99-004175 Pascal Canesse vs. Department Of Health, Board Of Nursing Status: Closed Recommended Order on Friday, April 28, 2000.

Summary: Documentation submitted by applicant for examination did not clearly establish his completion of all clinical training in subject matter deemed necessary by the Board.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

PASCAL CANESSE, )

)

Petitioner, )

)

vs. ) Case No. 99-4175

)

DEPARTMENT OF HEALTH, BOARD OF )

NURSING, )

)

Respondent. )

___________________________________)

RECOMMENDED ORDER

A hearing was held in this case in Bradenton, Florida, on

March 10, 2000, before Arnold H. Pollock, an Administrative Law

Judge with the Division of Administrative Hearings.

APPEARANCES

For Petitioner: Doris A. Bunnell, Esquire

608 15th Street West

Bradenton, Florida 34205

For Respondent: Lee Ann Gustafson, Esquire

Department of Legal Affairs

The Capitol, Plaza Level 01

Tallahassee, Florida 32399-1050

STATEMENT OF THE ISSUE

The issue for consideration in this hearing is whether

Petitioner meets the academic requirements for licensure as a

registered nurse in Florida.

PRELIMINARY MATTERS

By Notice of Educational Deficiency dated May 20, 1999, the

Board of Nursing notified Petitioner, Pascal Canesse, that a

review of his nursing education reflects insufficient

classroom/clinical instruction in obstetrical nursing to meet the

educational standards for examination for licensure as a

registered nurse in Florida. By petition dated September 20,

1999, Petitioner requested formal hearing on the agency’s

proposed denial, and this hearing ensued.

At the hearing, Petitioner testified in his own behalf and

presented the testimony of Ashley L. Canesse, his wife; Michelle

Allen, director of critical care at Blake Hospital and

Petitioner’s supervisor; and Mary Kay Jacobsen, nursing education

director for the Florida Board of Nursing. Petitioner also

introduced Petitioner’s Exhibits 2 and 4 through 9. Respondent

also presented the testimony of Ms. Jacobsen and introduced

Respondent’s Exhibit A.

A Transcript of the proceedings was provided. Subsequent to

the hearing, both counsel submitted matters in the form of

proposed recommended orders which have been carefully considered

in the preparation of this Recommended Order.

FINDINGS OF FACT

1. At all times pertinent to the issues herein, Respondent,

Board of Nursing, has been the state agency responsible for the

licensing of registered and licensed practical nurses in Florida

and the regulation of the nursing profession in this state.

2. On November 25, 1998, while residing in France,

Petitioner, Pascal Canesse, filled out an application for nursing

licensure (DH Form 1204. 8/98), seeking licensure by examination

as a registered nurse in Florida which he submitted in January

1999.

3. Prior to the hearing, the parties stipulated, and it is

found, that:

a. Petitioner attended the nursing program

at Institute Formation en Soins Infirmiers

(the Institute) in France from 1993 - 1995,

b. The Official Transcript submitted by the

Institute does not list classroom instruction

or clinical practice in obstetrics.

c. The Training Sessions, or clinical

practice, portion of the Official Transcript

submitted by the Institute includes a

breakdown of 350 hours of surgery training

that includes the following subject areas:

(1) emergency

(2) polyvalent intensive care

(3) digestive surgery and urology

d. The Form B submitted by the Institute

states that Petitioner had 600 hours of

classroom instruction and 490 hours of

clinical practice in surgical nursing.

e. The Training Sessions, or clinical

practice, portion of the Official Transcript

submitted by the Institute lists a total of

1,715 hours of training.

f. The theoretical Assessment portion of the

Official Transcript submitted by the

Institute does not include the number of

hours of instruction but breaks down the

training to include nursing care to patients

in the following categories:

(1) psychosis patients

(2) patients with breathing problems

(3) patients with ENT-stomatology-

dermamtology troubles

(4) patients with endocrinous troubles

(5) patients with digestive troubles

(6) patients with troubles of the

nutriment duct

(7) pediatrics and child psychiatry

(8) elderly patients with

neuropsychiatry troubes

(9) elderly patients

(10) patients with nervous system

troubles

(11) patients in emergencies-intensive

care-blood transfusions

(12) patients with

hematology/urology/ nephrology

troubles

g. In answer to question 6 on his

application, Petitioner stated that he

completed 40 hours of training in obstetrical

nursing under the categories listed on the

transcript.

h. The Form B anscript of Nursing

Education in a Foreign Country submitted by

the Institute and relating to Petitioner

reflects that he received 40 hours of

classroom instruction in obstetrical nursing.

No hours of clinical practical in obstetrical

nursing are reflected.

i. In correspondence to the Board dated

June 10, 1999, Petitioner set forth his

explanation of the discrepancies in the

application, Form B, and his transcript.

4. Petitioner contends that when he filled out his

application and the supporting documentation therefor, he listed

525 hours of clinical medical nursing practice and 490 hours of

clinical surgical nursing practice. While he reflected 40 hours

of instruction in obstetric nursing, he failed to indicate any

obstetric clinical practice. He claims the number of hours

claimed as being in medical/surgical area comprises the number of

hours in both, including obstetrics. His failure to enter any

clinical practice in the obstetrics area was the result of a

combination of that discipline with medical/surgical training as

is done in France. This reflects clinical hours only. His claim

of 40 hours training is for classroom work in obstetrics only.

It is not combined with surgery. It would have been much clearer

if he had marked down the course he took rather than just the

hours taken.

5. A review of the Official Transcript provided by the

Institute to be submitted to the Florida authorities in support

of Petitioner’s application clearly fails to specifically

indicate any obstetrical training.

6. The "Addendum to Transcript" dated May 4, 1999, reflects

70 hours of obstetric classroom in addition to two weeks'

clinical obstetrics experience. This is different from the

surgical nursing that had been combined with surgical nursing on

the Form B originally submitted. Other documentation from the

Institute, a letter dated June 25, 1999, indicates that two

"weeks" is equivalent to 70 hours.

7. That same letter notes that much of the training in

France is hospital-based with a significant amount of training

being clinical in nature with a heavy emphasis in surgery. The

French authorities claim that those surgical hours are

comprehensive, and it is in that curriculum that the students

receive clinical and classroom obstetrics training, with the

clinical portion being a full two weeks - that is, "a minimum of

70 hours."

8. Petitioner also introduced a syllabus for the module in

the Institute’s nursing training program which relates to

gynecology. This reflects the areas covered and includes a

significant amount of information apparently related to

obstetrics and childbirth. The syllabus reflects an extensive

amount of clinical instruction over the three years of nursing

training. However, again, the supporting documentation does not

clearly quantify that portion of the training which deals with

obstetrics, nor does it show where the training is integrated

into the surgical nursing training as claimed by Petitioner.

9. Petitioner was unable to convincingly recall at which

point in the three-year training program he took the required

clinical obstetrics training. At one point, in his deposition,

he claimed it was integrated in his emergency medicine training.

At hearing, however, he claimed it was integrated with medical

surgical training. The fact that the obstetrical clinic may have

been integrated with another service is not, of itself,

disqualifying. The Board of Nursing accepts integrated nursing

training, under certain conditions.

10. When course integration is claimed, however, the Board

requires the submission of a detailed course outline that

delineates where the specific course content, here, obstetrics,

is presented. Further, the Board considers the integration of

obstetrics with emergency surgery as inappropriate because the

basic nature of the disciplines is not the same. While one is

reactive, the other is pro-active.

11. No doubt, Petitioner was exposed to an obstetrics

curriculum which included both classroom and clinical

instruction. From the state of the evidence presented, however,

it is impossible to determine the breadth and content of this

exposure.

12. According to Ms. Jacobsen, the Board’s nursing

education director, staff which reviewed Petitioner’s application

was concerned over the unexplained inconsistency in the

supporting documentation submitted therewith. None of the

information on the various submitted documentation matched. On

its Notice of Educational Deficiencies dated May 20, 1999, it was

suggested that Petitioner have his school write a letter

explaining the discrepancy. The Institute’s letter of June 25,

1999 asserts that the required clinical training was provided,

but does not define with any particularity at which point in the

training the obstetrics discipline is treated. It appears to be

integrated into the surgical clinical training, but from the

state of the documentation presented, the particulars cannot be

determined.

CONCLUSIONS OF LAW

13. The Division of Administrative Hearings has

jurisdiction over the parties and the subject matter of these

proceedings. Section 120.57(1), Florida Statutes.

14. Petitioner in this case seeks to take the Florida

examination for licensure as a registered nurse. Section

464.008, Florida Statutes, requires applicants to show proof of

their graduation from an approved nursing program or equivalent

to be eligible to sit for the examination for licensure.

15. An "Approved Program Equivalent" is defined in Rule

64B9-3.001(2), Florida Administrative Code, as one conducted in a

school, college or university outside the State of Florida which

has been approved by the Board of Nursing in the jurisdiction in

which it is located, if such Board exists, and which demonstrates

it meets the criteria in the Rules of the Board of Nursing found

in Chapter 64B9-2, Florida Administrative Code.

16. The specific requirements for professional nursing

programs, as defined by Rule 64B9-2.006(2), Florida

Administrative Code, include theoretical instruction and clinical

experience in medical, surgical, obstetric, pediatric, geriatric,

and psychiatric nursing. Rule 64B9-3.002(1)(c), Florida

Administrative Code permits the Board of Nursing to accept

evidence that training which is not approved by a state board of

nursing, such as foreign nursing training, is equivalent to that

required in Florida at the time of the application for licensure.

This rule also requires the applicant to demonstrate completion

of the program equivalent by submission of an official certified

transcript which specifically sets forth all courses successfully

completed.

17. Notwithstanding Petitioner's genuine efforts to obtain

documentation that meets the rule requirement, he has not been

able to do so. Notwithstanding his assurances that the training

he received from the Institute included a comprehensive course of

both classroom and clinical training in obstetrics, the

documentation from the Institute does not specifically set forth

the courses relating to that discipline which Petitioner

completed. His inconsistent recollection of his obstetrical

training does not meet the rule requirements.

18. It would appear that with the exception of the clinical

obstetrical training, Petitioner meets all other requirements to

sit for examination.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law it is recommended that Petitioner’s application to sit for

examination for licensure as a registered nurse in Florida be

denied until he provides sufficient explanation of the clinical

training he received in obstetrical nursing or proof of

completion of the required training at an alternative approved

site.

DONE AND ENTERED this 28th day of April, 2000, in

Tallahassee, Leon County, Florida.

___________________________________

ARNOLD H. POLLOCK

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

[phone] SUNCOM 278-9675

Fax Filing (850) 92 1-6947

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 28th day of April, 2000.

COPIES FURNISHED:

Doris A. Bunnell, Esquire

608 15th Street, West

Bradenton, Florida 34205

Lee Ann Gustafson, Esquire

Office of the Attorney General

Department of Legal affairs

The Capitol, Plaza Level 01

Tallahassee, Florida 32399-1050

William Large, General Counsel

Department of Health

2020 Capital Circle, Southeast, Bin A02

Tallahassee, Florida 32399-1703

A ngela T. Hall, Agency Clerk

Department of Health

2020 Capital Circle, Southeast, Bin A02

Tallahassee, Florida 32399-1703

Ruth Stiehl, Executive Director

Board of Nursing

Department of Health

1940 North Monroe Street

Tallahassee, Florida 32399-0750

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.