oakland, CA 94612-0550 Telephone: (510) 622-2129 Facsimile: (510) 622-2270 Attorneys for Complainant BEFORE THE BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: DA YNA HICKMAN 940 Catalina Drive, Apt. 12 Livermore, CA 94550 Case No. 2007-173 OAH No. 2007010753 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER 15 Registered Nurse License No. 658338 16 Respondent. 17 18 19 20 21 22 23 IT IS HEREBY STIPULATED AND AGREED by and between the parties to the above-entitled proceedings that the following matters are true: PARTIES 1. Ruth Ann Terry, M.P.H, R.N (Complainant) is the Executive Officer of the Board of Registered Nursing. She brought this action solely in her official capacity and is represented in this matter by Edmund G. Brown Jr., Attorney General of the State of California, 24 25 26 27 28 by Shana A. Bagley, Deputy Attorney Genera1. 2. Respondent Dayna Hickman is representing herself in this proceeding and has chosen not to exercise her right to be represented by counsel. 1// 1 ~ : I 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 3. On or about June I, 2005, the Board of Registered Nursing issued Registered Nurse License No. 658338 to Dayna Hickman (Respondent). The License was in full force and effect at all times relevant to the charges brought in Accusation No. 2007-173 and will expire on February 28, 2007, unless renewed. JURISDICTION 4. Accusation No. 2007-173 was filed before the Board of Registered Nursing (Board), Department of Consumer Affairs, and is currently pending against Respondent. The Accusation and all other statutorily required documents were properly served on Respondent on December 18, 2006. Respondent timely filed her Notice of Defense contesting the Accusation. A copy of Accusation No. 2007-173 is attached as Exhibit "A" and incorporated herein by reference. ADVISEMENT AND WAIVERS 5. Respondent has carefully read, and understands the charges and allegations in Accusation No. 2007-173. Respondent has also carefully read, and fully understands the effects of this Stipulated Settlement and Disciplinary Order. 6. Respondent is fully aware of her legal rights in this matter, including the right to a hearing on the charges and allegations in the Accusation; the right to be represented by counsel at her own expense; the right to confront and cross-examine the witnesses against her; the right to present evidence and to testify on her own behalf; the right to the issuance of subpoenas to compel the attendance of witnesses and the production of documents; the right to reconsideration and court review of an adverse decision; and all other rights accorded by the California Administrative Procedure Act and other applicable laws. 7. Respondent voluntarily, knowingly, and intelligently waives and gives up 24 each and every right set forth above. 25 CULPABILITY 26 8. Respondent admits the truth of each and every charge and allegation in 27 Accusation No. 2007-173. 28 III 2 .~ I 9. Respondent agrees that her Registered Nurse License is subject to 2 discipline and she agrees to be bound by the Board's imposition of discipline as set forth in the 3 Disciplinary Order below. 4 CIRCUMSTANCES IN MITIGATION 5 6 7 8 9 10 II 12 13 14 IS 16 10. Respondent Dayna Hickman has never been the subject of any disciplinary action before the Board. She is admitting responsibility at an early stage in the proceedings. CONTINGENCY II. This stipulation shall be subject to approval by the Board of Registered Nursing. Respondent understands and agrees that counsel for Complainant and the staff of the Board of Registered Nursing may communicate directly with the Board regarding this stipulation and settlement, without notice to or participation by Respondent. By signing the stipulation, Respondent understands and agrees that she may not withdraw her agreement or seek to rescind the stipulation prior to the time the Board considers and acts upon it. If the Board fails to adopt this stipulation as its Decision and Order, the Stipulated Settlement and Disciplinary Order shall be of no force or effect, except for this paragraph, it shall be inadmissible in any legal action between the parties, and the Board shall not be disqualified from further action by having 17 considered this matter. 18 OTHER MATTERS 19 12. The parties understand and agree that facsimile copies of this Stipulated 20 Settlement and Disciplinary Order, including facsimile signatures thereto, shall have the same 21 force and effect as the originals. 22 DISCIPLINARY ORDER 23 In consideration of the foregoing admissions and stipulations, the parties agree 24 that the Board may, without further notice or formal proceeding, issue and enter the following 25 Disciplinary Order: 26 III 27 III 28 III 3 1 IT IS HEREBY ORDERED that Registered Nurse License No. 658338 issued to 2 Respondent is revoked. However, the revocation is stayed and Respondent is placed on 3 probation for three (3) years on the following tenns and conditions. 4 Severability Clause. Each condition of probation contained herein is a separate 5 and distinct condition. If any condition of this Order, or any application thereof, is declared 6 unenforceable in whole, in part, or to any extent, the remainder of this Order, and all other 7 applications thereof, shall not be affected. Each condition of this Order shall separately be valid 8 and enforceable to the fullest extent pennitted by law. 9 1. Obey All Laws. Respondent shall obey all federal, state and local laws. lOA full and detailed account of any and all violations oflaw shall be reported by Respondent to 11 the Board in writing within seventy-two (72) hours of occurrence. To pennit monitoring of 12 compliance with this condition, Respondent shall submit completed fingerprint fonns and 13 fingerprint fees within 45 days of the effective date of the decision, unless previously submitted 14 as part of the licensure application process. 15 Criminal Court Orders: If Respondent is under criminal court orders, including 16 probation or parole, and the order is violated, this shall be deemed a violation of these probation 17 conditions, and may result in the filing of an accusation and/or petition to revoke probation. 18 2. Comply with the Board's Probation Program. Respondent shall fully 19 comply with the conditions ofthe Probation Program established by the Board and cooperate 20 with representatives of the Board in its monitoring and investigation of the Respondent's 21 compliance with the Board's Probation Program. Respondent shall infonn the Board in writing 22 within DO more than 15 days of any address change and shall at all times maintain an active, 23 current license status with the Board, including during any period of suspension. 24 Upon successful completion of probation, Respondent's license shall be fully 25 restored. 26 3. Report in Person. Respondent, during the period of probation, shall 27 appear in person at interviews/meetings as directed by the Board or its designated 28 representatives. 4 1 4. Residency, Practice, or Licensure Outside of State. Periods of 2 residency or practice as a registered nurse outside of California shall not apply toward a reduction 3 of this probation time period. Respondent's probation is tolled, if and when she resides outside 4 of California. Respondent must provide written notice to the Board within 15 days of any change 5 ofresidency or practice outside the state, and within 30 days prior to re-establishing residency or 6 returning to practice in this state. 7 Respondent shall provide a list of all states and territories where she has ever been 8 licensed as a registered nurse, vocational nurse, or practical nurse. Respondent shall further 9 provide information regarding the status of each license and any changes in such license status 10 during the term of probation. Respondent shall inform the Board if she applies for or obtains a 11 new nursing license during the term of probation. 12 5. Submit Written Reports. Respondent, during the period of probation, 13 shall submit or cause to be submitted such written reports/declarations and verification of actions 14 under penalty of perjury, as required by the Board. These reports/declarations shall contain 15 statements relative to Respondent's compliance with all the conditions of the Board's Probation 16 Program. Respondent shall immediately execute all release of information forms as may be 17 required by the Board or its representatives. 18 Respondent shall provide a copy of this Decision to the nursing regulatory agency 19 in every state and territory in which she has a registered nurse license. 20 6. Function as a Registered Nurse. Respondent, during the period of 21 probation, shall engage in the practice of registered nursing in California for a minimum of 24 22 hours per week for 6 consecutive months or as determined by the Board. 23 For purposes of compliance with the section, "engage in the practice of registered 24 nursing" may include, when approved by the Board, volunteer work as a registered nurse, or 25 work in any non-direct patient care position that requires licensure as a registered nurse. 26 The Board may require that advanced practice nurses engage in advanced practice 27 nursing for a minimum of 24 hours per week for 6 consecutive months or as determined by the 28 Board. 5 If Respondent has not complied with this condition during the probationary tenn, 2 and Respondent has presented sufficient documentation of her good faith efforts to comply with 3 this condition, and if no other conditions have been violated, the Board, in its discretion, may 4 grant an extension of Respondent's probation period up to one year without further hearing in 5 order to comply with this condition. During the one year extension, all original conditions of 6 probation shall apply. 7 7. Employment Approval and Reporting Requirements. Respondent 8 shall obtain prior approval from the Board before commencing or continuing any employment, 9 paid or voluntary, as a registered nurse. Respondent shall cause to be submitted to the Board all 10 perfonnance evaluations and other employment related reports as a registered nurse upon request 11 of the Board. 12 Respondent shall provide a copy of this Decision to her employer and immediate 13 supervisors prior to commencement of any nursing or other health care related employment. 14 In addition to the above, Respondent shall notify the Board in writing within 15 seventy-two (72) hours after she obtains any nursing or other health care related employment. 16 Respondent shall notify the Board in writing within seventy-two (72) hours after she is 17 tenninated or separated, regardless of cause, from any nursing, or other health care related 18 employment with a full explanation of the circumstances surrounding the tennination or 19 separation. 20 8. Supervision. Respondent shall obtain prior approval from the Board 21 regarding Respondent's level of supervision and/or collaboration before commencing or 22 continuing any employment as a registered nurse, or education and training that includes patient 23 care. 24 Respondent shall practice only under the direct supervision of a registered nurse 25 in good standing (no current discipline) with the Board of Registered Nursing, unless alternative 26 methods of supervision and/or collaboration (e.g., with an advanced practice nurse or physician) 27 are approved. 28 III 6 I Respondent's level of supervision and/or collaboration may include, but is not 2 limited to the following: 3 (a) Maximum - The individual providing supervision and/or collaboration is 4 present in the patient care area or in any other work setting at all times. 5 (b) Moderate - The individual providing supervision and/or collaboration is in 6 the patient care unit or in any other work setting at least half the hours Respondent works. 7 (c) Minimum - The individual providing supervision and/or collaboration has 8 person-to-person communication with Respondent at least twice during each shift worked. 9 (d) Home Health Care - If Respondent is approved to work in the home health 10 care setting, the individual providing supervision and/or collaboration shall have person-to- I1 person communication with Respondent as required by the Board each work day. Respondent 12 shall maintain telephone or other telecommunication contact with the individual providing 13 supervision and/or collaboration as required by the Board during each work day. The individual 14 providing supervision and/or collaboration shall conduct, as required by the Board, periodic, on IS site visits to patients' homes visited by Respondent with or without Respondent present. 16 9. Employment Limitations. Respondent shall not work for a nurse's 17 registry, in any private duty position as a registered nurse, a temporary nurse placement agency, a 18 traveling nurse, or for an in-house nursing pool. 19 Respondent shall not work for a licensed home health agency as a visiting nurse 20 unless the registered nursing supervision and other protections for home visits have been 21 approved by the Board. Respondent shall not work in any other registered nursing occupation 22 where home visits are required. 23 Respondent shall not work in any health care setting as a supervisor of registered 24 nurses. The Board may additionally restrict Respondent from supervising licensed vocational 25 nurses and/or unlicensed assistive personnel on a case-by-case basis. 26 Respondent shall not work as a faculty member in an approved school of nursing 27 or as an instructor in a Board approved continuing education program. 28 III 7 I 2 3 4 5 6 7 8 9 10 II 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Respondent shall work only on a regularly assigned, identified and predetennined worksite(s) and shall not work in a float capacity. If Respondent is working or intends to work in excess of 40 hours per week, the Board may request documentation to determine whether there should be restrictions on the hours of work. 10. Complete a Nursing Course(s). Respondent, at her own expense, shall enroll and successfully complete a course(s) relevant to the practice of registered nursing no later than six months prior to the end of her probationary term. Respondent shall obtain prior approval from the Board before enrolling in the course(s). Respondent shall submit to the Board the original transcripts or certificates of completion for the above required course(s). The Board shall return the original documents to Respondent after photocopying them for its records. II. Cost Recovery. Respondent shall pay to the Board costs associated with its investigation and enforcement pursuant to Business and Professions Code section 125.3 in the amount of $1 ,646.00. Respondent shall be permitted to pay these costs in a payment plan approved by the Board, with payments to be completed no later than three months prior to the end of the probation term. If Respondent has not complied with this condition during the probationary term, and Respondent has presented sufficient documentation of her good faith efforts to comply with this condition, and if no other conditions have been violated, the Board, in its discretion, may grant an extension of Respondent's probation period up to one year without further hearing in order to comply with this condition. During the one year extension, all original conditions of probation will apply. 12. Violation of Probation. If Respondent violates the conditions of her probation, the Board after giving Respondent notice and an opportunity to be heard, may set aside the stay order and impose the stayed revocation of Respondent's license. /II /II 8 1 If during the period of probation, un accusation or petition to revoke probation has 2 been filed against Respondent's Iicerun: or the Attorney General's Office hIlS been requosted to 3 prepare an accusation or petition to revoke probation against Respondent's licclI5e, the 4 probationary period shall automatically be extended and shall not expire until the accusation Of 5 petition hIlS bccn acted upon by the Board. 6 13. LieeDle Surrender. During Respondent's term of probation, jf she ceases 7 pra\,llcing due to retirement, health reasons or is otherwise unable to satisfy the conditions of 8 probation, Respondent may surrender her Iicell5C to the Board. The Bourd reserves the right to 9 evalWlll! ResjlQndenl's request and to exercbe itl! di~-cretion whelhcr to grant the reqlU:~t, or to 10 tala: any other 8"'\ion deemed appropriate and ccasonable under the circumatances, without 11 further hCllJing. Upon forma1acceptance of the tendered license and wall certificate, Respondent 12 will no longer be subject to the cunilitions of probation. 13 Surrender of Respondent's license shall be conlo-idered a disciplinary action and 14 shall become a part of Respondent's licell5C history with the Board. A registered nurse whose 15 license has been surrendered may petition the Board for reinstatement no sooner than the 16 following minimum periods from the elfective date of the disciplinary decision: 17 (1) Two years for reinstatement of a Iicen'le that was surrendered for any 18 reason other than a mental or physical illness; or 19 (2) One year fur a license surrendered for a mental or physical ilinClls. 20 ACCEnANCE 21 I haye carefully read the Stipulated Settlement and Disciplinary Order. I 22 unden;tand the stipulation and the effect it will have on my Registered Nurse License. I enter 23 into this Stipulated Settlement and Disciplinary Order voluntarily, knowingly, and intelligently, 24 and agl1:!t! to be bound by the Decision and Order of thl! BOQl'd of Rfgistered Nursing. 25 DATED:---'lf(~;'?<+(JL/J1-,-- __ _ 26 27 28 ACKMAN R pondent 9 I ENDORSEMENT 2 The foregoing Stipulated Settlement and Disciplinary Order is hereby respectfully 3 submitted for consideration by the Board of Registered Nursing of the Department of Consumer 4 5 6 7 8 9 10 II 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Affairs. DATED: d, ZO .0'1- EDMUND G. BROWN JR., Attorney General of the State of California WILBERT E. BENNETT ---,~reM~ng-fie~ty Attorney General 10 .; Exhibit "A" Accusation No. 2007-173 1'. 1 BILL LOCKYER, Attorney General of the State of California 2 WILBERT E. BENNETT Supervising Deputy Attorney General 3 SHANA A. BAGLEY, State Bar No. 169423 Deputy Attorney General 4 California Department of Justice 1515 Clay Street, 20th Floor 5 P.O. Box 70550 Oakland, CA 94612-0550 6 Telephone: (510) 622-2129 Facsimile: (510) 622-2270 Attorneys for Complainant 7 8 9 BEFORE THE 10 11 12 BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: Case No. 1. 0 \) 7- 17J DA YNA A. HICKMAN 13 940 Catalina Drive, Apt. 12 Livermore, CA 94550 ACCUSATION 14 15 16 17 18 19 20 Registered Nurse License No. 658338 Respondent. Complainant alleges: PARTIES 1. Ruth Ann Terry, M.P.H., R.N. (Complainant) brings this Accusation solely in her official capacity as the Executive Officer of the Board of Registered Nursing, 21 I 22 23 24 25 26 27 28 Department of Consumer Affairs. 2. On or about June 1, 2005, the Board of Registered Nursing issued Registered Nurse, License Number 658338 to Dayna A. Hickman (Respondent). The Registered Nurse License was in full force and effect at all times relevant to the charges brought herein and will expire on February 28,2007, unless renewed. III III 1 1 2 3. JURISDICTION This Accusation is brought before the Board of Registered Nursing 3 (Board), Department of Consumer Affairs, under the authority of the following laws. All section 4 references are to the Business and Professions Code (Code) unless otherwise indicated. 5 STATUTORY PROVISIONS 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 4. Section 141 of the Code states: (a) For any licensee holding a license issued by a board under the jurisdiction of the department, a disciplinary action taken by another state, by any agency of the federal government, or by another country for any act substantially related to the practice regulated by the California license, may be a ground for disciplinary action by the respective state licensing board. A certified copy of the record of the disciplinary action taken against the licensee by another state, an agency of the federal government, or another country shall be conclusive evidence of the events related therein. (b) Nothing in this section shall preclude a board from applying a specific statutory provision in the licensing act administered by that board that provides for discipline based upon a disciplinary action taken against the licensee by another state, an agency of the federal government, or another country. 5. Section 2750 of the Code provides, in pertinent part, that the Board may discipline any licensee, including a licensee holding a temporary or an inactive license, for any reason provided in Article 3 (commencing with section 2750) of the Nursing Practice Act. 6. Section 2761 of the Code states, in pertinent part: The board may take disciplinary action against a certified or licensed nurse or deny an application for a certificate or license for any of the following: (a) Unprofessional conduct, which includes, but is not limited to, the following: (1) Incompetence, or gross negligence in carrying out usual certified or licensed nursing functions. (4) Denial oflicensure, revocation, suspension, restriction, or any other disciplinary action against a health care professional license or certificate by another state or territory of the United States, by any other government agency, or by another California health care professional licensing board. A certified copy of the decision or judgment shall be conclusive evidence ofthat action. 2 1 7. Section 2764 of the Code provides, in pertinent part, that the expiration of 2 a license shall not deprive the Board of jurisdiction to proceed with a disciplinary proceeding 3 against the licensee or to render a decision imposing discipline on the license. Under section 4 2811, subdivision (b), of the Code, the Board may renew an expired license at any time within 5 eight years after the expiration. 6 COST RECOVERY 7 8. Section 125.3 of the Code provides, in pertinent part, that the Board may 8 request the administrative law judge to direct a licentiate found to have committed a violation or 9 violations of the licensing act to pay a sum not to exceed the reasonable costs of the investigation 10 and enforcement of the case. II FIRST CAUSE FOR DISCIPLINE 12 (Disciplinary Action by Another State) 13 9. Respondent is subject to disciplinary action under section 2761, 14 subdivision (a)(4), of the Code in that on or about August 16, 2006, the Board of Nurse 15 Examiners of the State of Texas, issued a disciplinary decision suspending her registered nursing 16 license, with the suspension stayed, ordering a two year probationary term and the completion of 17 courses regarding Texas nursing jurisprudence, medication administration, and nursing 18 documentation. (A copy of said disciplinary action, is attached hereto as Exhibit "A" and is 19 herein incorporated by reference as though fully set forth.) The circumstances are as follows: 20 a. The disciplinary proceeding was entitled In the Matter of Multistate 21 Licensure Privilege Associated with Iowa Registered Nurse License Number 099747, Board of 22 Nurse Examiners of the State of Texas, and imposed license restrictions based upon findings of: 23 (1) unprofessional or dishonorable conduct that, in the Board's opinion, is likely to deceive, 24 defraud, or injure a patient or the public; (2) failure to care adequately for a patient or to conform 25 to the minimum standards of acceptable nursing practice in a manner that, in the Board's 26 opinion, exposes a patient or other person unnecessarily to risk of harm; (3) failure to correctly 27 administer medication; (4) failure to create an accurate and complete medical record; and (5) 28 unsafe practice. Respondent was found to have intravenously administered undiluted Vitamin K 3 1 too rapidly to a patient which may have contributed to the patient's demise due to 2 cardiopulmonary arrest; and to have failed to document in the patient's medical record her 3 assessment, nursing interventions, and the patient's responses and outcome, all of which resulted 4 in an incomplete medical record. The Order of the Board of Nurse Examiners of the State of 5 Texas became effective on September 12, 2006. 6 PRAYER 7 WHEREFORE, Complainant requests that a hearing be held on the matters herein 8 alleged, and that following the hearing, the Board of Registered Nursing issue a decision: 9 I. Revoking or suspending Registered Nurse License Number 658338, issued 10 to Dayna A. Hickman; 11 2. Ordering Dayna A. Hickman to pay the Board of Registered Nursing the 12 reasonable costs of the investigation and enforcement of this case, pursuant to Business and 13 Professions Code section 125.3; and 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 DATED: SF2006403019 90049031. wpd 3. Taking such other and further action as deemed necessary and proper. 1-t -Vv th c£'--'t~ UTH ANN TERRY, M.P.H., R.N. Executive Officer Board of Registered Nursing Department of Consumer Affairs State of California Complainant 4 EXHIBIT A Board of Nurse Examiners For the State of Texas Location Address; William P. Hobby Building, Ste. 3-460,333 Guadalupe Street, Austin, Texas 78701 Phone: (512) 305-7400 Fax: (512) 305-7401 Web: www.bne.state.tx.us Katherine A. Thomss, MN, RN Executive Director September 15, 2006 State of California Department of Consumer Affairs Board of Registered Nursing Letticia Castillo, Enforcement Technician PO Box 944210 Sacramento, California 94244-2100 RE: Dayna Annette Hickman, Iowa RN 099747, California RN 658338 Dear Ms. Castillo: We are providing you with a certified copy of the Order of the Board issued by the Board of Nurse Examiners to the above identified nurse on September 12, 2006. If you have any questions, please contact me at the Department ofInvestigations at (512)305-6829. Sincerely, addell, RN,C /jlsc Enclosures: Order of .the Board 11195-099 !'. .... ,;,; .. '" . Members or the Board Joyce Adams, PhD, RN Deborah Bell, CLU, ChFC George Buchenan, Jr., BSN, RN. MBA Virginia Campbell, BSN, RN, CNOR H(tuston Abilene Amarillo Me$quife '._ I • 81001:8 Rosa Garcia, PhD, RN Corpus Christi Richard Gibbs, LVN Mesquite Rachel Gomez, LYN Harlingen Brenda Jackson, PhD, RN SilO Antonio Beverley Jean Nutill. LVN Bryan Anita Palmer, ME, MA Oilley Fhyllls Rawley, eFe Vice.Prl!sidl!nl Linda Rounds, FhD, FNP, RN Preslde"t Frank SMndoval, Jr., J.D. San Antonio BEFORE THE BOARD OF NURSE EXAMINERS FOR THE STATE OF TEXAS ********************************************** In the Matter of Multistate Licensure Privilege Associated with Iowa Registered Nurse License Number 099747 issued to DA YNA ANNETTE mCKMAN § § § § AGREED ORDER On this day the Board of Nurse Examiners for the State of Texas, hereinafter referred to as the Board, considered the matter of the Multistate Licensure Privilege ofDA YNA ANNETTE mCKMAN, associated with Iowa Registered Nurse License Number 099747, hereinafter referred to as Respondent. Information received by the Board produced evidence that Respondent may have engaged in conduct constituting grounds for disciplinary action in accordance with Sections 301.4S2(b)(10)&(13) and 304:001 Article 3(c), Texas Occupations Code. Respondent waived representation by counsel, informal conference, notice and hearing, and agreed to the entry of this Order offered on July 23, 2006, by Katherine A. Thomas, MN, RN, Executive Director, subject to ratification by the Board. FINDINGS OF FACT 1. Prior to the institution of Agency proceedings, notice of the matters specified below in these Findings of Fact was served on Respondent and Respondent was given an opportunity to show compliance with all requirements of the law for retention of the license. 2. Respondent waived representation by counsel, informal conference, notice and hearing, and agreed to the entry of this Order. 3. Respondent received an Associate Degree in Nursing from North Iowa Community College, Mason City, Iowa, in May 1996. Respondent was licensed to practice professional nursing in the State of Iowa on March 11, 1998, and was licensed to practice professional nursing in the State of California on June 1,2005. 4. Respondent is currently licensed to practice professional nursing in the States of Iowa and California. lA 099747,083 - 2- 5. Respondent's professional employment history includes: 03/1998 - 0412004 05/2004 - 10/2005 1112005 - 1212005 01/2006 - Present Staff Nurse Unknown Travel Nurse Unknown Mercy Medical Center - North Iowa Mason City, Iowa InteliStaf Healthcare Medical City Dallas Hospital Dallas, Texas 6. On or about November 21, 2005, while employed as a Travel Nurse with InteliStaf Healthcare, Dallas, Texas, and assigned to the Progressive Care Unit of Medical City Dallas Hospital, Dallas, Texas, Respondent too rapidly administered undiluted Vitamin K intravenously to Patient Medical Record Number H000769306. Within minutes, the patient experienced cardiopulmonary arrest and was pronounced deceased after unsuccessful attempted resuscitation. Respondent's conduct may have contributed to the patient's demise. 7. On or about November 21, 2005, while employed as a Travel Nurse with InteliStaf Healthcare, Dallas, Texas, and assigned to the Progressive Care Unit of Medical City Dallas Hospital, Dallas, Texas, Respondent failed to document in the medical record her assessment of Patient Medical Record Number H000769306 and her nursing interventions, as well as the patient's responses and outcome, after she. too rapidly administered undiluted Vitamin K intravenously to the patient and the patient experienced cardiopulmonary arrest. Respondent's conduct resulted in an incomplete medical record. 8. Formal Charges were filed on May 11,2006. 9. Formal Charges were mailed to Respondent at her address of record on May 11, 2006. CONCLUSIONS OF LAW 1. Pursuant to Texas Occupations Code, Sections 301.451-301.555, the Board has jurisdiction over this matter. 2. Notice was served in accordance with law. 3. The evidence received is sufficient for disciplinary action in accordance with Sections 301.452(b)(10)&(13) and 304.001 Article 3(c), Texas Occupations Code, and to prove violations of 22 TEX. ADMIN. CODE §§ 217.11(1)(C)&(I)(D) an~217.l2(1)(A). - 3 - 4. The evidence received is sufficient cause pursuant to Sections 301.452(b) and 304.001 Article 3(c), Texas Occupations Code, to take disciplinary action against the multistate licensure privilege associated with Iowa Registered Nurse License Number 099747, heretofore issued toDA YNA ANNETTE HICKMAN, including revocation of Respondent's multistate licensure privilege to practice professional nursing in the State of Texas. ORDER IT IS THEREFORE AGREED and ORDERED, subject to ratification by the Board of Nurse Examiners, that the Multitate Licensure Privilege associated with Iowa Registered Nurse License Number 099747, previously issued to DA YNA ANNETTE HICKMAN, to practice professional nursing in Texas is hereby SUSPENDED and said suspension is ENFORCED until Respondent completes and provides documentation of successful completion of the following requirements: (1) RESPONDENT SHALL, within one (1) year of entry of this Order, successfully complete a course in Texas nursing jurisprudence. RESPONDENT SHALL obtain Board approval of the course prior to enrollment only if the course is not being offered by a pre-approved provider. Home study courses and video programs will not be approved. In order for the course to be approved, the target audience shall include nurses. It shall be a minimum of six (6) contact hours in length. The course's content shall include the Nursing Practice Act, standards of practice, 'and documentation of care. Courses focusing on malpractice issues will not be accepted. RESPONDENT SHALL CAUSE the sponsoring institution to submit a Verification of Course Completion form, provided by the Board, to the Office of the Board to verify RESPONDENT's successful completion of the course. This course shall be taken in addition to any other courses stipulated in this Order, if any, and in addition to any continuing education requirements the Board has for relicensure. Board-approved courses may be found on the' Board's website, www.bne.state.tx.us(under BNE events). lA 099141:083 - 4 - (2) RESPONDENT SHALL, within one (1) year of entry of this Order, successfully complete a course in medication administration. RESPONDENT SHAlL obtain Board approval of the course prior to enrollment only if the course is not being offered by a pre-approved provider. Home study courses and video programs will not be approved. In order for the course to be approved, the target audience shall include Nurses. The didactic portion of this course shall be a minimum of six (6) hours in length. The course shall contain a minimum twenty-four (24) hour clinical component which is to be provided by the same Registered Nurse who provides the didactic portion of this course. The clinical component SHAIL focus on tasks of medication administration only. In order for the course to be approved, the course's content shall include: a review of proper administration procedures for all standard routes; computation of drug dosages; the five (5) rights of medication administration; factors influencing the choice of route; and possible adverse effects resulting from improper administration. The course description shall indicate goals and objectives for the course, resources to be utilized, and the methods to be used to detennine successful completion of the course. RESPONDENT SHAlL successfully complete both the didactic and clinical portions of the course to satisfy this stipulation. RESPONDENT SHAlL CAUSE the. instructor to submit a Verification of Course Completion form, provided by the Board, to the office of the Board to verify RESPONDENT's successful completion of the course. This course shall be taken in addition to any other courses stipulated in this Order, if any, and in addition to any continuing education requirements the Board has for relicensure. Board approved courses may be found on the Board's website, www.bne.state.tx.us(under BNE events). (3) RESPONDENT SHALL, within one (1) year of entry of this Order, successfully complete a course in nursing documentation. RESPONDENT SHALL obtain Board approval of the course prior to enrollment only if the course is not being offered by a pre-approved provider. Home IA 099747:0B3 - 5 - study courses and video programs will not be approved. The course shall be a minimum of six (6) hours in length of classroom time. In order for the course to be approved, the target audience shall include Nurses. The course shall include content on the following: nursing standards related to accurate and complete documentation; legal guidelines for recording; methods and processes of recording; methods of alternative record-keeping; and computerized documentation. RESPONDENT SHAlL cause the instructor to submit a Verification of Course Completion form, provided by the Board, to the Board's office to verify RESPONDENT's successful completion of the course. This course shall be taken in addition to any other courses stipulated in this Order, if any, and in addition to any continuing education requirements the Board has for relicensure. Board-approved courses may be found on the Board's website, www.bne.state.tx.us(underBNEevents}. IT IS FURTHER AGREED that, upon verification of successful completion of the above requirements, the suspension will be STAYED, and RESPONDENT will be. placed on PROBATION for two (2) years under the following agreed terms: (4) RESPONDENT SHAlL comply in all respects with the Nursing Practice Act, Revised Civil Statutes of Texas as amended, Texas Occupations Code, §§301.001 et seq., the Rules and Regulations Relating to Professional Nurse Education,· Licensure and Practice, 22 TEX. ADMIN. CODE §211.01 et seq. and this Order. IT IS FURTHER AGREED, SHOULD RESPONDENT PRACTICE AS A REGISTERED NURSE IN THE STATE OF TEXAS, RESPONDENT WILL PROVIDE DIRECT PATIENT CARE AND PRACTICE IN A HOSPITAL, NURSING HOME, OR OTHER CLINICAL SETTING AND RESPONDENT MUST WORK IN SUCH SETTING A MINIMUM OF SIXTY·FOUR (64) HOURS PER MONTH UNDER THE FOLI:()WING PROBATION CONDITIONS FOR TWO (2) YEARS OF EMPLOYMENT. THE LENGTH OF THE IA 099147:083 - 6 - PROBATIONARY PERIOD WILL BE EXTENDED UNTIL SUCH TWENTY-FOUR (24) MONTHS HAVE ELAPSED. PERIODS OF UNEMPLOYMENT OR OF EMPLOYMENT THAT DO NOT REQUIRE THE USE OF A REGISTERED NURSE (RN) LICENSE OR PRIVILEGE WILL NOT APPLY TO THIS PROBATIONARY PERIOD: (5) RESPONDENT SHALL notify all future employers in professional nursing of this Order of the Board and the probation conditions on RESPONDENT's multistate licensure privilege. RESPONDENT SHALL present a complete copy of this Order and all Proposals for Decision issued by the Administrative Law Judge, if any, to each future employer prior to accepting . an offer of employment. (6) RESPONDENT SHALL CAUSE each present employer in professional nursing to submit the Notification of Employment form, which is provided to the Respondent by the Board, to the Board's office within ten (10) days of receipt of this Order. RESPONDENT SHALL CAUSE each future employer to submit the Notification of Employment form, which is provided to the Respondent by the Board, to the Board's office within five (5) days of employment as a professional nurse. (7) For the first year of employment as a Registered Nurse under this Order, RESPONDENT SHALL be directly supervised by a Registered Nurse. Direct supervision requires another professional nurse to be working on the same unit as RESPONDENT and immediately available to provide assistance and intervention. RESPONDENT SHALL work only on regularly assigned, identified and predetermined unit(s). The RESPONDENT SHALL NOT be employed by a nurse registry, temporary nurse employment agency, hospice, or home health agency. RESPONDENT SHALL NOT be self-employed or contract for services. ; Multiple employers are prohibited. IA 099747:083 -7- (8) For the remainder of the probation period, RESPONDENT SHAIL be supervised by a Registered Nurse who is on the premises. The supervising RN is not required to be on the same unit or ward as RESPONDENT, but should be on the facility grounds and readily available to provide assistance and intervention if necessary. The supervising RN shall have a minimum of two (2) years experience in the same or similar practice setting to which the Respondent is currently working. RESPONDENT SHAIL work only regularly assigned, identified and predetennined unites). RESPONDENT SHAIL NOT be employed by a nurse registry, temporary nurse employment agency, hospice, or home health agency. RESPONDENT SHAIL NOT be self employed or contract for services. Multiple employers are prohibited. (9) RESPONDENT SHALL CAUSE each employer to submit, on forms provided to the Respondent by the Board, periodic reports as to RESPONDENTs capability to practice professional nursing. These reports shall be completed by the Registered Nurse who supervises the RESPONDENT. These reports shall be submitted by the supervising Registered Nurse to the office of the Board at the end of each three (3) months for two (2) years of employment as a professional nurse. IT IS FURTHER AGREED and ORDERED that if during the period of probation, an additional allegation, accusation, or petition is reported or filed against the Respondent's multistate licensure privilege, the probationary_period shall not expire and shall automatically be extended until the allegation, accusation, or petition has been acted upon by the Board. IT IS FURTHER AGREED, that upon full compliance with the terms of this Order, RESPONDENT SHALL be issued unencumbered multistate licensure privileges, if any, to practice professional nursing in the State of Texas. IA 099747:083 - 8 - RESPONDENT'S CERTIFICATION I understand that I have the right to legal counsel prior to signing this Agreed Order. I waive representation by counsel. I have reviewed this Order. I neither admit nor deny the violations alleged herein. By my signature on this Order, I agree to the Findings of Fact, Conclusions of Law, Order, and any conditions of said Order, to avoid further disciplinary action in this matter. I waive judicial review ofthis Order. I understand that this Order is subject to ratification by the Board. When this Order is ratified, the terms of this Order become effective, and a copy will be mailed to me. I understand that if! fail to comply with all terms and conditions of this Order, I will be subject to investigation and disciplinary sanction, including revocation of mymultistate licensure privilege to practice professional nursing in the State of Texas, as a consequence of my noncompliance. Signed this ICe day of ~ , 20k-. ~ll fl Ikt&mA 2 DNA ANNETIE HICKMAN, Respondent Sworn to and subscribed before me this ~ day of _4...L..:.IA.,.Jt.:o ___ , 200& . . SEAL . ~------' ~ . . . . . . . . . . . . Notary Public in and for the State of __ G1L+--'----'-__ @ KAVFRENCH _ -. Comm~slon#1401317 f ~ . -iii Notary Public· Callfomla ~ • Alameda County - .. MyComm. expires Feb 18, 2007 IA 099747:083 -9- WHEREFORE, PREMISES CONSIDERED, the Board of Nurse Examiners for the State of Texas does hereby ratify and adopt the Agreed Order that was signed on the 16 th day of August, 2006, by DA YNA ANNETTE HICKMAN, Iowa Registered Nurse License Number 099747, and said Order is final. IA 099747:083 Effective this 12th day of September, 2006. ~a~ Katherine A. Thomas, MN, RN Executive Director on behalf of said Board - 10- 'i ~'_ 1 2 3 BEFORE THE. BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFF AlRS STATE OF CALIFORNIA 4 11-----------------------__ -, 5 iiI the Matter of the Accusation Against: Case No. 2010-230 6 7 8 9 10 11 12 13 KRYSTAL ANN BAUER 2760 Tech Drive, Unit No.107 Bettendorf, IA 52722 Registered Nurse License No. 502554 DEFAULT DECISION AND ORDER [Gov. Code, §11520] FINDINGS OF FACT 1. On or about October 22,2009, Complainant Louise R. Bailey, M.Ed.,RN, in her 14 official capacity as the Interim Executive Officer of the Board of Regislered Nursing, Department 15 of Consumer Affairs, filed Accusation No. 2010-230 against Krystal Ann Bauer (Respondent) 16 before the Board of Registered Nursing. 17 18 19 20 21 22 23 24 25 26 27 2. On or about August 26,1994, the Board of Registered Nmsing (Board) issued Registered Nurse License No. 502554 to Respondent. The Registered Nmse License was in full force and effect at all times relevant to the charges brought herein and will expire on September 30,2010, unless renewed. 3. On or about October 22, 2009, Kami Pratab, an employee of the Board of Registered Nursing, Deparhllent of Consumer Affairs, served by Certified and First Class Mail a copy of the Accusation No. 2010-230, Statement to Respondent, Notice of Defense, Request for Discovery, and Government Code sections 11507.5, 11507.6, and 11507.7 to Respondent's address of record with the Board, which was and is: 2760 Tech Drive, Unit No.107, Bettendorf, IA 52722. A copy of the Accusation is attached as Exhibit A, and is incorporated herein by reference. 4. Service ofthe Accusation was effective as a matter oflaw lUlder the provisions of 28 Govemment Code section 11505, subdivision (c). 1 DEFAULT DECISION AND ORDER (2010-230) , 7 1 . 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 : 26 ~ ! 27 28 As of November 19, 2009, twenty eight days after service oflhe accusation, neither the Certified Mail Receipt nor the First Class Mail was retumed to the Board. 5. Business and Professions Code section 2764 states: The lapsing or suspension of a license by operation oflaw or by order or decision of the board or a court of law, or the voluntary surrender of a license by a licentiate shall not deprive the board of jurisdiction to proceed with an investigation of or action or disciplinary proceeding against such license, or to render a decision suspending or revoking such license. 6. Government Code section 11506 states, in pertinent part: (c) The respondent shall be entitled to a hearing on the merits if the respondent files a notice of defense, and the notice shall be deemed a specific denial of all parts of the accusation not expressly admitted. Failure to file a notice of defense shall constitute a waiver of respondent's right to a hearing, but the agency in its discretion may nevertheless grant a hearing. Respondent failed to file a Notice of Defense within 15 days after service UpOli her of the Accusation, and therefore waived her right to a hearing on the merits of Accusation No. 2010- 230. 7. California Govermnent Code section 11520 states, in pertinent part: (a) If the respondent either fails to file a notice of defense or to appear at tlle hearing, the agency may talee action based upon the respondent's express admissions or upon other evidence and affidavits may be used as evidence without any notice to respondent. 8. Pursuant to its authority under Govemment Code section 11520, the Board finds Respondent is in default. The Board will talee action without further hearing and, based on the evidence on file herein, fmds that the allegations in Accusation No. 2010-230 axe tme. 9. The total costs for investigation and enforcement in c011l1ection Witll the Accusation are $845.25 as of November 19,2009. II II II II 2 DEFAULT DECISION AND ORDER (2010-230) r , 1 DETERMINATION OF ISSUES 2 1. Based on the foregoing findings of fact, Respondent Krystal Ann Bauer has subjected 3 her Registered Nurse License No. 502554, to discipline. 4 2. A copy of the Accusation is attached. 5 3. The agency has jurisdiction to adjudicate this case by default. 6 4. The Board of Registered Nursing is authorized to revoke Respondent's Registered 7 Nurse License based upon the following violations alleged in the Accusation: 8 9 a. Violation of Business and Professions Code section 2761(a) - Unprofessional 10 Conduct. 11 b. Violation of 2761(a)(4) - Disciplinary action by another State Board of Nursing. 12 c. Violation of 2762(a) - Obtaining or possessing controlled substances without a 13 prescription. 14 d. Violation of 2762(b) - Use of controlled substance or alcohol to an extent or in a 15 manner dangerous or injurious to oneself and others. 16 II 17 II 18 II 19 II 20 II 21 II 22 II 23 II 24 II 25 II 26 II 27 Attaclnnent: 28 Exhibit A: Accusation No. 2010-230 3 DEFAULT DECISION AND ORDER (2010-230) , 1 1 I 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 I 18 ~ ! 19 20 21 22 23 24 25 26 27 28 I ~ I BEFORETRE BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: KRYSTAL ANN BAUER 2760 Tech Drive, Unit No.107 Bettendorf, IA 52722 Registered Nurse License No. 502554 Case No. 2010-230 ORDER IT IS SO ORDERED that Registered Nurse License No. 502554, heretofore issued to Respondent Krystal Ann Bauer, is revoked. Pursuant to Government Code section 11520, subdivision (c), Respondent. may serve a written motion requesting that the Decision be vacated and stating the grounds relied on within seven (7) days after service ofthe Decision on Respondent. The agency in its discretion may vacate the Decision and grant a hearing on a showing of good cause, as defined in the statute. This Decision shall become effective on "f,:;::..bru 0 .jr J ').'5/2010. It is so ORDERED S o.n, J ClVj 2rf:J) 2010 FOR~~~SING DEPARTMENT OF CONSUMER AFFAIRS 4 DEFAULT DECISION AND ORDER (2010-230) , , J Exhibit A Accusation No. 2010-230 ( , 1 2 3 4 5 EDMUND G. BROWN JR. Attorney General of California ALFREDO TERRAZAS Special Assistant Attorney General JANICE K. LACHMAN Supervising Deputy Attorney General State BarNo. 186131 1300 I Street, Suite 125 P.O. Box 944255 Sacramento, CA 94244-2550 Telephone: (916) 445-7384 Facsimile: (916) 327-8643 Attorneys for Complainant BEFORE THE 6 7 8 9 BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA 10 11 In the Matter of the Accusation Against: 12 KRYSTAL ANN BAUER 2760 Tech Drive, Unit No. 107 13 Bettendorf, Iowa 52722 14 15 Registered Nurse Liceuse No. 502554 16 17 18 Complainant alleges: Respondent. CaseNo.a.-OIO- ~60 ACCUSATION 19 PARTIES 20 1. Louise R. Bailey, M.Ed., RN ("Complainant") brings this Accusation solely in her 21 official capacity as the Interim Executive Officer of the Board of Registered Nursing ("Board"), 22 Department of Consumer Affairs. 23 Registered Nurse License 24 2. On or about August 26, 1994, the Board issued Registered Nurse License Number 25 502554 to Krystal Ann Bauer ("Respondent"). The registered nurse license was in full force and 26 effect at all times relevant to the charges brought herein and will expire on September 30, 2010, 27 unless renewed. 28 III 1 Accusation I , STATUTORY PROVISIONS I 2 3. Section 2750 of the Business and Professions Code ("Code") provides, in pertinent 3 part, that the Board may discipline any licensee, including a licensee holding a temporary or an 4 inactive license, for any reason provided inArtic1e 3 (commencing with section 2750) of the 5 Nursing Practice Act. 6 4. Code section 2764 provides, in pertinent part, that the expiration of a license shall not 7 depJive the Board of jurisdiction to proceed with a disciplinary proceeding against the licensee or 8 to render a decision imposing discipline on the license. Under Code section 2811, subdivision 9 (b), the Board may renew an expired license at any time within eight years after the expiration. 10 5. Code section 118, subdivision (b), provides that the suspension, expiration, surrender, lIar cancellation of a license shall not deprive the BoardiRegistrar/Directpr of jurisdiction to 12 proceed with a disciplinary action during the period within which the license may be renewed, 13 restored, reissued or reinstated. 14 15 16 6. Code section 2761 states: The board may talee disciplinary action against acertified or licensed nurse or deny an application for a certificate or license for any of the following: (a) Unprofessional conduct, which includes, but is not limited to, the 17 following: 18 (4) Denial oflicensure, revocation, suspension, restriction, or any other disciplinary action against a health care professional license or certificate by another 19 state or territory of the United States, by any other government agency, or by another California health care professional licensing board. A certified copy of the decision 20 or judgment shall be conclusive evidence of that action. 21 7. Code section 2762 states: 22 In addition to other acts constituting unprofessional conduct within the meaning of this chapter [the Nursing Practice Act], it is unprofessional conduct for a 23 person licensed under this chapter to do any of the following: 24 (a) Obtain or possess in violation of law, or prescribe, or except as directed by a licensed physician and surgeon, dentist, or podiatrist administer to 25 himself or herself; or furnish or administer to another, any controlled substance as defined in Division 1 0 (commencing with Section 11000) of the Health and Safety 26 Code or any dangerous drug or dangerous device as defined in Section 4022. 27 (b) Use any controlled substance as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code, or any dangerous drug or 28 dangerous device as defined in Section 4022, or alcoholic beverages, to an extent or 2 Accusation 1 in a manner dangerous or injurious to himself or herself, any other person, or the public or to the extent that such use impairs his or her ability to conduct with safety to 2 the public the practice authorized by his or her license. 3 8. Code section 4060 states, in pertinent part: 4 No person shall possess any controlled substances, except that furnished to a person upon the prescription of a physician, dentist, podiatrist, optometrist, 5 veterinarian, or naturopathic doctor. ... 6 9. Health and Safety Code section 11173, subdivision (a) provides that no person shall obtain or attempt to obtain controlled substances, or procure or attempt to 7 procure the administration of or prescription for controlled substances, (1) by fraud, deceit, misrepresentation, or subterfuge; or (2) by the conceahnent of a material fact. 8 9 COST RECOVERY 10 10. Code section 125.3 provides, in pertinent part, that the Board may request the 11 administrative law judge to direct a licentiate found to have committed a violation or violations of 12 the licensing act to pay a sum not to exceed the reasonable costs of the investigation and 13 enforcement of the case. 14 11. DRUGS 15 "Morphine" is a Schedule II controlled substance as designated by Health and Safety Code 16 section 11055, subdivision (b)(I)(M), and a dangerous drug under Code section 4022 in that 17 under federal or state law it requires a prescription. 18 FIRST CAUSE FOR DISCIPLINE 19 12. Respondent has subjected her license to discipline pursuant to Code section 2761, 20 subdivision (a)(4) on the grounds of unprofessional conduct, in that Respondent has been 21 disciplined by other state boards, as follows: 22 Board of Nursing of the State of Iowa 23 a. Effective March 2, 2005, pursuant to the Stipulation and Order filed by the Board of 24 Nursing of the State ofIowa (hereinafter "Iowa Board"), in Case No. 03-149, attached hereto as 25 Exhibit" A" and incorporated herein by reference, Respondent's Iowa Nursing License and 26 Certificate Nos. 089513 and P33809 were suspended, pending the Iowa Board's receipt of a 27 chemical dependency evaluatio,n.· Pursuant to this stipUlation, a recommendation for services 28 would result in continuation of the suspension until appropriate treatment, including related after 3 Accusation i , , 1 care, had been completed and Respondent verified twelve (12) continuous months of sobriety. 2 Following satisfaction of these provisions, Respondent would be placed on probation, with terms. 3 and conditions. 4 b. On or about November 8, 2008, Respondent entered into a Consent Order with the. 5 Iowa Board to voluntarily relinquish her Iowa License Nos. 089513 and P33809, pursuant to the 6 Notice of Hearing and Statement of Charges filed by the Iowa Board in Case No. 07-566, 7 attached hereto as Exhibit "B" and incorporated herein by reference. The basis for discipline 8 was that on or about June 5, 2008, the Wisconsin Board of Nursing revoked Respondent's multi- 9 state privilege in Wisconsin for Respondent's inability to practice due to substance abuse and 10' unauthorized administration of medication. II Arizona State Board of Nursing 12 c. Effective July 29, 2008, pursuant to the Order to Revoke Multistate Licensure 13 Privilege in Arizona and Cease and Desist Order in Case No. 0712090, attached hereto as Exhibit 14 "C" and incorporated herein by reference, Respondent's Arizona Registered Nurse License No. 15 RN089513 and Practical Nurse License No. PN33809 were revoked. The basis of said discipline 16 was pursuant to her conduct in Wisconsin regarding controlled substances, as more particularly 17 set forth in subparagraphb, above. 18 State of Wisconsin Board of Nursing 19 d. Effective Jun~ 5, 2008, pursuant to the Final Decision and Order in Case No. 20 LS0806054, attached hereto as Exhibit "D", and incorporated herein by reference, Respondent's 21 privilege to practice nursing in Wisconsin pursuant to a multi-state nurse licensure compact under 22 her Iowa nursing license was revoked. The basis for discipline is that on or about December 7, 23 2007, while working as a travel nurse, Respondent, by her own admission, diverted Morphine 24 from the Pyxis machine while on duty as a registered nurse and later that day tested positive for 25 Morphine. In fact, Respondent admitted that she had given herself an injection of Morphine 26 intended for a patient. Further, an audit of Respondent's Pyxis access showed excessive access to 27 the controlled substances Temazepam, Morphine, Fentanyl, and Hydrocodone/Acetaminophen 28 with minimal or no documentation of having given the medications to patients. 4 Accusation i I i I , ! , , 1 SECOND CAUSE FOR DISCIPLINE 2 (Obtain and Possess Controlled Substances in Violation of Law; Self-administration) 3 13. Respondent has subjected her license to discipline pursuantto Code section 2761, 4 subdivision (a), on the grounds of unprofessional conduct as defmed in Code section 2762, 5 subdivision (a), in that on or about December 7, 2007, while on duty as a registered nurse at a 6 Saint Claire's Hospital in the State of Wisconsin, Respondent committed acts as follows: 7 a. Respondent obtained the controlled substance Morphine, by fraud, deceit, 8 misrepresentation or subterfuge by tal 170: .. ~J c f.::' \' '.,i,EKJ. 0 ,~ "" ~ ~ ~ GA,. .-~ t:rCI?! r, ':,'n~' 21,';[, Chairperson j":;'" ;,' :.":, .~-~. IOWA BOARD OF Iowa Board of Nursing . '< ' -','1: ',-" "X' , ~,LJFl~I~.~ 1hlv IS to cer.tlf.ydtiat IbiS Is"a lP~e and co"'~ct copy of records on • .iile .i.n this. office per;s ....... to ~, r y ~1dl' ietril~ \ ~ I,..,,!,.. I (, 1\ 1\ ~Inl ) . .. ' ... ~ .~. . ...... ! _ .. -'. .. ' eo., ... _ .... ~, .. .:.._. ~ .. _. Exhibit c Janet Napolitano Joey Ridenour GOl'l::rnor A~ State '8~ ~ ~ 4747 North 7'" Street; Suite 200 PhoenixAZ 85014-3653 Phone (602) 88~-5150 Fax (602) 88~-5155 E-Mail: arizona@azbn.org Home Page: http://ww:w,azbn,org AFFIDA VIT OF CUSTODIAN OF RECORDS ExecL1li vt: Director STATE OF ARlZONA COUNTY OF MARJCOPA ~ ," .. -... ',., ~. , :-',: .~. ", -:: I, Joey Ridenour, Executive Director for tfie Arizona State Board of .' Nursing, County of Maricopa, State of Arizona, do hereby certify that I am the . .officer having the legal custody for the records hereto attached in the office of the Arizona State Board of Nursing, County of Maricopa, State of Arizona, a public office of said State. The attached copies are true copies ofthe records on KRYSTAL A BAUER Personnel ofthe Arizona State Board of Nursing prepared the records during the ordinary course of business. Witness my hand and the seal ofthe Arizona State Board of Nursing at 4747 N. 7th Street, Suite 200, Phoenix, Arizona 85020 on October 21,2008. SEAL ~ ~ IZ..'1'L (1.,11.... iMiL Joey Ridenour, R.N., M.N., FAA.N. Executive Director BEFORE THE ARIZONA STATE BOARD OF NURSING IN THE MATTER OF THE PRlVILEGE TO PRACTICE NURSING UNDER THE NURSE LlCENSURE COMPACT IN THE STATE OF ARIZONA ISSUED TO: KRYSTAL A. BAUER RESPONDENT NURSE LlCENSE NO.: RN089513; PN33809 ) ) ) ) ) ) ) ) ) ) ~ST~A~T~E~O~F_:~IO~~~I~A~ ________________ ) ORDER TO REVOKE MULTISTATE LICENSURE PIUVILEGE IN AIUZONA AND CEASE AND DESIST ORDER NO. 0712090 On .I uly 29, 200~; the Arizona State Board of Nursing ("Board" and "RenJdte State") considered the multistate licensure privilege ofIZl'ystal A. Bauer ("Respondent"). Based on the evidence before it, the Board makes the following Findings of Fact and Conclusions of Law: FINDINGS OF FACT I. Respondent holds professional nurse license no. RN089513 and practical nurse license no. PN33809, with multistate licensure privileges ("Privilege') under the Nurse Licensure Compact ("Compact"), issued by Iowa, a Compact State. 2. On or about March 2, 2005, Respondent's Iowa licenses were indefinitely suspended related to a substance abuse problem. On or about April 5, 2006, Respondent successfully completed probation with the Iowa Board of Nursing. 3. On or about December 13,2007, a complaint was received by the Board alleging that, while working on the multi-state privilege granted by her Iowa license and assigned to Batmer Thunderbird Medical Center (BTMC) through Travel Nurse Across America, Respondent had narcotics discrepancies between October 2007 at1d November 2007. Of 10 charts audited, 8 were found to be out of compliance or to contain incomplete documentation. 4. On her written response received by the Board on or about February 4,2008, Respondent explained her narcotics discrepancies were due to her "really bad habit" of taking out more medication than she was likely to. need in an eff0l1 to maintain her patients' level of comioJi. Respondent signed a statement verifying the information she provided was true, .. . complete and correct, to the best of her knowledge and belief. 5. On or about June 5, 2008, the Wisconsin Board of Nursing revoked Respondent's multi-state privilege in Wisconsin for inability to practice due to substance abuse, and ~.;. ,,·r" .1"·" LiiiaLlthol'izeil' adlfili11sttation 6fJiiedica(ioll(see'attacI1ed Exhibit Pic; incorporated herein by , reference) . 6. On or about June 30, 2008, the North Carolina B081'd of Nursing revoked Respondent's multi-state privilege to practice in NOlih Carolina due to discrepancies in Respondent's documentation and handling of controlled subst811CeS (see attached Exhibit B, incorporated herein by reference). 7. On July 29, 2008, the Board voted and ordered Respondent's privilege to practice nursing in Arizona under the Compact rules and statutes revoked. The Board fmiher ordered Respondent to cease and desist the practice of nursing in Arizona. CONCLUSIONS OF LAW Based on the above Findings of Fact, the Board has cause to revoke Respondent's privilege under the Nurse Licensure Compact to practice nursing in the State of Arizona, under A.R.S. § 32-1663 (E); A.R.S. §32-1668 Article (II) (H), Aliicle (III)(B), Micle (V)(C), and AIticle (VI)(C) of the Compact as set fOlih for unprofessional conduct as defined in AR.S. § 32- OliBHVlO::JVS . 1601(l6)(d), (£), (g), (h), and Q); and AAC. R4-19-403(B) (~~b),CI&~(a'iYjH7}?(~8), (26), and (31). I £ :ZI ~id ~Z DO 900l 2 ORDER IT lS ORDERED that Respondent's privilege to practice nursing in the Stale of Arizona is hereby REVOKED. IT IS FURTHER OJWEIZED that Respondent shall immediately cease and ciesist the practice of nursing in the State of Arizona and is not eligible to practice nursing in Arizona under the privilege of any Compact state witbout prior approval from tbe Arizona Board of Nursing. PURSUANT TO A.R.S. §41-1 092.03, any person aggrieved by this Order may apply to .. ' 111eB'oard; iil wti1ing;"within thil1y days of'receipl'ofthis'{)j'der"arrd requesra public' hearingwith'" ....... . respect to this Order. If you request a public hearing with respect to this Order, you also have the right to request an informal settlement conference by filing a written request witb the Board, .. pursuant to A.R.S. § 41-1092.06, no later than 20 days before the schedule hearing. The conference will be beld within 15 days after the receipt of your request. Please note that you waive any right to object to the participation of the Board's representative in the final administrative decision of the matter if it is 110t settled at the conference. For answers to IIII IIII IIII IIII III/ IIII IIII IIII 3 '. , questions regarding the appeals process, contact Susall Barber at (602) 889-5161. SEAL JRfSMM:slIDl1 ARIZONA STATE BOARD OF NURSING Joey Ridenour, RN., M.N., F.AAN. Executive Director Dated: July 29,2008 ;: .. "~.' .: .. ,~ •. ,: ; .... ; . . ~" .. ' .;-, t., .. " ,. ,., .," ..... .., ~', ... ,",\" .' " ,', ,", ... ",.' • L •• ·~ .••• -.... ·',t., .. ,. ,. COpy mail ed this 9'h day of September, 2008, by First Class Mail alld by Celtified Mail Receipt No. 70063450000041866004 to: Krystal A Bauer 2543 Hawley St Bettendorf, IA 52722 By: Esther Garcia 4 . r 0 ,,\(\[0 "\ ,,' '1 Z lJ' t .... !·" IS :c. MJ ,----------------------- ~~-------- -------- ..• . l '.'", ~ ..... " .". -'" Exhibit D !-----------------------------,----------- Jim Doyle Governor Celia M. Jackson Secretary WISCONSIN DEPARTMENT OF REGULATION & LICENSING CERTIFICATE 1400 E Washington Ave PO Box 8935 Madison WI 53708-8935 Email: web@drl.state.wi.us Voice: 608-266-2112 FAX: 608-26}-0644 ny: 608-267-2416 I, Jeff Scanlan, Bureau Director, Bureau of Health Services, Wisconsin Department of Regulatiori and Licensing and the legal deputy custodian of records-{G'Hhe· B()ard'ok~' Nursing, do hereby certify that the documents annexed hereto have'been-·cohlpafecj-by~ .. "' .. · me with the originals filed in the office of the Wisconsin Board of Nursing and that the annexed documents are true and correct copies thereof. Dated in Madison, Wisconsin this 2th day of July 2009. BOARD OF NURSING Bureau Director Bureau of Health Professions SEAL STATE OF WISCONSIN BEFORE THE BOARD OF NURSING IN THE MA TIER OF THE DISCIPLINARY PROCEEDINGS AGAINST KRYSTALA BAUER, R.N., RESPONDENT. ,':' FINAL DECISION AND ORDER LS 0 I? 0 r.r, 0 <; Y- NUR Division of Enforcement Case # 07 NUR 448 The parties to this action for the purposes of Wis. Stat. § 227.53 are: ., ..... , '~-!'f""""""""-; r,o;-' P.'·-' Krystal A. Bauer, R.N. '.l%3C_;:r\.J.:'''~,,--.'''_'_" .. :.', .. ~,'.,-- • ", "._ .. _. ,,"'...., '. ..,~;"' ..... ::_: :'.,,_, ;" .. 7. . Vlhell .qll~~t.iol).xd.ajJqut the posltivemorphine reslllt, Respondent admitted to .11 Medical Review Officer that she had given herself an irljection that was intended for a patient. 8. An audit of Respondent's Pyxis access showed excessive access of medication ,with minimal or no documentation of having given the medication to patients, including; Temazepam, morphine, Fentanyl, and Hydrocodone/Acetaminophen. CONCLUSIONS OF LAW 1. The Wisconsin Board of Nursing has jurisdiction over tlus matter .pursuant to Wis. Stat. § 441:07 and 441.S0(3)(b) and (c), and has authority to enter into this stipulated resolution of this matter pursuant to Wis. Stat. § 227.44(5). 2. The conduct set forth in paragraphs 4 - 8. above constitutes a violation of Wis. Admin. Code § N 7.03(2) and N 7.04(2), and subjects Respondent to discipline pursuant to Wis. Stat. § 441.07(1)(c) and (d). . ORDER IT IS ORDERED; 1. The privilege of Respondent Krystal A. Bauer, R.N., to practice as a. nurse in the State of Wisconsin pursuant to the multi-state nurse licensure compact is REVOKED 2. In the event Respondent applies fOL_Wisconsin licensure as a nurse, the Board may issue a limited license based on the facts set out in the Final Decision and Order, or may deny that application, in its discretion, without further notice or hearing. Respotident expressly waives all rights to a hearing on any such denial or limitation. 3. Respondent shall, within 90 days of the date of this Order, pay to the Department of Regulation and Licensing costs of this proceeding in the amount of One Hundred Dollars ($100.00) pursllant to Wis. Stat. § 440.22(2). 4. Payment shall be mailed or delivered to; Department Monitor Department of Regulation and Licensing 4 I ' - ~----~~--------------------, STATE OF WISCONSIN BEFORE THE BOARD OF NURSING IN THE MATTER OF DISCIPLINARY PROCEEDINGS AGAINST STIPULATION KRYSTALA. BAUER, R.N. LS' b 8' DCe, OS-~UR RESPONDENT. Division of Enforcement Case # 07 NUR 448 Krystal A. Bauer, R.N., personally on her own behalf; and Jeanette Lytle, attorney for the Department of Regulation and Licensing, Division of Enforcement, stipulate: .. ' . . -. ." .. --. ~ .. ". .- - 1. This Stipulation is entered into as a result of a pending investigation of Respondent's practice in Wisconsin .pursuant to the multi-state nurse licensure compact (case # 07 NUR 448). Respondent consents to the resolution of this investigation by stipulation. 2. Respondent understands that by signing this Stipulation she voluntarily ana knowingly waives her rights, including: the right to a hearing on the allegations against her, at which time the state has the burden of proving those allegations by a preponderance of the evidence(the right to confront and cross-examine the witnesses against her; t.':le right to call witnesses on her behalf and to compd their attendance by subpoena; the right to testify herself; the right to file obj ections to any proposed decision and to present briefs or oral arguments to the officials who are to [(mder the fmaldecision; the right to .petition for rehearing; and all other applicable rights afforded to her under the United States Constitution, the Wisconsin Constitution, the Wisconsin Statutes, the Wisconsin Administrative Code, und any other provisions of state or federal law. 3. Respondent has had the opportunity to obtain the advice oflegal counsel prior to signing this stipulation. 4. Respondent agrees to the revocation of her privilege to practice as a nurse in Wisconsin pursuant to the multi-state nurse licensure compact. In the event that Respondent applies for Wisconsin licensure as a nurse, the Board may issue a limited license based on the facts set out in the Final Decision and Order, or may deny that application, in its discretion, without fUlther notice or hearing. Respondent expressly waives all rights to a' hearing on any such denial or limitation. 5. Respondent agrees to the adoption of the attached Final Decision and Order by the Board of Nursing. The parties to the Stipulation consent to the entry of t1.:le a:ttached Fill~l Decision and Order without further notice, pleading, appearance or consent of the parties. Respondent waives all rights to any appeal of the Board's order, if adopted in the fann us attached. 6. If the terms of this Stipulation are not acceptable to the Board, the parties shall not be bound by the contents of this Stipulation, and the matter shall be returned to the Division of \ Enforcement for further proceedings. In the event that this Stipulation is not aocepted by the Board, the parties agree not to contend that the Board has been prejudiced or biased in any' manner by consideration of this attempted resolution. 7. The parties to this Stipulation agree that the attorney or other agent for the Division of Enforcement and any member of the Board of Nursing ever assigned as an advisor in, this investigation may ,appear before the Board in open or closed session, witho.ul the.presence of the Respondent or her attorney, for purposes of speaking in support of this agreement and answering questions that any member of the Board may have in connection with the Board's deliberations on the Stipulation. Additionally, any such Board advisor may vote on whether the Board should accept this Stipulation and issue the attached Final Decision and Order. 8. Respondent is informed that should the Board adopt this Stipulation, the Board's final decision and order is a public record and will be published in accordance with standard Department prosedure. 9. The Division of Enforcement Joins'Respondent in recommending the Boara ad-opt this Stipulation and issue the attached Final Decision and Order. Date 2 In the matter of BEFORE THE NORTH CAROLINA BOARD OF NURSING OF THE STATE OF NORTH CAROLINA Krystal A. Bauer, Registered Nurse ORDER TO REVOKE PRIVILEGE TO PRACTICE Certificate # 089513 Pursuant to the authority vested by Article 9A, Chapter 90 of the General Statutes of North Carolina and Article 3A of Chapter 150B-38 of the General Statutes of North Carolina, the North Carolina Board of Nursing (hereafter referred to as the Board) revokes the Registered Nurse privilege to practice as granted by the Nurse Licensure Compact of Krystal A. Bauer for violation of the North Carolina Nursing Practice Act. 1) Krystal A. Bauer is the holder of Registered Nurse Certificate # 89513 which was issued by the state of Iowa. Her license has an expiration date of 08/15/2009. 2) Ms. Bauer was assigned to work at the Pitt County Memorial Hospital in Greenville, North Carolina from Invictus Medical Solutions, a traveler staffing agency, working on her privilege to practice as granted through the Nurse Licensure Compact. By agreeing to work on her privilege to practice as granted through the Nurse Licensure Compact, the licensee agreed to comply with all the laws, rules and regulations of practice promulgated by the Boards in the party states in which she chose to practice. 3) Ms. Bauer was assigned to work at the Pitt County Memorial Hospital from May 27, 2008 until her termination on June 11, 2008. During her shift on June 10 and June 11, 2008 discrepancies were identified in her documentation and handling of controlled substances. When confronted by Risk Management, Ms. Bauer admitted to using narcotics on duty. 4) Prior to the investigation being conducted regarding the situation at the Pitt County Memorial Hospital, the North Carolina Board of Nursing received information that in December 2007, while Ms. Bauer was assigned to the Banner Thunderbird Medical Center in Glendale, Arizona, working on her privilege to practice, she was caught diverting Morphine. Action is pending in that jurisdiction. 5) Additionally, the North Carolina Board of Nursing learned that on or about December 7,2007 while Ms. Bauer was assigned to work the night shift at St. Claire's Hospital in Weston, Wisconsin, she was observed removing a large quantity of Morphine from the Pyxis. An investigation into that matter led to a urine drug screen being obtained from Ms. Bauer, which was positive for Morphine. Ms. Bauer admitted to the Medical Review Officer (MRO) that she had given herself an injection that was intended for a patient. 6) The accountability audit conducted at S1. Claire's Hospital in Weston, Wisconsin regarding her removals of narcotics for the Pyxis also showed discrepancies with Temazepam, Fentanyl and Hydrocodone. Page 1 of 5 BEFORE THE NORTH CAROLINA BOARD OF NURSING OF THE STATE OF NORTH CAROLINA In the matter of Krystal A. Bauer, Registered Nurse ORDER TO REVOKE PRIVILEGE TO PRACTICE Certificate # 089513 7) On April 15, 2008 Ms. Bauer signed a Stipulation with the Wisconsin Board of Nursing agreeing to the revocation of her privilege to practice. The Final Decision and Order was entered by the Wisconsin Board of Nursing on June 5, 2008 was revoking Ms. Bower's privilege to practice as granted through the Nurse Licensure Compact. 8) This is not the first time Ms. Bauer has been the subject of disciplinary action. On March 2, 2005, and Order was entered by the Iowa Board of Nursing indefinitely suspending Ms. Bauer's license to practice in Iowa related to a substance abuse problem. Her license was indefinitely suspended until she completed a chemical dependency evaluation and could document 12 months of sobriety. Following this, she was on 12 months probation. Ms. Bauer completed her requirements and has an active Registered Nurse license in Iowa effective until August 15, 2009. 9) The information obtained in this matter suggests Ms. Bauer has an ongoing pattern and practice of the diversion and that she has a substance abuse problem; and therefore, cannot be reasonably expected to provide safe incompetent care at this time. The investigation determined the licensee has violated G.S. 90-171.37 (3) (4) (5) (6) (7) (8) and 21 NCAC 36.0217(c ) (1) (2) (11) (21) (22). 10) Therefore, the privilege to practice as granted through the Nurse Licensure Compact for Krystal A. Bauer is hereby REVOKED, and the licensee must immediately CEASE AND DESIST from the practice of nursing in North Carolina. 11) In accordance with Chapter 150B of the General Statutes, the licensee is entitled to a "Show Cause" Hearing before a majority of the members of the Board to determine why the Board should not take further action because of the licensee's failure to comply with the probationary conditions, including imposing further discipline. 12) The licensee is entitled to be represented by counsel and to present evidence and witnesses/testimony on the licensee's behalf. 13) Pursuant to North Carolina General Statute Section 150B-40(d), the licensee may not communicate, directly or indirectly, with any individual member of the Board about this matter. If the licensee or legal representative has questions, they should contact Donna H. Mooney, RN, MBA, Manager for Discipline Proceedings. 14) If the licensee is disputing the fact that the violations as alleged did occur, the licensee must file a written objection with the Board within ten (10) working days of the date of the notice of violations to Krystal A. Bauer. The notice must contain with specificity the violations being disputed. 15) When the licensee has properly filed notice of objections with the Board, then the licensee will be notified of the exact date and time for the "Show Cause" Hearing. The Hearing will Page 2 of 5 In the matter of BEFORE THE NORTH CAROLINA BOARD OF NURSING OF THE STATE OF NORTH CAROLINA Krystal A. Bauer, Registered Nurse ORDER TO REVOKE PRIVILEGE TO PRACTICE Certificate # 089513 be held at the next scheduled Board meeting for which appropriate notice can be provided, or scheduled by consent of the parties. 16) Failure to return the written objection within the designated time period will be construed to mean the licensee is not contesting the matter and all further proceedings to which the licensee is otherwise entitled by law are hereby waived. 17) The license will then remain revoked until the licensee requests in writing the opportunity to appear before the Licensure Committee to petition for issuance of a license to practice in North Carolina. 18) This ORDER to REVOKE will be placed in the licensee's file and becomes a public record pursuant to the North Carolina Public Record Statute G.S. Chapter 132 and Board policy. 19) By not contesting the violations contained in this ORDER, the licensee is waiving the rights to a "Show Cause" Hearing, to challenge the validity of this ORDER and to any further proceedings to which the licensee may be entitled by law. 20) By contesting the violations contained in this ORDER. the licensee is requesting a "Show Cause" Hearing to be scheduled before a majority of the members of the Board. 21) The licensee understands that a written objection with the specific violations/charges being disputed must be received within 10 business days of the date of this notice. 22) The subject of the "Show Cause' Hearing shall be limited to the specific reasons for which the probationary license was suspended/revoked. 23) When the licensee has properly filed notice of objection with the Board, then the Licensee will be provided a Hearing before the Board at the next scheduled Board meeting for which appropriate notice can be provided, or scheduled by consent of the parties. 24) In accordance with G.S. 90-171.27 (d) and Board policy derived therefrom, a fee may be assessed for disciplinary matters. A "Show Cause" Hearing is considered a diSCipline matter. FAILURE TO RETURN THE ATTACHED PAGE WITHIN 10 BUSINESS DAYS WILL RESULT IN THE LICENSEE WAIVING ALL RIGHTS TO CHALLENGE THE VALIDITY OF THIS ORDER OR TO ANY OTHER PROCEEDINGS TO WHICH THE LICENSEE MAY OTHERWISE BE ENTITLED BY LAW. Page 3 of 5 In the matter of BEFORE THE NORTH CAROLINA BOARD OF NURSING OF THE STATE OF NORTH CAROLINA Krystal A. Bauer, Registered Nurse ORDER TO REVOKE PRIVILEGE TO PRACTICE Certificate # 089513 This the 30th day of June, 2008 Mary P. Johnson, RN, MSN, FAAN Executive Director North Carolina Board of Nursing Page 4 of 5 BEFORE THE NORTH CAROLINA BOARD OF NURSING OF THE STATE OF NORTH CAROLINA In the matter of KrystalA. Bauer, Registered Nurse ORDER TO REVOKE PRIVILEGE TO PRACTICE Certificate # 089513 Krystal A. Bauer PLEASE RETURN THIS PAGE COMPLETED WITHIN 10 BUSINESS DAYS. Initial the appropriate response, date and sign the document and return to Donna Mooney, RN, ManagerlDiscipline Proceedings LICENSEE'S NAME DATE I do not contest the information reported as violations of the NPA and I do not wish to have a "Show Cause" Hearing. I am requesting a "Show Cause" Hearing. Attached is my written objection with the specific violations/charges I am disputing. The subject of the "Show Cause" Hearing shall be limited to the specific reasons for which the Temporary license was suspended/revoked. Page 5 of 5 January 2008 MULTI-STATE NURSE LICENSURE In 2005, the Ohio Board of Nursing (Board) examined issues and learned about the experience of some Compact states participating in multi-state licensure. Although the Board recognized that multi-state nurse licensure could be advantageous for occupational health nurses, traveling nurses, or employers, the Board discussed that potential risks of harm to the public outweigh the potential benefits. With multi-state licensure, nurses could be practicing in Ohio when they have not been held to the same standards of safe practice that Ohio has deemed important for public safety. For example, Ohio requires criminal records checks for licensure, but not all Compact states have the same requirement. Also, Ohio statute specifies that there are absolute bars to licensure. If an applicant has been convicted of certain crimes such as Murder and Rape, among others, the applicant cannot be considered for licensure in Ohio. The majority of Compact states either do not bar violent felonies, or impose only time-limited, rather than absolute, bars to licensure. Also in 2005, the Board reviewed the actual experience of other states and identified the potential impact of multi-state licensure on public safety. We were advised of nurses with multi- state licenses relocating to states as soon as they find themselves under investigation in their home state. While in theory, the home state would immediately report the investigation to the next state, the reality is neither state may learn of the relocation for a significant period of time. Furthermore, not all states have laws like that in Ohio permitting sharing of investigative information with other governmental entities. In addition, when the nurse moves to another state, the home state does not always continue its investigation. This means that Ohio would not receive vital information unless Ohio attempted to conduct an out-of-state investigation and this is not realistic. In fact, it is unclear whether Ohio would have the ability to compel the production of out-of-state documents or witnesses necessary to prepare a case. These are just some examples of issues that nursing boards across the country are attempting to address. On September 16, 2005, the Board voted to delay action seeking the introduction of interstate compact legislation until such time more information is gathered to assure that the benefits of multi-state licensure outweigh any risks related to public safety. During 2006, the Board discussed multi-state licensure at numerous meetings and also worked at the national level to address Ohio’s concerns. In 2007, the Board continued to be concerned about the differences in licensure standards between states and specifically about criminal convictions. While the Compact states are being encouraged to implement criminal records checks for licensure, Compact states have not been uniformly successful in enacting the requirement. At this time, the Board continues to believe the potential risks of harm to the public outweigh the potential benefits because nurses with multi-state licenses could practice in Ohio without meeting the current statutory and regulatory standards established by the General Assembly and the Board to protect the public. The Board continues to address these issues at the national level through the National Council of State Boards of Nursing. WISCONSIN DEPARTMENT OF REGULATION & LICENSING Wisconsin Department of Regulation & Licensing Access to the Public Records of the Reports of Decisions This Reports of Decisions document was retrieved from the Wisconsin Department of Regulation & Licensing website. These records are open to public view under Wisconsin’s Open Records law, sections 19.31-19.39 Wisconsin Statutes. Please read this agreement prior to viewing the Decision: The Reports of Decisions is designed to contain copies of all orders issued by credentialing authorities within the Department of Regulation and Licensing from November, 1998 to the present. In addition, many but not all orders for the time period between 1977 and November, 1998 are posted. Not all orders issued by a credentialing authority constitute a formal disciplinary action. Reports of Decisions contains information as it exists at a specific point in time in the Department of Regulation and Licensing data base. Because this data base changes constantly, the Department is not responsible for subsequent entries that update, correct or delete data. The Department is not responsible for notifying prior requesters of updates, modifications, corrections or deletions. All users have the responsibility to determine whether information obtained from this site is still accurate, current and complete. There may be discrepancies between the online copies and the original document. Original documents should be consulted as the definitive representation of the order's content. Copies of original orders may be obtained by mailing requests to the Department of Regulation and Licensing, PO Box 8935, Madison, WI 53708-8935. The Department charges copying fees. All requests must cite the case number, the date of the order, and respondent's name as it appears on the order. Reported decisions may have an appeal pending, and discipline may be stayed during the appeal. Information about the current status of a credential issued by the Department of Regulation and Licensing is shown on the Department's Web Site under “License Lookup.” The status of an appeal may be found on court access websites at: http://ccap.courts.state.wi.us/InternetCourtAccess and http://www.courts.state.wi.us/wscca . Records not open to public inspection by statute are not contained on this website. By viewing this document, you have read the above and agree to the use of the Reports of Decisions subject to the above terms, and that you understand the limitations of this on-line database. Correcting information on the DRL website: An individual who believes that information on the website is inaccurate may contact the webmaster at web@drl.state.wi.gov STATE OF WISCONSIN BEFORE THE BOARD OF NURSING _____________________________________________________________________________ IN THE MATTER OF THE DISCIPLINARY : PROCEEDINGS AGAINST : : FINAL DECISION AND ORDER KRYSTAL A. BAUER, R.N., : LS0806054NUR RESPONDENT. : _____________________________________________________________________________ Division of Enforcement Case # 07 NUR 448 The parties to this action for the purposes of Wis. Stat. § 227.53 are: Krystal A. Bauer, R.N. 3363 Winston Drive Bettendorf, IA 52722 Division of Enforcement Department of Regulation and Licensing 1400 East Washington Avenue P.O. Box 8935 Madison, WI 53708-8935 Wisconsin Board of Nursing Department of Regulation and Licensing 1400 East Washington Avenue P.O. Box 8935 Madison, WI 53708-8935 PROCEDURAL HISTORY The parties in this matter agree to the terms and conditions of the attached Stipulation as the final decision of this matter, subject to the approval of the Board of Nursing. The Board has reviewed this Stipulation and considers it acceptable. Accordingly, the Board in this matter adopts the attached Stipulation and makes the following: FINDINGS OF FACT 1. Krystal A. Bauer, R.N., is licensed as a registered nurse by the State of Iowa (license number 089513). The effective date of her license was August 16, 2006, and it expires on August 15, 2009. Respondent’s last known address is 3363 Winston Drive, Bettendorf, IA, 52722. 2. At all relevant times, Respondent was working as a registered nurse in Wisconsin pursuant to the multi-state nurse licensure compact, under her Iowa license. Wisconsin (pursuant to Wis. Stat. § 441.50) and Iowa are party states of the compact, which provides for multi-state licensure privileges and allows a nurse with a license from a “home state” to engage in the practice of nursing in all other party states, which are called “remote states.” 3. At all relevant times, Respondent was employed by Travel Nurse across American, LLC, who subcontracted to Cross Country Staffing, who placed her at Saint Claire’s Hospital in Weston, Wisconsin. 4. On or about December 7, 2007, Respondent was assigned to work the night shift at Saint Claire’s Hospital. During her shift, she was observed removing a large quantity of morphine from a Pyxis machine. Further investigation showed that Respondent had removed 20 mg of morphine, while her patient had orders for 2-4 mg every 2-4 hours. When confronted, Respondent stated that she had taken out the large does of morphine so that she would not have to keep re- entering the Pyxis machine. 5. Respondent agreed to take a drug test at the end of her shift. She told the nursing supervisor that her test may be positive, as she had taken Vicodin the previous day for menstrual cramps, from a friend’s prescription. 6. Respondent’s test was positive for morphine. 7. When questioned about the positive morphine result, Respondent admitted to a Medical Review Officer that she had given herself an injection that was intended for a patient. 8. An audit of Respondent’s Pyxis access showed excessive access of medication with minimal or no documentation of having given the medication to patients, including: Temazepam, morphine, Fentanyl, and Hydrocodone/Acetaminophen. CONCLUSIONS OF LAW 1. The Wisconsin Board of Nursing has jurisdiction over this matter pursuant to Wis. Stat. § 441.07 and 441.50(3)(b) and (c), and has authority to enter into this stipulated resolution of this matter pursuant to Wis. Stat. § 227.44(5). 2. The conduct set forth in paragraphs 4 – 8 above constitutes a violation of Wis. Admin. Code § N 7.03(2) and N 7.04(2), and subjects Respondent to discipline pursuant to Wis. Stat. § 441.07(1)(c) and (d). ORDER IT IS ORDERED: 1. The privilege of Respondent Krystal A. Bauer, R.N., to practice as a nurse in the State of Wisconsin pursuant to the multi-state nurse licensure compact is REVOKED 2. In the event Respondent applies for Wisconsin licensure as a nurse, the Board may issue a limited license based on the facts set out in the Final Decision and Order, or may deny that application, in its discretion, without further notice or hearing. Respondent expressly waives all rights to a hearing on any such denial or limitation. 3. Respondent shall, within 90 days of the date of this Order, pay to the Department of Regulation and Licensing costs of this proceeding in the amount of One Hundred Dollars ($100.00) pursuant to Wis. Stat. § 440.22(2). 4. Payment shall be mailed or delivered to: Department Monitor Department of Regulation and Licensing Division of Enforcement 1400 East Washington Ave. P.O. Box 8935 Madison, WI 53708-8935 Fax (608) 266-2264 Telephone (608) 267-3817 5. This Order is effective on the date of its signing. Wisconsin Board of Nursing By: Kathleen Sullivan 6/508 A Member of the Board Date STATE OF WISCONSIN BEFORE THE BOARD OF NURSING IN THE MATTER OF : DISCIPLINARY PROCEEDINGS AGAINST : : STIPULATION KRYSTAL A. BAUER, R.N. : LS __________ NUR RESPONDENT. : Division of Enforcement Case # 07 NUR 448 Krystal A. Bauer, R.N., personally on her own behalf; and Jeanette Lytle, attorney for the Department of Regulation and Licensing, Division of Enforcement, stipulate: 1. This Stipulation is entered into as a result of a pending investigation of Respondent's practice in Wisconsin pursuant to the multi-state nurse licensure compact (case # 07 NUR 448). Respondent consents to the resolution of this investigation by stipulation. 2. Respondent understands that by signing this Stipulation she voluntarily and knowingly waives her rights, including: the right to a hearing on the allegations against her, at which time the state has the burden of proving those allegations by a preponderance of the evidence; the right to confront and cross-examine the witnesses against her; the right to call witnesses on her behalf and to compel their attendance by subpoena; the right to testify herself; the right to file objections to any proposed decision and to present briefs or oral arguments to the officials who are to render the final decision; the right to petition for rehearing; and all other applicable rights afforded to her under the United States Constitution, the Wisconsin Constitution, the Wisconsin Statutes, the Wisconsin Administrative Code, and any other provisions of state or federal law. 3. Respondent has had the opportunity to obtain the advice of legal counsel prior to signing this stipulation. 4. Respondent agrees to the revocation of her privilege to practice as a nurse in Wisconsin pursuant to the multi- state nurse licensure compact. In the event that Respondent applies for Wisconsin licensure as a nurse, the Board may issue a limited license based on the facts set out in the Final Decision and Order, or may deny that application, in its discretion, without further notice or hearing. Respondent expressly waives all rights to a hearing on any such denial or limitation. 5. Respondent agrees to the adoption of the attached Final Decision and Order by the Board of Nursing. The parties to the Stipulation consent to the entry of the attached Final Decision and Order without further notice, pleading, appearance or consent of the parties. Respondent waives all rights to any appeal of the Board's order, if adopted in the form as attached. 6. If the terms of this Stipulation are not acceptable to the Board, the parties shall not be bound by the contents of this Stipulation, and the matter shall be returned to the Division of Enforcement for further proceedings. In the event that this Stipulation is not accepted by the Board, the parties agree not to contend that the Board has been prejudiced or biased in any manner by consideration of this attempted resolution. 7. The parties to this Stipulation agree that the attorney or other agent for the Division of Enforcement and any member of the Board of Nursing ever assigned as an advisor in this investigation may appear before the Board in open or closed session, without the presence of the Respondent or her attorney, for purposes of speaking in support of this agreement and answering questions that any member of the Board may have in connection with the Board’s deliberations on the Stipulation. Additionally, any such Board advisor may vote on whether the Board should accept this Stipulation and issue the attached Final Decision and Order. 8. Respondent is informed that should the Board adopt this Stipulation, the Board’s final decision and order is a public record and will be published in accordance with standard Department procedure. 9. The Division of Enforcement joins Respondent in recommending the Board adopt this Stipulation and issue the attached Final Decision and Order. _________________________________ _______________________________ Krystal A. Bauer, R.N. Date 3363 Winston Drive Bettendorf, IA 52722 _________________________________ _______________________________ Jeanette Lytle, Attorney Date Division of Enforcement Wisconsin Department of Regulation and Licensing P.O. Box 8935 Madison, WI 53708-8935 m ; I<'ORE TIlE ARIZONA STATE BOARD OF NURSING IN THE MAlTER UF THE I'RIVILEGE TO PRA C1"lCE NURSINO UNDER THE NURSE LICENSURE COMPACT TN HIE STATE OF ARIZONA ISSUED TO: THERESE MORGAN RESPONDENT NURSE LICENSENQ,: RI 67611 ) ) ) ) ) ) ) ) ) .!i:ST!JA~TEl!!JO!!F::" MA!!!!ll!RrYLA~N~D~ ______ ) OKOI£R TO REVOKE MULTISTATE UCENSURE PRIVILEGE IN ARIZONA AND CEASE AND DESIST ORDER NO. 0801087 On November 19,2008. the Arizona State Board of Nursing ("Board'') and ("Remote State") considered the multislate licensufC privilcgc ofThcfCsc Morgan, ("Privilege Holder'') and ("Respondent"). Based on the evidence before it, the Board makes the following Findings of Fact and Conclusions of Law: FINDINGS OF FAIT I. Respondent holds professional nurse licensure, with multiSlate licensure privileges ("Privilege") under the Nurse Licensure Compact ("Compact"), issued by Maryland, a Compact State. 2. From on or about February 27,2007 until March 13,2007 Respondcnt was employed at Banner Health System in Phoenix, Ari zona. 3. On or about March 13.2007 Respondent was !erminated for uo callfno show for two days. Respondcnt inlonncd Board starr ~hc had resilj.ncd and was mu tcnninalcd. 4. rrolll on or abou t March 200"1 , until April 2007 l{t:spondCnl was employed by PPI{ Healthcare Travel in Jacksonville, Florida. I ; I i 5. On or about April 12, 2007 Respondent was assigned 10 work at Correctional 11 calth Services (CHS) and her Inlvel contract was Icnninalcd for misconduct. According 10 the counseling, Respondent had been a problem from the first day and thi s was the third assignment she had been terminated from. 6. From on or about April 17,2007 unli l June 2007 Re. ~ pondenl WIIll employed by Supplemental Health Care in Park City, Utah. 7. On or about April 17.2007 Re spondent was terminated from Banner Thunderbird Hospi tal fur unsuccessful orientation. Respondent lold Board staff s.he had n:sign«l and W!I.'l not terminated. 8. From on or about May 14,2007 until lunc 27, 2007, Respondent was assigned by Supplcmenlall-lealth Care to work at Boswell H0.5pital in Sun City, A ri7.onll. 9. On or aboutlune 25, 2007 Responde nt called II physician because the pat ient cou ld not void lifter Respondent removed the fo ley catheter. The physician infooned Respondent to follow his written orders which were to catheterize the patient ie the patient was unable to void . The next morning when the physic ian visited the patien t, she was crying and told him "Respondent h~tes me." The patient was afraid to ask Responden t for any assistance. The phys icia n requested that Respondent not care for hi s patient A se<:ond physician fo und hi s patients dressing salurntcd. Thr patient had a drain and thc doctor nskcd why no nurse had cht'Cked the patient for drainage. 10. From on or about September 12,2007 until December 13, 2007 Respondent was employed at Mountain Vista Medical Center in Mesa, Arizona. II . On or about November 21,2007 Respondent was infonncd she should have 00 further contllCl with a particular patient. Darron Boc k and Cyndy Crownover supervisory staff 2 wen l lO thc Gero-psych unil to speak with Respondent. On approaching her desk Respondent held up a sign Ihal read "subtl e racism stops with m e . ~ Crownover sa id when patients had problems with the nurse, the besl thing to do was to reassign the patient. Morgan was issued a Notice ofCorreclive Aclion on or aboul November 2 1,2007 which included lhe following: • Infonned by Sue Davidson Intcrim Director not to assume the care of a particular palient due to complaint from the patient and family. Respondent defied the reque~t and assigned heTllClfto the patient the followin g day. Whcn asked 10 change the assignment by the house supervisor, Respondenllold her she could take cure Oflhc pat ient hersclf. • rina! counselin~ stating Rc ~pondcnl must accept and agree 10 changcs in order to continue her employment. 12. On or about December 13,2007 Respondent was counseled rcgaroing the CM e of patient 1. Il. According 10 the co unseling 1. B. was on a cel! phone speaking with her son M. R Respondent took the cell phone and lold 1.B. that cell phones were not allowed in the facility. Respondent spoke with M. R , on the cell phone. Respondent told M. B. he was lying to hi s mother J,B. and that J,B. did not need 10 be in an independent living environment and Respondent hung up. According to M.B., J.B. had a diagnosis of Borderline Personali ty Disorder (BPD) and he was making arrangements for long tenn placement for 1.B. M.B. believes Respondent callscd J.B. irreversible damage. M. B. was infonned by Respondents' supervisors that she would not br assigned to Cnl~ for J.B. again. 13. On or about [)ecember 13.2007 Rt:spondt:m wa~ tt:rmimlled from Mounta;" VIsta Medical Center for unsuccessful performance. 3 14. On November 19,2008 the Board voted and ordered Respondent's privilege to practice nursing in Arizona under the Compact rules and statutes revoked. The Board further ordered Respondent to ccase and desist the practice of nursing in Arizona. CONCLUSIONS OF LAW Based on the above Findings of Fact. the Board has cause to revoke Respondent's privilege under the Nun;c Licensure Compact to practice nursing in the State of Ari7..ona, under A.K.S . § 32· 1663 (E); A.R.S. §32-1668 Article (II) (H), Article (lIl)(B), and Article (V) (C) of the Compact as set forth for unprofessional conduct as defined in AR.s. § 32-1601 (16) (d) and (j) and AA.C. R4-l9-40J (13) (1), (2), (9), and (31); (adopted effective November 13, 2005). IT IS ORDERED that Respondellt·s privilege to practice nursing in the State of Arizona is hereby REVOKED. IT IS FURTHER ORDERED that Respondent shall immediately ccase and desist the practice of nursing in the State of Arizona and is not eligible to pmctice nursing in Ariwna under the privilcge of any Compact state without prior approval from the Arizona Board of Nursing. PURSUANT TO A.R.S. §41-I092.03 . any person aggrieved by this Ordcr may apply to the Boord., in writing, within thirty days of receipt ofthis Order and request 11 public hearing with respect to this Order. lfyou request a public hearing with respect to this Order, you also have the right to reque~t an informal settlement conference by filing a written requcst with the Board, pursuant to A.R.S. § 41-1092.06, no laK'!" than 20 days before the schooule heuring. The 4 conference will be held wilhin 15 days after the re<:eipt of your ~uest . Please note th:lt you waive 3I\y right to object to the participation of the Board's representative in the linal administrntive decision of the matter if it is not settled at the conference. For answers 10 questions regarding the appeals process, contoct Susan Barber at (602) 889-5 16 1. SEAL JR/SRT:ts ARIWNA STATE 1l0AR.D OF NURSING Joey Ridenour, R.N., M.N., F.A. A.N . Executi ve Director Dated: November 19,2008 COPY mai led this 4111 day of December, 2008, by Fitst Class Mail and by Certified Mail Receipt No. 70030500000358144853, to: Therese Morgan 575 Jefferson Street /1 13 Hutch inson, MN 55626 AND COPY mailed this 4111 day of December. 2008. by Fitst Class Mai l and by Cert ified Mail Receipt No. 70030500000358144860.10: Thcll:sc Morgan 600 Arbor Terrnce Drive. #203 Frederick, MD 2 1703 fly: Trin!! Smith Lega l Secretary 5 BEFORE THE TEXAS BOARD OF NURSING ********************************************** In the Matter of § AGREED Registered Nurse License Number 624978 § issued to STEPHEN ALEXANDER WOODFIN § ORDER On this day the Texas Board of Nursing, hereinafter referred to as the Board, considered the matter of STEPHEN ALEXANDER WOODFIN, Registered Nurse License Number 624978, hereinafter referred to as Respondent. Information received by the Board produced evidence that Respondent may have violated Section 301.452(b)(2),(8),(9),(lO)&(12), Texas Occupations Code. Respondent waived representation by counsel, informal conference, notice and hearing, and agreed to the entry of this Order offered on June 20, 2008, by Katherine A. Thomas, MN, RN, Executive Director, subject to ratification by the Board. FINDINGS OF FACT 1. Prior to the institution of Agency proceedings, notice ofthe matters specified below in these Findings of Fact was served on Respondent and Respondent was given an opportunity to show compliance with all requirements of the law for retention of the license. 2. Respondent waived representation by counsel, informal conference, notice and hearing, and agreed to the entry of this Order. 3. Respondent is currently licensed to practice professional nursing in the State of Texas. 4. Respondent received a Baccalaureate Degree in Nursing from Texas Tech University, Lubbock, Texas, on December 1, 1995. Respondent was licensed to practice professional nursing in the State of Texas on January 23, 1996. Respondent received a Masters Degree in Nurse Anesthesia from Texas Wesleyan University, Fort Worth, Texas, on December 1, 2001. Respondent was authorized to practice as a Nurse Anesthetist by the Board of Nurse Examiners for the State of Texas on August 26,2004. 624978:133 - 2 - 5. Respondent's professional nursing employment history includes: 01196 - 1998 1999 - 01/02 02/02 - 06/04 07/04 - 01105 02/05 - 08/06 09/06 - 09/07 10107 - 11107 12/07 - present RN Unknown Staff Nurse Staff Nursel Anesthetist Unknown Staff Nurse Anesthetist Unknown University medical Center Lubbock, Texas St. Joseph's Hospital Asheville, North Carolina Parkland Memorial Hospital Dallas, Texas UTMB Galveston Galveston, Texas Baptist St. Anthony'sl Amarillo Anesthesia Consultants Amarillo, Texas 6. On or about January 13,2006, Respondent's consent to the surrender of his licensel privilege to practice professional nursing in the State of North Carolina for a minimum of one (1) year was accepted by the North Carolina Board of Nursing , Raleigh, North Carolina. The consent was based in part, on Respondent's lack of fitness and admission of a substance abuse issue. A copy of the Consent to Surrender LicenselPrivilege to Practice dated January 13, 2006, is attached and incorporated, by reference, as part of this Order. 7. On or about June 6, 2006, Respondent engaged in the intemperate and/or unlawful use of Tramodol in that he produced a specimen for a drug screen which resulted positive for Tramadol. Possession ofTramadol, without a valid prescription is prohibited by Chapter 483 of the Texas Health & Safety Code (Dangerous Drugs Act). The use of Tramadol by a Registered Nurse, while subject to call or duty, could impair the nurse's ability to recognize subtle signs, symptoms or changes in the patient's condition, and could impair the nurse's ability to make rational, accurate, and appropriate assessments, judgments, and decisions regarding patient care, thereby placing the patient in potential danger. 8. On or about November 19, 2007, while employed as a CNRA at Amarillo Anesthesia Consultants/Baptist St. Anthony's Hospital, Amarillo, Texas, Respondent may have lacked fitness to practice professional nursing in that he was observed exhibiting impaired behavior including, but not limited to; passed out in the operating room during a case, dazed and 624978:133 - 3 - incoherent appearance, and no physical response to external stimuli. Re,spondent was also observed to be bleeding from his antecubital region. Respondent's condition could have affected his ability to recognize subtle signs, symptoms or changes in the patients' conditions, and could have affected his ability to make rational, accurate, and appropriate assessments, judgments, and decisions regarding patient care, thereby placing the patient in potential danger. 9. On or about November 19, 2007, while employed as a CNRA at Amarillo Anesthesia Consultants/BaptistSt. Anthony's Hospital, Amarillo, Texas, Respondent engaged in the intemperate use of Fentanyl, in that he produced a specimen for a drug screen which resulted positive for Fentanyl. Possession of Fentanyl, without a valid prescription is prohibited by Chapter 481 of the Texas Health & Safety Code (Controlled Substances Act). The use of Fentanyl by a Registered Nurse, while subject to call or duty, could impair the nurse's ability to recognize subtle signs, symptoms or changes in the patient's condition, and could impair the nurse's ability to make rational, accurate, and appropriate assessments,judgements, and decisions regarding patient care, thereby placing the patient in potential danger. 10. On or about May 6, 2008, Respondent submitted an Online Renewal Document for Registered Nurses with Advanced Practice Authority to the Texas Board of Nursing, in which he provided false, deceptive, andlor misleading information, in that he answered "No" to the questions: "In the past 5 years, have you been addicted or treated for the use of alcohol or any other drug? (You may answer "no" if you have completed andlor are in compliance with TPAPN). "Has any licensing authority refused to issue you a license or ever revoked, annulled, cancelled, accepted surrender of, suspended, placed on probation, refused to renew a nursing license, certificate or multi -state privilege held by you now or previously, or ever fined, censured, reprimanded or otherwise disciplined you?" On or about January 22, 2008, through February 13,2008, Respondent was treated for chemical abuse/dependence at Chatsworth Pavilion, Montreal, Quebec, Canada. On or about January 13, 2006, Respondent's consent to surrender of his license/ privilege to practice professional nursing in the State of North Carolina for a minimum of one (1) year was accepted by the North Carolina Board of Nursing, Raleigh, North Carolina. 11. Respondent has been attending The Right Step Aftercare since March 19, 2008. Kathy Herranen Fisher, Aftercare Coordinator, states that Respondent appears to be motivated and very active in 12-step meetings. Respondent states that he has been making every effort to avert any return to making poor decisions. 12. Respondent's states December 20,2007, as his date of sobriety. 624978:133 - 4- l3. The Board finds that there exists serious risks to public health and safety as a result of impaired nursing care due to intemperate use of controlled substances or chemical dependency. CONCLUSIONS OF LAW 1. Pursuant to Texas Occupations Code, Sections 301.451-301.555, the Board has jurisdiction over this matter. 2. Notice was served in accordance with law. 3. The evidence received is sufficient to prove a violations of Section 301.452(b)(2),(8),(9),(10)&(12), Texas Occupations Code, and 22 TEX. ADMIN. CODE §217 .12(5),(6)(1),(1 O)(A)(D)&(11 )(B). 4. The evidence received is sufficient cause pursuant to Section 30 1.452(b), Texas Occupations Code, to take disciplinary action against Registered Nurse License Number 624978, heretofore issued to STEPHEN ALEXANDER WOODFIN, including revocation of Respondent's license to practice nursing in the State of Texas. ORDER IT IS THEREFORE AGREED and ORDERED, subject to ratification by the Texas Board of Nursing, thafRegistered Nurse License Number 624978, previously issued to STEPHEN ALEXANDER WOODFIN, to practice nursing in Texas is hereby SUSPENDED and said suspension is enforced until Respondent completes a treatment program approved by the Board, provides documentation of successful completion, and has obtained twelve (12) consecutive months of sobriety. Any relapse prior to the completion ofthe twelve (12) consecutive months of sobriety will result in an extension ofthe enforced suspension until such twelve (12) consecutive months of sobriety and additional treatment have been attained. IT IS FURTHER ORDERED that Permanent Certificate Number 624978 previously issued to STEPHEN ALEXANDER WOODFIN, upon receipt of this Order, be immediately delivered to the office of the Texas Board of Nursing. 624978:133 - 5 - IT IS FURTHER AGREED and ORDERED that this Order SHALL be applicable to Respondent's multi-state privilege, if any, to practice professional nursing in compact states. IT IS FURTHER AGREED and ORDERED that while Respondent's license is encumbered by this order the Respondent may not work outside the State of Texas pursuant to a . multi-state licensure privilege without the written pennission ofthe Texas Board of Nursing and the Board of Nursing in the party state where Respondent wishes to work. IT IS FURTHER AGREED, upon verification of successful completion of the approved treatment and twelve (12) consecutive months of sobriety as, set out in this Order, the Suspension will be stayed, and RESPONDENT will be placed on probation for three (3) years with the following agreed terms of probation: (1) RESPONDENT SHALL comply in all respects with the Nursing Practice Act, Revised Civil Statutes of Texas as amended, Texas Occupations Code, §§301.001 et seq., the Rules and Regulations Relating to Nurse Education, Licensure and Practice, 22 TEX. ADMIN. CODE §211.1 et seq. and this Order. (2) RESPONDENT SHALL pay all re-registration fees, if applicable, and be issued a license to practice nursing in the State of Texas with the appropriate notation. (3) RESPONDENT SHALL pay a monetary fine in the amount of one thousand dollars ($1000). RESPONDENT SHALL pay this fine within ninety (90) days of the suspension being stayed. Payment is to be made directly to the Texas Board of Nursing in the fonn of cashier's check or U.S. money order. Partial payments will not be accepted. (4) RESPONDENT SHALL, within one (1) year of the suspension being stayed, successfully complete a course in Texas nursing jurisprudence and ethics. RESPONDENT SHALL 624978:133 - 6 - obtain Board approval of the course prior to enrollment only if the course is not being offered by a pre-approved provider. Home study courses and video programs will not be approved. In order for the course to be approved, the target audience shall include nurses. It shall be a minimum of six (6) contact hours in length. The course's content shall include the Nursing Practice Act, standards of practice, documentation of care, principles of nursing ethics, confidentiality, professional boundaries, and the Board's Disciplinary Sanction Policies regarding: Sexual Misconduct; Fraud, Theft and Deception; Nurses with Substance Abuse, Misuse, Substance Dependency, or other Substance Use Disorder; and Lying and Falsification. Courses focusing on malpractice issues will not be accepted. RESPONDENT SHALL CAUSE the sponsoring institution to submit a Verification of Course Completion form, provided by the Board, to the Office of the Board to verify RESPONDENT's successful completion of the course. This course shall be taken in addition to any other courses stipulated in this Order, if any, and in addition to any continuing education requirements the Board has for relicensure. Board-approved courses may be found at the following Board website address: http://www.bon.state.tx.us/about/stipscourses.html. IT IS FURTHER AGREED, SHOULD RESPONDENT PRACTICE AS A NURSE IN THE STATE OF TEXAS, RESPONDENT WILL PROVIDE DIRECT PATIENT CARE AND PRACTICE IN A HOSPITAL, NURSING HOME, OR OTHER CLINICAL SETTING AND RESPONDENT MUST WORK IN SUCH SETTING A MINIMUM OF SIXTY-FOUR (64) HOURS PER MONTH UNDER THE FOLLOWING PROBATION CONDITIONS FOR THREE (3) YEARS OF EMPLOYMENT. THE LENGTH OF THE PROBATIONARY PERIOD WILL BE EXTENDED UNTIL SUCH THIRTY-SIX (36) MONTHS HAVE ELAPSED. PERIODS OF UNEMPLOYMENT OR OF EMPLOYMENT 624978:133 - 7 - THAT DO NOT REQUIRE THE USE OF A REGISTERED NURSE (RN) LICENSE WILL NOT APPLY TO THIS PROBATIONARY PERIOD: (5) RESPONDENT SHALL notify all future employers in nursing of this Order of the Board and the probation conditions on RESPONDENT's license. RESPONDENT SHALL present a complete copy of this Order and all Proposals for Decision issued by the Administrative Law Judge, if any, to each future employer prior to accepting an offer of employment. (6) RESPONDENT SHALL CAUSE each present employer in nursing to submit the Notification of Employment form, which is provided to the Respondent by the Board, to the Board's office within ten (10) days of receipt of this Order. RESPONDENT SHALL CAUSE each future employer to submit the Notification of Employment form, which is provided to the Respondent by the Board, to the Board's office within five (5) days of employment as a nurse. (7) For the first year of employment as a nurse under this Order, RESPONDENT SHALL be directly supervised by a Registered Nurse. Direct supervision requires another nurse to be working on the same unit as RESPONDENT and immediately available to provide assistance and intervention. RESPONDENT SHALL work only on regularly assigned, identified and predetermined unites). The RESPONDENT SHALL NOT be employed by a nurse registry, temporary nurse employment agency, hospice, or home health agency. RESPONDENT SHALL NOT be self-employed or contract for services. Multiple employers are prohibited. (8) For the remainder ofthe probation period, RESPONDENT SHALL be supervised by a Registered Nurse who is on the premises. The supervising nurse is not required to be on the same unit or ward as RESPONDENT, but should be on the facility grounds and readily available to provide assistance and intervention if necessary. The supervising nurse shall have a minimum of 624978:133 - 8 - two (2) years experience in the same or similar practice setting to which the Respondent is currently working. RESPONDENT SHALL work only regularly assigned, identified and predetermined unites). RESPONDENT SHALL NOT be employed by a nurse registry, temporary nurse employment agency, hospice, or home health agency. RESPONDENT SHALL NOT be self employed or contract for services. Multiple employers are prohibited. (9) RESPONDENT SHALL NOT practice as a nurse on the night shift, rotate shifts, work overtime, accept on-call assignments, or be used for coverage on any unit other than the identified, predetermined unit(s) to which Respondent is regularly assigned for one (1) year of employment as a nurse. (10) RESPONDENT SHALL NOT practice as a nurse in any critical care area for one (1) year of employment as a nurse. Critical care areas include, but are not limited to, intensive care units, emergency rooms, operating rooms, telemetry units, recovery rooms, and labor and delivery units. (11) RESPONDENT SHALL NOT administer or have any contact with controlled substances, Nubain, Stadol, Dalgan, Ultram, or other synthetic opiates for one (1) year of employment as a nurse. (12) RESPONDENT SHALL CAUSE each employer to submit, on forms provided to the Respondent by the Board, periodic reports as to RESPONDENT's capability to practice nursing. These reports shall be completed by the nurse who supervises the RESPONDENT. These reports shall be submitted by the supervising nurse to the office of the Board at the end of each three (3) months for three (3) years of employment as a nurse. (13) RESPONDENT SHALL abstain from the consumption of alcohol, Nubain, Stadol, Dalgan, Ultram, or other synthetic opiates, andlor the use of controlled substances, except 624978:133 - 9 - as prescribed by a licensed practitioner for a legitimate purpose. If prescribed, RESPONDENT SHALL CAUSE the licensed practitioner to submit a written report identifying the medication, dosage and the date the medication was prescribed. The report shall be submitted directly to the office of the Board by the prescribing practitioner, within ten (10) days of the date of the prescription. In the event that prescriptions for controlled substances are required for periods oftwo (2) weeks or longer, the Board may require and RESPONDENT SHALL submit to an evaluation by a Board approved physician specializing in Pain Management or Psychiatry. The performing evaluator will submit a written report to the Board's office, including results ofthe evaluation, clinical indications for the prescriptions, and recommendations for on-going treatment within thirty (30) days from the Board's request. (14) RESPONDENT SHALL submit to random periodic screens for controlled substances, tramadol hydrochloride (Ultram), and alcohol. For the first three (3) month period, random screens shall be perfonned at least once per week. For the next three (3) month period, random screens shall be perfonned at least twice per month. For the next six (6) month period, random screens shall be perfonned at least once per month. For the remainder of the probation period, random screens shall be performed at least once every three (3) months. Specimens shall be screened for at least the following substances: Amphetamines Barbiturates Benzodiazepines Cannabinoids Cocaine Ethanol tramadol hydrochloride (Ultram) Meperidine Methadone Methaqualone Opiates Phencyclidine Propoxyphene A Board representative may appear at the RESPONDENT's place of employment at any time during the probation period and require RESPONDENT to produce a specimen for screening. 624978:133 - 10 - All screens shall be properly monitored and produced in accordance with the Board's policy on Random Drug Testing. A complete chain of custody shall be maintained for each specimen obtained and analyzed. RESPONDENT SHALL be responsible for the costs of all random drug screening during the probation period. Any positive result for which the nurse does not have a valid prescription will be regarded as non-compliance with the terms of this Order and may subject the nurse to further disciplinary action by this Board. Failure to report for a drug screen may be considered the same as a positive result and may result in further disciplinary action by this Board. (15) RESPONDENT SHALL attend at least two (2) support group meetings each week, one of which shall be for substance abuse; and RESPONDENT SHALL provide acceptable evidence of attendance. Acceptable evidence shall consist of a written record of at least; the date of each meeting, the name of each group attended, and the signature and printed name of the chairperson of each group attended by RESPONDENT. RESPONDENT SHALL submit the required evidence on the forms provided by the Board at the end of every three (3) months. No duplications, copies, third party signatures, or any other substitutions will be accepted as evidence. IT IS FURTHER AGREED and ORDERED that if during the period of probation, an additional allegation, accusation, or petition is reported or filed against the Respondent's license, the probationary period shall not expire and shall automatically be extended until the allegation, accusation, or petition has been acted upon by the Board. IT IS FURTHER AGREED, that upon full compliance with the terms of this Order, RESPONDENT SHALL be issued an unencumbered license and multistate licensure privileges, if any, to practice nursing in the State of Texas. 624978:133 - 11 - RESPONDENT'S CERTIFICATION I understand that I have the right to legal counsel prior to signing this Agreed Order. I waive representation by counsel. I have reviewed this Order. I neither admit nor deny the violations alleged herein. By my signature on this Order, I agree to the Findings of Fact, Conclusions of Law, Order, and any conditions of said Order, to avoid further disciplinary action in this matter. I waive judicial review of this Order. I understand that this Order is subject to ratification by the Board. When this Order is ratified, the terms ofthis Order become effective, and a copy will be mailed to me. I understand that in fail to comply with all terms and conditions of this Order, I will be subject to investigation and disciplinary sanction, including revocation of my license to practice nursing in the State of Texas, as a consequence of my noncompliance. Signed this 19 day of A06US~ ,20/l!§L. -hk0~ , S~ AL~ER WOODFIN, Respondent Sworn to and subscribed before me this / Of day of Au....gu..5+, 20~. SEAL :P~o.... ;::: ;( Notary Public in and for the State of (e--,,---=OOL- 624978:133 - 12 - WHEREFORE, PREMISES CONSIDERED, the Texas Board of Nursing does hereby ratify and adopt the Agreed Order that was signed on the 19th day of August, 20 08, by STEPHEN ALEXANDER WOODFIN, Registered Nurse License Number 624978, and said Order is final. 624978:133 Effective this ~ day Of/¥~ , 200.r . ~~~ Katherine A. Thomas, MN, RN Executive Director on behalf of said Board - 13 - =EE:.1f26 9:38AM NC SOA~D OF NURSING NO.0043-P. 3 lUOb J~.N \ q A I,D: 22 NORTH CAROLINA BOARD OF NURSING CONSENT TO SURRENDER LICENSE/PRIVILEGE TO PRACTICE I, Stephen Alexander Woodfin, Texas RN Cert. #624978, having been advised by a R~presentative of the Board of pending charges against me and, also, of my right to have an Administrative Hearing where I am afforded notice and an opportunity to confront witnesses against me, do hereby voluntarily waive my rights before the Board in exchange for ending this matter and no further investigation will be conducted. Further, I hereby surrender, to the Board, my license/privilege to practice as a RN for a minimum of one (1) year . . ----'-"'-.----"'- -.. ·-.-............ -- ... --.. ,------.-~,--' ..... -----..-. .. _-.- .--... - ,-,-.-- ......................... ~~-- .. -.;. - . ""------. - ._, This surrender shall constitute my consent to all conditions as explained to me by Judy Knox, RN, Compliance Manager for the Board on January 4, 2006. I fully understand and agree, that I shall not practice nursing during the time my license is held by the Board, and, in, turn, the Board agrees to consider my petition for review of my status at some point in the future. I NATURE I