05-000957PL Department Of Health, Board Of Nursing vs. Beatrice A. Henderson, L.P.N. Status: Closed Recommended Order on Friday, August 26, 2005.

Summary: Respondent gave an IV push without direct supervision and gave a larger dose of medication than ordered by the physician.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF HEALTH, BOARD OF )

NURSING, )

)

Petitioner, )

)

vs. ) Case No. 05 - 0957PL

)

BEATRICE A. HENDERSON, L.P.N., )

)

Respondent. )

)

RECOMM ENDED ORDER

Pursuant to notice, a final hearing was held in this case

on May 27, 2005, in Orlando, Florida, before Susan B. Harrell, a

designated Administrative Law Judge of the Division of

Administrative Hearings.

APPEARANCES

For Petitioner: S. J. DiCon cilio, Esquire

Katharine B. Heyward, Esquire

Department of Health

4052 Bald Cypress Way, Bin C - 65

Tallahassee, Florida 32399 - 3265

For Respondent: Beatrice A. Hend erson, pro se

Post Office Box 731823

Ormond Beach, Florida 32173

STATEMENT OF THE ISSUES

Whether Respondent violated Subsection 4 64 .018(1)(h),

Florida Statutes (2001), 1 and Florida Adminis trative Code Rules

64B9 - 8.005(2) and 64B9 - 8.005(15), and, if so, what discipline

should be imposed.

PRELIMINARY STATEMENT

On September 29, 2003, Petitioner, the Department of

Health, Board of Nursing (Department), filed a two - count

Administrative Complai nt against Respondent, Beatrice A.

Henderson (Ms. Henderson), alleging that she violated Subsection

464.018(1)(h), Florida Statutes, by engaging in unprofessional

conduct as defined in Florida Administrative Code Rules 64B9 -

8.005(2) and 6B9 - 8.005(15). Ms. Henderson requested an

administrative hearing by an Election of Rights Form dated

November 24, 2003. The case was forwarded to the Division of

Administrative Hearings on March 14, 2005.

On May 20, 2005, Petitioner filed Petitioner's Motion to

Take Offici al Recognition of certain rules. The motion was

granted, and an O rder was entered on May 25, 2005, taking

official recognition of the following rules: Florida

Administrative Code Rule 64B9 - 8.005, which was in effect from

March 23, 2000, until February 14 , 2002; Florida Administrative

Code Rule 64B9 - 12.002, which has been in effect from January 16,

1991, to the present; Florida Administrative Code Rule 64B9 -

12.003, which has been in effect from April 9, 1998, to the

present; and Florida Administrative Code Rule 64B9 - 12.004, which

has been in effect from January 16, 1991, to the present.

At the final hearing, the Department called the following

witnesses: Carol Paris, Donna Payne, Sidronio Casas, Erlinda

Lagman, Norma Dorothy Collins, and Bonnie Edwina Stra de.

Petitioner's Exhibits 1 through 8 were admitted in evidence. At

the final hearing, Ms. Henderson testified on her own behalf.

Respondent's Exhibits 1 through 5 were admitted in evidence.

The parties agreed to file their proposed recommended

orders w ithin ten days of the filing of the two - volume

Transcript, which was filed on August 3, 2005. The Department

filed its Proposed Recommended Order on August 12, 2005. As of

the date of the Recommended Order, Ms. Henderson has not filed a

proposed recommen ded order.

FINDINGS OF FACT

1. The Department is the agency of the State of Florida

charged with the responsibility for the investigation and

prosecution of complaints involving nurses licensed to practice

in Florida.

2. Ms. Henderson is and was, at all times material to this

proceeding, a Licensed Practical Nurse (LPN), licensed to

practice nursing in Florida, having been issued license number

PN1279561.

3. In July 2001, Ms. Henderson was employed as a LPN II at

Lucerne Transitional Care Center (Lucerne ). Lucerne is a

hospital - based skilled nursing unit, similar to a nursing home

and is part of the Orlando Regional Healthcare System (Orlando

Regional). The policies of Orlando Regional apply to all the

hospitals within Orlando Regional, including Lucern e. One of

the policies of Orlando Regional deals with the types of IV

medications that can be administered by a LPN and provides:

LPN - IV medications may be administered by

LPN's who have completed the IV therapy

course required by the Florida State Boar d,

and demonstrated competency.

1. Exception: Aspects of intravenous

therapy that are outside the scope of

practice of the LPN per Florida State Board

and therefore not allowed in ORH facilities

are:

a. Initiation of blood or blood products;

b. Initiat ion of administration of cancer

chemotherapy;

c. Initiation of plasma expanders;

d. Initiation of administration of

investigational drugs;

e. Mixing IV solutions;

f. IV pushes, except heparin and saline

flushes.

The policy further provides that IV pus hes may be administered

by a qualified Registered Nurse (RN). Florida Administrative

Code Rule 64B9 - 12.003(1) allows a LPN to administer IV pushes if

done under the direct supervision of a RN or physician; however,

Orlando Regional's policy prohibited LPN s from administering

medications by IV push even if a RN or physician was directly

supervising the IV push.

4. R.U. was a patient at Lucerne on July 28, 2001. R.U.

was a quadriplegic who had infected decubiti. When he was

admitted on July 20, 2001, his physician ordered morphine

sulfate to be administered for pain. The order provided:

MORPHINE SULFATE INJ 8 MG. IV PUSH, O2H,

PRN -- SEVERE PAIN -- MAY GIVE 6 - 8 MG.

5. Ms. Henderson was on the team assigned to provide care

for R.U. on July 28, 2001. At appr oximately 0130 hours on that

date, R.U. requested his pain medication. Ms. Henderson went to

get the RN on her team to administer the morphine sulfate. The

RN was dressing another patient's wounds and could not leave the

patient until the wounds were cov ered. The RN told Ms.

Henderson that R.U. would have to wait until she finished

dressing the wounds.

6. Although Ms. Henderson was aware of the Orlando

Regional's policy , which did not allow a LPN to administer

medication by IV push, she did not wait f or the RN, but decided

to administer the morphine sulfate by IV push herself. Instead

of administering the dosage ordered by the physician, she

administered ten milligrams. R.U. questioned Ms. Henderson

about her ability to administer an IV push, stating that his

home health care nurse could not do so. Ms. Henderson told him

that she was qualified to do it and that an RN was on the

premises.

7. On July 28, 2001, at 0430 hours, R.U. again asked for

pain medication. The RN on duty was not available to gi ve the

IV push because she was with another patient providing wound

care. Again, Ms. Henderson took it upon herself to administer

the morphine sulfate by IV push and administered ten milligrams,

in violation of the physician's order.

8. Neither the RN on duty nor the RN supervisor delegated

to Ms. Henderson the authority to administer IV push medications

to R.U. Ms. Henderson was not under direct supervision of an RN

either time she administered the morphine sulfate to R.U. by IV

push.

9. Ms. Henderson was aware that the physician's order for

R.U. was for an eight - milligram dose of morphine sulfate. In a

letter dated March 1, 2002, to an attorney for the Department,

she stated:

I administered 10 mg. b ecause I thought that

amount would be effective in re lieving my

patient's severe pain. I did read the

orders, took the facts into consideration,

and used the dose range calculation and

determined that since so much time had

elapsed, it would be acceptable.

10. The physician's order for the morphine sulfat e by IV

push was never changed by the physician to ten milligrams while

R.U. was at Lucerne.

11. The morphine sulfate by IV push was administered to

R.U. through a Groshong catheter. Medication administered

through a Groshong catheter travels directly t o the big central

vena cava vein of the patient. Improper administration of

medication through a Groshong catheter is dangerous because it

can cause respiratory distress or even death to a patient.

12. Ms. Bonnie Strade, a RN, testified on behalf of the

Department and was qualified as an expert in the field of

nursing for both RNs and LPNs. It was Ms. Strade's opinion ,

which is credited, that Ms. Henderson's administration on two

occasions of ten milligrams of morphine sulfate by IV push to

R.U. did not conform to the minimum standards of acceptable and

prevailing nursing practice.

CONCLUSIONS OF LAW

13. The Division of Administrative Hearings has

jurisdiction over the parties to and the subject matter of this

proceeding. §§ 120.569 and 120.57, Fla. Stat. (2004).

14. The Department has the burden to establish the

allegations in the Administrative Complaint by clear and

convincing evidence. Department of Banking and Finance v.

Osborne Stern & Co. , 670 So. 2d 932 (Fla. 1996).

15. The Department alle ged in the Administrative Complaint

that Ms. Henderson violated Subsection 464.018(1)(h), Florida

Statutes, which provides that the following constitutes grounds

for taking disciplinary action against LPN's in Florida :

Unprofessional conduct, which shall include

but not be limited to, any departure from,

or the failure to conform to, the minimum

standards of acceptable and prevailing

nursing practice, in which case actual

injury need not be established.

16. In Count I of the Administrative Complaint, the

Department alleged that Ms. Henderson was guilty of

unprofessional conduct as defined in Florida Administrative Code

Rule 64B9 - 8.005(2), which includes "[a]dministering medications

or treatments in a negligent manner" in the definition of

unprofessional c onduct.

17. Florida Administrative Code Rule 64B9 - 12.003(1)

provides:

(1) Aspects of intravenous therapy which

are outside the scope of practice of the

licensed practical nurse unless under the

direct supervision of the registered

professional nurse or p hysician and which

shall not be performed or initiated by the

licensed practical nurse without direct

supervision include the following:

(a) initiation of blood or blood products;

(b) initiation or administration of cancer

chemotherapy;

(c) initiation o f plasma expanders;

(d) initiation or administration of

investigational drugs;

(e) mixing Iv solution;

(f) IV pushes except heparin flushes and

saline flushes.

18. Florida Administrative Code Rule 64B9 - 12.002 defines

"direct supervision" as "on the pr emises and immediately

physically available." Although a RN was on the premises when

Ms. Henderson administered the medication by IV push, the RN was

not immediately physically available. The RN was changing the

dressing on a wound that she could not lea ve uncovered in order

to immediately assist Ms. Henderson if necessary.

19. Ms. Henderson violated Orlando Regional policy by

administering the medication by IV push. The policy prohibited

a LPN from administering IV pushes , except heparin flushes and

sa line flushes even if the LPN was under the direct supervision

of a RN.

20. Ms. Henderson failed to administer the dosage

prescribed by R.U.'s physician. She administered ten milligrams

instead of the six to eight milligrams , which had been ordered

by the physician.

21. The Department has established by clear and convincing

evidence that Ms. Henderson was guilty of unprofessional conduct

by administering the morphine sulfate in a negligent manner.

Thus, Ms. Henderson violated Subsection 464.018(1)(h), Fl orida

Statutes , by violating Florida Administrative Code Rule 64B9 -

8.005(2).

22. In Count II of the Administrative Complaint, the

Department alleged that Ms. Henderson was guilty of

unprofessional conduct as defined in Florida Administrative Code

Rule 64 B9 - 8.005(15), which includes "[p]racticing beyond the

scope of the licensee's license, education preparation, or

nursing experience" in the definition of unprofessional conduct.

The Department has established by clear and convincing evidence

that Ms. Hend erson practiced beyond the scope of her license

when she administered morphine sulfate to R.U. by IV push

without the direct supervision of a RN or physician. Thus, Ms.

Henderson violated Subsection 464.018(1)(h), Florida Statutes,

by violating Florida Ad ministrative Code Rule 64B9 - 8.005(15).

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law, it is

RECOMMENDED that a final order be entered finding that

Beatrice A. Henderson violated Subsection 464.018(1)(h), Florida

Statutes, b y violat ing Florida Administrative Code Rules 64B9 -

8.005(2) and 64B9 - 8.005(15); imposing an administrative fine of

$350; and placing her on probation for two years.

DONE AND ENTER ED this 2 6 th day of August , 2005 , in

Tallahassee, Leon County, Florida.

S

SUSAN B. HARRELL

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675 SUNCOM 278 - 9675

Fax Filing (850) 921 - 6847

www.doah.st ate.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 2 6 th day of August , 2005 .

ENDNOTE

1/ Unless otherwise indicated, all references to the Florida

Statutes are to the 2001 version.

COPIES FURNISHED :

S. J. DiConcilio, Esqu ire

Katharine B. Heyward, Esquire

Department of Health

4052 Bald Cypress Way, Bin C - 65

Tallahassee, Florida 32399 - 3265

Beatrice A. Henderson

Post Office Box 731823

Ormond Beach, Florida 32173

R. S. Power, Agency Clerk

Department of Health

4052 Bald Cyp ress Way, Bin A02

Tallahassee, Florida 32399 - 1701

Dan Coble, RN, PhD, CNAA C, BC

Executive Director

Board of Nursing

Department of Health

4052 Bald Cypress Way, Bin C02

Tallahassee, Florida 32399 - 3252

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 should be filed with the agency that

will issue the Final Order in this case.