00-002951PL Department Of Health, Board Of Nursing vs. Pamela Franklin Status: Closed Recommended Order on Tuesday, October 24, 2000.

Summary: Respondent`s advance charting of patient care constitutes unprofessional conduct and subjects respondent to disciplinary sanctions.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF HEALTH, )

BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) Case No. 00-2951PL

)

PAMELA FRANKLIN, )

)

Respondent. )

_____________________________________)

RECOMMENDED ORDER

On September 25, 2000, a formal administrative hearing in

this case was conducted in Tallahassee, Florida, before Don W.

Davis, an Administrative Law Judge of the Division of

Administrative Hearings.

APPEARANCES

For Petitioner: Michael E. D uclos, Esquire

Agency for Health Care Administration

2727 Mahan Drive

Building 3, Room 3240

Tallahassee, Florida 32308

For Respondent: Donna H. Stinson, Esquire

B road & Cassel

215 South Monroe Street, Suite 400

Post Office Box 11300

Tallahassee, Florida 32302

STATEMENT OF THE ISSUE

The issue in the case is whether the allegations of the

Administrative Complaint filed by Petitioner are correct and, if

so, what penalty should be imposed against Respondent.

PRELIMINARY STATEMENT

By Amended Administrative Complaint dated June 13, 2000, the

Department of Health (Petitioner) alleged that Pamela Franklin

(Respondent) violated Section 464.018(1)(h), Florida Statutes.

Respondent requested a formal hearing. The Department forwarded

the request for hearing to the Division of Administrative

Hearings, which scheduled and conducted the proceeding.

At the hearing, Petitioner presented the testimony of three

witnesses and had Exhibits numbered 2-7 admitted into evidence.

Respondent presented the testimony of three witnesses, inclusive

of herself and had Exhibits numbered 1-10 and 12 admitted into

evidence. The Transcript of the hearing was filed on October 5,

2000. Both parties filed Proposed Recommended Orders which have

been reviewed and utilized in the preparation of this Recommended

Order.

FINDINGS OF FACT

1. Petitioner is the state agency charged with regulation

of the practice of nursing in State of Florida.

2. At all times material to this case, Respondent has been

licensed as a registered nurse in the State of Florida, holding

license no. 2003552, with a last known address of 1407 Wekewa

Nene, Tallahassee, Florida 32301.

3. Respondent was employed at all times material to this

case by Tallahassee Memorial Hospital (TMH) until December 1,

2000, when her employment was terminated.

4. On November 23, 1999, Respondent was working a day shift

at TMH as a nurse at 1300 Miccosukee Road, Tallahassee, Florida.

5. On November 23, 1999, Sharissa Holloway was a student

nurse from the Florida State University (FSU) School of Nursing

and happened to be doing a clinical rotation on the TMH

orthopedic/neurological floor. Respondent was the primary nurse

for the patients on that floor who were under the care of the

student nurse.

6. The student nurse received the patient assessment sheets

from Respondent prior to 8:00 a.m. with entries already charted

by Respondent for estimating Patient N.C.'s pain, and a sedation

scale already charted by Respondent covering the period of time

that stretched all the way to 12 o'clock noon. When handing the

patient assessment sheets to the student nurse at approximately

7:30 a.m., Respondent stated "I have already started the notes."

The note entries had Respondent's initials next to them in the

appropriate column.

7. Narrative notes on Patient N.C. had already been written

indicating that a dressing change of a surgical wound had been

done at 8:00 a.m. These notes bore Respondent's signature. The

student nurse also got these notes from Respondent before

8:00 a.m.

8. Concerned with the advanced notations that she

discovered, the student nurse took the patient assessment sheets

which bore Respondent's entries for future times up to 12 o'clock

noon to her FSU clinical nursing instructor who was on the

premises at the time. Proceeding to Patient N.C., the instructor

verified that the patient's wound dressing had not been changed.

The student nurse did the dressing change at approximately

8:30 a.m.

9. The nursing instructor took the documents to the head

nurse for the orthopedic/neurological floor, Kay Keeton. Keeton

requested that both the student nurse and the nursing instructor

submit independent written statements. They complied with

Keeton's request.

10. Contemporaneously with the drafting of statements by

the clinical nurse instructor and the student nurse, photocopies

of the patient assessment sheets were made at least two hours

prior to 12 o'clock noon. Keeton made notes on the sheets to

show entries charted by Respondent as opposed to entries charted

by the student nurse. Keeton is familiar with Respondent's

signature. After determining that Respondent had charted

something that had not been done yet, Keeton made her report to

the TMH administration.

11. When questioned about the entries on December 1, 1999,

Respondent denied making the entries. She was given a

disciplinary form entitled "Notice of Corrective Action." Upon

her refusal to sign the form, Respondent was terminated from her

employment.

12. Respondent has experienced employment problems at TMH

for which Notices of Corrective Action were issued which date

back to 1996. This history, in conjunction with Respondent's

demeanor while testifying and her lack of candor, dictate that

her denial of improper action in this case, cannot be credited.

13. Minimal acceptable standards of prevailing nursing

practice require that documentation of care provided to patients

be recorded contemporaneously with the provision of the care.

14. Respondent's "before the fact" documentation of care

provided to the patients identified herein fails to meet

minimally acceptable standards of prevailing nursing practice.

15. The placing of a care provider's initials on a

medication administration record indicates that medication has

been administered to patients. "Pre-initialing" or signatures on

medication administration records poses a risk of confusion to

other care providers working in the facility and is not an

acceptable practice.

CONCLUSIONS OF LAW

16. The Division of Administrative Hearings has

jurisdiction over the parties to and subject matter of this

proceeding. Section 120.57(1), Florida Statutes.

17. The Department of Health, Board of Nursing, is

responsible for disciplinary proceedings against registered

nurses in Florida. Chapter 464, Florida Statutes.

18. The Department has the burden of proving the

allegations against Respondent by clear and convincing evidence.

Ferris v. Turlington , 510 So. 2d 292 (Fla. 1987). In this case,

the burden has been met.

19. Section 464.018, Florida Statutes, provides grounds for

disciplinary actions against licensees. Section 464.018(1)(h),

provides for the imposition of discipline for "[u]nprofessional

conduct, which shall include, but not be limited to, any

departure from, or the failure to conform to, the minimal

standards of acceptable and prevailing nursing practice. . . ."

20. Rule 64B9-8.005, Florida Administrative Code, includes

"inaccurate recording, falsifying or altering of patient records

or nursing progress reports" within the definition of

unprofessional conduct.

21. Rule 64B9-8.006(3)(i), Florida Administrative Code,

provides a range of disciplinary guidelines for use by the Board

of Nursing in imposing discipline for violation of Section

464.018(1)(h), Florida Statutes, where the violation involves

administrative duties including charting. The rule authorizes a

fine of $250 to $1000 for an infraction of the sort perpetuated

by Respondent plus probation or suspension of licensure.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law, it is

RECOMMENDED that Petitioner enter a final order against

Respondent, imposing a fine of $250, requiring completion of

appropriate continuing education in nursing records documentation

in addition to any existing continuing education requirement, and

placing the Respondent on probation for a period of one year under

such conditions as the Board of Nursing determines are warranted.

DONE AND ENTERED this 24th day of October, 2000, in

Tallahassee, Leon County, Florida.

___________________________________

DON W. DAVIS

Administrative Law Judge

Division of Administrative Hearings

The DeSo to Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

[phone] SUNCOM 278-9675

Fax Filing [phone]

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 24th day of October, 2000.

COPIES FURNISHED:

Michael E. Duclos, Esquire

Agency for Health Care Administration

2727 Mahan Drive

Building 3, Room 3240

Tallahassee, Florida 32308

Donna H. Stinson, Esquire

Broad & Cassel

215 South Monroe Street, Suite 400

Post Office Box 11300

Tallahassee, Florida 32302

Ruth R. Stiehl, Ph.D., R.N.

Executive Director

Board of Nursing

Department of Health

4080 Woodcock Drive, Suite 202

Jacksonville, Florida 32207-2714

Theodore M. Henderson, Agency Clerk

Department of Health

4052 Bald Cypress Way, Bin A02

Tallahassee, Florida 32399-1701

William W. Large, General Counsel

Department of Health

4052 Bald Cypress Way, Bin A00

Tallahassee, Florida 32399-1701

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within 15

days from the date of this Recommended Order. Any exceptions to

this recommended order must be filed with the agency that will

issue the final order in this case.