Case #2011-005926

Ohio Board of Nursing

17 South High Street, Suite 400
.43

www.nursing.ohio,gov
(614) 466-3947

Columbus, Ohio 43215-7410

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Ashley Marie Adams (aka "Ashley Marie Ratliff'), L.P.N. 750 Clara Dr. Trenton, Ohio 45067 Dear Ms. Adams: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 472328, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 5, 2012, in Butler County Court of Common Pleas Case No. CR 2012-03--489, you pled guilty to one (1) count of Forgery, a fifth-degree felony, in violation of Section 2913.31(A)(3), ORC, and were found eligible for Intervention in Lieu of Conviction.

Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 472328 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence -and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearing@nursing.oloy,

Ashley Marie Adams (aka "Ashley Marie Ratliff"), L.P.N. Page 2 If the. Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may,.., in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, AN Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0642 cc: Henry G. Appel, Senior Assistant Attorney General

&V./.'

Case #12-005361

Ohio Board ofNorgitig www.rm sing,ohio:gov

17 South High Street, Suite 400 a Columbus, Ohio 43215-7410 (614) 466-3947

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Ashley Nicole Allen, L.P.N. 3648 East 53' Street Cleveland, Ohio d'1105 Dear Ms. Allen: In accordance with Chapter 119 Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about October 5, 2012, in Franklin County Court of Common Pleas Case No. 12CR-09-4576, you pled guilty to and were subsequently convicted of one (1) count of Theft, a fourth-degree felony in violation of Section 2913.02, ORC. You were ordered to pay restitution in the amount of $99,593.10 to the Ohio Department of Job and Family Services. The acts underlying your conviction occurred between May 4, 2009 and August 1, 2012 and involve you engaging in theft of monies by deception. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing on this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing this notice. You are hereby further informed that if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present you position, argument, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you.

Ashley Nicole Allen, L.P.N. Page 2

Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit Manager, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearin @nursinu.ohio ov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in the Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0413 cc: Henry G. Appel, Senior Assistant Attorney General

Cases #12-001203

Ohio Board of Nursing

1.7 South High Street, Suite 4(X) January 25, 2013

www.nursing.ohio.gov (614) 466-3947 Columbus, Ohio 4321.5-7410

NOTICE OF OPPORTUNITY FOR HEARING

Bonnie Sue Ames-Wernet, R.N. 980 Evening Star Avenue, SE East Canton, Ohio 44730 Dear Ms. Ames-Wernet: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise- discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: In late 2011 and in early 2012 while employed as a registered nurse by Akron Children's Hospital, Home Care Group you provided in home nursing care to Patient #1 [see Attached Patient Key to Remain Confidential and Not Subject to Public Disclosure]. During the course of that employment you acted in the manner described below. (a) On or about February 24, 2012, you reported to supervisors that, for the past several months, based on your observations you suspected that Patient #1 had been sexually abused. Despite your reported suspicions and despite being directed by a clinical supervisor to report your suspicions and observations to a local child protective agency by the end of the day, in a written statement to the Board, you indicate that you first called the protective agency on Monday (February 27, 2012). Section 4723.28(8)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(C), Ohio Administrative Code (OAC), states that a registered nurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged which includes, but is not limited to, the following: (1) Consistent performance of all aspects of nursing care; and (2) Appropriate recognition, referral or consultation, and intervention, when a complication arises. (b) On several occasions during the course of your employment as a nurse in the home of Patient #1, you took pictures of Patient #1, her home and her pets. Some of these photographs were on your cell phone. You caused Patient #1's mother to sign a statement giving you permission

Bonnie Sue Ames-Wernet, R.N. Page 2 to "have, take, [or] print," photographs related to herself, her children and her pets. Section 4723.28(B)(31), ORC, authorizes the Board to discipline a licensee for failure to establish and maintain professional boundaries with a patient, as specified in rules adopted under section 4723.07, ORC. Rule 4723-4-06(L), OAC, states, in pertinent part, that a licensed nurse shall not: (1) Engage in behavior that constitutes inappropriate involvement in the client's personal relationships; or (2) Engage in behavior that may reasonably be interpreted as inappropriate involvement in the client's personal relationships. For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or informed consent to the behaviors by the nurse set forth in this paragraph. (c) During a meeting with your supervisor on or about February 24, 2012, you admitted that, during the course of your employment as a nurse in the home of Patient #1, your husband was present in Patient #1's home with you. Rule 4723-4-03(H), OAC, states that a registered nurse shall maintain the confidentiality of client information. The registered nurse shall communicate appropriate client information with other members of the health care team for health care purposes only. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearin g @nursino.ohio ov. If the Board fails to receive a request for a hearing within thirty (30) days of the firne of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Bonnie Sue Ames-Wernet, R.N. Page 3

Sincerely,

Rhonda. S. Barkheimer, C.N.P. Supervising Board Member

Certified Mail Receipt No. 7012 2210 0000 6272 0567 cc: Henry G. Appel, Senior Assistant Attorney General

Case 11-002801

Ohio Board of Nursing www.nursing.ohio.gov

17 South High. Street, Suite 400 Columbus, Ohio 43215-7410 6 (614) 466-3947

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Jaylene V. Ballard, L.P.N. 102 Imo Boulevard Greenville, Ohio 45331 Dear Ms. Ballard: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about May 13, 2011, you provided a pm-employment drug screen specimen for the Preble County Council on Aging, Inc., in Preble County, Ohio, that was positive for marijuana and cocaine. On or about June 24, 2011, while working as nurse for Caring Hearts Home Health Care, in Cincinnati, Ohio, you provided a random drug screen specimen that was positive for cocaine. During, an interview with a Board Compliance Agent, on or about July 19, 2011, you reported recurrent weekly use of cocaine for approximately the preceding five years. On or about August 1., 2011, you submitted a written statement to the Board acknowledging you had spoken with, the Board Compliance Agent on July 19, 2011, and reporting that you were pursuing treatment. Section 4723 .28(B)(8), ORC [as in effect prior to June 8, 2012], authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time, of mailing of this notice,

Jaylene V. Ballard, L.P.N. Page 2

You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing; 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearino@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0437 cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-001012

Ohio Board of Nursing

January 25, 2013

www.nui-sing.ohip.gay

17 South High Street, Suite 400 4E, Columbus, Ohio 43215-7410 t (614) 466-3947

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Jennifer Barr, L.P.N. 8790 W. Bolsinger Oak Harbor, Ohio 43449 Dear Ms. Barr: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about December 21, 2012, in Sandusky County Court of Common Pleas Case Number 12-CR-1180, you pled guilty to two (2) counts of Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(1), ORC, and were found eligible for Intervention in Lieu of Conviction. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(1), ORC, constitutes a "felony drug abuse offense" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-133599, IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice as a licensed practical nurse; reprimand or otherwise

Jennifer Barr, L.P.N. Page 2 discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about December 21, 2012, in Sandusky County Court of Common Pleas Case Number 12-CR-1180, you pled guilty to two (2) counts of Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(1), ORC, and were found eligible for Intervention - in Lieu of Conviction. The acts underlying this case occurred on or about February 18 and 24, 2012, and involve you obtaining or exerting control over property with the consent of the owner or person authorized to give consent to wit: you took Xanax and Percocet from a patient(s) while working at Bethesda Care Center. Section 4723 .28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. On or about March 2, 2012, your position as a licensed practical nurse with Volunteers of America was terminated after you admitted to stealing and using narcotics.

Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you.

Jennifer Barr, L.P.N. Page 3 Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearin @nursin .ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, X. At Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6270 6776 Attorney 1 Certified Mail Receipt No. 7012 2210 0000 6270 6790 Attorney 2 Certified Mail Receipt No. 7012 2210 0000 6270 6783 cc: Henry G. Appel, Senior Assistant Attorney General Thomas J. DeBacco, Esq. Kristopher K. Hill, Esq.

Case #2012-006065

Ohio Board of Nursing

17 South High Street, Suite 400

www.nursing.oh.i.o7 gov

Columbus, Ohio 43215-7410 0? (614) 466-3947

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Misty Dawn Bissell, R.N. 46952 SR 248 Long Bottom, Ohio 45743 Dear Ms. Bissell: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse in Ohio; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about October 4, 2012, you and the State of West Virginia Board of Examiners for Registered Professional Nurses entered into a Proposed Consent Agreement and Order (West Virginia Board 2012 Order) in which your license to practice as a registered professional nurse in West Virginia was placed on probation. A copy of the West Virginia Board 2012 Order is attached hereto and incorporated herein. Section 4723.28(8)(1), ORC, authorizes the Board to deny .a license or otherwise discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 452157410, or to the email address, hearing@nursing.ohio.gov.

Misty Dawn Bissell, R.N. Page 2

If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and, upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse in Ohio; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, A7 At .it/..757 / Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0338 cc: Henry G. Appel, Senior Assistant Attorney General

Laura S. Rhodes, IVLS.N P.N. Executive Director email: mboad@wv.gov web addresgt wwwwvmboard.com

TELEPHONE: (304) 558-3596 FAX (304) 558-3666

STATE OF WEST VIRGINIA

BOARD OF EXAMINERS FOR REGISTERED PROFESSIONAL NURSES 101 Dee Drive, Suite 102 Charleston, WV 25311-1620

.46

October 26, 2012

Carol Poianski Administrative Assistant Compliance Unit Ohio Board of Nursing 17 South High Street, Suite 400 Columbus, OH 43215

C")

I, ALICE R FAUCETT, JD, GENERAL COUNSEL & DIRECTOR OF DISCIPLINE

of the West Virginia Board of Examiners for Registered Professional Nurses do hereby certify that the attached documents, all in the matter of Misty Bissell, registered professional nurse, license number 55503 are true and correct copies of said public documents as they appear among the files and records of this office. Witness my hand and seal of the Board of Nursing this 26th day of October, 2012.

BOARD NURSING

By: Alice R. Faucett, JD General Counsel and Director of Discipline

WEST VIRGINIA STATE BOARD OF EXAMINERS FOR REGISTERED PROFESSIONAL NURSES IN THE MATTER OF MISTY BISSELL PROPOSED CONSENT AGREEMENT Comes now MISTY BISSELL (BISSELL), and the West Virginia Board of Examiners for Registered Professional Nurses. ("Board"), for the purpose of determining what disciplinary action should be taken against BISSELL by the Board pursuant to West Virginia Code 30-7-1 et seq. (1993). As reflected in this document, BISSELL has admitted to the stipulations set forth herein, and moves the Board consider these stipulations and the terms of the accompanying proposed agreement, and enter an ORDER accepting the proposed terms set forth below. In offering this proposal for settlement of the complaint against license number 55503, BISSELL acknowledges that the Board may reject this proposal, and may hold a hearing to impose revocation or other conditions of a disciplinary nature as it deems appropriate. STIPULATION$ 1. BISSELL holds registered professional nursing license number 55503, issued by the Board on or about April 14,1998. 2. At all times pertinent BISSELL was employed by Camden Clark Hospital (CCH), Parkersburg, WV. 3., BISSELL was terminated from CCH on December 20, 2011 due to falsification of her time card discovered during a payroll audit indicating BISSELL submitted forty-three shifts during June 2011 and November 2011 for time she did not work. 4. As a result of and was paid $14,477.09 for time she did not work as well as a $1,500.00 bonus for a total amount of $15,977.09. 4. BISSELL submitted forty-three shifts during June 2011 and November 2011 for payment in a cash value of $15,977',09. BISSELL responded to the complaint stating "I was accused of altering my time 5. card. I was told in a meeting with the VP of Human Resources Toni Heller, Director of Emergency Services Susan Abdella, and Emergency Department Manager. June Kuntz that if the accused funds were repaid within 2 weeks, that no criminal charges or further actions would be taken. Therefore, I repaid the funds within the 2 week time period." 6. Todd A. Kruger, General Legal Counsel for CCH, confirmed that BISSELL paid back the required amount.
Wi RN BOARD RECEIVED 2012-10-01 M45 PM

BISSELL acknowledges that her conduct violated West Virginia Code 30-7-11 6. (f), which state that the licensee may be disciplined if he or she (f)[1js guilty of 'conduct derogatory to the morals or standing of the profession of registered nursing."
CONCLUSIONS OF LAW

The West Virginia Board of Examiners for Registered Professional Nurses concludes that the stipulations support the sanction of disciplinary action pursuant to West Virginia Code 30-7-1 et sea. pertaining to the practice of registered professional nursing. Specifically, the stipulations support sanctions under the following sections of the West Virginia Code: West Virginia Code 30-7-11 (f), which states that a licensee may be disciplined a. upoh proof that he or she [ils guilty of conduct derogatory to the morals or standing of the profession of registered nursing.
CONSENT

BISSELL, by affixing her signature hereon, agrees to the following: She acknowledges that she is aware of her option to retain legal counsel and to 1. be represented by legal counsel at a formal hearing before the Board. She intelligently and voluntarily waives her right to a formal hearing before the 2. Board in this matter, if the Board accepts the terms and conditions set forth herein and joins with her in executing this agreement. She acknowledges that she is fully aware that without her consent, no legal 3. action can be taken against her by this Board, except pursuant to West Virginia Code 30-7-1 et sea. and relevant rules. She submits this proposed agreement freely and voluntarily and not under 4. duress, restraint or compulsion. She agrees that the Board may investigate her background at any time during the 5, term of this agreement. She consents to the entry of the folloWing order affecting her license to practice 6. registered professional nursing in the State of West Virginia. She understands that the Board may accept or reject the facts and terms set forth 7. in this proposed agreement, and may impose revocation or other conditions of a disciplinary nature as are deemed appropriate.

ORDER

On the basis of the foregoing, the Board hereby ORDERS that license number 55503, issued to BISSELL, be suspended for the period of one (1) year. Such suspension is hereby stayed contingent upon BISSELL complying with the terms set forth below, and license number 55503 is placed on probation for a period of 2 years employment as a registered professional nurse. The computation of such period is to begin on the date on which notice is received in the office of the Board that BISSELL is employed as a registered professional nurse and shall run only during such time that she is employed as a registered professional nurse on at least a permanent part-time basis (forty hours every two weeks) or full time basis in the State of West Virginia. The Board also ORDERS BISSELL pay a fine and administrative costs in the amount of Two Thousand Dollar(s) And Zero Cent(s) ($2,000.00). To receive and maintain a probationary license, regardless of employment status, BISSELL shall meet the following conditions:

Terms:
1. BISSELL shall not violate the provisions of West Virginia Code 30-7-1 et seq..

BISSELL shall not commit any act which would be a crime under West Virginia or 2. federal law. If MISTY BISSELL is charged by any law enforcement agency with committing any such criminal act, she shall notify the Board in writing of the formal charge(s) against her, and resolution of same. , BISSELL shall maintain a current and active license in the State of West 3. Virginia. She shall not allow her license to lapse or be placed on an inactive status. 4. BISSELL shall not, under any circumstances, misrepresent her licensure status.

BISSELL shall not be employed by a nursing registry, temporary nursing agency, 5. home health care agency, or as a private duty nurse. 6. BISSELL shall not work in an autonomous nursing position. She shall work only under the direct supervision of a registered professional nurse in a structured setting throughout the term of her probation. Such supervising registered professional nurse must, at the time of said supervision, hold an active, unencumbered West Virginia license. BISSELL shall inform the Board in writing within ten (10) days of the date she 7. assumes the practice of registered professional nursing, or any employment in the health care field, in the State of West Virginia and shall include the name, address, and telephone number of her employer. She shall provide in writing the name of her immediate registered professional nurse supervisor. BISSELL shall inform the Board of any interruption in nursing practice or change in employment within ten (10) days of such interruption or change.

8. BISSELL shall immediately inform her nursing employer, any prospective nursing employer, and the director of any nursing education program in which she enrolls or teaches, that the Board has placed her license on probation, and shall provide a complete copy of this agreement to her employer(s). The Board may provide her employer(s) with a copy of this agreement and may communicate with her employer(s). 9. BISSELL shall, within ten (10) days of employment or continuation of practice, cause her employer or immediate registered professional nurse supervisor, to notify the Board, in writing, of the employer or supervisor's receipt of a copy of this agreement. BISSELL shall further cause her employer or supervisor to submit monthly reports to the Board describing BISSELL's job performance, attendance, attitude, and other work behaviors during the first year of probation and if her progress is satisfactory to the Board, quarterly thereafter. 10. BISSELL shall submit documentation of fifteen (15) contact hours of continuing education regarding ethics, documentation and professionalism awarded each year during the time her license is on probation, in addition to the thirty (30) required by law. 11. BISSELL shall report in person for appointment with the Board staff upon request. 12. BISSELL shall annually submit to the Board a 'written personal statement regarding her progress. The statement shall be due at the end of the first year and in each subsequent year during the month in which this agreement is accepted by the Board.

Violation of Terms:
13, Any deviation from these requirements without prior written consent of the Board shall constitute a violation of this Order, and result in immediate suspenSion of BISSELL'S probationary license. 14.. The Board shall immediately,notify BISSELL via certified mail of the specific nature of the charges, and the suspension of her license. BISSELL may request reinstatement of her probationary license through renewal a. of this agreement, or execution of a new agreement, which may contain different or additional terms. The Board is not bound to comply with this request. If the Board does not accept a renewed or new agreement, BISSELL shall be b. notified in writing. BISSELL may, within fifteen (15) days of receipt of the Board's decision, request a hearing to seek reinstatement of her probationary license. Such hearing shall be held within fifteen (15) days of receipt of BISSELL's request in the office of the Board, BISSELL hereby waives the provisions of West Virginia Code 30-1-8, or any other applicable statute, including but not limited to the West Virginia

Board of Examiners for Registered Professional Nurses Rules, requiring thirty (30) days notice prior to hearing. If BISSELL requests a hearing following suspension for violation of this agreement and does not prevail, the cost incurred in holding such hearing shall be borne by BISSELL. If BISSELL prevails, the cost of such hearing shall be borne by the Board. Cost shall refer only to the expense of employing a court reporter and hearing examiner for the purpose of the hearing, and shall not include any legal or other fees incurred by the Board or BISSELL in bringing the matter to hearing. c. The Board may schedule a hearing on its own initiative for the purpose of allowing the Board opportunity for considering further suspension or revocation of BISSELL's license. Said hearing shall be scheduled in accordance with the provisions of West Virginia Code 30-1-8 and 30-1-7 pima The Board shall bear the cost if it should seek a hearing following suspension of BISSELL'S probationary license for violation of this agreement. Cost shall refer only to the expense of employing a court reporter and hearing examiner for the purpose of the hearing, and shall not include any legal or other fees incurred by BISSELL in bringing the matter to hearing.

Modification of Terms:
15. If BISSELL is proceeding successfully in meeting the terms of her probation, she may petition the Board after no less than one (1) year from the execution of this agreement for a modification of the terms of the agreement. In the event that the Board finds that BISSELL has made significant progress, based upon all information available, the Board may, at its discretion, alter or amend certain provisions of this agreement.

Petition for Reinstatement:

16, Following the 2 year probationary period, BISSELL may petition to appear before the Board and submit satisfactory evidence that she is presently able to safely engage in the practice of registered professional nursing. Evidence in support of this request shall include: a. b. Letter of reference from BISSELL's employer, if employed; and Letter from BISSELL outlining her future plans.

However, the terms of this Order shall remain in effect and subject to yearly review and appropriate revision by the Board until such time as BISSELL's license is fully reinstated by the Board. WHEREFORE, BISSELL hereby requests that the Board accept the stipulations and impose sanctions in accordance with West Virginia Code 30-7-1 et seq.

tx; WHEREFORE, BISSELL hereby requests that the Board accept the stipulatis:. 4:gd impose sanctions in accordance with West Virginia Code 30-7-1 et seq. P1 ca
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Witness

Date

Agreed to:

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M Jud f Nystri5m Disciplinary Review Committee Member Date

;44,141-6b
Teresa Ritchie, DNP,1RN, FNP-BC Disciplinary Review Committee Member Date

04,b
Disdplinary Review Committee Member

Date

410A,c_.
au a S. Rhodes, RN, MSN Executive Director West Virginia Board of Examiners for Registered Professional Nurses Date

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ENTERED: This the Li

day of

, 80A RD RECEIVED 201Z-09-13 01;.52 PM

WV

Cases # 12-005632

Ohio Board
January 25, 2013

'Nursitig

www.nursing.ohip.gov

17 South High Street, Suite 400 * Columbus, Ohio 43215-7410 * (6:14) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Kristen Marie Boal, R.N. 17925 Chatham Court Strongsville, Ohio 44136 Dear Ms. Boal: You are hereby notified that, on or about November 19, 2010, you entered into a Consent Agreement (November 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that upon meeting the requirements for renewal, your license to practice nursing as a registered nurse in the State of Ohio would be reinstated and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations until at least November 2013. Attached to and incorporated within the November 2010 Consent Agreement is a May 16,2008 Consent Agreement. A. Item 2. of the November 2010 Agreement states, "MS. BOAL shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee." Despite this provision, you failed to appear at your scheduled personal interview with your Board Monitoring Agent at the Board's office on November 28, 2012 at 10:00 a.m. B. Item 4. of the November 2010 Consent Agreement states, "MS. BOAL shall abstain completely from the use of alcohol." Item. 5. of the November 2010 Consent Agreement states, "MS. BOAL shall continue submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. BOAL shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. BOAL's history of chemical dependency and recovery status." Despite these provisions, on the following dates, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program

Kristen Marie Boal, R.N. Page 2 administrator, that tested positive for Ethyl Glucuronide (Alcohol): May 24, 2012; September 25, 2012; and October 4, 2012. Furthermore, on or about the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: December 13, 2010; July 5, 2011; July 14, 2011; December 27, 2011; February 2, 2012; October 27, 2012; November 9, 2012; and November 15, 2012. C. Item 7. of the November 2010 Consent Agreement states, "Upon request by the Board or its designee and within sixty (60) days of such a request, MS. BOAL shall, at her expense, obtain a comprehensive evaluation by a psychiatrist who is certified by the American Board of Medical Specialties (ABMS) in Addiction Psychiatry and who is approved in advance by the Board. Prior to the evaluation, MS. BOAL shall provide the evaluating psychiatrist with a copy of this Consent Agreement, the attached May 2008 Consent Agreement, and summaries from her treating physicians for the past five years, including the types and frequency of drugs she has been prescribed in that period. Further, MS. BOAL shall execute releases to permit the evaluating psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. BOAL's license, and a statement as to whether MS. BOAL is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care." You were sent a letter dated July 3, 2012, from your Board Monitoring Agent requesting that you obtain an Addiction Psychiatric Evaluation and submit documentation of the completed evaluation to the Board on or before September 15, 2012. Despite this provision, you failed to submit documentation of a completed Addiction Psychiatric Evaluation to the Board by September 15, 2012. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the November 2010 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 2., 4., 5. and 7. of the November 2010 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-330680, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC.

Kristen Marie Boal, R.N. Page 3

You are further notified that in accordance with Chapter 119; ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about November 19, 2010, you entered into a Consent Agreement (November 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that upon meeting the requirements for renewal, your license to practice nursing as a registered nurse in the State of Ohio would be reinstated and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations until at least November 2013. Attached to and incorporated within the November 2010 Consent Agreement is a May 16,2008 Consent Agreement. 2. Item 2. of the November 2010 Agreement states, "MS. BOAL shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee." Despite this provision, you failed to appear at your scheduled personal interview with your Board Monitoring Agent at the Board's office on November 28, 2012 at 10:00 a.m. 3. Item 4. of the November 2010 Consent Agreement states, "MS. BOAL shall abstain completely from the use of alcohol." Item 5. of the November 2010 Consent Agreement states, "MS. BOAL shall continue submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. BOAL shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. BOAL's history of chemical dependency and recovery status." Despite these provisions, on the following dates, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol): May 24, 2012; September 25, 2012; and October 4, 2012. Furthermore, on or about the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been

Kristen Marie Boal, R.N. Page 4 selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: December 13, 2010; July 5, 2011; July 14, 2011; December 27, 2011; February 2, 2012; October 27, 2012; November 9, 2012; and November 15, 2012. 4. Item 7. of the November 2010 Consent Agreement states, "Upon request by the Board or its designee and within sixty (60) days of such a request, MS. BOAL shall, at her expense, obtain a comprehensive evaluation by a psychiatrist who is certified by the American Board of Medical Specialties (ABMS) in Addiction Psychiatry and who is approved in advance by the Board. Prior to the evaluation, MS. BOAL shall provide the evaluating psychiatrist with a copy of this Consent Agreement, the attached May 2008 Consent Agreement, and summaries from her treating physicians for the past five years, including the types and frequency of drugs she has been prescribed in that period. Further, MS. BOAL shall execute releases to permit the evaluating psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. BOAL's license, and a statement as to whether MS. BOAL is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care." You were sent a letter dated July 3, 2012, from your Board Monitoring Agent requesting that you obtain an Addiction Psychiatric Evaluation and submit documentation of the completed evaluation to the Board on or before September 15, 2012. Despite this provision, you failed to submit documentation of a completed Addiction Psychiatric Evaluation to the Board by September 15, 2012. Section 4723 .28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter, If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit

Kristen Marie Boal, R.N. Page 5 Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0963 cc: Henry G. Appel, Senior Assistant Attorney General

Case *1-0-4350

Ohio Board of Nursing www.pursing.ohiagov

17 South High Street, Suite 400 0 Columbus, Ohio 43215-7410 (614) 466-3947

REINSTATEMENT CONSENT AGREEMENT BETWEEN KRISTEN M. BOAL, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between KRISTEN M. BOAL, R.N. (MS. BOAL) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723, of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. BOAL voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement, BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. MS. BOAL admits to violating Section 4723.28, ORC, as set forth in her May 16, 2008 Consent Agreement (May 2008 Consent Agreement). Further, MS. BOAL admits to additional violations of Section 4723.28, ORC, Specifically, Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of

- Kristen M. Boa(, R.N. Page 2

eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. B. MS. BOAL has been licensed to practice nursing in Ohio as a registered nurse, RN-330680, since February 2007. The Board notes that, on December 13, 2007, MS. BOAL submitted a form to the Board in which MS. BOAL requested that her nursing license be placed on inactive status. MS. BOAL's license has been indefinitely suspended by her May 2008 Consent Agreement, a copy of which is attached hereto and incorporated herein. On or about January 6, 2009, in Cuyahoga County Court of Common Pleas Case No. CR-08-517463-A, MS. BOAL pled guilty to felony charges of Theft of Drugs, Illegal Processing of Drug Documents and Drug Possession and was granted Intervention In Lieu of Conviction (ILC). The acts underlying MS. BOAL's ILC were the events described in her May 2008 Consent Agreement. MS. BOAL successfully completed the terms of her ILC and her criminal case was dismissed in December 2009. Under the terms of her May 2008 Consent Agreement, MS. BOAL is eligible to request reinstatement of her license and submitted such a request in writing. MS. BOAL provided her July 19, 2010 chemical dependency and psychiatric evaluations to the Board from Susan M. Daum, RN, CS-ANP, LICDC and David Stream, M.D., an addiction psychiatrist at the Cleveland Clinic. MS. BOAL was diagnosed with Alcohol and Sedative, Hypnotic Dependence in Remission, with Depression, and with a history of Bipolar Disorder. MS. BOAL reported that she was prescribed Tramadol for back pain and Zoloft by her primary physician, Jennifer T. Henson, M.D. It was opined that MS. BOAL is stable and may safely return to the practice of nursing. It was recommended that MS. BOAL taper herself off of Tramadol by using Dr. Streem's schedule and, if necessary, obtain further treatment for her back pain. MS. BOAL should also follow up with Dr. Streem, for pain medication as needed. MS. BOAL should continue attending recovery meetings and attend a bimonthly relapse prevention group. MS-, BOAL reported to the Board that in September 2010, she discontinued taking her prescribed Tramadol.

C,

D.

E.

F.

Kristen M. Boal, R.N. Page 3

G.

MS. BOAL understands that any violations of this Consent Agreement and/or any further violations of the laws and rules governing the practice of nursing may result in further disciplinary action, up to and including permanent revocation of her license to practice nursing as a registered nurse in the State of Ohio. AGREED CONDITIONS

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. BOAL knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for renewal, MS. BOAL's license to practice nursing as a registered nurse shall be reinstated and suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations until at least November 2013: 1. MS. BOAL shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. BOAL shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.

2.

Monitoring of Rehabilitation and Treatment 3. MS. BOAL shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. BOAL's history of chemical dependency and recovery status. MS. BOAL shall self-administer prescribed drugs only in the manner prescribed. MS. BOAL shall abstain completely from the use of alcohol, MS. BOAL shall continue submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. BOAL shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who

4. 5.

Kristen M. Boal, R.N. Page 4

has full knowledge of MS. BOAL's history of chemical dependency and recovery status. 6. Within thirty (30) days of the effective date of this Consent Agreement, MS. BOAL shall continue attending a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. BOAL shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning January 1, 2011.

Evaluations 7. Upon request by the Board or its designee and within sixty (60) days of such a request, MS. BOAL shall, at her own expense, obtain a comprehensive evaluation by a psychiatrist who is certified by the American Board of Medical Specialties (ABMS) in Addiction Psychiatry and who is approved in advance by the Board. Prior to the evaluation, MS. BOAL shall provide the evaluating psychiatrist with a copy of this Consent Agreement and the attached May 2008 Consent Agreement, and summaries from her treating physicians for the past five years, including the types and frequency of drugs she has been prescribed in that period. Further, MS. BOAL shall execute releases to permit the evaluating psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. BOAL's license, and a statement as to whether MS. BOAL is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. Upon request by the Board or its designee and within sixty (60) days of such a request, MS. BOAL shall, at her own expense, obtain a comprehensive physical examination by a Board approved physician for the purposes of evaluating MS. BOAL's fitness for duty and safety to practice nursing as a registered nurse. This Board approved physician shall provide the Board with complete documentation of MS. BOAL's comprehensive physical examination and with a comprehensive assessment regarding MS. BOAL's fitness for duty and safety to practice nursing as a registered nurse. Prior to the examination, MS. BOAL shall provide the Board approved physician with a copy of this Consent Agreement and the attached May 2008 Consent Agreement. Further, MS. BOAL shall execute releases to permit the ,Board approved physician performing the comprehensive physical examination and assessment to obtain any information deemed appropriate and necessary for the assessment. This Board approved

8.

Kristen M. Boal, RN. Page 5

physician shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. BOAL's license to practice, and a statement as to whether MS. BOAL is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 9. If the above evaluation(s) are requested, MS. BOAL shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the physician(s) described above until released. Further, MS. BOAL agrees that the Board may utilize the physician(s)'s recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. BOAL's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement.

Treating Practitioners and Reporting 10. Within sixty (60) days of the effective date of this Consent Agreement, MS. BOAL shall provide a copy of this Consent Agreement and the attached May 2008 Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. BOAL shall be under a continuing duty to provide a copy of this Consent Agreement and the attachment, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. MS. BOAL shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all subitances prescribed, administered, or dispensed to MS. BOAL throughout the duration of this Consent Agreement Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. BOAL shall notify the Board of any and all medication(s) or prescription(s) received.

11.

12.

Employment Conditions 13. Prior to accepting employment as a nurse, each time with every employer, MS. BOAL shall notify the Board in writing.

Kristen M. Boal, R.N. Page 6

14.

MS. BOAL is under a continuing duty to provide a copy of this Consent Agreement and the attached May 2008 Consent Agreement prior to accepting employment as a nurse. MS. BOAL shall, have her employer(s) submit written reports regarding job performance on a quarterly basis beginning January 1, 2011 or within thirty days of accepting nursing employment. Further, MS. BOAL shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement and the attachments, including the date they were received.

po

Reporting Requirements of Licensee 15. MS. BOAL shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. BOAL shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. BOAL shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. BOAL shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. BOAL shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. BOAL shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, MS. BOAL shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. BOAL shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

16.

17.

18.

19.

20.

21.

22.

Kristen M. Boal, Page 7 Nursing Refresher Course or Orientation Prior to working in a position where a nursing license is required, MS. BOAL shall complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation to be approved in advance by the Board or its designee. Temporary Narcotic Restriction MS. BOAL shall not administer, have access to, or possess (except as prescribed for MS. BOAL's use by another so authorized by law who has full knowledge of MS. BOAL's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum of six (6) months in which MS. BOAL is working in a position that requires a nursing license. At any time after the six (6) month period of time previously described, MS. BOAL may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. BOAL shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers, MS. BOAL shall not call in or order prescriptions or prescription refills for any narcotics, other controlled substances, or mood altering drugs. Permanent Practice Restrictions MS. BOAL further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: Unless otherwise approved in advance by the Board or its designee, MS. BOAL shall not practice nursing as a registered nurse (I) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. BOAL to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance by the Board or its designee, MS. BOAL shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice-President of Nursing. FAILURE TO COMPLY MS. BOAL agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. BOAL has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. BOAL via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. BOAL may request a hearing regarding the charges.

Kristen M. Boat, R.N. Page 8

The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. BOAL appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement, other than the permanent practice restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. BOAL and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. BOAL has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. BOAL is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. BOAL and review of the reports as required herein. Any period during which MS. BOAL does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. BOAL acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. BOAL waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement, MS. BOAL waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC.

600

[TOTS ON XU/III TO:Z- T RBI OTOVPZ/OT

Kristen M. Boal, Page 9

FEECTIVE DATE
MS. BOAL understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

/1.44,ipn >(72 (1547, -'

TEN M. BOAL, R.N. DATE

BERTHA LOVELACE, President Ohi Board of Nursing

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Ohio Board of Nursing www.nursing.ohio.gov

17 South High Street, Suite 400 a Columbus, Ohio 43215-7410 (614) 466-3947

CONSENT AGREEMENT BETWEEN KRISTEN M. BOAL, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between KRISTEN M. BOAL, R.N. (MS. BOAL) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. BOAL voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right.to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTJQN This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723 .28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(G), Ohio Administrative Code, states that a licensed nurse shall not falsify any client record, or any other document prepared or utilized in the course of, or in conjunction with, nursing practice,

Kristen M. Boal, R.N. Page 2 B. MS. BOAL's license to practice nursing as a registered nurse in the State of Ohio, RN-330680, has been inactive since December 13, 2007. MS. BOAL's Ohio nursing license was initially issued in February 2007. MS. BOAL knowingly and voluntarily admits to the following: In October 2007, while employed as a registered nurse on the Bone Marrow Transplant Unit at The Cleveland Clink Foundation (CCF), MS. BOAL was noted to have numerous discrepancies in her withdrawal and documented administration of controlled substances. The discrepancies included MS. BOAL withdrawing more medications than were ordered and failing to document administration and/or wasting Medications she withdrew, and involved Ativan, Hydromorphone, and Oxycodone. Further, MS. BOAL was previously counseled by CCF for various practice and documentation issues from June through October 2007 including failing to address diabetic patients' critical blood sugar levels. MS. BOAL indicated that she had a history of depression and anxiety and was feeling overwhelmed at work. MS. BOAL admitted that she was abusing her prescribed Xanax and began diverting Ativan from work in approximately June 2007 to supplement her prescription. MS. BOAL further admitted to occasional diversion of Oxycodone and Hydromorphone for her self-administration, MS. BOAL voluntarily made her nursing license inactive on December 21, 2007. MS. BOAL underwent a chemical dependency assessment at CCF Alcohol and Drug Recovery Center on October 8, 2007, and was diagnosed with Benzodiazepine (Sedative) Dependency. MS. BOAL completed the Partial Hospitalization Phase of treatment at CCF on November 7, 2007, and was scheduled to participate in the Intensive Outpatient and AfterCare Phases of treatment and attend Nurses Therapy Group meetings. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. BOAL knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: SUSPENSION OF LICENSE 1. MS. BOAL's license to practice nursing as a registered nurse is hereby suspended for an indefinite period of time. MS. BOAL may submit a written request for reinstatement anytime after the terms and conditions of reinstatement have been met.

C.

Kristen M. Boal, R.N. Page 3

CONDITIONS FOR REINSTATEMENT 2. MS. BOAL shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. BOAL shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. Within six (6) months prior to requesting reinstatement, MS. BOAL agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. BOAL, including a check of Federal Bureau of Investigation records, and shall cause BCII to submit MS. BOAL's completed criminal records check reports to the Board. Prior to reinstatement, MS. BOAL shall enter into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of three (3) years following reinstatement. 6. In addition to the continuing nursing education required for licensure renewal, MS. BO AL shall successfully complete and submit documentation of satisfactory completion of the following continuing nursing education: eight (8) hours of care of diabetic patients; eight (8) hours of medication administration; eight (8) hours of documentation; and eight (8) hours of patient assessment.

3.

4.

Monitoring of Rehabilitation and Treatment 7. MS. BOAL shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. BOAL's history of chemical dependency and recovery status. MS. BOAL shall self-administer the prescribed drugs only in the manner prescribed. MS. BOAL shall abstain completely from the use of alcohol. Within three (3) months prior to seeking reinstatement by the Board, MS. BOAL shall, at her own expense, seek a second chemical dependency evaluation by CCF or another Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. BOAL shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. BOAL shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions to be placed on MS. BOAL's license to

8. 9.

Kristen M. Boal, R.N. Page 4 practice, and stating whether MS. BOAL is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 10. MS. BOAL shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by CCF and by the chemical dependency professional described above (if different) until released. Further, MS, BOAL agrees that the Board may utilize the professionals' recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. BOAL's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement, For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement, MS. BOAL shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. BOAL's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily process. The specimens submitted by MS. BOAL shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. BOAL's history of chemical dependency and recovery status, a. Within thirty (30) days prior to MS. BOAL initiating drug screening, M.S. B 0 AL shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. BOAL. b. After initiating drug screening, MS. BOAL shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. BOAL shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment 12, For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement, MS. BOAL shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and licensee shall provide satisfactory documentation of such attendance to the Board prior to reinstatement.

11.

Kristen M. Boal, R.N. Page 5 Psychiatric Evaluation and Treatment 13. Within six (6) months prior to seeking reinstatement by the Board, MS. BOA.L shall, at her own expense, seek a psychiatric evaluation from a Board approved psychiatrist and shall provide the Board with complete documentation of such evaluation. Prior to the evaluation, MS. BOAL shall provide the psychiatrist with a copy of this Consent Agreement and shall execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. BOAL's license, and a statement as to whether MS. BOAL is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS. BOAL shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the professional until released, Further, MS. BOAL agrees that the Board may use the professional recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. BOAL's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement.

14.

Reporting Requirements of Licensee 15, MS. BOAL shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. BOAL shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board, MS. BOAL shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. BOAL shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. BOAL shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. BOAL shall submit the reports and documentation required by this Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410.

16.

17.

18,

19.

20,

Kristen M. Boal, R.N. Page 6

21.

MS. BOAL shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. BOAL shall inform the Board within five (5) business days, in writing, of any change in address and/or telephone number.

22.

NursingRe ruler Course or_Orientation Upon request by the Board or its designee, MS. BOAL shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation approved in advance by the Board or its designee. Temporary Narcotic Restrictions Upon reinstatement of her license, MS. BOAL shall not administer, have access to, or possess (except as prescribed for MS. BOAL's use by another so authorized by law who has full knowledge of MS. BOAL's history of chemical dependency) any narcotics, other controlled substances, or mood altering drugs. MS. BOAL may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. BOAL shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. BOAL shall not call in or order prescriptions or prescription refills for any narcotics, other controlled substances, or mood altering drugs. Permanent Practice Restrictions MS. BOAL further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: Unless otherwise approved in advance by the Board or its designee, MS. BOAL shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. BOAL to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance by the Board or its designee, MS. BOAL shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing.

Kristen M. Boal, R.N. Page 7

FAILURE TO COMPLY The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. BOAL appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/MODIFICATION OF TERMS The terms, limitations, and conditions of this Consent Agreement, other than the permanent ['censure restrictions, may be modified or terminated in writing at any time upon the agreement of both MS. BOAL and the Board. The Board may only alter the indefinite suspension imposed if: (1) MS. BOAL submits a written request for reinstatement; (2) the Board determines that MS. BOAL has complied with all conditions of reinstatement; (3) the Board determines that MS. BOAL is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. BOAL and review of the documentation specified in this Consent Agreement; and (4) MS. BOAL has entered into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of three (3) years following reinstatement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. BOAL acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. BOAL waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. BOAL waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Agreement. This Consent Agreement is not an adjudication order within the meaning of Section 119.01(D), ORC, Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be, reported to appropriate organizations, data banks and governmental bodies.

soo0 [OM ON x!/K.7 ocet. 3111 BOWWS0

Kristen M. Boal.

Rige. 8 EF'CE(.7.1WE DATE

N' S. BOAL understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature bE low,

KRISTEN M. BOA

DATE

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USA KLENK President 0;aio Board of Nursing DATE

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ATTACHMENT A
Period From: Monday, 11/01/2010 Name: Kristen Boal Missed call History Missed Date call?
11/23/10 12/4/10 12/17/10 3/5/11 3/7/11 3/28/11 4/9/11 4/20/11 5/1/11 5/5/11 5/13/11 5/15/11 5/17/11 5/20/11 6/5/11 6/26/11 8/28/11 9/7/11 9/30/11 10/8/11 10/17/11 1/29/12 2/19/12 2/25/12 3/18/12 3/30/12 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

To: Thursday, 11 / 29/2012

Case ID: 130941 Status: Active

4/2/12 9/8/12 10/21/12

10/27/12 10/28/12 11/10/12 11/16/12 11/17/12 11/18/12 11/19/12 11/20/12 11/21/12 11/22/12 11/23/12 11/24/12 11/25/12 11/26/12 11/27/12 11/28/12 11/29/12

Missed Call Missed Call Missed Call Missed Call Scheduled for Testing Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

Row Count: 46

Case# 12-006948

Ohio Board of Nursing

January 25, 2013

www.nuts.ing.ohlogov

17 South High Street, Suite 400 0 COlumbus, Ohio 43215-7410 m (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Lisa Marie Bolton, R.N. 149 Lakeview Lane Chagrin Falls, Ohio 11022 Dear Ms. Bolton: You are hereby notified that, on or about July 27, 2012, you entered into a Consent Agreement (July 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. A. Item 5. of the July 2012 Consent Agreement states, "MS. BOLTON shall abstain completely from the use of alcohol or products containing alcohol." Item 6. of the July 2012 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. BOLTON shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. BOLTON's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. BOLTON shall be negative, except for substances preScribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. BOLTON." Despite this provision, on November 10, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol). In a statement received by the Board on December 4, 2012, you admit that you "took Nyquil the night prior to testing" and that you "consumed two glasses of champagne." Furthermore, you state "I know that this violates my probation . . ."

Lisa Marie Bolton, R.N. Page 2 B. Item 6 b. of the July 2012 Consent Agreement states, "After initiating drug screening, MS. BOLTON shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. BOLTON shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment." Despite this provision, you failed to timely update your list of treating practitioners after you began treatment with a new physician on or about November 21, 2012. Furthermore, you failed to timely notify the Board of new medications and/or prescriptions you were issued on or about November 21, 2012. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the July 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 5., 6., and 6 b. of the July 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-222530, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about July 27, 2012, you entered into a Consent Agreement (July 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. 2. Item 5. of the July 2012 Consent Agreement states, "MS. BOLTON shall abstain completely from the use of alcohol or products containing alcohol." Item 6. of the July 2012 Consent Agreement states, "Within forty-five (45)

Lisa Marie Bolton, R.N. Page 3 days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. BOLTON shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. BOLTON's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. BOLTON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. BOLTON." Despite this provision, on November 10, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol). In a statement received by the Board on December 4, 2012, you admit that you "took Nyquil the night prior to testing" and that you "consumed two glasses of champagne." Furthermore, you state "I know that this violates my probation . . ." 3. Item 6 b. of the July 2012 Consent Agreement states, "After initiating drig screening, MS. BOLTON shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. BOLTON shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment." Despite this provision, you failed to timely update your list of treating practitioners after you began treatment with a new physician on or about November 21, 2012. Furthermore, you failed to timely notify the Board of new medications and/or prescriptions you were issued on or about November 21, 2012. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC.

Lisa Marie Bolton, R.N. Page 4 In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguinents, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215!,nursing.ohio.gov. 7410, or to the e-mail address, hearing(i) If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
ram Ad,

-.=o

'

C.N.P. Rhonda S. Barkheimer, Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1038 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 1045 cc: Henry G. Appel, Senior Assistant. Attorney General Joseph Triscaro, Esq.

Case # 11-000488

Ohio Board of Nursing

17 South High Street, Suite 400

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 e (614) 466-3947

CONSENT AGREEMENT BETWEEN LISA MARIE BOLTON, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between LISA MARIE BOLTON, R.N. (MS. BOLTON) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation, Section 4723.28(G) of the Ohio Revised Code authorizes the Ohio Board of Nursing to compel a licensee to submit to a mental or physical examination, or both, as required by the Board and at the expense of the individual, if the Board finds reason to believe that the individual under investigation may have a physical or mental impairment that may affect the individual's ability to provide safe nursing care. Section 4723.28(B)(11), ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of a physical or mental disability. Rule 4723-3-02, Ohio Administrative Code, defines impairment as an inability to practice according to acceptable and prevailing standards of safe nursing care without appropriate treatment, monitoring or supervision. B. MS. BOLTON was initially licensed to practice nursing as a registered nurse in the State of Ohio, RN#222530, in September 1989. MS. BOLTON's license is currently active. C. MS. BOLTON knowingly and voluntarily states as follows:

Lisa Mark Bolton, R.N. Page 2

1) On or about November 18, 2011, in Geauga County Municipal Court Case No. 2011 TRC 00625, MS. BOLTON was convicted of Having Physical Control of a Vehicle While Under the Influence. 2) On December 21, 2011, the Board ordered MS. BOLTON to an examination pursuant to Section 4723.28(G), ORC. MS. BOLTON complied with the December 2011 Exam Order and was evaluated by Dr. Richard N. Whitney (Examiner) on April 12, 2012. The Examiner provided a written report to the Board dated April 17, 2012 (April 2012 Exam Report) diagnosing MS. BOLTON with active Chemical Dependency, The Examiner recommended MS. BOLTON enter a qualified treatment program at the Intensive Outpatient level of care, 3) MS. BOLTON reports that her arrest occurred during a stressful time in MS. BOLTON's life, when she was working long hours and dealing with a family member's illness. Since her conviction MS. BOLTON has attended AA meetings and counseling sessions, and passed a drug test, MS. BOLTON is agreeable to obtaining treatment and monitoring in order to retain her license to practice nursing as a registered nurse in accordance with acceptable and prevailing standards of safe nursing care. AGRUD CON

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Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. BOLTON knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. BOLTON's license to practice nursing as a registered nurse shall be suspended indefinitely. Such suspension shall be stayed, subject to the following. PROBATIONARY terms, conditions, and limitations for a minimum period of two (2) years: 1. MS. BOLTON shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio, M.S. BOLTON shall comply with all terms and conditions imposed upon her by the Geauga County Municipal Court in Case No. 2011 TRC 00625, IV'S. BOLTON shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. MS. BOLTON agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. BOLTON, including a check of Federal Bureau of Investigation (FBI) records, and shall request 13CII to submit MS. BOLTON's criminal records check reports to the Board, MS. BOLTON's completed criminal records check, including the FBI check, must be received by the Board prior to release from these probationary terms.

2.

3.

Lisa Marie Bolton, R.N. Page 3 Monitoring 4. MS. BOLTON shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. BOLTON. MS. BOLTON shall self-administer the prescribed drugs only in the manner prescribed. MS. BOLTON shall abstain completely from the use of alcohol or products containing alcohol. Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. BOLTON shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. BOLTON's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. BOLTON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. BOLTON. a. Prior to MS. BOLTON initiating drug screening, MS. BOLTON shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. BOLTON. b. After initiating drug screening, MS. BOLTON shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner, Further, MS. BOLTON shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. 7. Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period MS. BOLTON shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board or its designee, or a Twelve Step program, and MS. BOLTON

5. 6.

Lisa Marie Bolton, R.N. Page 4

shall provide satisfactory documentation of such attendance to the Board beginning within six (6) months of the effective date of this Consent Agreement and every six (6) months thereafter. Treatment 8. Within sixty (60) days following the effective date of this Consent Agreement, MS. BOLTON shall, at her expense, begin chemical dependency counseling at the Intensive Outpatient Level with a provider OOP Provider) approved in advance by the Board or its designee. MS. BOLTON shall cause the TOP Provider to submit quarterly written reports to the Board regarding: (i) MS. BOLTON's current diagnosis; (ii) MS. BOLTON's compliance with treatment recommendations/plans, including but not limited to appropriate use of prescribed medications; (iii) all dates MS. BOLTON was seen in the three month period prior to the date of the report; and (iv) any concerns regarding MS. BOLTON's ability to practice nursing in accordance with acceptable and prevailing standards of safe nursing care. Further, MS. BOLTON agrees that the Board may use the TOP Provider's recommendations during the course of treatment, and recommendations for continuing care, as a basis for additional terms, conditions, and limitations on MS. BOLTON's license and that the terms, conditions, and limitations may be incorporated in any addendum to this Consent Agreement. At the first appointment following the effective date of this Consent Agreement, MS. BOLTON shall provide the IOP Provider with a copy of this Consent Agreement, the December 2011 Exam Order, and the April 2012 Exam Report from Dr. Whitney. In addition, MS. BOLTON shall execute releases to permit the program to obtain any information deemed appropriate and necessary for the treatment and evaluation of MS. BOLTON.

9.

Employment Conditions 10, MS. BOLTON shall notify the Board, in writing, of the name and address of any current employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to accepting nursing employment. MS. BOLTON, within fifteen (15) days of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS. BOLTON is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting nursing employment. MS. BOLTON shall have her ernployer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of the effective date of this Consent Agreement or beginning within thirty (30) days of working in a nursing position. MS. BOLTON shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date Consent Agreement was received.

11.

Lisa Marie Bolton, R.N. Page 5

Reporting Requirements
.12.

MS, BOLTON shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. BOLTON shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. BOLTON shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. BOLTON shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. BOLTON shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board, MS. BOLTON shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. BOLTON shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. BOLTON shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

13.

14,

15.

16.

17.

18.

19.

Temporary Practice Restrictions Unless otherwise approved in advance, in writing, by the Board or its designee, MS. BOLTON shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. BOLTON to provide nursing services for fees, compensation, or other consideration or who engage MS. BOLTON as a volunteer.

Lisa Marie Bolton, R.N. Page 6

Unless otherwise approved in advance, in writing, by the Board or its designee, MS. BOLTON shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY MS. BOLTON agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. BOLTON has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. BOLTON via certified mail of the specific nature of the charges and automatic suspension of her license, MS. BOLTON may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. BOLTON appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement, DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MS. BOLTON and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. BOLTON has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. BOLTON is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. BOLTON and review of the reports as required herein. Any period during which MS. BOLTON does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. BOLTON acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. BOLTON waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement.

Lisa Marie Bolton, R.N. Page 7

MS. BOLTON waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 14943, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreeinent is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. EFFECTIVE DATE MS. BOLTON understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

LP LISA MARIE BOLTON, R.N. DATE

/Oof

J EPH RISCARO, Esq. Attorney for Lisa Marie Bolton, R.N.

DAT

61/

BERTHA LOVELACE, President Ohio Board of Nursing

DATE

I al feloi0-,

Case #2011-004644

Ohio Boaxd ,of Nursing

17 South High Street, Suite 400 January 25, 2013

www.nursing.ohio,gov

Columbus, Ohio 43215-7410 (614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Ginger Fawn Bowman, R.N. 423 S. Arlington Avenue Springfield, Ohio 45505 Dear Ms. Bowman: In accordance with Chapter 119, Ohio Revised Code (hereinafter "ORC"), you are hereby notified that the Ohio Board of Nursing (hereinafter "Board") proposes under authority of Section 472328 ORC, to deny your application for renewal of your registered nursing license, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about October 9, 2012, in the Common Pleas Court of Clark County Case No. 12-CR-29, you pled guilty to an Amended charge of Unauthorized Use of Property, a fourth-degree misdemeanor in violation of Section 2913.04, ORC. The acts underlying this conviction involved your unauthorized use of property, to wit: Fentanyl, on or about October 19, 2011. In an interview with a Board Compliance Agent on or about November.21, 2011, you stated that, while working as a registered nurse at Essex of Springfield, Springfield, Ohio, you signed out a Fentanyl patch ordered for a patient and did not remember "where it could have gone."

Section 4723.28(B)(3), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, of a misdemeanor committed in the course of practice. 2. While working as a registered nurse at Essex of Springfield, Springfield, Ohio, the following occurred: a. On or about October 19, 2011, you documented at 8:00 pm that you applied a .25 mcg Fentanyl patch as ordered for Patient #1 [see attached.Patient Key to remain Confidential and not subject to public disclosure] to be applied at 8:00 pm every 72 hours. Despite this, on October 20, 2011, nursing staff observed that the patch on Patient #1 was dated October 16, 2011. In an interview with a Board Compliance Agent on or about November 21, 2011, you admitted that you signed

Ginger Fawn Bowman, R.N. Page 2 out a Fentanyl patch ordered for a patient and but did not remember "where it could have gone." Section 4723.28(3)(19), ORC, authorizes the Board to _discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Ohio Administrative Code (OAC), Rule 4723-4-06(E), states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the clients response to that care. b. On or about October 19, 2011, you documented withdrawing two (2) Ambien (Zolpidern) 5 mg tablets for Patient #2 at 10:00 pm. However, Patient #2 was ordered only one (1) tablet. In an interview with a Board Compliance Agent on or about November 21, 2011, you stated that you must have given the patient the medication twice. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(C), OAC, states that a registered nurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged which includes, but is not limited to, the following: (1) Consistent performance of all aspects of nursing care. c. You documented that you administered one (1) tablet of Ativan (Lorazepm) .5mg to Patient #3 on October 20, 2012. You were not working at 8:00 pm on that date. In an interview with a Board Compliance Agent on or about November 21, 2011, you stated that you must have signed out the pill wrong. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(E), OAC, states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. 3. On or about August 28, 2011, you submitted an application for employment, as a registered nurse, to Atrium Living Centers/Essex of Springfield. Under Employment Experience, the application stated that you were to disclose "your job history for the past five years (and, at minimum, your last four employers)." You were also required to disclose your reason for leaving the positions. You wrote, "Please see resume attached" in response to this question. On your resume, you

Ginger Fawn Bowman, R.N. Page 3 did not disclose your employment at Whispering Pines/Vienna Meadows in 2010, or your employment at Villa Nursing Home in 2010. You were terminated from both of these positions. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06 (P), OAC, states that a licensed nurse shall not make any false, misleading, or deceptive statements, or submit or cause to be submitted any false, misleading or; deceptive information, or documentation to: (3) Prospective employers when applying for positions requiring a nursing license. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410 or to the email address, hearingnursing,ohio,guv. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny your application for renewal of your registered nursing license, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, "iga,t/S-r64.2,7.2_,L) Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0192 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 12-003839

Ohio Board of Nursing

17 South High Street,. Suite 400

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 A (614) 466-3947

January 25, 2013 NOTICE OF OPPORTUNITY FOR HEARING James Robert Brent, R.N. 9412 W. 130 St. Strongsville, Ohio /11136 Dear Mr. Brent: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about August 22, 2012, you told a Board Compliance Agent that beginning in or about August 2011 while working as a nurse at the Cleveland Clinic Foundation you stole Fentanyl numerous times and consumed the medication. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. 2. On or about August 22, 2012, you told a Board Compliance Agent that you obtained and administered Oxycontin purchased "on the streets" without a valid prescription for selfadministrati on . Section 4723.28 (B)(8), ORC [as in effect as ofJune 8, 2012], authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(8), ORC [as in effect prior to June 8, 2012], authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.0,1, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Accordingly, the Board is authorized, to impose one or more of the sanctions cited in Section 4723.28, ORC.

James Robert Brent, R.N. Page 2 In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, bearing@nursing,ohio.2ov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Sincerely, .4/4 , Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0239 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 0246 /(/

cc: Henry G. Appel, Senior Assistant Attorney General Barry Doyle, Esq.

Case# 12-005797

Ohio Board of Nursing.

www.nursing.ohio.gov (614) 466-3947 17 South High Street, Suite 400 e. Columbus, Ohio 43215-7410

January 25, 2013

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Kristen Ruth Burline (fka "Kristen Ruth Voth"), L.P.N. 8010 Whittington Drive Parma, Ohio d4129 Dear Ms. Burline: You are hereby notified that, on or about September 25, 2009, you entered into a Consent Agreement (September 2009 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely, and that such suspension may be stayed subject to reinstatement and probationary terms, conditions, and limitations for a minimum period of three (3) years. Attached to and incorporated within the September 2009 Consent Agreement is a September 19, 2008 Consent Agreement. On March 23, 2010, the Board issued you a letter reinstating your nursing license subject to the terms and conditions of probation as set forth in the September 2009 Consent Agreement. A copy of the March 23, 2010 Reinstatement Letter is attached hereto and incorporated herein. A. Item 1. of the September 2009 Consent Agreement states, "MS. VOTE shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(8)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 6. of the September 2009 Consent Agreement states, "MS. VOTE shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VOTE's history of chemical dependency and recovery status. MS. VOTE shall self-administer prescribed drugs only in the manner prescribed." Despite this provision, on or about October 8, 2012, while working as a nurse at Parma Care Center, in Parma, Ohio, you submitted a drug screen specimen that tested positive for Opiates, without a legal, valid prescription. In a statement you submitted to the Board, you admit to self-administering one (1) "Vicodin left from two years ago . . that was no longer a valid script" for back pain. You

Kristen Ruth Burline (flea "Kristen Ruth Voth"), L.P.N. Page 2 further admitted that your friend gave you a Vicodin to take the next evening for the same reason. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723 28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. B. Item 8. of the September 2009 Consent Agreement states, "For a minimum, continuous period of three (3) months immediately prior to requesting reinstatement of her nursing license and continuing throughout the probationary period, MS. VOTH shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. VOTH shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VOTH's history of chemical dependency and recovery status." Despite this provision, on or about the dates set forth below, you failed to call Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis: February 20, 2011; August 27, 2011; December 3, 2011; February 25, 2012; March 10, 2012; April 14, 2012; July 14, 2012; July 22, 2012; August 12, 2012; September 29, 2012; October 14, 2012; and November 18, 2012. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the September 2009 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 6. and 8. of the September 2009 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-101134, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a licensed practical nurse without a current, valid license, which is a violation of Section 4723.03(B), ORC.

Kristen Ruth Burline (flea "Kristen Ruth Voth"), L.P.N. Page 3 You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherVvise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 25, 2009, you entered into a Consent Agreement (September 2009 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely, and that such suspension may be stayed subject to reinstatement and probationary terms, conditions, and limitations for a minimum period of three (3) years. On March 23, 2010, the Board issued you a letter reinstating your nursing license subject to the terms and conditions of probation as set forth in the September 2009 Consent Agreement. A copy of the March 23, 2010 Reinstatement Letter is attached hereto and incorporated herein. 2. Item 1. of the September 2009 Consent Agreement states, "MS. VOTH shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal,, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 6. of the September 2009 Consent Agreement states, "MS. VOTH shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VOTH's history of chemical dependency and recovery status. MS. VOTH shall self-administer prescribed drugs only in the manner prescribed." Despite this provision, on or about October 8, 2012, while working as a nurse at Parma Care Center, in Parma, Ohio, you submitted a drug screen specimen that tested positive for Opiates, without a legal, valid prescription. In a statement you submitted to the Board, you admit to self-administering one (1) "Vicodin left from two years ago . . , that was no longer a valid script" for back pain. You further admitted that your friend gave you a Vicodin to take the next evening for the same reason. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board.

Kristen Ruth Burline (fka "Kristen Ruth Voth"), L.P.N. Page 4

3. Item 8. of the September 2009 Consent Agreement states, "For a minimum, continuous period of three (3) months immediately prior to requesting reinstatement of her nursing license and continuing throughout the probationary period, MS. VOTH shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. VOTH shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VOTH's history of chemical dependency and recovery status." Despite this provision, on or about the dates set forth below, you failed to call Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis: February 20, 2011; August 27, 2011; December 3, 2011; February 25, 2012; March 10, 2012; April 14, 2012; July 14, 2012; July 22, 2012; August 12, 2012; September 29, 2012; October 14, 2012; and November 18, 2012. Section 4723 .28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing*nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal

Kristen Ruth Burline (fka "Kristen Ruth Voth"), L.P.N. Page 5 allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

K.&
Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0956 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 08-2889 & 09-2422

Ohio i3oa

(1.

Nursing

www.nursing.ohio.gov
(614) 466-3447

17 South High Street, Suite 400 t Columbus, Ohio 43215-7410

CONSENT AGREEMENT BETWEEN KRISTEN RUTH VOTH, L.P.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between KRISTEN RUTH VOTH, (MS. VOTH) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. VOTH voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings:

A.

The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(10), ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of habitual or excessive use of drugs, alcohol, or other chemical substances that impair the ability to practice. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in, the course of practice. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under, Specifically, Rule 4723-4-06(B), Ohio Administrative Code (OAC), states that a licensed nurse

Kristen Ruth Voth, L.P.N. Page 2 shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client. B. MS. VOTH's license to practice nursing as a licensed practical nurse, PN101134, in the State of Ohio has been placed on inactive status since October 6, 2008. MS. VOTH was initially issued a nursing license as a licensed practical nurse in August 1997. MS. VOTH knowingly and voluntarily admits to the following: 1. On or about September 19, 2008, MS. VOTH entered into a Consent Agreement with the Board (September 2008 Consent Agreement) under which MS. VOTH's Ohio nursing license was subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. The September 2008 Consent Agreement was based on events occurring in June 2007 and June 2008. MS. VOTH has been unable to comply with the September 2008 Consent Agreement due to entering residential treatment. A copy of the September 2008 Consent Agreement is attached hereto and incorporated herein. On September 3, 2008, while working as a licensed practical nurse at Manor Care of Parma in Patina, Ohio, MS. VOTH was suspected of diverting narcotics. An investigation was conducted and discrepancies in documentation were noted in MS. VOTH's removal of Vicodin and Ativan for several residents. Two residents were drug screened with negative results. MS. VOTH was subsequently terminated. On September 9, 2008, MS. VOTH entered a detoxification program at Stella Maris in Cleveland, Oho and was diagnosed with Opiate Dependence. On September 15, 2008, MS. VOTH was discharged from Stella Maris and immediately entered residential treatment at Edna House for Women (Edna House), a structured sober living program. On October 6, 2008, MS. VOTH voluntarily placed her nursing license on inactive status. On. April 4, 2009, after seven months of residential treatment, MS. VOTH was successfully discharged from Edna House. MS. VOTH continues to attend weekly 12-Step meetings and has a home group and sponsor.

C.

2.

3.

4. 5.

Kristen Ruth Voth, Page 3 6. MS. VOTH reports that she is working hard on her recovery and is willing to cooperate with the Board in order to reinstate her nursing license. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. VOTH knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. VOTH's license to practice nursing as a licensed practical nurse shall be SUSPENDED. After JANUARY 1, 2010, MS. VOTH may request reinstatement, and such suspension shall be stayed, if MS. VOTH is in full compliance with this Consent Agreement and has obtained prior approval from the Board or its designee. MS. VOTH shall be subject to the following REINSTATEMENT and PROBATIONARY terms, conditions and limitations for a minimum of at least three (3) years: 1. 2. 3. MS. VOTH shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. VOTH shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. Prior to requesting reinstatement of her nursing license, MS. VOTH shall be in fEll compliance with this Consent Agreement and shall obtain approval from the Board or its designee. In addition to the continuing nursing education required for licensure renewal, MS. VOTH shall successfully complete, and submit documentation of satisfactory completion of the following continuing nursing education prior to January 1, 2010: eight (8) hours of documentation and eight (8) hours of medication administration. Within three (3) months prior to requesting reinstatement, MS. VOTH agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. VOTH, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. VOTH's criminal records check reports to the Board. MS. VOTH agrees that a request for reinstatement will not be considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board. MS. VOTH shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VOTH's history of chemical dependency and recovery status.. MS. VOTH shall self-administer prescribed drugs only in the manner prescribed. MS. VOTH shall abstain completely from the use of alcohol.

4.

5.

6.

7.

Kristen Ruth Voth, L.P.N. Page 4 8. For a minimum, continuous period of three (3) months immediately prior to requesting reinstatement of her nursing license and continuing throughout the probationary period, MS. VOTH shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS, VOTH shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VOTH's history of chemical dependency and recovery status. For a minimum, continuous period of three (3) months immediately prior to requesting reinstatement of her nursing license and continuing throughout the probationary period, MS. VOTH shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program. MS. VOTH shall provide satisfactory documentation of such attendance to the Board prior to requesting reinstatement of her license and every six (6) months during the probationary period, Upon request by the Board or its designee and within sixty (60) days of such request, MS. VOTH shall, at her own expense, obtain a chemical dependency evaluation and/or psychiatric evaluation from a Board approved professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. VOTH shall provide the evaluator with a copy of this Consent Agreement and the attached September 2008 Consent Agreement and shall execute releases to permit the evaluator to obtain any information deemed appropriate and necessary for the evaluation. The evaluator shall submit a written opinion to the Board that includes diagnoses, recommendations for' treatment and monitoring, any additional restrictions that should be placed on MS. VOTH's license, and whether MS. VOTH is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If an evaluation is requested, MS. VOTH shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by a chemical dependency professional and/or psychiatrist until released. Further, MS. VOTH agrees that the Board may use the evaluator's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. VOTH's license and that the terms, conditions, and limitations may be incorporated by an addendum to this Consent Agreement.

9.

10.

11.

Kristen Ruth Voth, L.P.N. Page 5 Treating Practitioners and Reporting 12. Within thirty (30) days of the effective date of this Consent Agreement, VOTH shall provide a copy of this Consent Agreement and the attached September 2008 Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. VOTH shall be under a continuing duty to provide a copy of this Consent Agreement and the attached September 2008 Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. MS. VOTH shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. VOTH throughout the duration of this Consent Agreement, Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. VOTH shall notify the Board of any and all medication(s) or prescription(s) received.

13.

14.

Employment Conditions 15. Prior to accepting employment as a nurse, each time with every employer, MS. VOTH shall notify the Board, in writing, and shall provide a copy of this Consent Agreement and the attached September 2008 Consent Agreement to the employer. MS. VOTH shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of employment as a nurse. MS. VOTH shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement and the attached September 2008 Consent Agreement, including the date they were received.

16.

Reporting Requirements of Licensee 17. 18. MS. VOTH shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. VOTH shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board.

Kristen Ruth Voth, L.P.N. Page 6 19. MS. VOTH shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. VOTH shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. VOTH shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. VOTH shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. VOTH shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. VOTH shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

20.

21.

22.

23. 24.

Nursing Refresher Course Upon request by the Board or its designee and prior to working in a position where a nursing license is required, MS. VOTH shall complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation approved in advance by the Board or its designee. Permanent Narcotic Restrictions MS. MOTH further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: Unless otherwise approved by the Board or its designee, MS. VOTH shall not administer, have access to, or possess (except as prescribed for MS. VOTH's use by another so authorized by law who has full knowledge of MS. VOTH's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs. In addition, MS. VOTH shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. VOTH shall not call in or order prescriptions or prescription refills for any narcotics, other controlled substances, or mood altering drugs.

Kristen Ruth Voth, L.P.N. Page 7 Permanent Practice Restrictions MS. VOTH further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: Unless otherwise approved in advance by the Board or its designee, MS. VOTH shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. VOTH to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance by the Board or its designee, MS. VOTH shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, and Vice President of Nursing. FAILURE TO COMPLY MS. VOTH agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. VOTH has violated or breached any terms or conditions of the Consent Agreement, Following the automatic suspension, the Board shall notify MS. VOTH via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. VOTH may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. VOTH appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION! MODIFICATION OF TERMS The terms, limitations and conditions of this Consent Agreement, other than the permanent licensure restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. VOTH and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. VOTH has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. VOTH is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. VOTH and review of the reports as required herein. Any period during which. MS.

Kristen Ruth -Sloth, L.P.N. Page 8 VOTH does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. VOTH acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questiOns asked have been answered in a satisfactory manner. MS. VOTH waives all of her rights under Chapter 119, ORC, as they relate to matters that arc the subject of this Consent Agreement. MS. VOTH waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act Chapter 119, ORC. CTIVE DATE MS. VOTH understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

46tAttnqckthb Val-) bP/\)

KRISTEN RUTH VOTH, L.P.N.

ct 1
DATE

O CA

LISA ICLENICE, President Ohio Board of Nursing

DATE

Case #07-2080 & 07-3371

Ohio Board of Nursing

www.nursing_ohio.gov 17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947

CONSENT AGREEMENT BETWEEN KRISTEN RUTH VOTH, AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between Taus rEN RUTH VOTH, (MS. VOTH) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. VOTH voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. J3ASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(E), Ohio Administrative Code, states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. VOTH has been licensed to practice nursing as a licensed practical nurse in the State of Ohio, PN-101134, since August 1997,

Kristen Ruth Voth, Page 2 C.

MS. VOTH knowingly and voluntarily admits to the following: (1) On or about June 27, 2007, while employed as a licensed practical nurse at Pleasantview Care Center in Parma, Ohio, MS. VOTH underwent a reasonable suspicion drug - screen and tested positive for Cocaine. MS. VOTH admitted that she did use Cocaine, but indicated that it was an isolated incident. MS. VOTH completed a chemical dependency assessment at Oakview Behavioral Health Center in Middleburg Heights, Ohio, on July 10, 2007. According to, the evaluators, MS. VOTH did not meet the clinical criteria for a diagnosis of chemical dependency and was referred for individual psychotherapy to help her deal with stress management and anxiety. MS. VOTH was allowed to remain employed at Pleasant View Care Center, where she had been employed since 2000, under the condition that she submit to random drug screens and complete the employee assistance program. MS. VOTH completed the employee assistance program in August 2007. MS. VOTH resigned from her job at Pleasantview Care Center in October 2007. (2) While employed as a licensed practical nurse at Harborside Broadview Nursing Center in Broadview Heights, Ohio, issues were raised regarding MS. VOTIPs practice including the following: On June 16, 2008, at 7:45 pm, MS. VOTH documented administering PRN Ativan to Patient #1 (as identified on the attached patient keyto be withheld from public disclosure) at 5:00 pm for complaints of increased anxiety. Patient #1 was drug screened the next day and tested negative for Ativan, MS. VOTH states that she was not given the opportunity to undergo a drug screen herself to prove that she did not self-administer the Ativan. On June 10, 200S, MS. VOTH was counseled for failing to sign out an Ultram tablet on a controlled drug log. On June 16, 2008, MS. VOTH was counseled for failing to have a supervisor witness her wasting of a Duragesic patch. MS. VOTH indicated that this involved a Duragesic patch that was three days old and due to be removed, and that this was a new practice/policy that she was not aware of at the time. MS. VOTH further indicated that she replaced the old Duragesic patch with a new ono, MS. VOTH resigned from her employment at Harborside Broadview Nursing Center. AGREED CONDITIONS

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. VOTH knowingly and voluntarily agrees with

Kristen Ruth Voth, Page 3 the Board to the following terms, conditions, and limitations: MS. VOTH's license to practice nursing as a licensed practical nurse is hereby suspended indefinitely. Such suspension is hereby stayed, subject to the following probationary terms, conditions, and limitations for a minimum period of three (3) years: 1. MS. VOTH shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. VOTH shall appear in person for an interview before the full Board or its designated representative, as requested by the Board or its designee. In addition to the continuing nursing education required for licensure renewal, MS. VOTH shall successfully complete, and submit documentation of satisfactory completion of the following continuing nursing education prior to November 1, 2008: eight (8) hours of documentation and eight (8) hours of medication administration.

2. 3.

Monitoring 4. MS. VOTH shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VOTH's history of chemical use. MS. VOTH shall self-administer prescribed chugs only in the manner prescribed. Beginning within forty-five (45) days following the effective date of this Consent Agreement and throughout the probationary period, MS. VOTH shall submit, at her expense and on the day selected, blood Or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 472328(B), ORC. This screening shall require a daily call-in process. The specimens that MS. VOTH submits shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VOTH's history of chemical use. Upon request by the Board or its designee and within shay (60) days of such request, MS. VOTH shall, at her own expense, seek a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board complete documentation of this evaluation. Prior to the evaluation, MS. VOTH shah provide the chemical dependency professional with a copy of this Consent Agreement, Further, MS. VOTH shall execute releases to permit the chemical dependency

5.

6.

Kristen Ruth Yoth, Page 4 professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions to be placed on MS. VOTH's license to practice, and a statement as to whether MS. VOTH is capable of practicing nursing according to prevailing and acceptable standards of nursing. If a chemical dependency evaluation is requested, MS. VOTH shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional until released. Further, MS. VOTH agrees that the Board may use the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. VOTHis iicen'se and that the terms, conditions, and limitations shall be incorporated by an addendum to this Consent Agreement, Treating Practitioners and Reporting 8. Within sixty (60) days of the effective date of this Consent Agreement, MS. VOTH shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Fw-ther, MS. VOTH shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. MS. VOTH shall cause all treating practitioners to complete a medication prescription report, which'is to be mailed by the practitioners directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to M.S. VOTH throughout the term of this Consent Agreement. Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. VOTH shall notify the Board of any and all medication(s) or prescription(s) received.

9.

10.

Employment. Conditions 11. MS. VOTH shall notify the Board, in writing, of the name and address of any current employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to beginning employment.

Kristen Ruth Voth, L,P,N. Page 5 12. MS. VOTH, within fifteen (15) days of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS. VOTH is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting employment. MS. VOTH shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning September 1, 2008. MS. VOTH shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received.

Psychiatric Evaluation and Treatment 13, Upon request by the Board or its designee, MS. VOTH shall, at her own expense, seek a psychiatric evaluation from a Board approved psychiatrist and shall provide the Board with complete documentation of such evaluation. Prior to the evaluation, MS. VOTH shall provide the psychiatrist with a copy of this Consent Agreement and shall execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. YOTH's license, and a statement as to whether MS. VOTH is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If a psychiatric evaluation is requested, MS. VOTH shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the professional until released. Further, MS. VOTH agrees that the Board may use the professional recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. VOTH's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement.

14.

Reporting Requirements of Licensee 15. MS. VOTH shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. VOTH shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board.

16.

Kristen Ruth V oth, Page 6 MS. VOTH shall submit any and all information, which the Board or its designee may request, regarding her ability to practice nursing according to acceptable and prevailing standards of safe nursing care, MS. VOTH shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers_ MS. VOTH shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. MI reporting and communications reqeired by this Consent Agreement shall be made to the Compliance Unit of the Board, MS. VOTH shall submit all documentation required by this Consent Agreement or requested by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. VOTH shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. VOTH shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

17.

18.

19.

20.

21.

22.

Temporary Practice Restrictions Unless otherwise approved in advance by the Board or Board designee, MS. VOTH shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. VOTH to provide nursing services for fees, COMpellSati011, or other consideration or as a volunteer. Unless otherwise approved in advance by the Board or Board designee, MS. VOTH shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing.

Kristen Ruth Voth, L.P.N. Page 7 Tennpnnary Narcotic Restrictions MS. VOTH shall not administer, have access to, or possess (except as prescribed for MS. VOTH's use by another so authorized by Jaw who has full knowledge of MS. VOTH's history of chemical use) any narcotics, other controlled substances, or mood altering drugs for a minimum period of six (6) months in which MS. VOTH is working in a position that requires a nursing license. At any time after the sixmonth period previously described, M.S. VOTH may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. VOTH shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. FAILU TO COMPLY

MS. VOTH agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. VOTH has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. VOTH via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. VOTH may request a hearing regarding the charges.
The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 472328(B), ORC. If, in the discretion of the Board, MS. VOTH appears to have violated or breached any terms or conditions of the Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/MODIFICATIONDF TERMS The terms, limitations and conditions of this Consent Agreement may be modified or terminated in writing at any time upon the agreement of both MS. VOTH and the Board. The Board shall only alter the probationary period imposed by this Consent Agreement if: (I) MS. VOTH has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. VOTH is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring based upon an interview with MS. VOTH and review of the reports required herein. Any period during which MS. VOTH does not work in a position for which a nursing deem is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. VOTH acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner.

07/2212888 101.14 FAX 440 439 1782

5ALE2i

g}002

Kristen Ruth Voth, Page 8 MS. VOTH waives all of her rights under Chapter 119, ORC as they relate to matters that are the subject of this Consent Agreement. MS. VOTH waives any and all claims or causes of action she may have against the Board, and members, officers, employees and/or agents of either, arising out of matters that are the subject of this Consent Agreement, This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. However, any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, RC_ This Consent Agreement shall be considered a public record as that term is used in Section 14943, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies.

Ei IIECTIVE DA'L'E
MS. VOTH understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

KRISTEN RUTH VOTH, L.I.N.

Vcch

D779c9-63/
DATE

LISA KLENICE, President Ohio Board of Nursing

DATE

07/22/2008 TUE 10:29 CTX/RX No 3425] e092

Cs #09-2422

Ohio Board of Nursing

17 South High Street, Suite 400

www.uursing.ohio,gov COILIMNIS, Ohio 43215-7410 (614) 466-3947

March 23, 2010

Kristen Voth 8010 Whittington Dr, Parma OH 44129 .Ref: Consent Agreement of September 25, 2009 License #P.N. 101134 Dear Ms. Voth: The Board considered and approved your request for reinstatement of your nursing license having met the requirements for reinstatement contained within your Consent Agreement of September 25, 2009. Your license is therefore reinstated subject to the terms and conditions of probation effective March 19, 2010. HOWEVER, THE PERMANENT PRACTICE AND PERMANENT NARCOTIC RESTRICTIONS IMPOSED BY YOUR CONSENT AGREEMENT REMAIN IN EFFECT. Sincerely,

Betsy T. Houchen, R.N.; M.S.; J.D. Executive Director 1,FR/d.if

Case #12-005580 & 2010-3966

Ohio -Board of Nursing

17 South High Street, Suite 400

www.nu sip.g.ohio.gov
(614) 466-3947

Columbus, Ohio 43215-7410

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Jennifer Lynn Burnette, L.P.N. 2428 Apricot Drive Beavercreek, Ohio 45431 Dear Ms. Burnette: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Board proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about October 7, 2011, you entered into a Settlement Agreement with the Ohio Department of Job and Family Services (ODJFS), under Docket No. 11 HCS 39, in which you agreed to voluntarily relinquish your Medicaid Provider Agreement Number 2713979 as of September 23, 2011. You further agreed that you would not reapply to be a nonagency Medicaid provider for two years.

Section 4723.28(B)(1), ORC, authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. 2. On or about June 29, 2012, you submitted an on-line application to the Board for the renewal of your licensed practical nursing license (2012 Application). Under the Compliance section of the 2012 Application, you were asked: "Has any board, bureau, department, agency or other body, including those in Ohio, other than this Board, in any way limited, restricted, suspended, or revoked any professional license, certificate, or registration granted to you; placed you on probation; or imposed a fine, censure, or reprimand against you? Have you ever voluntarily surrendered, resigned, or

Jennifer Lynn Bumette, Page 2 otherwise forfeited any professional license, certificate, or registration?" You answered "No." to this question. However, as noted in Paragraph 1, on or about October 7, 2011, you entered into a Settlement Agreement with the Ohio Department of Job and Family Services (ODJFS), under Docket No. 11 HCS 39, in which you agreed to voluntarily relinquish your Medicaid Provider Agreement Number 2713979 as of September 23, 2011. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation. of Chapter 4723, ORC, or any rules adopted under it. Specifically, Ohio Administrative Code (OAC), Rule 4723-4-06(P)(1), states that a licensed nurse shall not submit or cause to be submitted any false, misleading or deceptive information, or documentation to the board or any representative of the board. 3. In February 2010, ODJFS issued an Adjudication Order, under Docket No. 09HCS61, that implemented a 2009 Settlement Agreement. Pursuant to the 2009 Settlement Agreement, you agreed that you would not provide care for any consumer who has a written behavioral plan in place.

Section 4723.28(B)(1), ORC, authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice

Jennifer Lynn Burnette, L.P.N. Page 3 nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, KA4 Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0659 Attorney #1 Certified Mail Receipt No. 7012 2210 0000 6272 0666 Attorney #2 Certified Mail Receipt No. 7012 2210 0000 6272 0673 cc: Henry G. Appel, Senior Assistant Attorney General Richard A. Cline, Esq. William Mann, Esq.

Case #2012-005601

Ohio Board of Nursing

17 South High Street, Suite 400 January 25;2013

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 0 (614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Katrina Yvonne Cain, L.P.N. 1211 Webster Street Farrell, Pennsylvania 16121 Dear Ms. Cain: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 27, 2012, the Commonwealth of Pennsylvania, Bureau of Professional and Occupational Affairs, State Board of Nursing issued a Final Order Adopting Hearing Examiner's Proposed Adjudication and Order (Pennsylvania Board 2012 Final Order) in which, on or about July 6, 2012, your license to practice nursing as a licensed practical nurse was placed on probation. A certified copy of the Pennsylvania Board 2012 Final Order, along with the Attachments are attached and incorporated herein.

Section 4723.28(B)(1), ORC, authorizes the Board to deny a license and/or certificate or otherwise discipline a licensee and/or a certificate holder for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may" also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215l @nursin .ohio ov. 7410, or to the email address, litadlig

Katrina Yvonne Cain, L.P.N. Page 2

If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on your lic'enSe to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0321 cc: Henry G. Appel, Senior Assistant Attorney General

'RECEIVED .

201 OCT 22 Ptil E t` GM OF PENNSYLVANIA . DEPARTMENT OF STATE BOARD 'OF NURSgtooRE THE STATE BOARD OF NURSING OHIO Co. nag of Pennsylvania, Bitrean'af PrOfesSidnal .andDocket No. 0227.5142 Oecupathnal Affairs A-51-07157 File No. v. Katrina Yvonne Cain, LPN, Respondent FINAL ORDER ADOPTING BEARING EXAMINER'S PROPOSED ADJUDICATION AND ORDER

COPY
CP) r I\)

.1

AND NOW, this al-k37- of September, 2012, the State Board of Nursing, having 1a,y reviewed the evidentiary record of this proceeding, together with the hearing examiner's proposed adjudication and order, and noting that neither party filed exceptions to the hearing examiner's proposal, it is hereby ORDERED that the proposed adjudication and order of the hearing examiner, including the proposed findings of fact, proposed conclusions of law, discussion, and proposed order, be adopted as the FINAL Order of the State Board of Nursing in this disciplinary proceeding. A copy of the hearing examiner's proposed adjudication and order is appended to this order as Appendix A, This order shall take effect immediately. BY ORDER: BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS STATE BOARD OF NURSING

COMMISSIONER

JOSEPH NAPOLITANO, PhD, MPH, CRNP CI AIRMAN

TRUE AND CORRECT COPY CERTIFIED FROM TilE. RECORD DAYCOzikoberA.D, 14-1664,

 Respondent: .

Katrina Yvonne Cain 1211 Webster Street Farrell; PA 16121 Margaret Sheaffer, Esquire 2601 North Third Street, P.O. Box 2649 Harrisburg, PA 17105-2649 Beth Sender Michlovitz, Esquire 2601 North Third Street, P.O. Box 2649 Harrisburg, PA 17105-2649 aP1

Prosecuting Attorney:

Board Counsel:

bate: of Mailing:

APPENDIX A

RECEIVED
JUL 0 6 2012 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE BEFORE THE STATE BOARD OF NURSDK1
Department of State Prothonotary

Commonwealth of Pennsylvania, Bureau of Profe'ssional an.d Occupational Affairs v.. Katrina Yvonne Cain, LPN, Respondent Docket No. 0227-51-12 . File No. .10-51-07157

PROPOSED ADJUDICATION AND ORDER

John T. Henderson, Jr. Hearing Examiner Commonwealth of Pennsylvania GOVERNOR'S OFFICE OF GENERAL COUNSEL Department. of State P.O. Box 2649 Harrisburg, PA 17105-2649 (717) 772-2686.

DATE DiSTRIBUTEL) -7 PRO$ECUTJQN COUNSEL HEARING EXAMINER OTHER

HISTORY This matter comes before the hearing examiner for the State Board of Nursing (Board) on a one count order to show cause (OSC) filed on February 3, 2012, alleging that Katrina Y. Cain (Respondent) is subject to disciplinary action under. Section 16(a)(5) of the Practical Nursing Law, Act of March 2, 1956, RL. (1955) 1211, as amended, 63 P.S. 651 et seq, 63 P.S, 666(a)(5), in that Respondent pleaded guilty to two misdemeanor crimes of moral tatp tilde in the courts of this Commonwealth, Respondent filed an answer to the OSC on February 21, 2012, in which she admitted to the allegations and set forth mitigation. A formal administrative hearing was held on May 7, 2012 in Harrisburg, Pennsylvania, before Hearing Examiner John T. Henderson, Jr. Tammi Snyder Queen, Esquire, appeared at the hearing on behalf of the Commonwealth and presented the Commonwealth's case through documentary evidence, Respondent appeared at the hearing, without counsel, and presented her case through her testimony and documentary evidence. The parties waived the filing of post-hearing briefs and the record in this matter was closed on.May 15, 20.12, with the filing of the hearing transcript. (Docket No. 0227-51-12)

FINDINGS OF FACT 1. Respondent holds a license to practice as a practical nurse in the Commonwealth

of Pennsylvania, license no, PN277294, since October 10, 2007. (Board records) Respondent's license is current through June 30, 2014, and may be renewed, reactivated or reinstated thereafter upon the filing of the appropriate documentation and payment of the necessary fees. (Board records) 3. Respondent's address on file with the Board is 1211 Webster Street, Farrell, -PA

1612.1. (Board records) 4. On April 5, 2011, Respondent pleaded guilty to one count of fraud in obtaining

public assistance benefits, in violation of 62 P.S. 481(a), a misdemeanor of the first degree, in violation of 62 P.S. 481(a); and one count of Criminal Conspiracy to Commit Theft by Deception, also a misdemeanor of the first degree, in violation of 18 Pa_ C.S. 903(c). (Exhibit C-3) 5. On 4.nuary,31, 2012, on the charge of public assistance fraud, Respondent was

sentenced to pay costs, restitution to the inspector General of Pennsylvania in the amount of $14,219.00, and placed on probation for a period of 18 months under supervision of the Penniylvania Board of Probation and Parole, 250 hours of community service, with other terms" and conditions, and on the charge of Criminal Conspiracy, Respondent was ordered to pay costs and placed on probation for 18 months concurrent with the fast charge, subject to the same terms and conditions of probation. (Exhibit C-3) 6, In the CPUtSe of the criminal investigation into her actions, Respondent voluntarily

submitted to interviews with the Attorney General'S Office as well as the Department of Public

.3

Welfare investigators, and fully cOoperdte,c1 with regard to her prosecution and the prosecution of her co-defendants. (Exhibit R-1) 7, Respondent accepted responsibility for her criminal. conduct and continues to

make restitution and provide community service. (N.T. 29-30, 33-34; Exhibit C-3) 8, Respondent is also responsible for the care and support of her six children ages

21, 13, 10, 8, and 3 year old twins and is the sole source of income for her family. (N.T, 21., 27,28, 30,31, 32) 9. Respondent has had no previous disciplinary actions against her nursing license.

(Board records) 10. Respondent has been gainfully employed part-tithe as a home healthcare aid for a .

diabetic patient since 2008. (N.T. 19-20) 11. Respondent was served with all pleadings, orders and notices filed of record in

this matter and appeared, pro se, at a formal administrative hearing on May 7, 2012, to pros nt mitigating evidence. (Docket No. 0227-51-12)

CONCLUSIONS OF LA. 7 I 2, The Board has jurisdiction in this matter'. (Findings of Fact, Nos, 1-2) Respondent has been afforded reasonable notice of the charges against her and an

opportunity to be heard in this proceeding in accordance with the Administrative 'Agency Law, 2 Pa. C.S. 504. (Findings of Fact, No. 11) 3.. Respondent is subject to disciplinary action under section .16(a)(5) of the Act, 63

P.S. 666(a)(5), in that Respondent has pleaded guilty to othnes of moral turpitude in the courts of this Commonwealth. (Findings of Fact, No. 4) Respondent's violation of section 16(a)(5) of the Act, 63 P.S.. 6660)(5), . authorizes the Board to impose disciplinary or corrective measures under section 16(b) of the Act, 63 P.S. 666(b).

DISCUSSION This action is brought udder the Practical Nurse Law (Act), .Act of March 2, 1956, Pl. 1211', as amended, 63 P.S. 651 et seq. The relevant provisions of the Act are as follows; 666. Refusal, suspensin or revocation of license; grounds (a) . The board may refuse, suspend or revoke any license in any ease where the board shall find that the licensee *** (5) Has been convicted, or has pleaded guilty or entered 'a plea of nolo contendere or has. been found guilty by a judge or jury of a felony or a crime of moral turpitude in the courts of this Commonwealth ,

63 P.S. 666(a)(5) The Commonwealth charges that Respondent is subject to discipline under section 16(a)(5) of the Act, 63 P.S. 666(a)(5), in that she pleaded guilty to crimes of moral turpitude in a court of this Commonwealth. The Cartunoriv,lealth Court has defined moral turpitude as anything done knoWingly contrary to justice, honesty, or good morals," _Moretti v. Stizte Board of Pharmacy,. 277. A.2d 516, 518 (Pa. Cniwitla. 1971); Foote v. State Board of Vehicle Manufacturers, Dealers and Salespersons, 578 A,2d 1355 (Pa. Cniwith, 1990). "Determination of whether a crime involves moral turpitude turns on the elements of the crime, not on an independent examination of .the details of the behavior underlying the crime." Startzel v. COmmonwealth of Pennsylvania, Department of Education, 562 A.2d 1005, 1007 (Pa. Cm-with. 1989), citing Flickinger v. .Commonw'ealth of Pennsylvania, Department of State, 439 A.2d 235 (Pa. Cm:with. 1982). Crimes of which fraud is an element have been held to be crimes of moral turpitude, Moretti, 277 A.2d 516,, Iturick v. Dept of State, 402.A.2d 290 (Pa. Cmwlth. 1979).

There is no dispute in the record that Respondent pleaded guilty in the Mercer County Court of Common Pleas tb one count of public assistance fraud under section 481(a) of . the Public Welfare Code, a first-degree misdemeanor, and 'one count of .Criminal Conspiracy to Commit Theft by Deception, also a misdemeanor of the. first degree, in violation of 18 Pa. C.S. 903(c): A conviction under section 481(a) of the Public Welfare Code conclusively establishes that "either prior to, or at the time of, or subsequent to the application for assistance, by means of a willfully false statement or misrepresentation, or by impersonation or by willfully failing to disclose a. material fact regarding eligibility or other fraudulent means, secures, or attempts to .secure, or aids or abets or attempts to aid or abet any person in securing assistance, or Federal food stamps, ..." 62 P.S. 481(a). Willfully making a false statement Or misrepresentation, as described above, is an act knowingly done contrary to honesty and good morals. In determining whether Respondent's guilty plea to Criminal Conspira.cyl to Commit Theft by Deception charge is a crime of moral turpitude, we must first determine whether the underlying offense, Theft by Deception,2 is a crime of moral turpitude. See McNaughton v. INS, 612 F.2d 457, 459 (9th Cir. 1980),
903. Criminal conspiracy.

("'Where the underlying, subStantive offense is a crime

* (e) Conspiracy with multiple criminal objectives.If a person conspires to commit a number of crimes, he is guilty of only one conspiracy so long as such multiple crimes are the object of the same agreement or continuous conspiratorial relationship.

3922. Theft by deception. (a) Offense defined.- A person is guilty of theft if he intentionally obtains or withholds property of another by deception. A person deceives if he intentionally: (1) creates or reinforces a false impression, including false impressions as to law, value, intention or other state. of mind; but deception as to a person's intention to perform a promise shall not be inferred from the fact alone that he did not subsequently perform the promise; (2) prevents another from acquiring information whibh would affect his judgment of a transaction; or (3) fails to correct a false impression which the deceiver previously created or reinforced, or which the deceiver knows to be influencing another to whom he stands in a fiduciary or confidential relationship.

involving moral turpitude

conspiracy to commit such an offense is also a'crime involving

moral turpittlde.") The Commonwealth Court has already determined that Theft By Deception is crime involving moral turpitude authorizing-:e Board to take licensure discipline, under the Act. See, Krystai Jeep Eagle,. Inc, v., Bureau of Professional and Occupational Affairs, 725 A.2d 846, 849-850 (Pa, Cmwith. 1999), appeal denied, 559 Pa. 723, 740 A.2d 1150 (1999) The Commonwealth Court has held that "crimes involving dishonesty, such as fraud and theft by deception.are crimes of moral turpitude." Bowalick oi, Dep't. of Educ., 840 A.2d 519, 524. (Pa. CmwIth.2004). As such, public assistance fraud and conspiracy to commit theft by dtception are crimes of moral turpitude Respondent is therefore again subject to disciplinary action under section 16(a)(5) of the Act, 63 P.S. 666(a)(5) for also having committed this crime. Based on the above violations, the Board is authorized to impose disciplinary or Corrective measures under section 16(b) of the Act, 63 P.S. 666()), In assigning a sAnction, the Board weighs the number and seriousness of the violation against any mitigating evidence. In this case, Respondent agreed with her daycare provider to obtain childcare benefits through the county assistance office by providing false information. (N.T. 16-48; Exhibit C-3) The daycare provider falsely represented to the county assistance office that Respondent's children were attending .her daycare, when in fact, the children were not there. (NT. 16-18, 26) in exchange,. the daycare provider would pay Respondent a portion of the reimbursement she received. (N.T. 25). in mitigation, Respondent detailed the conduct leading to her convictions. Respondent explained that she had lost her job and was no longer eligible for childcare or able to finish her studies. (N.T. 17) She sought to remove her children from the daycare, at which time the daycare provider convinced Respondent to keep her children "enrolled" so that she could

complete her studies. (N.T. 17) Respondent 'continued making these false representations for about one year. (N.T, 18, 25) Respondent represents, in mitigation.; that she ended her involvement in the scheme prior to the criminal investigation; cooperated With authorities in their investigation of 9 other individuals involved in the scheme; and is making court-ordered restitution in the amount of about $14,000.00 and has completed approximately 218 of the 250 hours of community service. (Exhibits G-3 and R-1) Respondent is single mother of six children ages 21, 13, 10, 8, and 3 year old twins and is the sole source of income for her family. Additionally, Respondent has been gainfully employed part-time as a home healthcare aid for a diabetic patient since 2008. Respondent is currently on probation for her criminal conviction and continues to pay restitution, The duty of the Board is to protect the health and safety of the citizens of the Commonwealth and ensure that the sanction imposed reaches that end. The Practical Nurse Law ensures that only persons with good moral character, integrity, and honesty are licensed to practice nursing, It is reasonable, to expect professionals licensed by the Commonwealth to possess a reasonable level of character, integrity and honesty. See Foose, supra. Respondent was remorseful,for her actions and would like to move forward with her life, ('N.T. 33-34) The 'Commonwealth recommended that Respondent's license should be actively suspended with the suspension stayed in favor of probation to run concurrent with her criminal probation and that a civil penalty of no more than $1,000.00 be imposed. (N.T. 34) After carefully considering the entire record, and the recommendation of the parties, the Hearing Examiner concludes that an active suspension is not warranted in order to protect the public and that a suspension stayed in favor of probation, to run concurrently 'with Respondent's criminal probation, is an appropriate sanction under the circumstances of this case. Respondent's cambial conviction was not related

to the practice of nursing and appeais to be an isolated event in an otherwise law abiding life, Considering the extent of Respondent's culpability, her acceptance of responsibility, the fact that she is paying over $14,000.00 in restitution and is a single mother supporting six children, the Hearing Examiner concludes that a civil penalty is not necessary in order to deter Respondent and others from committing similar viora.tiOns in the future. The proposed sanction is consistent with previous sanctions issued by the Board in similar cases, See, Commonwealth of Pennsylvania, BP OA v, Melissa Ann Wade, LPN, Docket No. 0121-51-11/Elle No. 10-51-02203, and Commonwealth of Pennsylvania, BPOA v. Mary Louise x' e, LPN, Docket No. 0920-5109fFile No, 08-51-07845, Accordingly, the Board enters the following Order:

10

COMMONWEALTH OF PENNSYLVANIA. ljEPARTMENT OF STATE BEFORE THE STATE BOARD OF NURSING Commonwealth of Pennsylvania, Bureau of Professional and Occupational Affairs Docket No. 0227-51-12 10-51-07157 Pile No. Kat:Ma Yvonne Cain, LPN, Respondent PROPOSED ORDER , NOW, this 6th day of July 2012, upon consideration of the foregoing findings of fact', conclusions of lav,, and discussion, it is ORDERED that the' license issued to Respondent, Katrina Yvonne Cain, LPN, license no. PN277294, shall be INDEFINITELY SUSPENDED, that suspension to be immediately stayed in favor PROBATION until such time as Respondent completes her criminal probation, subject to the terms and conditions set forth below, Respondent may petition for reinstatement to unrestricted, non-probationary status upon 'an affirmative showing that ReSpondent has successfully completed her criminal probation and has provided verification' that she has not practiced in violation of this order. Respondent shall comply with the following terms of probation: D1SCIPL> NARY PROBATION GUIDWI,INES GENERAL 1. Respcindent shall abide by and obey all laws of the United States, the Commonwealth of Pennsylvania and its political subdivisions and all toles and regulations and laws pertaining to the practice of the profession in this Commonwealth or any other state or jurisdiction in Which

.11

Respondent holds a license .to practice a health care profession. Summary traffic violations shall not constitute a violation of this Order. 2. Respondent shall cooperate with the Bureau of Professional and Occupational Affairs ("Bureau"), its agents or employees and the Bureau of Enforcement and Investigation ("BEI") and its agents or employees, in the monitoring, supervision and investigation of Respondent's compliance with the terms and conditions of this Order, including requests for written reports, records and. verifications of actions that may be required by the Bureau or BEL 3. Respondent shall not falsify, misrepresent or make material omission of any information Submitted pursuant to 'this Order. 4. Respondent shall notify BEI, in writing at Bureau of Enforcement and Investigation Box 2649, Harrisburg, PA 17105-2649, within twenty (20) days of the filing of any criminal charges, the initiation of any other legal action pertaining to the practice of Respondent's profession, the initiation, action, restriction or limitation relating to Respondent by the professional licensing authority of any state or jurisdiction, or the Drug Enforcement Agency of the US. Department of justice, or any investigation, action, restriction or limitation relating to. Respondent's privileges to practice a health care profession at any health care facility, 5. Respondent shall notify BEI by telephone within 72 hours at (717) 783-722l, and in writing within ten (10) days, of the change of her home address; phone number, place(s) of .employment and/or practice. 6. Respondent shall execute any waivers or consent forms required to allow the Bureau or BEI to obtain access to any agreements or any other records generated through the Board or BET or its agents.

7. Respondent shall bear the responsibility of all costs incurred by Respondent in complying with the terms of this Order, including production of records. VIOLATION OF TIES ORDER 8, Notification of a violation of the terms or conditions of this Order 81r11 result in VACATING the stay, TERMINATING the period of probation, and ACTIVATING the twoyear suspension of Respondent's license to practice practical nursing in the Commonwealth of Pennsylvania as follows: (a) The prosecuting attorney for the Commonwealth shall file with the probable cause screening committee of the Board a Petition which indicates that Respondent has violated any terms or conditions of this Consent Agreement and Order; . (b) Upon a probable cause determination that Respondent has violated any of the terms or conditions of this Consent Agreement and Order, the probable cause screening committee of the Board shall,. without holding a formal hearing, issue a preliminary order vacating the stay of the suspension in this matter, terminating the period of probation and activating the entire period of suspension of Respondent's license; (c) Respondent shall be notified of the Preliminary Order, within three (3) days of its issuance by certified mail and first class mail postage prepaid, sent to the last registered address on file with the Board; (d) Within twenty (20) days of mailing of the preliminary order, Respondent may answer the Commonwealths Petition arid request that a formal hearing be convened concerning Respondent's violation of probation, in which Respondent may seek relief from ;the Preliminary Order activating the suspension. Respondent shall serve the

13

prosecuting attorney for the Commonwealth with a copy of the answer arid all subsequent filings in this matter; (e) If a request fora formal hearing is received from Respondent, the Board shall convene a formal hearing within forty-five (45) days from the .date of the Board's receipt of Respondent's request for a formal hearing; (I) If Respondent files an answer and request for a hearing within the twenty (20) day period, the Preliminary. Order activating the suspension shall remain in effect unless and until the Board issues a determination favorable to Respondent after holding the formal hearing; (g) If the Board after such hearing makes a determination adverse to Respondent, the Board will issue a Final Order activating the suspension of Respondent's license and imposing any additional disciplinary measures it deems appropriate; (h) If a request for a formal hearing is not received from Respondent within the prescribed twenty (20) day period, the Board's Preliminary Order shall become a Final Order twenty (20) days after the date of its mailing, 9. If the stay is terminated, ReSpondent shall still comply with all terms and conditions of probation during the active suspension, other than those terms and conditions pertaining to practicing the profession. Continued failure by Respondent to comply with the unaffected terms and conditions of probatiOn shall result in further disciplinary action against Respondent. .10, Respondent's failUre to fully comply with any terms of this Order may also constitute grounds for additional disciplinary action.

11. Nothing in this Order sli211 preclude the Prosecuting Attorney for the Commonwealth from filing charges or the Board from imposing disciplinary or corrective Measures for violations or facts not contained in this Adjudication and Order. COMPLETION 12. UpOn successful completion of her criminal probation, Respondent may petition the Board to administratively reinstate her license to unrestricted, non-prOba.tionary status by providing verification that Respondent has not practiced in violation of this order and by providing proof that she has completed her criminal probation. Respondent shall include with the petition a summary of Respondent's Criminal History Record Information (a/kia "Criminal Record Check") obtained at Respondent's expense.. Respondent's petition for reinstatement to unrestricted, non-probationary status may be mailed to: The State Board of Nursing has announced its intention to review this Proposed Report in accordance with 1 Pa. Code 35.226(a)(2). BY ORDER:

In T. Henderson, Jr. Hearing Examiner RespOndent Katrina Yvonne Cain 1211 Webster Street Farrell, PA 16121 Margaret Sbeafier, Esquire Cointnonwealth of Pennsylvania GOVERNOR'S OFFICE OF GENERAL COUNSEL DepartMent of State P.O. Box 2649 Harrisburg, PA 17105-2649

Prosecuting Attorney:

Date of Mailing: 15

.NOTICE
SERVICE OF PROPOSED REPORT;

The foregoing is the proposed report issued In this matter by a Hearing Examiner for the Department of State, in accordance with the General Rules of Administrative Practice and Procedure at 1 Pa, Code 3.207, EXCEPTIONS TO PROPOSED REPORT: Any participant who wishes to appeal all or part of the Hearing Exarninees proposed report to the Board must file exceptions in the form of a Brief on Exceptions with the Prothonotary of the Department of State within 30 days after the date of mailing shoWn on this proposed report in accordance with the General Rules of Administrative Practice and Procedure at I Pa. 'Code 35211-214, The Brief on Excepdons shall contain a short statement of the case, a summary of the appealing party's position, the grounds for filing exceptions to the proposed 'report; and the argument in support of the appealing party's position with citations to the record and legal authority. The *pealing party rriay also include proposed findings of fact and conclusions of law, In the event any participant files exceptions, the Board- may substitute its findings for those of the Hearing Examiner, and /or may impose a greater or lesser sanction than that .imposed by the Hearing Examiner without regard to the relief requested or the position argued by any party, and without hearing additional argument or facing additional evidence. Failure to file a Brief On Exceptions within the time allowed under the General Rules of Administrative Practice and Procedure at 1 Pa, Code 35.211-214 shall constitute a waiver of all objections to the proposed report, FILING AND SERVICES*: An original and three (3) corAes of the Brief on Exceptions Mail be flied with: Prothonota!y 2601 North Third Street P. 0, Box 264,9 Harrisburg, PA 17105-2649 Copies of the Brief on Exceptions must also be served on all participants to the proceeding, Briefs on Exceptions must be received for filing by the Prothonotary within the time limits specified herein. Date of receipt by the Office of Prothonotary and not date of deposit in the mail is determinative,

NOTICE The attached Final Order represents the final agency decision in this matter. It may be appealed to the Commonwealth Court of Pennsylvania by the filing of a Petition for Review with that Conrt within 30 days after the entry of the order in accordance with the Pennsylvania Rules of Appellate Procedure. See Chapter 15 of the Pennsylvania Rules of Appellate Procedure. entitled "Tudicial Review of Governmental Determinations?" Pa. R,A,2 1501 * 1561. Please note: An order is entered On the date it is mailed. If you take an appeal to the Commonwealth Court, you must serve the Board with a copy of your Petition for Review. The agency contact for receiving service of such an appeal is: Board Counsel P.O. Box 2649 Harrisburg, PA. 17105-2649 The name of the individual Board Counsel is identified on the Final Order,

Case# 12-007048

Ohio Board of Nursing

17 South High Street, Suite 400 January 25, 2013

www.ni, sing.ohio.gov

Columbus, Ohio 43215-7410 41, (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR, HEARING

Bryan Keith Carlson, R.N. 6985 Mountain View Drive Hillsboro, Ohio 45133 Dear Mr. Carlson: You are hereby notified that, on or about March 19, 2010, you entered into a Consent Agreement (March 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension may be stayed subject to reinstatement and probationary terms, conditions, and limitations for a minimum period of three (3) years. On March 29, 2011, the Board reinstated your nursing license subject to the terms and conditions of probation as set forth in the March 2010 Consent Agreement. A copy of the March 29,2011 Reinstatement Letter is attached hereto and incorporated herein. A. Item 6. of the March 2010 Consent Agreement states, "For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement of his Ohio nursing license and continuing throughout the probationary period, MR. CARLSON shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR. CARLSON shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. CARLSON's history of chemical dependency and recovery status." Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis.

Bryan Keith Carlson, R.N. Page 2 Furthermore, on the following dates, you were selected to provide a specimen for analysis and failed to do so: October 5, 2012; November 10, 2012; November 26, 2012; and December 3, 2012. B. Item 7. of the March 2010 Consent Agreement states, "For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement of his Ohio nursing license and continuing throughout the probationary period, MR. CARLSON shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step Program, and licensee shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning prior to requesting reinstatement." Despite this provision, as of December 11, 2012, you have failed to submit to the Board satisfactory documentation of meeting attendance since April 2012. Section 4723 .28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the March 2010 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 6. and 7. of the March 2010 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-327277, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: I. On or about March 19, 2010, you entered into a Consent Agreement (March 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that, your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension may be stayed subject to reinstatement and probationary terms, conditions, and limitations for a minimum period of three (3) years. On March 29, 2011, the Board reinstated your nursing license subject to the terms and conditions of probation as set forth in the March 2010 Consent Agreement. A copy of the March 29, 2011 Reinstatement Letter is attached hereto and incorporated herein.

Bryan Keith Carlson, R.N. Page 3

2. Item 6. of the March 2010 Consent Agreement states, "For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement of his Ohio nursing license and continuing throughout the probationary period, MR. CARLSON shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR. CARLSON shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. CARLSON's history of chemical dependency and recovery status." Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. Furthermore, on the following dates, you were selected to provide a specimen for analysis and failed to do so: October 5, 2012; November 10, 2012; November 26, 2012; and December 3, 2012. 3. Item 7. of the March 2010 Consent Agreement states, "For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement of his Ohio nursing license and continuing throughout the probationary period, MR. CARLSON shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step Program, and licensee shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning prior to requesting reinstatement." Despite this provision, as of December 11, 2012, you have failed to submit to the Board satisfactory documentation of meeting attendance since April 2012. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice.

Bryan Keith Carlson, R.N. Page 4

You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board,, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0949 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 09-2640 & 09-264"I

Ohio Board of Nursing

CONSENT AGREEMENT BETWEEN BRYAN K. CARLSON, R.N. AND OHIO BOARD OF NURSING

www.nursing.ohio.gov

17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947

This Consent Agreement is entered into by and between BRYAN K. CARLSON, R.N. (MR. CARLSON) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MR. CARLSON voluntarily enters into this Consent Agreement being fully informed of his rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding .of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care.

Bryan K. Carlson, R.N. Page 2

B.

MR. CARLSON's license to practice nursing as a registered nurse in the State of Ohio, RN-327277, has been inactive since June 1, 2009. MR. CARLSON's Ohio nursing license was initially issued in July 2006. MR. CARLSON knowingly and voluntarily admits to the following: (1) On or about May 22, 2009, while employed as a registered nurse in the Emergency Department at Clinton Memorial Hospital in Wilmington, Ohio, MR. CARLSON was investigated for removing Dilaudid (Hydromorphone) from the PYXIS using a coworker's identification. An audit revealed numerous other discrepancies involving MR. CARLSON's removal of Dilaudid from the PYXIS without a documented physician's order. MR. CARLSON subsequently admitted that he had stolen Dilaudid from Clinton Memorial Hospital and self-administered the stolen Dilaudid to treat chronic pain. MR. CARLSON also admitted that he occasionally removed drugs from the PYXIS without an appropriately documented physician's order for the drugs. On or about December 7, 2009, in Clinton County Court of Common Pleas Case Number CRT 2009-5211, MR. CARLSON pled guilty to nine (9) counts of Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(I), ORC, and was found eligible for Intervention in Lieu of Conviction. Case Number CRI 2009-5211 was based upon MR. CARLSON's theft of Dilaudid from Clinton Memorial Hospital in April 2009 and May 2009. On October 27, 2009, MR. CARLSON was assessed at FRS Counseling in Hillsboro, Ohio, and was diagnosed with Opioid Abuse. MR. CARLSON successfully completed the Intensive Outpatient Program at FRS Counseling on December 7, 2009, and is currently in their Aftercare Program. According to his counselor, MR. CARLSON has attended Twelve Step meetings and has been an active participant in group meetings. MR. CARLSON has had six random drug screens at FRS Counseling, all of which have been negative. AGREED CONDITIONS

C.

(2)

(3)

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MR. CARLSON knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MR. CARLSON's license to practice nursing as a registered nurse is hereby suspended indefinitely, but for a minimum period of six (6) months. After the six (6) month period, MR. CARLSON may submit a written request to the Board or its designee to stay the suspension. The Board or its designee may stay the suspension, and MR. CARLSON may proceed with the licensure renewal process, as long as MR. CARLSON is in full compliance with this Consent Agreement.

Bryan K. Carlson, R.N. Page 3 MR. CARLSON's license shall be subject to the following REINSTATEMENT and PROBATIONARY terms, conditions, and limitations for a minimum period of three (3) years: 1. MR. CARLSON shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio, and shall comply with all terms and conditions imposed in Clinton County Court of Common Pleas Case Number CR1 2009-5211. MR. CARLSON shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. MR. CARLSON agrees that he will submit a request to the Bureau of Criminal Identification and Investigation (BC1I) to conduct a criminal records check of MR. CARLSON, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MR. CARLSON's criminal records check reports to the Board, MR. CARLSON's completed criminal records check, including the FBI check, must be received by the Board within three months prior to MR. CARLSON requesting reinstatement.

2,

3.

Monitoring of Rehabilitation and Treatment 4. MR. CARLSON shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. CARLSON's history of chemical dependency and recovery status. MR. CARLSON shall selfadminister prescribed drugs only in the manner prescribed. MR. CARLSON shall abstain completely from the use of alcohol. For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement of his Ohio nursing license and continuing throughout the probationary period, MR. CARLSON shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of.. Section 4723,28(B), ORC, This screening shall require a daily call-in process. The specimens submitted by MR. CARLSON shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. CARLSON's history of chemical dependency and recovery status. a. Within thirty (30) days prior to MR. CARLSON initiating drug screening, MR. CARLSON shall provide a copy of this Consent

5.

Bryan K. Carlson, RN. Page 4 Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MR. CARLSON. b. After initiating drug screening, MR. CARLSON shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MR. CARLSON shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment.

7.

For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement of his Ohio nursing license and continuing throughout the probationary period, MR. CARLSON shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and licensee shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning prior to requesting reinstatement. Within three (3) months prior to requesting reinstatement of his Ohio nursing license, MR. CARLSON shall, at his own expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional, and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MR. CARLSON shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MR. CARLSON shall execute releases to permit the chemical dependency professional to obtain any information from FRS Counseling and any other information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MR. CARLSON's license to practice, and stating whether MR. CARLSON is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MR. CARLSON shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MR. CARLSON agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MR. CARLSON's license and that the

8.

9.

Bryan K. Carlson, R.N. Page 5 terms, conditions, and limitations may be incorporated in an addendum to this. Consent Agreement. Physical Evaluation and Treatment 10. Within six (6) months prior to requesting reinstatement of his Ohio nursing license, MR. CARLSON shall, at his own expense, obtain a comprehensive physical evaluation to address MR. CARLSON's chronic pain by a Board approved physician, and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MR. CARLSON shall provide the physician with a copy of this Consent Agreement. Further, MR. CARLSON shall execute releases to permit the physician to obtain any information from FRS Counseling and any other information deemed appropriate and necessary for the evaluation. The physician shall submit a written opinion to the Board that includes dia.gnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MR. CARLSON's license to practice, and stating whether MR. CARLSON is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MR. CARLSON agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MR. CARLSON's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

11.

Additional Evaluation and Treatment 12. Upon request by the Board or its designee and within sixty (60) days of such request, MR. CARLSON shall, at his own expense, obtain a chemical dependency and/or psychiatric evaluation from a Board approved chemical dependency professional/psychiatrist and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MR. CARLSON shall provide the evaluator with a copy of this Consent Agreement and shall execute releases to permit the evaluator to obtain any information from FRS Counseling and any other information deemed appropriate and necessary for the evaluation. The evaluator shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MR. CARLSON's license, and whether MR. CARLSON is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If an evaluation is requested pursuant to the above paragraph, MR. CARLSON shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the evaluator until released. Further, MR. CARLSON agrees that the Board may use the

13.

Bryan K. Carlson, R.N. Page 6 evaluator's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MR. CARLSON's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement. Employment Conditions 14. MR. CARLSON shall notify the Board of the name and address of any employer prior to accepting employment in a position where a nursing license is required. MR. CARLSON is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting employment in a position where a nursing license is required. MR. CARLSON shall have his employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of working in a nursing position. MR. CARLSON shall have his employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received.

15.

Reporting Requirements of Licensee 16. MR. CARLSON shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MR. CARLSON shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MR. CARLSON shall submit any and all information that the Board may request regarding his ability to practice according to acceptable and prevailing standards of safe nursing practice. MR. CARLSON shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MR. CARLSON shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MR. CARLSON shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the

17.

18.

19.

20.

21.

Bryan K. Carlson, R.N. Page 7 attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. 22. MR. CARLSON shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MR. CARLSON shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number,

23.

Nursing Refresher Course Upon request by the Board or its designee, MR. CARLSON shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a refresher course or an extensive orientation to be approved in advance by the Board or its designee. Temporary Narcotic RestrictioB MR, CARLSON shall not administer, have access to, or possess (except as prescribed for MR. CARLSON's use by another so authorized by law who has full knowledge of MR. CARLSON's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum period of six (6) months in which MR. CARLSON is working in a position that requires a nursing license. At any time after the six-month period previously described, MR. CARLSON may submit a written request to the Board to have this restriction re-evaluated. In addition, MR. CARLSON shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MR. CARLSON shall not call in or order prescriptions or prescription refills for any narcotics, other controlled substances, or mood altering drugs. Permanent Practice Restrictions MR. CARLSON further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: Unless otherwise approved in advance, in writing, by the Board or its designee, MR. CARLSON shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MR. CARLSON to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance, in writing, by the, Board or its designee, MR. CARLSON shall not function in a position or employment where the job duties

Bryan K. Carlson, R.N. Page 8 or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, and Vice President of Nursing. FAILURE TO COMPLY MR. CARLSON agrees that his license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MR. CARLSON has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MR. CARLSON via certified mail of the specific nature of the charges and automatic suspension of his license. Upon receipt of this notice, MR. CARLSON may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MR. CARLSON appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. pURATION/ MODIFICATION OF TERMS The terms, limitations and conditions of this Consent Agreement, other than the permanent licensure restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MR. CARLSON and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MR. CARLSON has complied with all aspects of this Consent Agreement; and (2) the Board determines that MR. CARLSON is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MR. CARLSON and review of the reports as required herein. Any period during which MR. CARLSON does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement, ACKNOWLEDGMENTS/LIABILITY RELEASE MR. CARLSON acknowledges that he has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MR. CARLSON waives all of his rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement.

Bryan K. Carlson, R. N. Page 9 MR. CARLSON waives any and all claims or causes of action he may have against the Board, and its members, officers, employees and/or agents arising out of matters which are the subject of this Consent Agreement, This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. EFFECTIVE DATE MR. CARLSON understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

BRYAN Ii::-CARLSON, R.N.

DATE

A90/06-1RiAie
BERTHA LOVELACE, President Ohio Board of Nursing

DATE

3111 1D

Case #09-2644

Ohio Beard of Nursing www,nursing.ohio.gov

17 South High Street, Suite 400 g Columbus, Ohio 43215-7410 0 (614) 466-3947

March 29, 2011

Bryan Carlson, 6985 Mountain View Dr Hillsboro, OH 45133 Ref: Consent Agreement of March 19, 2010 License # R.N. 327277 Dear Mr. Carlson: The Board Supervising Member considered and approved your request for reinstatement of your nursing license having met the requirements for reinstatement contained within your Consent Agreement of March 19, 2010. Your license is therefore reinstated subject to the tenets and conditions of probation including the PERMANENT PRACTICE AND TEMPORARY NARCOTIC RESTRICTION(S) effective March 18, 2011. .Sincerely,

Betsy J. Houchen, RN., MS., JD. Executive Director LFR/marn

ATTACHMENT A

Period From: Thursday, 04/01/2010

To: Thursday, 12/06/2012

Name: Bryan Carlson Missed call History Missed Date call? 3/10/11 Missed Call 5/11/11 Missed Call 5/13/11 Missed Call 7/13/11 Missed Call 10/13/11 Missed Call 10/16/1 1 Missed Call 10/28/11 Missed Call 11/11/11 Missed Call 11/12/11 Missed Call 11/13/11 Missed Call 11/14/11 Missed Cali Missed Call 11/15/11 Missed Call 11/16/11 11/17/11 Missed Call 11/18/11 Missed Call 9/1 Missed Call 11/1 1 11/20/11 Missed Call 11/21/11 Missed Call 11/22/11 Missed Call 11/23/11 Missed Call 11/24/11 Missed Call 11/25/11 Missed Call 11/26/11 Missed Call 11/27/11 Missed Call 11/28/11 Missed Call 11/29/11 Missed Call

Case ID: 137170

Status: Active

11/30/11 12/1/11 12/2/11 12/3/11 12/4/11 12/8/11 12/10/11 12/11/11 1/8/12 1/27/12 2/12/12 3/25/12 4/1/12 4/18/12 4/22/12 5/20/12 6/3/12 6/9/12 6/11/12 6/13/12 2 6/16/1 6/22/12 6/27/12 6/30/12 7/4/12 7/12/12 7/14/12 7/22/12 8/3/12 8/18/12 8/24/12 8/30/12 9/2/12 9/3/12 9/7/12 9/8/12 9/15/12 2 9/16/1 9/22/12 9/28/12

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

9/29/12 10/6/12 10/7/12 11/3/12 11/11/12 11/21/12 11/22/12 11/23/12 11/24/12 11/25/12

11/26/12 11/27/12 11/28/12 11/29/12 11/30/12 12/1/12 12/2/12

12/3/12 1 2/4/12 12/5/12 12/6/12

Row Count: 87

Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call 1 Missed Call Missed Call Missed Call Missed Call Missed Call Scheduled for Testing Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Scheduled for Testing Missed Call Missed Call Missed Call

Case #12-003140

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 40() 0 Columbus, Ohio 43215-7410 0. (614) 466-3947,

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Saxah R. Carpenter, L.P.N. 277 W. Meadowbrook Tiffin, Ohio 48833 Dear Ms. Carpenter: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about August 8, 2012, in Bowling Green Municipal Court Case No. 12 CR-A01601, you pled guilty to, and were convicted of Attempted Receiving Stolen Property, being a misdemeanor of the first degree. The acts underlying this offense involve you, on or about June 23, 2012, while working as a nurse for MedlCare, LLC, depriving Patient #1 [See attached Patient Key to remain confidential and not subject to public disclosure] of twenty (20) Vicodin pills. Section 4723.28(B)(3), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, of a misdemeanor committed in the course of practice. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 472328 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 432157410, or to the email address, hearing@nursing.ohio.gov.

Sarah R. Carpenter, L.P.N. Page 2

If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, ..&r.--74-se-9.-.-=7,za.,0 X. A/ d:A/./e7 / Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0550 r'o

cc:

Henry G. Appel, Senior Assistant Attorney General

Case# 12-006323

Ohio Board,of Nursing

January 25, 2013

www.nursing.ohio.gov
(614) 466-3947

17 South High Street, Suite 400 6 Columbus, Ohio 43215-7410

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Kim Michelle Cocchi, L.P.N. 3454 Smugglers Cove Willoughby, Ohio '11094 Dear Ms. Cocchi: You are hereby notified that, on or about July 27, 2012, you entered into a Consent Agreement (July 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. A. Item 1. of the July 2012 Consent Agreement states, "MS. COCCHI shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 6. of the July 2012 Consent Agreement states, "MS. COCCHI shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. COCCHI. MS. COCCHI shall self-administer the prescribed drugs only in the manner prescribed." Item 10. of the July 2012 Consent Agreement states, "Within forty five (45) days of the effective date of the Consent Agreement and continuing throughout the probationary period, MS. COCCHI shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. COCCHI's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a- restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. COCCHI shall be negative, except for substances prescribed, administered, or dispensed to her

Kim Michelle Cocchi, L.P.N. Page 2 by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. COCCHI." On or about September 21, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that also tested positive for Oxazepam and for Lorazepam. In a written statement to the. Board received on or about October 19,- 2012, you indicate that your positive screen may have been due to your taking "nerve pills" given to you by a friend over Labor Day weekend. You did not have a legal, valid prescription for Oxazepam or Lorazepam. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the July 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 6., and 10. of the July 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-089792, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of, suspension shall be considered engaging in the practice of nursing as a licensed practical nurse without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about July 27, 2012, you entered into a Consent Agreement (July 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. 2. Item 1. of the July 2012 Consent Agreement states, "MS. COCCHI shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into

Kim Michelle Cocchi, L.P.N. Page 3 the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into, the body any drug that is a schedule I controlled substance. Item 6. of the July 2012 Consent Agreement states, "MS. COCCHI shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. COCCHI. MS. COCCHI shall self-administer the prescribed drugs only in the manner prescribed." Item 10. of the July 2012 Consent Agreement states, "Within forty five (45) days of the effective date of the Consent Agreement and continuing throughout the probationary period, MS. COCCHI shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. COCCHI's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. COCCHI shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. COCCHI." On or about September 21, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that also tested positive for Oxazepam and for Lorazepam. In a written statement to the Board received on or about October 19, 2012, you indicate that your positive screen may have been due to your taking "nerve pills" given to you by a friend over Labor Day weekend. You did not have a legal, valid prescription for Oxazepam or Lorazepam. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723 .28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice.

Kim Michelle Cocchi, L.P.N. Page 4 You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing@nursing,ohio,gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, >043-7.z.d/zr_-

"gct--=/---/-s-4",-

R. A/

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1083 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 11-000309

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947

CONSENT AGREEMENT BETWEEN KIM MICHELLE COCCHI, L.P.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between KIM MICHELLE COCCHI, L.P.N. (MS. COCCHI) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723, of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(10), ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of habitual or excessive use of drugs, alcohol, or other chemical substances that impair the ability to practice, Section 4723.28(B)(21), ORC, authorizes the Board to discipline a licensee for, in the case of a licensed practical nurse, engaging in activities that exceed the practice of nursing as a licensed practical nurse. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(P), Ohio Administrative Code, states that a licensed nurse shall not make any false, misleading, or deceptive statements, or submit or cause to be submitted any false, misleading or deceptive information, or documentation to: (1) The board or any representative of the board. B. MS. COCCHI was initially licensed to practice nursing as a licensed practical nurse in the State of Ohio, PN#089792, in December 1992.

Kim Michelle Cocchi, L.P.N. Page 2

C. MS. COCCHI knowingly and voluntarily admits to the following: 1. On or about December 8, 2009, in Willoughby, Ohio Municipal Court Case No. 09TRC09267, MS. COCCHI was convicted of Operating a Vehicle Intoxicated, being a misdemeanor of the first degree, On or about November 17, 2010, in Willoughby, Ohio Municipal Court Case No. 10TRC07668-A, MS. COCCHI was convicted of Operating a Vehicle Intoxicated, being a misdemeanor of the first degree. 2. On or about May 25, 2010, MS. COCCHI submitted an application for renewal of her license to practice nursing as licensed practical nurse. MS. COCCHI falsely indicated that she had not been convicted of a misdemeanor. 3. On or about January 20, 2011, while working as a nurse for Homestead I nursing facility in Painesville, Ohio, you took a resident home with you, and there was a misunderstanding with the facility as to whether you had previously received the guardian's approval D. MS. COCCHI states the following: 1. MS. COCCHI has received treatment for alcoholism with the LakeGeauga Recovery Center in Mentor, Ohio (Lake-Geauga). This treatment included Intensive Outpatient Therapy from January 2011 until March 2011, followed immediately by Aftercare until July 2011. MS. COCCHI continues to attend AA meetings three times each week. MS. COCCHI's sobriety date is October 28, 2010. 2. MS. COCCHI states that a friend filed her renewal application for her because she was not able to file the application electronically. MS. COCCHI acknowledges that she is responsible for submitting accurate information to tlie:13oard on her renewal ariplicition.' 3. MS. COCCHI states that she did have prior approval from the guardian prior to taking the resident out of the nursing home. The resident reported that she had fun with MS. COCCHI during the outing. 4. MS. COCCHI is currently employed as a nurse with the Lake County Board of Developmental Disabilities. MS. COCCHI is willing to consent to monitoring in order to ensure that she is safe to practice. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. COCCHI knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. COCCHI's license to

Kim Michelle Cocchi, L.P.N. Page 3

practice nursing as a licensed practical nurse shall be suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum period of three (3) years.. MS. COCCHI shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. COCCHI shall comply with all of the terms and conditions imposed upon her by the Willoughby, Ohio Municipal Court in Case Nos. 09TRC09267 and 10TRC07668-A. 2. MS. COCCHI shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. MS. COCCHI agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. COCCHI, including a check of Federal Bureau of Investigation (FBI) records, and shall request BCII to submit MS. COCCHI's criminal records check reports to the Board. MS. COCCHI's completed criminal records check, including the FBI check, must be received by the Board prior to release from these probationary terms.

3.

Educational Requirement 4. Within six (6) months of the effective date of this Consent Agreement, MS. COCCHI shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education, or another comparable course approved in advance by. the Board or its designee, taken subsequent to the effective date of this Consent Agreement: fifteen (15) hours of Professional Boundaries, two (2) hours of critical thinking, two (2) hours of documentation, two (2) hours of professional accountability.

Fine 5. MS. COCCHI is hereby fined five hundred dollars ($500.00) for the application she submitted to the Board that contained false information. BY JANUARY 1, 2013, MS. COCCHI shall pay the fine of five hundred dollars ($500.00) by certified check, cashier check, or money order, made payable to the "Treasurer, State of Ohio,' to the Board, Payment shall be mailed to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410,

Monitoring of Rehabilitation and Treatment 6. MS. COCCHI shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for

Kim Michelle Cocchi, L.P.N. Page 4

MS. COCCHI. MS. COCCHI shall self-administer the prescribed drugs only in the manner prescribed. 7. MS. COCCHI shall abstain completely from the use of alcohol or any products containing alcohol. Within forty-five (45) days of the effective date of this Consent Agreement, MS. COCCHI shall, at her expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS, COCCHI shall provide the chemical dependency professional with a copy of this Consent Agreement and her assessments, evaluations, and treatment records from Lake-Geauga. Further, MS. COCCHI shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. COCCHI's license to practice, and stating whether MS. COCCHI is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS. COCCHI shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. COCCHI agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. COCCHI's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement. Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. COCCHI shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. COCCIII's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. COCCHI shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. COCCHI. a. Prior to MS. COCCHI initiating drug screening, MS. COCCHI shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a

8.

9.

10.

Kim Michelle Cocchi, L.P.N. Page 5

medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. COCCHI, b. After initiating drug screening, MS. COCCHI shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. COCCHI shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. 11 MS. COCCHI shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board or its designee, or a Twelve Step program, and MS. COCCHI shall provide satisfactory documentation of such attendance to the Board beginning within six (6) months of the effective date of this Consent Agreement and every six (6) months thereafter. Upon request of the Board or its designee and within ninety (90) days of that request, MS. COCCHI shall, at her expense, obtain a psychiatric evaluation from a Board approved psychiatrist and shall provide the Board with complete documentation of such evaluation. Prior to the evaluation, MS. COCCHI shall provide the psychiatrist with a copy of this Consent Agreement and her assessments, evaluations, and treatment records from Lake-Geauga, and shall execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. COCCHI 's license, and a statement as to whether MS. COCCHI is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If a psychiatric evaluation is requested, MS. COCCHI shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the professional until released. Further, MS. COCCHI agrees that the Board may use the professional recommendations and conclusions from the evaluation as a basis for additional terms, conditions, limitations on MS. COCCHI 's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

12.

13.

Employment Conditions 14. MS. COCCHI shall notify the Board, in writing, of the name and address of any current nursing employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to accepting nursing employment.

Kim Michelle Cocchi ,LP.N. Page 6

15.

MS. COCCHI, within fifteen (15) days of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS. COCCHI is under, a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting nursing employment. MS. COCCHI shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of the effective date of this Consent Agreement or beginning within thirty (30) days of working in a nursing position. MS. COCCHI shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date Consent Agreement was received.

Reporting Requirements 16. MS. COCCHI shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. COCCHI shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. COCCHI shall submit any and all information that the Board may request regarding' her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. COCCHI shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. COCCHI shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. COCCHI shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, MS. COCCHI shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. COCCHI shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

17.

18.

19.

20.

21.

22:

23.

Kim Michelle Cocchi, L.P.N. Page 7

Temporary Practice Restrictions MS. COCCHI shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. COCCHI,to provide nursing services for fees, compensation, or other consideration or who engage MS. COCCHI as a volunteer. M.S. COCCHI shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY MS. COCCHI agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. COCCHI has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. COCCHI via certified mail of the specific nature of the charges and automatic suspension of her license. MS. COCCHI may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. COCCHI appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MS. COCCHI and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. COCCHI has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. COCCHI is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. COCCHI and review of the reports as required herein. Any period during which MS. COCCHI does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement.

Kim Michelle Cocchi, L.P.N. Page 8

ACKNOWLEDGMENTS/LIABILITY RELEASE MS. COCCHI acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. M.S. COCCHI waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. COCCHI waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. EFFECTIVE DATE MS. COCCHI understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below,

1)(-41-atolUi 6o401 _Lpd M MICHELLE COCCHI, L.P.N.

i t, Akdigift. SAMAYrR

1T 9\ 1_j1
Iota
DATE

BERTHA uOVELACE, President Ohio Board of Nursing

0 3A1303ei

Cases # 08-1830; 12-005796

Ohio ttoard of Nursing

January 25, 2013

www.nursing.ohio.gov
(614) 466-3947

17 South High Street, Suite 400 . Columbus, Ohio 43215-7410

NOTICE OF TEMPORARY SUSPENSION AND OPPORTUNITY FOR HEARING

Nancy A. Cox, R.N. 5751 Penn Avenue Dayton, Ohio 45432 Dear Ms. Cox: In accordance with Section 4723.35(D)(2) of the Ohio Revised Code (ORC), it has been determined that you were significantly out of compliance with the terms and conditions for participation in the Alternative Program for Chemical Dependency {Program) of the Ohio Board of Nursing (Board) based on the information set forth below in Item 2. Further, Section 4723.35(D)(2), ORC, states as follows: If the program coordinator determines that a participant is significantly out of compliance with the terms and conditions for participation, the coordinator shall notify the Board's supervising member for disciplinary matters and the supervising member shall temporarily suspend the participant's license or certificate. The program coordinator shall notify the participant of the suspension by certified mail sent to the participant's last known address and shall refer the matter to the Board for fointal action under section 4723.28 or 4723.86 of the Revised Code. WHEREFORE, PURSUANT TO SECTION 4723.35(D)(2), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-155613, IS HEREBY TEMPORARILY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. In or about June 2008, while working as a registered nurse at DigestiveCare, Inc., Beavercreek Ohio, your employer discovered that you had forged the signature of Dr. Romeo, one of the DigestiveCare physicians, and used Dr. Romeo's DEA number, to obtain Vicodin. In a written statement to the Board, dated July 21,

Nancy A. Cox, R.N. Page 2 2008, you state that: "I became physically dependent upon Vicodin. I don't call-in sick. I haven't had a sick day in 6-7 years, so I continued to take the Vicodin to avoid withdrawal symptoms." Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. 2. On or about October 9, 2008, you entered into an Alternative Program Participant Agreement (Agreement) with the Board's Alternative Program for Chemical Dependency (Program). The Agreed Conditions, Page 2, provide that the Agreement would be for a period of four (4) years, unless early release was granted. a. Item 52. of your Agreement states, "Participant acknowledges and agrees that successful completion of the Program is dependent upon Participant's re-entry to practice while under the terms of the Agreement, and a determination that Participant's practice is in accordance with the acceptable and prevailing standards of care." Despite this provision, you never re-entered nursing practice while under the terms of the Agreement. b. On or about October 9, 2012, you were terminated from the Program based on your failure to comply with the terms and conditions of your Agreement.

Section 4723.28(B)(25), ORC, authorizes the Board to discipline a licensee for failure to comply with the terms and conditions of participation in the chemical dependency monitoring program established under Section 4723.35, ORC. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-6-03(A), Ohio Administrative Code, requires a participant in the. Alternative Program for Chemical Dependency to comply with all of the terms and conditions of the participant's agreement with the Alternative Program for Chemical Dependency for the time period specified in the agreement. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in

Nancy A. Cox, R.N. Page 3 writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager, Ohio Board of Nursing, 17. South High Street, Suite 400, Columbus, Ohio 43215-7410 or to the e-mail address, hearing*nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Temporary Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, At C.N.P. Rhonda S. Barkheimer, Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1281 ec: Henry Appel, Senior Assistant Attorney General

Case #12-002570

Ohio Board of Nursing

January 25, 2013

www.nursing.ohio.gov
9

17 South High Street, Suite 400 9 Columbus, Ohio 43215-7410

(614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Laurie Cross-Bazzoli, L.P.N. 685 W. Lake St. Ravenna, Ohio 44266 Dear Ms. Cross-Bazzoli: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny or permanently deny your request to reinstate your license to practice nursing as a licensed practical nurse in Ohio; revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about May 9, 2012, the Delaware Board of Nursing issued a Consent Agreement and Order (Delaware Board 2012 Order) in which your license to practice nursing as a licensed practical nurse was placed on probation for a period of one (1) year. A certified copy of the Delaware Board 2012 Order is attached hereto and incorporated herein.

Section 4723.28(B)(1), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High. Street, Suite 400, Columbus, OH 432157410, or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal

Laurie Cross-Bazzoli, L.P.N. Page 2

allegations set forth in this Notice of Opportunity for Hearing, to deny or permanently deny your request to reinstate your license to practice nursing as a licensed practical nurse in Ohio; revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0710 cc: Henry G. Appel, Senior Assistant Attorney General

BEFORE TIM DELAWARE BOARD OF NURSING IN RE: LAURIE CROSS-BAZZOLI ) LICENSE NO.: L24)003493 CONSENT AGREEMENT A written Complaint has been filed with the Delaware Board of Nursing ("Board") alleging that Laurie Cross-Bazzoli ("Respondent"), a licensed practical nurse in the State of Case No.: 1I-81-11

4::=1

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rs)

Delaware with an active license, has engaged in conduct which constitutes grounds for discipline under the Nurse Practice Act (24 Del. C. Ch.19). In order to avoid a formal disciplinary hearing before the Board, Respondent, the State, by the undersigned Deputy Attorney General, and the Board hereby enter into this Consent Agreement without the necessity of a formal disciplinary hearing and administrative prosecution before the Board pursuant to 24 Del, C. Ch. 19 and 29 Del. C. Ch. 101. IT IS UNDERSTOOD AND AGREED 'FIIAT: 1. Respondent is licensed practical nurse in the State of Delaware, license number

L2-0003493. Respondent's license was issued March 21, 1984 and is not currently active, 2. At all times relevant Respondent was employed as a licensed practical nurse at

Newark Manor Nursing Horne ("Newark Manor"). 3. On or about August 16, 2010, a CNA staff member ("H.B.") sought assistance of

another CNA staff member ("S.W.") to transfer an elderly resident ("Resident") from the shower to her wheelchair. 4. During the course of such activity, S.W., in an attempt to quiet Resident, later

admitted to placing a soiled bath towel.over the Resident's mouth, and cupped Resident's mouth' with herhand.

5. group. 6. Respondent. 7.

On or about August 16, 2010, Respondent was the charge nurse in charge oilier

On or about August 16, 2010, I-LB. reported an incident similar to the above to

Respondent admitted that she did not believe that S.W. would have engaged in had described a different incident

that type of conduct in that the Respondent belieVeA

ge f8bi-i ly witnessed by the Respondent; The Respondent, therefore, dismissed the accusations described to her. 8. Pursuant to Newark Manor's policy, any employee who does not report suspected

abuse will be treated as though she had committed the abuse herself. 9. 10. Respondent was terminated from Newark Manor for failing to report the incident. Respondent's above noted conduct was deemed to be unprofessional, violating

the provisions of 24 Del. C. 1922 (a)(8), and the following Board Rules: a. 10.4.2.12 in that she failed to take appropriate action to safeguard a patient from incompetent, unethical or illegal health care practice. b. 10.4.2.27 in that she failed to take appropriate action or to follow policies and procedures in the practice situation designed to safeguard the patient. 11. It is understood that Respondent has chosen not to work in the field of nursing

since she was terminated from Newark Manor. 12. This is the first complaint filed against Respondent during her almost twenty-

eight (28) years as a licensed practice nurse. 13. Respondent admits that the facts contained in paragraphs one (I) through twelve

(12) herein are true and correct. 2

14.

Respondent and the State agree that the appropriate disciplinary sanctions for her

unprofessional conduct shall be a one (1) year period of probation beginning on the date the Board enters this Consent Agreement as an Order of the Board. 15, Respondent shall notify the. Executive Director within ten (10) days of any change

in her residential address. 16. Respondent shall notify the Executive Director of all nursing employment and

any change thereto within ten (10) days of such change. 17. Respondent shall provide the Executive Director with a written self-evaluation status report before the end of the period of probation. The contents of the report must meet with the approval of the Executive Director in her sole discretion. 18. During the period of probation, Respondent shall inform all nursing employers that the Board has placed her license on probation and provide said employers with a copy of this written Consent Agreement and Order of the Board. lf, during the period of probation, Respondent is employed through a staffing agency, she shall inform her supervisor in any facility where she is assigned that her nursing license is on probation and also provide such supervisor with a copy of this written Consent Agreement and Order of the Board. 19. Respondent shall arrange with all of her nursing employers for the submission of

a written performance evaluation from her nursing supervisor to the Executive Director before the end of the period of probation. If, for any reason, a nursing employer is unable or unwilling to provide such performance evaluation, that fact shall be reported by the Respondent in writing to the Executive Director. The contents of the report must meet with the approval of the Executive Director in her sole discretion.

tO_

Before the end of the period of probation, Respondent will submit proof to the 3

Executive Director that she has successfully completed six (6) hours of Continuing Education in following facility procedure. These hours shall be in addition to those required under Rule 9. 21. Respondent acknowledges that she is waiving her right under 24 Del. C. Ch. 19

and 29 Del. C. Ch. 101 to a disciplinary hearing before the Board prior to the imposition of disciplinary sanctions, 22. Respondent hereby acknowledges and agrees that she has carefully read and

understands this Consent Agreement and that she is entering into this Consent Agreement freely, knowingly, voluntarily, and after having received or having been afforded the opportunity to receive the advice of counsel. 23. Respondent understands and agrees that if the Board accepts this Consent

Agreement it will become a public document and that the Board will report this Consent , Agreement and the Board's Order to the licensing authority of all other States in which she is licensed to practice nursing and to national databases which collect information on nursing disciplinary actions. 24. Respondent further agrees and acknowledges that in the event the Board

determines not to accept this Consent Agreement, neither she nor anyone on her behalf will ire any way or in any forum challenge the ability of the Board or any of its members to conduct an evidentiary hearing relating to the allegations in the subject Complaint on the basis of the Board's prior consideration of this proposed Consent Agreement. 25. This Consent Agreement shall be effective after execution by Respondent, the

designated Board member, and the Deputy Attorney General for the State and upon approval by the Board.

A fr-t,CI 1.4, - Vp-, Laurie Cross-Bazzoli Respondent Dated: l

orce.,

Kelli; Walsh Deputy Attorney General Dated:

BEFORE TM: DELAWARE BOARD OF NURSING IN RE: LAURIE CROSS-BAZZOLI ) LICENSE NO.: L2-0003493 Case No.: 11-8141

ORDER
WHEREAS, the Delaware Board of Nursing has reviewed this matter and hereby approves the Consent Agreement of the parties, and enters it now as an Order of the Delaware Board of Nursing;

t
IT IS SO ORDERED this

day of

, 2012.

Case #12-006966

Ohio Board,
January 25, 2013

Nursing

WWW.TILITS ing

ohip gus:,

17 South High Street, Suite 400 6 Columbus, Ohio 43215-7410 6 (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Clark Kendall Davidson, R.N. 3724 E. Fifth Street Dayton, Ohio 45403 Dear Mr. Davidson: You are hereby notified that, on or about January 22, 2010, you entered into a Consent Agreement (January 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension may be stayed subject to reinstatement and probationary terms, conditions, and limitations for a minimum period of three (3) years. On August 8, 2011, the Board notified you that your license to practice nursing as a registered nurse was reinstated, subject to the terms and conditions of probation set forth in the January 2010 Consent Agreement. A copy of the August 8, 2011 Reinstatement Letter is attached hereto and incorporated herein. A. Item 6. of the January 2010 Consent Agreement states, "For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement of his Ohio nursing license and continuing throughout the probationary period, MR, DAVIDSON shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR. DAVIDSON shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. DAVIDSON's history of chemical dependency and recovery status." Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis.

Clark Kendall Davidson, R.N. Page 2 Furthermore, on the following dates, you were selected to provide a specimen for analysis and failed to do so: March 20, 2012; November 26, 2012; December 10, 2012, and January 15, 2013. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the January 2010 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Item 6. of the January 2010 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-250655, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about January 22, 2010, you entered into a Consent Agreement (January 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension may be stayed subject to reinstatement and probationary terms, conditions, and limitations for a minimum period of three (3) years. On August 8, 2011, the Board notified you that your license to practice nursing as a registered nurse was reinstated, subject to the terms and conditions of probation set forth in the January 2010 Consent Agreement. A copy of the August 8, 2011 Reinstatement Letter is attached hereto and incorporated herein. 2. Item 6. of the January 2010 Consent Agreement states, "For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement of his Ohio nursing license and continuing throughout the probationary period, MR. DAVIDSON shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR. DAVIDSON shall be negative, except for

Clark Kendall Davidson, R.N. Page 3 substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. DAVIDSON's history of chemical dependency and recovery status." Despite this provision, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. Furthermore, on the following dates, you were selected to provide a specimen for analysis and failed to do so: March 20, 2012; November 26, 2012; December 10, 2012, and January 15, 2013. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the. Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing@nursing.ohio,g9v. If the Board fails to receive a request for a hearing within thirty. (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Clark Kendall Davidson, R.N. Page 4 Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0970 ce: Henry G. Appel, Senior Assistant Attorney General

Case # 09-5765

Ohio Board of Nursing

17 South High Street, Suite 400
*

www.ntn'sing.ohici.gov ca as 70: lam:

Columbus. Ohio 43215-7410 t( IArko6V* -) 147

CONSENT AGREEMENT BETWEEN CLARK K. DAVIDSON, R.N. AND OHIO BOARD OF NURSING

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csi

rn

This Consent Agreement is entered into by and between CLARK K. DAVIDSON; R.N. (MR. DAVIDSON) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723, of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MR. DAVIDSON voluntarily enters into this Consent Agreement being fully informed of his rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500,00) or less per violation. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01,, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(9), ORC, authorizes the Board to discipline a licensee for habitual indulgence in the use of controlled substances, other habit-forming drugs, 'or alcohol or other chemical substances to an extent that impairs 'ability to practice. Section 4723.28(B)(25), ORC, authorizes the Board to discipline a licensee for failure to comply with the terms and conditions of participation in the chemical dependency monitoring program established under Section 4723.35, ORC. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it, Specifically, Rule 4723-6-03(A), Ohio Administrative COde, requires a participant in the Alternative Program for Chemical Dependency to comply with all of the terms and conditions of the participant's agreement with the Alternative Program for Chemical Dependency for the time period specified in the agreement.

Clark K, Davidson, R.N. Page 2 B. MR. DAVIDSONts license to practice nursing as a registered nurse in the State of Ohio, RN-250655, has been inactive since 2000. M.R. DAVIDSON's Ohio nursing license was initially issued in 1994. MR. DAVIDSON knowingly and voluntarily admits to the following: (1) In April 1999, MR. DAVIDSON entered into a Participant Agreement with the Board's Alternative Program for Chemical Dependency (Alternative Program) based upon his abuse of Cocaine. In September 2000, MR. DAVIDSON tested positive for, and admitted using, Marijuana, in violation of his Participant Agreement. In October 2000, MR. DAVIDSON withdrew from the Alternative Program. MR. DAVIDSON recently contacted the Board and requested reactivation of his nursing license. MR.. DAVIDSON reported that he has not used drugs since his positive Marijuana screen in September 2000 and that he attends Twelve Step meetings on a regular basis. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MR. DAVIDSON knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MR. DAVIDSON's license to practice nursing as a registered nurse is hereby suspended indefinitely, but for a minimum period of six (6) months. After the six (6) month period, MR. DAVIDSON may submit a written request to the Board or its designee to stay the suspension. The Board or its designee may stay the suspension, and MR. DAVIDSON may proceed with the licensure renewal process, as long as MR. DAVIDSON is in full compliance with this Consent Agreement, MR. DAVIDSONts license shall be subject to the following REINSTATEMENT and PROBATIONARY terms, conditions, and limitations for a minimum period of three (3) years: 1. 2. 3. MR. DAVIDSON shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MR. DAVIDSON shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. MR. DAVIDSON agrees that he will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MR. DAVIDSON, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCD to submit MR. DAVIDSON's criminal records check reports to the Board. MR. DAVIDSON's completed criminal records check, including the FBI check,

C.

(2)

Clark K. Davidson, R.N. Page 3 must be received by the Board within six (6) months prior to MR. DAVIDSON requesting reinstatement. Monitoring of Rehabilitation and Treatment 4. MR. DAVIDSON shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. DAVIDSON's history of chemical dependency and recovery status. MR. DAVIDSON shall self-administer prescribed drugs only in the manner prescribed, MR. DAVIDSON shall abstain completely from the use of alcohol. For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement of his Ohio nursing license and continuing throughout the probationary period, MR. DAVIDSON shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723,28(B), ORC, This screening shall require a daily call-in process. The specimens submitted by MR. DAVIDSON shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. DAVIDSON's history of chemical dependency and recovery status. a. Within thirty (30) days prior to MR. DAVIDSON initiating drug screening, MR. DAVIDSON shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MR. DAVIDSON. Alter initiating drug screening, MR. DAVIDSON shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MR. DAVIDSON shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment,

5, 6.

b.

Clark K. Davidson, R.N. Page 4

7.

For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement of his Ohio nursing license and continuing throughout the probationary period, MR. DAVIDSON shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and licensee shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning prior to requesting reinstatement. Within six (6) months prior to requesting reinstatement of his Ohio nursing license, MR. DAVIDSON shall, at his own expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional, and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MR. DAVIDSON shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MR. DAVIDSON shall execute releases to permit the chemical dependency professional to obtain any other information deemed appropriate and necessary for the evaluation, The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MR. DAVIDSON's license to practice, and stating whether MR. DAVIDSON is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MR. DAVIDSON shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MR. DAVIDSON agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MR. DAVIDSON's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

8.

9.

Additional Evaluation and Treatment 10. Upon request by the Board or its designee and within sixty (60) days of such request, MR. DAVIDSON shall, at his own expense, obtain a chemical dependency and/or psychiatric evaluation from a Board approved chemical dependency professional/psychiatrist and shall provide the Board with complete documentation of this evaluation, Prior to the evaluation, MR. DAVIDSON shall provide the evaluator with a copy of this Consent Agreement and shall execute releases to permit the evaluator to obtain any information deemed appropriate and necessary for the. evaluation. The evaluator shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on M.R. DAVIDSON's license, and whether MR.

Clark K. Davidson, R.N. Page 5 DAVIDSON is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 11. If an evaluation is requested pursuant to the above paragraph, MR. DAVIDSON shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the evaluator until released. Further, MR. DAVIDSON agrees that the Board may use the evaluator's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MR. DAVIDSON's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

Employment Conditions 12. MR. DAVIDSON shall notify the Board, in writing, of the name and address of any employer prior to accepting employment in a position where a nursing license is required, MR. DAVIDSON is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting employment in a position where a nursing license is required. MR. DAVIDSON shall have his employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of working in a nursing position. MR. DAVIDSON shall have his eniployer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received.

13.

Reporting Requirements of Licensee 14. MR. DAVIDSON shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MR. DAVIDSON shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MR. DAVIDSON shall submit any and all information that the Board may request regarding his ability to practice according to acceptable and prevailing standards of safe nursing practice, MR. DAVIDSON shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers.

l5,

16.

17.

Clark K. Davidson, R.N. Page 6 18. MR. DAVIDSON shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MR. DAVIDSON shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MR. DAVIDSON shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MR. DAVIDSON shall inform the Board within five (5) business days, in writing, of any change in. employment status or of any change in residential or home address or telephone number.

19.

20.

21.

Nursing Refresher Course MR. DAVIDSON shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a refresher course or an extensive orientation to be approved in advance by the Board or its designee. Temporary Narcotic Restrictions MR. DAVIDSON shall not administer, have access to, or possess (except as prescribed for MR. DAVIDSON's use by another so authorized by law who has full knowledge of MR. DAVIDSON's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum period of three (3) months in which MR. DAVIDSON is working in a position that requires a nursing license. At any time after the three-month period previously described, MR. DAVIDSON may submit a written request to the Board to have this restriction re-evaluated. In addition, MR. DAVIDSON shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MR. DAVIDSON shall not call in or order prescriptions or prescription refills for any narcotics, other controlled substances, or mood altering drugs. permanent Practice Restrictions MR. DAVIDSON further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: Unless otherwise approved hi advance, in writing, by the Board or its designee, MR. DAVIDSON shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is

Clark K. Davidson, R.N. Page 7 reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MR. DAVIDSON to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance, in writing, by the Board or its designee, MR. DAVIDSON shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, and Vice President of Nursing. FAILURE TO COMPLY MR. DAVIDSON agrees that his license to practice nursing as .a registered nurse will be automatically suspended if it appears to the Board that MR. DAVIDSON has violated or breached any terms or conditions of the Consent Agreement, Following the automatic suspension, the Board shall notify MR. DAVIDSON via certified mail of the specific nature of the charges and automatic suspension of his license. Upon receipt of this notice, MR. DAVIDSON may request a hearing regarding the charges, The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MR. DAVIDSON appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement, DURATION/ MODIFICATION OF TERMS The terms, limitations and conditions of this Consent Agreement, other than the permanent licensure restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MR. DAVIDSON and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MR. DAVIDSON has complied with all aspects of this Consent Agreement; and (2) the Board determines that MR. DAVIDSON is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MR. DAVIDSON and review of the reports as required herein. Any period during which MR. DAVIDSON does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement.

Clark K. Davidson, R.N. Page 8

ACKNOWLEDGMENTS/LIABILITY RELEASE
MR. DAVIDSON acknowledges that he has had an opportunity to ask questions concerning the terms Of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MR. DAVIDSON waives all of his rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MR. DAVIDSON waives any and all claims or causes of action he may have against the Board, and its members, officers, employees and/or agents arising out of matters which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC, The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC.

EFFECTIVE DATE
MR. DAVIDSON understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

CLARK K. DAVIDSON, R.N.

DATEth

BA*019-1 Rd
BERTHA LOVELACE, President Ohio Board of Nursing

60na3a)lb
DATE

Case 1109-5765

Ohio Board of Nursing www.nursing.ohio.gov

1.7 South 1:11g13 Street, Suite 4(10 CalmIbtn, Ohio 43215-7410 (614) 466-3947

August 8, 2011

Clark Davidson 3724 East Fifth St Dayton, OH 45403 Ref: Consent Agreement of January 22, 2010 License 250655 Dear Mr, Davidson; On July 29, 2011, the Board approved your request for reinstatement of your nursing license, Your license is therefore reinstated subject to the terms and conditions of probation. Sincerely,

Betsy J. Houchen, RN., MS., J.D. Executive Director LFR/ main

ATTACHMENT A
02/1912010 - 01/16/2013
,/eMelq ...

Missed Call History:

Date 04/05/2010 09/19/2010 05/06/2011 05/31/2011 07/31/2011 08/03/2011 08/04/2011 10/26/2011 11/26/2012 11/27/2012 11/28/2012 11/29/2012 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

Detail s

11/30/2012 12/01/2012 12/02/2012 12/03/2012 12/04/2012 12/05/2012 12106/2012 12/07/2012 12/08/2012 12/09/2012 12/10/2012 12/11/2012 12/12/2012 12/13/2012 12/14/2012 12/15/2012 12/16/2012 12/17/2012 12/18/2012 12/19/2012 12/20/2012 12/21/2012 12/22/2012 12/23/2012 12/24/2012 12/25/2012

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cal] Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

12/26/2012 12/27/2012 12/28/2012 12/29/2012 12/30/2012 12/31/2012 01/01/2013 01/02/2013 01/03/2013 01/04/2013 01/05/2013 01/06/2013 01/07/2013 01/08/2013 01/09/2013 01/10/2013 01/11/2013 01/12/2013

Missed Call . Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

01/13/2013 Missed Cali 01/14/2013 01/15/2013 01/16/2013 Missed Call Missed Call Missed Call

Row Count: 60

Case #2012-005969

Ohio Board of Nursing

17 South High Street, Suite 400 January 25, 2013

www.nursing.ohlogov
(614) 466-3947

Columbus, Ohio 43215-7410

NOTICE OF OPPORTUNITY FOR HEARING

Mandy M. Demedeiros (aka "Mandy Marie Patrick"), R.N. 120 Calle Amistad r305 San Clemente, California 92673 Dear Ms. (Patrick) Demedeiros: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse in Ohio; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: The Board of Registered Nursing Department of Consumer Affairs State of California, in Case No. 2012-237 adopted a Decision and Order (California Board 2012 Order) that went into effect on or about October 19, 2012, in which your application for licensure was granted, and upon issuance of a license to practice nursing as a registered nurse in California, that license was subject to probation for a three (3) year period. A certified copy of the California Board 2012 Order, along with Attachments are attached hereto and incorporated herein. Section 4723.28(B)(1), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 432157410, or to the email address, hearing@nursing.ohio.gov.

Mandy M. Demedeiros (aka "Mandy Marie Patrick"), R.N. Page 2

If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth iri this Notice of Opportunity for Hearing, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse in Ohio; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0314 cc: Henry G. Appel, Senior Assistant Attorney General

BEFORE THE BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Mattes of the Statement of Issues Against: MANDY MARIE DEMEDEIROS A.K.A. MANDY MARIE PATRICK Case No. 2012-237 0AI-1 No, 2011120516 Respondent

DECISION AND ORDER The attached Stipulated Settlement and Disciplinary Order is hereby adopted by the Board of Registered Nursing, Department of Consumer Affaiis, as its Decision in this matter. This Decision shall become effecti4e on. October 19, 2012.. IT IS SO ORDERED September 21, 2012.
vatumn.0,,.. o 0 1; O ,'.0 COArs7%,. ;ez,ts,G1 e 1,,

1 hereby certify the' of the documents on fife in our Office,

foregoing to be a true copy

.;% 0 BOARD OF:REGISTERED NURSING 1P.: %5t- , b ,c7kg'.44144...#444, of.

Louise R. BefleyN, tO., R14 Executive Officer 0 '#4$'4/OP CAI 1

Raymond Meal, President Board of Registered NurSing Department of Consumer Affairs State of California

1 2 3 4 5 6 7 .8 `9 10 11 . 12 13 14 15
16

ICANiALA D. HARRIS Attorney General of California JAMES M. LEDAKIS Supervising Deputy Attorney General DESIREE I. KELLOGG Deputy Afton:10 General Slate Bar No. 126461 110 West "A" Street, Suite 1100 ' San Diego, CA 92101 P.O. Box 85266 San Diego, CA 92186-5266 Telephone: (619) 645-2996 Facsimile: (619) 645-2061 Attorneys for Complainant BEFORE THE BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA . In the Matter of the Statement of Issues Against: MANDY MARIE DEMEDEIROS, AKA IVIANDY MARIE PATRICK 120 Calle Amistad, #7209 San Clemente, CA 92673 'Case No. 2012-237 OAHNo. 2011120516 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER

17. 18 19

Respondent

IT IS HEREBY STIPULATED AND AGREED by and between the parties to the above_entitled,propeedings,that thefollowingmatters .she true: _

21 22 23 24 25 26 27 28 1.

PARTIES Louise R. Bailey, M.Ed., RN (Complainant) is the Interim Executive Officer

a the

Board.of Registered Nursing. ,She brought this action solely in her official capacity and, is represented in this matter by Kamala D. Harris, Attorney General of the State of California, by .Desiree I. Kellogg,'Deputy Attorney General. 2. Respondent Mandy Marie DemedeiroS; aka Mandy Marie Patrick (Respondent) is

representing herself in this proceeding and has chosen not to exercise her right to be represented by counsel. 1 STIPULATED SETTLEME'k (2012-237)

3.

On or about October 7, 2010, Respondent filed an application dated September 26;

2 . 2010, with the Board of Registered Nursing to obtain a Registered Nurse License. 3 4 5 6 7 8 9 10 '11 12 6. 4. JURISDICTION Statement of Issues No. 2012-237 was filed before the Board of Registered Nursing

(Board), Department of Consumer Affairs, and is currently pending against Respondent The Statement of Issues and all other statutorily required documents were properly served on Respondent on 06tober 14, 2011. 5. . A copy of Statement .of Issues No. 2012-237 is attached as exhibit A and incorporated herein by reference. ADVISEMENT AND WAIVERS ReSpondent has carefully read, and understands the charges and allegations in

Statement of Issues No. 2012-237. Respondent has also carefully read, and understands the

13' effects of this Stipulated..Settlement and Disciplinary Order. 14 - 15 16 7. Respdident is fully aware of her legal rights in this matter, including the right to a

hearing on the charges and allegations in. the Statement of Issues; 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

18 19 20 21 22 23 24 25
26

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. 8. Respondent voluntarily, knowingly, and intelligently waives and gives up each and

every right set forth above. CULPABILITY 9. Respondent admits the truth of each and every charge and allegation in Statement of

Issues No. 2012,237. 10, Respondent agrees that her Registered Nurse License is subject to denial and she

27 28

agrees to be bound by the Board's probationary terms as set forth in the Disciplinary Order below.

STIPULATED SETTLEMENT (2012-237)

1 2 3 4 5 6 7 g 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 11.

CONTINGENCY 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 Boardfails 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 considered this matter. 12. The patties understand and agree that facsimile copies of this Stipulated Settlement and Disciplinary Order, including facsimile signatures thereto, shall have the same force and effect as the originals., 13. This Stipulated Settlement and Disciplinary Order is intended by the parties to be an integrated writing representing the complete, final, and exelusive embodiment of their agreement. It supersedes anY and all prior or contemporaneous agreements,' understnndings, discussions, negotiations,. and commitments (written or oral). This Stipulated Settlement and Disciplinary Order may not be altered, amended, modified, supplemented, or otherwise changed except by a writing executed by an authorized representative of each of the parties. _

.14. In consideration of the foregoing admissions and stipulations, the parties agree that the Board may, without further notice or formal proceeding, issue and enter the following Disciplinary Order: DISCIPLINARY ORDER IT IS HEREBY ORDERED that the application of Respondent Mandy Marie Demedeiros for licensure is hereby granted and a license shall be issued to Respondent upon successful completion of all licensing requirements. Said license shall immediately be revoked, the order of

3
STIPULATED SETTLEMENT (2012-237)

1 2 3 4 5 6 7 8
9

revocation stayed and Respondent placed on probation for a period of three (3) years on the following conditions: Severability Clause. Bach condition of probation contained herein is a separate and distinct condition. If any condition of this Order, or any application thereof, is declared unenforceable in whole, in part, or to any extent, the remainder of this Order, and all other aPpiications thereof, sail not be affected. Each condition of this Order shall separately be valid and enforceable to the fullest extent permitted by law. 1. Obey All Laws. Respondent shall obey all federal, state and local laws, A till, and

detailed account of any and all violations of law shall be reported by Respondent to the Board in writing Within seventy-two (72) hours of occurrence, To permit monitoring of compliance with this condition, Respondent shall submit completed fingerprint forms and fingerprint fees within 45 days of :the effective date of the decision, nnless previously submitted as part of the licensure application process. Criminal Court Orders: If Respondent is under criminal court orders, including probation or parole, and the order is violated, this shall be deemed a violation of these probation conditions, and may result in the filing of an accusation and/or petition to revoke probation 2. Comply with the Board's Probation Program. Respondent shad folly comply with

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12

13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

the conditions of the Probation Program.' established by the Board and cooperate with representatives of the Board in its monitoring and investigation of the Respondent's compliance with the Board's Probation Program, Respondent shall inform the Board in writing within no more than 15 days of any address change and shall at all times maintain an active, current license status with the Board, including during any period of suspension. Upon successful completion of probation, Respondent's license shall be fully restored. 3. Report in Person. Respondent, during the period of probation, shall appear in

person at interviews/meetings as directed by the Board or its designated representatives. 4. Residency, Practice, or Licensure Outside of State. Periods of residency or

practice as a registered nurse outside of California shall not apply toward a reduction of this probation time period. Respondent's probation is tolled, if and when she resides outside of 4
STIPULATED SETTLEMENT (2012..237)

1 2
3

California. Respondent must provide written notice to the Board within 15 days of any change of residency or practice outside the state, and within 30 days prior to re-establishing residency or returning to practice in this state. Respondent shall provide a list of all states and territories where she has ever been licensed as a registered nurse, vocational nurse, or practical nurse. Respondent shall further provide information regarding the status of each license and any changes in snob license status during the term of probation. Respondent shall inform the Board if she applies for or obtains a nei nursing license during the term of probation. 5. Submit Written Reports. Respondent, during the period of probation, shall submit

4 5
6

7
8

9. 10 11 12 13 14 IS 16 17 18 19

or cause to be 'submitted such written reports/declarations and verification of actions under penalty of perjury, as required by the Board. These-reports/declarations shall contain statements, relative to Respondent's compliance with all the conditions of the Board's Probation Program. Respondent shall immediately execute all release of information forms as may be required by the Board or its representativei. Respondent shall provide a copy of this Decision to the nursing regulatory agency in every state and territory in which she has a registered nurse license. 6. Function as a*Registered Nurse. Respondent, during the period of probation, shall

engage in the practice of registered nursing in California for a minimum of 24 hours per week for. 6 consecutive months or as determined by the Board. For purposes of compliance with the section, "engage in the practice of registered nursing"

20 21 22 23 24 25 26 27 28

may include, when approved by the Board, volunteer work as a registered nurse, or work in any non-direct patient care position that requires licensure as a registered nurse. The Board may require that advanced practice nurses engage in advanced practice nursing for a minimum of 24 hours per week for 6 consecutive months or,as determined by the Board., If Respondent has not complied with this conditionduring 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 5
STIPULATRD SETTLEMENT (24I2-237)

I,
2

comply with this condition. During the one year extension, all original conditions of probation shall apply. 7. Employment Approval and Reporting Requirements. Respondent shall obtain prior approval from. the Board before commencing or continuing any employment, paid or voluntary, as a registered nurse.. Respondent shall cause to be submitted to the Board all performance evaluations and other employment related reports as a registered nurse upon request of the Board. Respondent shall provide a copy of this Decision to her employer and immediate supervisors prior to commencement of any nursing or other health care related employment. In addition to the above, Respondent shall notify the Board in writing within seventy-two (72) hours after she obtains any nursing or other health care related employment Respondent shall notify the Board in writing within seventy-two (72) hours after she is terminated or separated, regardless of cause, from any nursing, or other health care 'related employment with a full explanation of the circumstances surrounding the termination or separation. 8. Supervision. Respondent shall obtain prior approval from the Board regarding

3 4 5, 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Respondent's level of supervision and/or collaboration; before commencing or continuing any employMent as a registered nurse, or education and training that includes patient care. Respondent shall practice only under the direct supervision of a registered nurse in good standing (no current discipline) with the Board of Registered Nursing, unless alternative methods

20_ of sppervision and/or collaboration (e,g, with an advanced_ practice nurse or physician) are 21 approved. 22 Respondent's level of supervision and/or collaboration may include, but is not limited to the

23 following: 24 25 26 27 28 (a) MaXimurn. - The individual providing supervision and/or collaboration is present in the patient care area or in any other work setting at all times. (b) Moderate - The individual providing supervision and/or collaboration is in the patient care unit or in any other work setting at least half the hours Respondent works. (c) Minimum - The individual providing supervision and/or collaboration has person-to6
STIPULATED Sl LLD/LENT (2012.257)

1 2 3 4
5

person communication with Respondent at least twice during each shift worked. (d)

Home Health. Care - If Respondent is' approved to work in the home health care

setting, the individual providing supervision and/or collaboration shall have person-to-person communication with Respondent as required by the Board each work day. Respondent shall maintain telephone or other telecommunication contact with the individual providing supervision and/or collaboration as required by the Board during each work day. The individual providing supervision and/or collaboration shall conduct, as required by the Board, periodic, on-site visits to patients' homes visited by Respondent with or without Respondent present. 9, Employment Limitations. Respondent shall not work for a nurse's registry, in any

6 7 8 9 10 11 12 13 4 1 15 16 17 18 19 20 21 22 23 24 25.

private duty position as a registered nurse, a temporary nurse placement agency, a traveling nurse, or for an in-house nursing pool. Respondent shall not work for a licensed home health agency as a visiting nurse unless the registered nursing supervision and other protections for home visits have been approved by the Board. Respondent shall not work in any other registered nursing occupation where home visits are required. Respondent shall not work in any health care setting as a. supervisor of registered nurses. The Board may additionally restrict Respondent from supervising licensed vocational nurses and/or unlicensed assistive personnel on a case-by-ease basis. Respondent shall not work as a faculty member in an approved school of nursing or as an _instructor ina .Board approyedcomtintting:education program. Respondent shall work only on a regularly assigned, identified and predeternined 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 27 28 months prior to the end of her probationary term. Respondent shall obtain prior approval from the Board before enrolling in the course(s). 7
STIPULATED SETTLEMENT (2012-237)

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

3 photocopying them for its records. 4 5 6 7 8

9

11. 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 discipline (revocation/suspension) of Respondent's license, If during the period of probation, an accusation or petition to revoke probation has been filed against Respondent's license or the Attorney General's Office has been requested to prepare an accusation or petition to revoke probation against Respondent's license, the probationary period shall automatically be extended and shall not expire until the accusation or petition has been acted upon by the Board. 12. License Surrender. During Respondent's term of probation, if she ceases practicing

10 11 . 12 13 4 1 15 16 17 . 18 19 20 21 22 23 24 25 26 27 28

due to retirement, health reasons or is otherwise unable to satisfy the conditions of probation, Respondent may surrender her license to the Board. The Board reserves the right to evaluate Respondent's request and to exercise its discretion whether to grant the request, or to take any other action deemed appropriate and reasonable under the circumstances, without further healing. Upon formal acceptance of the tendered license and wall certificate, Respondent will no longer be subject to the conditions of probation. Surrender of Respondent's license shall be considered a disciplinary action and shall become a part of Respondent's license history with the Board. A registered nurse whose license has been 'surrendered may petition the Board for reinstatement no sooner than the following minimum periods from the effective date of the disciplinary decision: (1) Two years for reinstatement of a license that was surrendered for any reason other

than a mental or physical illness; or (2) One year for a license surrendered for a mental or physical illness.

8
STIPULATED SETTLEMENT (2012-237)

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

13. Physical Examination. Within 45 days of the effective date of this Decision, Respondent, at her expense, shall have a licensed physician, nurse practitioner, or physician assistant, who is approved by the Board before the assessment is performed, submit an assessment of the Respondent's physical condition and capability to perform the duties of a registered nurse. Such an assessment shall be submitted in a format acceptable to the Board. If medically determined, a recommended treatment program will be instituted and followed by the Respondent with the physician, nurse Practitioner, or physician assistant providing written reports to the Board on forms provided by the Board, If Resp'ondent is determined to be unable to practice safely as a registered nurse, the licensed physician, nurse practitioner, or physician assistant making this determination shall immediately notify the Board and Respondent by telephone, and the Board shall request that the .Attorney General's office prepare an accusation or petition to revoke probation. Respondent shall immediately cease practice and shall not resume practice until notified by the Board. During this period of suspension, Respondent shall not engage in any practice for which a license issued by the Board is required until the Board has notified Respondent that a medical determination permits Respondent to resume practice. ,This period of suspension will not apply to the reduction of this probationary time period. If Respondent fails to have the above assessment submitted to the Board within the 45-day requirement, Respondent shall immediately cease practice and shall not resume practice until notified by the Board, This period of suspension will not apply to the reduction of this probationary time period. The. Board may waive or postpone this suspension only if significant, documented evidence of Mitigation is provided. Such evidence must establish good faith efforts , by Respondent to obtain the assessment, and a specific date for compliance must be provided. Only one such waiver or extension may be permitted. 14, Participate in TreatmentiRehabilitation Program for Chemical Dependence. Respondent, at her expense, shall successfully complete during the probationary period or shall have successfully completed prior to commencement of probation a Board-apprOved treatnaendrehabilitation program of at least six months duration. As required, reports shall be 9
STIPULATED SETTLEMENT (212-237)

I 2 3 .4 5

submitted by the program on forms provided by the Board. If Respondent has not completed a Board-approved treatment/rehabilitation program prior to commencement of probation, Respondent, within 45 days from the effective date of the decision, shall be enrolled hr a program. If a program is not successfully completed within the first nine months of probation, the Board shall consider Respondent in violation of probation.

Based on Board recommendation, each week Respondent shall be required to attend at least
6

one, but no more than five 12-Step recovery meetings or equivalent (e.g,Narcotics Anonymous, Alcoholics Anonymous, etc.) and a nurse support group as approved and directed by the Board. If a nurse support group is not available, an additional 12-step meeting or equivalent shall be added. Respondent shall submit dated and signed documentation confirming such attendance to the Board during the entire period of probation. Respondent shall continue with the recovery plan recommended by the treatment/rehabilitation program or a licensed mental health examiner and/or other ongoing recovery groups. 15. Abstain from Use of Psychotropic (Mood-Altering) Drugs. Respondent shall

8 9 1g 11 12 13 14 15 16 17 18 19

completely abstain from the possession, injection or consumption by any route of all controlled substances and. all psychotropic (mood altering) drugs, including alcohol, except when the same are ordered by a health care professional legally authorized to do so as part of documented medical treatment Respondent shall have sent to theBoard, in writing and within fourteen (14) days, by the prescribing health professional, a report identifying the medication, dosage, the date the medication was prescribed, the Respondent's prognosis, the date the medication will no

21 22 23 24 25 26 27 28

longer be required, and the effect on the recovery plan, if appropriate. Respondent shall identify for the Board a-single physician, nurse practitioner or physician assistant who shall be aware of Respondent's history of substance abuse and will coordinate and monitor any prescriptions for Respondent for dangerous drugs, controlled substances or moodaltering drugs. The coordinating physician, nurse practitioner, or physician assistant shall report to the Board on a quarterly basis Respondent's compliance with this condition. If any substances considered addictive have been prescribed, the report shall identify a program for the time limited use of any such substances. 10
STIPULATED WI L LEMENT (2012237)

1 2
3

The Board may require, the single coordinating physician, nurse practitioner, or physician assistant to be a specialist in addictive medicine, or to consult with a specialist in'addictive medicine. 16. Submit to Tests and Samples. Respondent, at her expense, shall participate in a

4 5 6 7 8 9 10 11 12 13

random, biological fluid testing or a drug screening program which the Board approves. The length, of time and frequency will be subject to approval by the Board. Respondent is responsible for keeping the Board informed of Respondent's current telephone number at all times. Respondent shall also ensure that messages may be left at the telephone number when she is not available and, ensure that reports are submitted directly by the testing agency to the Board, as directed. Any confirmed positive finding shall be reported immediately to the Board by the program and Respondent shall be considered in violation of probation. In addition, Respondent, at any time during the period of prObation, shall fully cooperate with the Board or any of its representatives, and shall, when requested, submit to such tests and

14: samples as the Board or its representatives may require for the detection of alcohol, narcotics, is 16 17 18 19 20 21 22 23 24 25 26 27 28 11
STIPULATED sErn,EmENT (2012-237)

hypnotics, dangerous drugs, or other controlled substances. If Respondent has a positive drug screen for any substance not legally authorized and not reported to the coordinating physician, nurse practitioner, or physician assistant, and the Board files, a petition to revoke probation or an accusation, the Board may suspend Respondent from practice pending the final decision on the petition to revoke probation or the accusation. This period of suspension will not apply to the reduction of this probationary time period. If Respondent fails to participate in a random, biological fluid testing or drug screening program within the specified time frame, Respondent shall immediately cease practice and shall not resume practice until notified by the Board. After taking into account documented evidence of mitigation, if the Board files a petition to revoke probation or an accusation, the Board may suspend Respondent from practice pending the final decision on the petition to revoke probation or the accusation: This period of suspension will not apply to the reduction of this probationary time period.

17. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18. 19

Mental Health Examination. :Respondent shall, within 45 days of the, effective date

of this Decision, have a mental health examination including psychological testing as appropriate todetermine her capability to perform the duties of a registered nurse. The examination will be performed by a psychiatrist, psychologist or other licensed mental health practitioner approved by the Board. The examining mental health practitioner will submit a written report of that assessment and recommendations to the Board. All costs are the responsibility of Respondent. . Recommendations for treatment, therapy or counseling made as a result.of the mental health examination will be instituted and followed by Respondent. If Respondent is determined to be unable to practice safely as a registered nurse, the licensed-mental health care practitioner making this determination shall immediately notify the Board and Respondent by telephone, and the Board shall request that the Attorney General's office prepare an accusation or petitiOn to revoke probation. Respondent shall immediately cease practice and may not resume practice until notified by the Board. During this period of suspension, Respondent shall not engage in any practice for which a license issued by the Board is required, until the Board has,notified Respondent that a mental health determination Permits Respondent to resume practice. This period of suspension will not apply to the reduction of this probationary time period.' If Respondent fails to have the above assessment submitted to the Board within the 45-day requirement, Respondent shall immediately cease practice and shall not resume practice until

_20.. notified by the Board. This period of suspension will not apply to the reduction of this 21 22 23 24 25 26 27 28 probationary time period. The Board may waive or postpone this suspension only if significant, documented evidence of mitigation is provided. Such evidence must establish good faith efforts by Respondent to obtain the assessment, and a specific date for compliance must be provided. Only one such waiver or extension may be permitted. , . 18. Therapy or Counseling Prograni. Respondent, at her expense, shall participate in an on-going colinseling program until such time as the Board releases her from this requirement and only upon the recommendation of the counselor. Written progress reports from the counselor will be required at various intervals. 12
S ITPULATED SETTLEMENT (2012-237)

06/04/2012 20:116'

, 349941J164b

ACC TAN 2 I have carefully read the Stipillsted Settl:mnent and Diseipanaq Order. I under.' 4. the stipulation and, the effect it 'will have on my Registered Nurse License. I enter into this Stipulated

4
5 6 7

Settlement and. Diseipliraty Order voluntarily, knowingly, and intelligently, and agree to.be . bound by the Decision and Order of the Board of Registered Nuratigr-DAM.. ' ot,q 0 t a 01;, MANGY WRIE DEW]) MARX:4 PATRICK Respondent

I 11 12 IS 14 15 16 17 IS .
13

INISORSBIONI` The foregoing Stipulated Setae/neat and Disciplinary Order is hereby respectfully submitted for consiclefaiion. by the Board of Registered 'Nursing of the Departmenrof Consumer' Affairs. Dated: Respeotfinly submitted, KAMAI.A D. HAMS Attorney General of California JAMES M. LE'DAKIS Supervising Deputy Attorney General

20 21 22 25 24 25 26 27 2g. 13 SI:4011801151 7056981240e

DESIRE L KET,L0(80 Deputy Attorney oenerzi Attorneys for Comic:Maw

1 2 3 4

ACCEPTANCE I have carefully read the Stipulated gel&meut and Disciplinary Order. I understAnd the stipulation and the effect it will have on my Registered Nurse License. I enter into this Stipulated Settlement and Disciplinary Order voluntarily, knowingly, and intelligently, and agree to be bound by the Decision and Order of the Board of Registered Nursing:

6 DAfl.D: 8 9 10 11 12 13 14 15 16 17 18 . ENDORSEMENT The foregoing Stipulated Settlement and Disciplinary Order is hereby respectfully ' MANDY MARIE DEMEDEIROS, AKA MANDY MARIE PATRICK Respondent

submitted fox consideration by the Board of Registered Nursing of the Department of Consumer Affairs. Dated: Respectfully submitted, ICAMALk D. HARM Attorney General of California JAMES M Supervi ng Dep Attome General

20
21

I. KELL 0 DE Dip A:Udine31t . Atto eys for Comp inant

22 23 24 25 26 27 28. 13 STIPULATED SETTLEMENT (2012-237) 502011801151 705693 I2.cloe

Exhibit A
Statement of Issues No. 2012-237

4 5 6 7

KAN/ALA al-IA.R.tus Attorney General of California LINDA K. SCENEIDER Supervising Deputy Attorney General State Bar No. 101336 AMANDA. DOORS Senior Legal Analyst 110 West "A" Street, Suite 1100 San Diego, CA 92101 P.O. Box 85266 San Diego, CA 92186-5266 Telephone: (619) 645-2141 Facsimile: (619) 645-2061 Attorneys for Complainant BEFORE THE BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Statement of Issues Against; MANDY MARIE DEMEDEIROS aka MANDY MARIE PATRICK 240 Avenida Vista Montana, Apt, 9F San Clemente, CA 92672 Respondent. Complainant alleges: PARTIES 1, Louise R. Bailey, MEd., RN (Complainant) brings this Statement of Issues solely in Case No. 14

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

11

STATEMENT OF ISSUES

er_offielal_cap.acitY_as_the-Execuslye Orncer_otthe Board of Registered Nursing, Department of Consumer Affairs. 2. On or about October 7, 2010, the Board of Registered Nursing, Deport nent of

Consumer Affairs received an application for a Registered Nurse License from Mandy Marie Demedeiros, also known as Mandy Marie Patrick (Respondent). On or about September 26, 2010, Mandy Marie Demedeiros certified under penalty of perjury to the trutllfuiness of all statements, answers, and representations in the application. The Board denied the application on April 28, 2011. il l 1 STATEMENT OF ISSUES

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 5. 3.

`JURISDICTION This Statement of Issues is brought befOre the Board of Registered Nursing (Board),

Department of Consumer Affairs, under the authority of the following laws. All section references are to the Business and Professions Code (Code) unless otherwise indicated. 4. Section 2736 of the Code provides, in pertinent part, that the Board may deny a

license when it finds that the applicant has committed any acts constituting grounds for denial of licensme under section 480 of that Code. STATUTORY PROVISIONS Section 475 of the Code states: .

(a) Notwithstanding any other provisions of this code, the provisions of this division shall govern the denial of licenses on the grounds of (1) Knowingly making a false statement of material fact, or knowingly omitting to state a material fact, in an application for a license. (2) Conviction of a crime.
(3) C0113111iSSi011 of any act involving dishonesty, fraud or deceit with the intent to substantially benefit himself or another, or substantially injure another.

(4) Gm/mission of any act which, if done by a licentiate of the business or profession in question, would be grounds for suspension or revocation of license.
(b) Notwithstanding any other provisions of this code, the provisions of this division shalt govern the suspension and revocation of licenses on grounds specified in paragraphs (1) and (2) of subdivision (a).

(e) A license shall not be denied, suspended, or, revoked on the grounds of a lack of good moral character or any similar ground relating to an applicant's character,..reputation, personality, odiabits 6. Section 480 of the Code states:

(a) A board may deny a license regulated by this code on the grounds that the applicant has one of the following: (1) Been convicted of a crime. A conviction within the meaning of this section means a plea or verdict of guilty or a conviction following a plea of nolo contendere. Any action that a board is permitted to take following the establishment of a conviction may be taken when the time for appeal has elapsed, or the judgment of conviction has been affirmed on appeal, or when an order granting probation is made suspending the imposition of sentence, irrespective of a subsequent order under the provisions of Section 1203.4 of the Penal Code. (2) Done any act involving dishonesty, fraud, or deceit with the intent to substantially benefit himself or herself or another, or substantially injure another. 2
STATEMENT OF ISSUES

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

(3) (A) Done any act that if done by a licentiate of the business or profession in question, would be grounds for suspension or revocation of license. (B) The board inay deny a license pursuant to this subdivision only if the crime er act is substantially related to the qualifications, functions, or duties of the business or profession for which application is made.

7.

Section 482 of the Code states:

Bach board under the provisions of this code shall develop criteria to evaluate the rehabilitation of a person when: (a) Considering the denial of a license by the board under Section 480; or (b) Considering suspension or revocation of a license under Section 490. Each board shall take into account all competent evidence of rehabilitation furnished by the applicant or licensee. 8. Section 2761 of the Code states:

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:

(f) Conviction of a felony or of any offense substantially related to the qualifications, functions, and duties of a registered nurse, in which event the record of the conviction shall be conclusive evidence thereof.

9.

Section 2762 of the Code states:

In addition to other acts constituting unprofessional conduct within the meaning of this chapter [the Nursing Practice Act], it is unprofessional conduct for a person licensed under this chapter to do any of the following:

(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 dangerous device as defined in Section 4022, or alcoholic beverages, to an extent or 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 the public the pradtice authorized by his or her license.

3
STATEMENT O ISSUES

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

(c) Be convicted of a criminal offense involving the prescription, consumption, or self-ad-ministration of any of the substances described in subdivisions (a) and (b) of this section, or the possession of, or falsification of a record pertaining to, the substances described in subdivision (a) of this section, in which event the record of the conviction is conclusive evidence thereof

10.

Section 2765 of the Code states:

A plea or verdict of guilty or a conviction following a plea of nolo contendere made to a charge substantially related to the qualifications, functions and duties of a registered nurse is deemed to be a conviction within the meaning of this article. The board may order the license or certificate suspended or revoked, or may decline to issue a license or certificate, when the time for appeal has elapsed, or the judgment of conviction has been affirmed on appeal or when an order granting probation is made suspending the imposition of sentence, irrespective of a subsequent order under the provisions of Section 1203.4 of the Penal Code allowing such person to withdraw his or her plea of guilty and to enter a plea of not guilty, or setting aside the verdict of guilty, or dismissing the accusation, information or indictment. REGULATORY PROVISIONS 11. California Code of Regulations, title 16, section 1444 states:

A conviction or act shall be considered to be substantially related to the qualifications, functions or duties of a registered nurse if to a substantial degree it evidences the present or potential unfitness of a registered nurse to practice in a manner consistent with the public health, safety, or welfare. Such convictions or acts shall include but not be limited to the following: (a) Assaultive or abusive conduct including, but not limited to, those violations listed in subdivision (d) of Penal Code Section 11160. (b) Failure to comply with any mandatory reporting requirements. (c) Theft, dishonesty, fraud, or deceit. (d) Any conviction or act subject to an order of registration pursuant to. Section 290 of the Penal Code. 12. California Code of Regulations, title 16, section 1445 states: (a) When considering the denial of a license under Section 480 of the code, the board, in evaluating the rehabilitation of the applicant and his/her present eligibility for a license will consider the following criteria: (1) The nature and severity of the act(s) or crfine(s) under consideration as grounds for denial. (2) E-vidence of any act(s) committed subsequent to the acts) or crime(s) under consideration as grounds for denial which also could be considered as grounds for denial under Section 480 of the code. 4
STATEMENT OF ISSUES

o
2 3 4 5 6 7 8 ,, 9 10
11

C)

(3) The time that has elapsed since commission of the act(s) or crime(s) referred to in subdivision (1) or (2) (4) The extent to which the applicant has complied with any terms of parole, probation, restitution,.or any other sanctions lawfully imposed against the applicant. (5) Evidence, if any, of rehabilitation submitted by the applicant

FIRST CAUSE FOR DENIAL OF APPLICATION (October 22, 2009 Criminal Conviction for DUI on January II, 2009) 13. Respondent's application is subject to denial under sections 480, subdivision (a)(1)

of the Code in that she was convicted of a crime that is substantially related to the qualifications, duties, and functions of a registered nurse. The circumstances are as follows: a. On or about October 22, 2009, in a criminal proceeding entitled The State

12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

of Ohio v. Mandy M. Patrick; in Cuyahoga County Court, case number 09'1RC00122, Respondent was convicted on her plea of no contest to violating Ohio Revised Statutes (ORC) 434.01, driving or physical control while under the influence of alcohol, a misdemeanor. b. As a result of the conviction, on or about October 22, 2009, Respondent

was sentenced to nine days in the city jail, with credit for six days, and payment of court costs and fees in the amount of $595. c. The circumstances that led to the conviction are that at approximately 3;00

a.m., on January 11, 2009, while in the City of Middleburg Heights, Respondent was arrested for driving under the influence of alcohol, speeding, unsafe lane changes, and having a blood alcohol concentration (BAC) of .17 percent or more. Respondent provided a breath sample that was analyzed with a BAC of ,194 percent at the time of her arrest. SECOND CAUSE FOR DENIAL OF APPLICATION (July 28, 2006 Criminal Conviction for DUI on January 8, 2006) 14. Respondent's application is subject to denial under sections 480, subdivision (a)(1)

of the Code in that she was convicted of a crime that is substantially related to the qualifications, duties, and functions of a registered nurse. The circumstances are as follows: 111

STATEMENT' OF ISSUES

1 2
3

a.

On or about July 28, 2006, in a criminal proceeding in the Brea (Ohio)

Mrinicipal Court, case number 06TRC00159, Respondent was convicted on her plea of no contest to violating Ohio Revised Statutes (CRC) 4511.194, having physical control of vehicle while under the influence, a misdemeanor moving violation. b. As a result of the conviction, on or about July 28', 2006, Respondent was

4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

sentenced to three days in jail and one year of probation, and ordered to complete a MADD program, attend two A.A. meetings per week for eight weeks, pay costs and fees in the amount of $250, and comply with probation terms. THIRD CAUSE FOR DENIAL OF APPLICATION (Unprofessional Conduct - Dangerous Use of Alcohol) 15. Respondent's application is subject to denial under sections 480, subdivision (a)(3)(A) of the Code in that on or about January 8, 2006, and January 11, 2009, Respondent used alcoholic beverages to an extent or in a manner that was dangerous and potentially injurious to herself and the public when she operated a motor vehicle while under the influence of alcohol, as detailed in paragraphs 13 and 14, above, which is a violation of section 2762, subdivision (b) of the Code for a licensed registered nurse. FOURTH CAUSE FOR DENIAL OF APPLICATION (Unprofessional Conduct Alcohol-Related Convictions) 16. Respondent's application is subject to denial under sections 480, subdivision (a)(3)(A)

24 of the Code in that on or about July 28, 2006 and October 22, 2009, Respondent was convicted of 21 22 23 24 25 26 27 28 11. alcohol-related offenses, as detailed in paragraphs 13 and 14, above, which is a violation of section 2762, subdivision (c) of the Code for a licensed registered nurse. CAUSE FOR DENIAL OF PPLICATION (Criminal Conviction for Theft Committed on May 14, 2003) Respondent's application is subject to denial under sections 480, subdivision (a)(1)

of the Code in that she was convicted of a crime that is substantially related to the qualifications, duties, and functions of a registered nurse. The circumstances are as follows: f 6
STATEMENT OF ISSUES

1 2 3 4 5 6 7 8 18. 10 11 12 13 14 15 16. 17 18 19 2Q 21 22 23 24 25 26 27 28 SD201180I151 DATED:

a.

On or around 2003, in a criminal proceeding entitled City of Panna (Ohio)

v Mandy Patrick in the Parma Municipal Court, case number 03CRA01694(1), Respondent was convicted on her plea of guilty to an amended charge of violating O.R.C. section 2913.02, misdemeanor theft b. As a result of the conviction, Respondent was sentenced to 30 days in jail,

with 29 days suspended, and payment of a $500 fine, with $450 suspended. SIXTH C USE FOR. DENIAL OF APPLICATION (Dishonest Act) Respondent's application is subject to denial under sections 480, subdivision (a)(3) of

the Code in that on or about May 14, 2003, Respondent committed an act of involving dishonesty with the intent to substantially benefit herself or another, as detailed in paragraph 17, above. PRAYER WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged, and that following the hearing, the Board of Registered Nursing issue a decision: 1. Denying the application of Mandy Marie Demedeiros, also known as Mandy Marie

Patrick, for a Registered Nurse License; 2. Taking such other and further action as deemed necessary and proper.

0 ,6-a

OUSE R._13A1LFY,M Executive Officer Board of Registered Nursing Department of Consumer Affairs State of California Complainant

STATEMENT OF ISSUES

Case #2012-001275

Ohio Board of :Cursing

www.nursing.ohio.gov
(614) 466-3947

17 South High Street, Suite 400 ffi Columbus, Ohio 43215-7410

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Sara Jane Dials, R.N. 511 Dale Avenue Willard, Ohio 44890 Dear Ms. Dials: In accordance with Chapter 119, Ohio Revised. Code (hereinafter "ORC"), you are hereby notified that the Ohio Board of Nursing (hereinafter "Board") proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1 On or about March 28, 2012, you were interviewed by a law enforcement officer regarding discrepancies in your documentation of removal, waste and/or administration of narcotics while working as a nurse at MedCentral Health Systems/Mansfield, Ohio. You admitted that beginning in February 2012, you had stolen Oxycodone from the Accudose dispenser by falsifying records indicating that you had administered Oxycodone to patients when you had not. You stated that you also diverted Oxycodone by taking waste medication for yourself, and not wasting it in the presence of another nurse. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Ohio Administrative Code (OAC) Rule 4723-4-06(G), states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client. Accordingly, the Board is authorized to impose. one or more of the sanctions cited in Section 4723.28, ORC.

Sara Jane Dials R.N. Page 2 In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments., or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing@nursing.ohiy. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0420 cc: Henry G. Appel, Senior Assistant Attorney General

Case# 12-005207 & 12-007490

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 0 Columbus, Ohio 43215-7410 0 (614) 466-3947

January 25, 2013

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Cheryl L. Driggs, R.N. 19163 Divelbiss Road Fredericktown, Ohio 43019 Dear Ms. Driggs: You are hereby notified that, on or about May 18, 2012, you entered into a Consent Agreement (May 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of one (1) year. A. Item 6. of the May 2012 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. DRIGGS shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. DRIGGS's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. DRIGGS shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. DRIGGS." Despite this provision, on August 15, 2012, you failed to call Firstiab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. Furthermore, on the following dates, you were selected to provide a specimen for analysis and failed to do so: August 16, 2012; and December 14, 2012. B. Item 6 a. of the May 2012 Consent Agreement states, "Prior to MS. DRIGGS initiating drug screening, MS. DRIGGS shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and

Cheryl L. Driggs, R.N. Page 2 cause 'all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. DRIGGS." Item 6b of the May 2012 Consent Agreement states, "After initiating drug screening, MS. DRIGGS shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. DRIGGS shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment." Despite these provisions, on or about June 8, 2012, you obtained medical treatment from Simona L. Moore, R.N., C.N.P. and were issued a prescription for Vicodin. You: 1). Failed to list Simona L. Moore, R.N., C.N.P. as a treating practitioner; 2) Failed to provide Simona L. Moore, R.N., C.N.P. a copy of the May 2012 Consent Agreement; and 3) Failed to have Simona L. Moore, RN., C.N.P. submit a medication prescription report listing the prescription for Vicodin you filled on or about June 10, 2012. Section 4723.28(8)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the May 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 6., 6a. and 6 b. of the May 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-324205, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about May 18, 2012, you entered into a Consent Agreement (May 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of one (1) year.

Cheryl L. Driggs, R.N. Page 3

2. Item 6. of the May 2012 Consent Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. DRIGGS shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. DRIGGS's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. DRIGGS shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. DRIGGS." Despite this provision, on August 15, 2012, you failed to call Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a specimen for analysis. Furthermore, on the folloWing dates, you were selected to provide a specimen for analysis and failed to do so: August 16, 2012; and December 14, 2012. 3. Item 6 a. of the May 2012 Consent Agreement states, "Prior to MS. DRIGGS initiating drug screening, MS. DRIGGS shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. DRIGGS." Item 6b. of the May 2012 Consent Agreement states, "After initiating drug screening, MS. DRIGGS shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. DRIGGS shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment." Despite these provisions, on or about June 8, 2012, you obtained medical treatment from Simona L. Moore, R.N., C.N.P. and were issued a prescription for Vicodin. You: 1) Failed to list Simona L. Moore, R.N., C.N.P. as a treating practitioner; 2) Failed to provide Simona L. Moore, R.N., C.N.P. a copy of the May 2012 Consent Agreement; and 3) Failed to have Simona L. Moore, R.N., C.N.P. submit a medication prescription report listing the prescription for Vicodin you filled on or about June 10, 2012.

Cheryl L. Driggs, R.N. Page 4 Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit. Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearingAnursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Sincerely, .4,-,z,lizet Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1090 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 1106 cc: Henry G. Appel, Senior Assistant Attorney General Phillip Lehmkuhl, Esq.

Case # 11-000178

Ohio Board of Nursing

www.nursing.ohio.gov 17 South High Stxeet, Suite 400 Columbus, Ohio 43215-7410 (614) 466.3947

49)

CONSENT AGREEMENT BETWEEN CHERYL L. DRIGGS, R.N. AND OHIO BOARD OF NURSING

C")

This Consent Agreement is entered into by and between CHERYL L. IIRIGGS, R.N. (MS. DRIGGS) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. DRIGGS voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. ,BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, Ohio Revised Code (ORC), to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual. MS. DRIGGS has been licensed to practice nursing as a registered nurse in the State of Ohio, RN-324205, since April 2006. MS. DRIGGS's license to practice as a registered nurse is active. MS. DRIGGS knowingly and voluntarily admits that while working as a nurse for Medical Staffing Network in Columbus, Ohio, on or about January 9, 2011, MS. DRIGGS was required to submit to a random drug screen for her employer along with several other nurses. MS. DRIGGS's

B.

C.

Cheryl L. Driggs, R.N. Page 2 drug screen tested positive for Marijuana. MS. DRIGGS resigned from her employment on January 10,2011. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. DRIGGS knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. DRIGGS's license to practice nursing as a registered nurse shall be suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum period of one (1) year: 1. 2. 3. MS. DRIGGS shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. DRIGGS shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. MS. DRIGGS agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCID to conduct a criminal records check of MS. DRIGGS, including a check of Federal Bureau of Investigation (FBI) records, and shall request BC1I to submit MS. DRIGGS's criminal records check reports to the Board. MS. DRIGGS's completed criminal records check, including the FBI check, must be received by the Board within six (6) months following the effective date of the Consent Agreement. Within six (6) months of the effective date of this Consent Agreement, MS. DRIGGS shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education, or another comparable course approved in advance by the Board or its designee, taken subsequent to the effective date of this Consent Agreement: three (3) hours of the Scope of Practice for Ohio RNs and LPNs; five (5) hours of Medication Administration: and ten (10) hours of Chemical Dependency/ Substance Abuse.

4.

Monitoring MS. DRIGGS shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. DRIGGS. MS. DRIGGS shall selfadminister the prescribed drugs only in the manner prescribed.

Cheryl L. Driggs, Page _3 6. Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. DRIGGS shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. DRIGGS's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. DRIGGS shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. DRIGGS. a. Prior to MS. DRIGGS initiating drug screening, MS. DRIGGS shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. DRIGGS. b. After initiating drug screening, MS. DRIGGS shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. DRIGGS shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. 7. Within thirty. (30) days of a request by the Board or its designee and continuing throughout the probationary period, MS. DRIGGS shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board or its designee, or a Twelve Step program, and MS. DRIGGS shall provide satisfactory documentation of such attendance to the Board beginning within six (6) months of the request and every six (6) months thereafter. Upon the request of the Board or its designee and within ninety (90) days of that request, MS. DRIGGS shall, at her expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. DRIGGS shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. DRIGGS shall execute releases to permit the chemical dependency

8.

Cheryl L, Driggs, R.N. Page 4 professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. DRIGGS's license to practice, and stating whether MS. BRIGGS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 9. If a chemical dependency evaluation is requested, MS. BRIGGS shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. BRIGGS agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. DRIGGS's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

Employment Conditions 10. MS. DRIGGS shall notify the Board, in writing, of the name and address of any current employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to accepting employment. MS. BRIGGS, within fifteen (15) day of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS. BRIGGS is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting nursing employment. MS. BRIGGS shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of the effective date of this Consent Agreement or beginning within thirty (30) days of working in a nursing position. MS. BRIGGS shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date Consent Agreement was received.

11.

Reporting Requirements 12. 13. MS. BRIGGS shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. BRIGGS shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board.

Cheryl L. Driggs, Page 5

14.

MS. DRIGGS shall submit any and all information that the Board may request regarding her ability to practice according to Acceptable and prevailing standards of safe nursing practice. MS. DRIGGS shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. DRIGGS shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. DRIGGS shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. DRIGGS shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. DRIGGS shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

15.

16.

17.

18. 19.

Temporary Practice Restriction Unless otherwise approved in advance, in writing, by the Board or its designee, MS. DRIGGS shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. DRIGGS to provide nursing services for fees, compensation, or other consideration or who engage MS. DRIGGS as a volunteer. Unless otherwise approved in advance, in writing, by the Board or its designee, MS. DRIGGS shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing.

Cheryl L. Driggs, R.N. Page 6

FAILURE TO COMPLY MS. DRIGGS agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. DRIGGS has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. DRIGGS via certified mail of the specific nature of the charges and automatic suspension of her license. MS. DRIGGS may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. DRIGGS appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MS. DRIGGS and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. DRIGGS has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. DRIGGS is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. DRIGGS and review of the reports as required herein, Any period during which MS. DRIGGS does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. DRIGGS acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. DRIGGS waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. DRIGGS waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149,43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies.

Cheryl L, Driggs, RN. Page 7 This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. EFFECTIVE DATE MS. DRIGGS understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

CHERYL DRI/ GS, R.N. G

DATE

?,C.)&
P IP D LEHMKUHX, ESQ, Attorney for Cheryl L. Driggs, R.N. DATE

/2..

51 i$ 1 12_
BERTHA LOVELACE, President Ohio Board of Nursing DATE

Case #12-005055

km Board of Nursing
17 South High Street, Suite 400

www.nursing.ohi.o.gov
(614) 466-3947

Columbus, Ohio 43215-7410

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Sherry L. Duffey, R.N. 4301 Don Juan Street Abilene, Texas 79605

Dear Ms. Duffey: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 10, 2012, the Texas Board of Nursing issued an Order of the Board in which your voluntary surrender of your Texas nursing license to practice as a registered nurse was accepted (Texas Board 2012 Order). A certified copy of the Texas Board 2012 Order, along with Attachments are attached hereto and incorporated herein.

Section 4723.28(B)(1), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew; in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition .to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 432157410, or to the email address, hea 'n @nursin .ohio ov.

Sherry L. Duffey, R.N. Page 2

If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0703 cc: Henry G. Appel, Senior Assistant Attorney General

BEFORE THE TEXAS BOARD OF NURSING

********************************************** a

In the Matter of Registered. Nurse License Number 739952 issued to SHERRY L DUFFEY ORDER OF THE BOARD On this day, the Texas Board of Nursing, hereinafter referred to as the Board, accepted the voluntary surrender of Registered Nurse License Number 739952, issued to SHERRY L DUFFEY, hereinafter referred to as Respondent. This action was taken in accordance with Section 301.453(c), Texas Occupations Code. Respondent waived representation by counsel, informal proceedings, notice and hearing, The Board makes the following Findings of Fact and Conclusions of Law.

FINDINGS OF FACT 1. 2. - 3. Respondent is currently licensed to practice professional nursing in the State of Texas. Respondent waived representation by counsel, informal proceedings, notice and hearing. Respondent received an Associate Degree in Nursing from Owens Community College, Toledo, Ohio, on June 1, 1985. Respondent was licensed to practice professional nursing in the,State of Texas on April 5, 2007. sporident's professional nursing employment history includes: 1985 - 1989 1989 - 1994 c) .1994 4 1998 . Unknown Weekend Supervisor Whitehouse Country Manor Whitehouse,. Ohio Nellis Air Force Base Las Vegas, Nevada
EC5

cc

Staff Nurse

--739952;007

Respondent's professional nursing employment history continued: 1998 - 2001 Staff Nurse Wilford Hail Medical Center San Antonio, Texas Wright-Patterson Air Force Base Dayton, Ohio Dyess Air Force Base Abilene, Texas Wesley Court Methodist Center Abilene, Texas

2001 - 2004

Staff Nurse

2004 - 2007

Nurse Manager

2007 - 2008

Charge Nurse

2008 - present 5.

Unknown

On December 14, 2010, Respondent was issued the sanction of a Reprimand with Stipulations by the Texas Board of Nursing. A copy of the December 14, 2010, Agreed Order, Findings of Fact, and Conclusions of Law is attached and incorporated, by reference, as part of this Order, On March 16, 2012, the Board received a notarized statement from Respondent voluntarily surrendering the right to practice nursing in Texas in lieu of complying with the Agreed Order issued to her on December 14, 2010. A copy of Respondent's notarized statement,, dated March 13, 2012, is attached and incorporated, by reference, as part of this Order. CONCLUSIONS OF LAW

6.

1.

Pursuant to Texas Occupations Code, Sections 301,451-301.555, the Board has jurisdiction over this matter. Notice was served in accordance with law. The evidence received is sufficient to prove violation(s) of 22 TEX. ADMIN. CODE 217,12(11)(B). The evidence received is sufficient cause pursuant to Section 301.452(b)(1) and (10), Texas Occupations Code, to take disciplinary action against Registered Nurse License Number 739952, heretofore issued to SHERRY L DUFFEY, including revocation of Respondent's license(s) to practice nursing in the State of Texas.

2 3.

5.

Under Section 301.453(c), Texas Occupations Code, the Board has the authority to accept the voluntary surrender of a license.
'45

735952:047

6.

Under Section 301,453(d), Texas Occupations Code, the Board may impose conditions for reinstatement of licenstire. Any subsequent reinstatement ofthis license will be controlled by Section 301.452 (b), Texas Occupations Code, and 22 TAC2I3.26-,29, and any amendments thereof in effect at the time of the reinstatement.

7,

ORDER NOW, THEREFORE, IT IS ORDERED that the voluntary surrender of Registered Nurse License Number 739952, heretofore issued to SHERRY L DUFFEY, to practice nursing in the State of Texas,, is accepted by the Executive Director on behalf of the Texas Board of Nursing. In connection with this acceptance, the Board imposes the following conditions:

1.

RESPONDENT SHALL NOT practice professional nursing, use the title of registered nurse or the abbreviation "RN" or wear any insignia identifying herself as a registered nurse or use any designation which, directly or indirectly, would lead any person to believe that RESPONDENT is a registered nurse during the period in which the license is surrendered. RESPONDENT SHALL NOT petition for reinstatement of licensure until: one (1) year has elapsed from the date of this Order. Upon petitioning for reinstatement, RESPONDENT SHALL satisfy all then existing requirements for relicensure. IT IS FURTHER AGREED and ORDERED that this Order SHALL be applicable

2.

3.

to Respondent's nurse licensure compact privileges, if any, to practice nursing in the State of Texas.
"

Effective this 10th day of September , 2012.

:4

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...
Vry

TEXAS BOARD OF NURSING

r, / `.,:r. ,;...- z-P -.t .,.. - F" :

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By: Katherine A. Thomas, MN, RN, FAAN Executive Director on behalf of said Board
115.

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739952;007

SHERRY DUFFEY 15526 Westwood Avenue Monroe, MI 48161 Texas RN License #739952 Voluntary Surrender Statement December 16, 2031

Dear Texas Board of Nursing: I no longer desire to be licensed as a professional nurse/ Accordingly, I voluntarily surrender my license/licenses to practice in Texas. I, SHERRY DUFFEY, waive representation by counsel and consent to the entry of an Order which outlines requirements for reinstatement of my license, I understand that I will be required to comply with the Board's Rules and Regulations in effect at the timeI submit any petition for reinstatement.

Signature Date

zorz
9-1 ,i--,

Texas Nursing License Number/s I ?..) The State of Texas

Before me, the undersigned authority, on this date personally appeared SHERRY DUFFEY who, being duly sworn by me, stated that she executed the above for the purpose therein contained and that she understood same. Sworn to before me the t SEAL Notary Public in and for the State of day of , 20

t)-',,;cik.c.jai. N
SHEILA FORD NPTAEIY P-Wit49, SATE' OF MICHIGAN Uttrt0E-MCINRC*0.4610P Wtrest APTit B. St411 @WM 0

BEFORE THE lEXM BOARD OF NURSING

**** *tit* *#*******.**** tit gx ***AI bi;*14,,t:****Al***** )iorgisAvit

In the Matter of Registered Nurse . License Number 739952 issued to SHERRY L. DUFFEY
On

AGREED ORDER

this day the Texas Beard of Nursing, hereinafter referred to as the Board,

considered the matter of SHERRY L DUFFEY, Registered Nurse License Number 739952, hereinafter referred to as Respondent. Information received by the Board produced evidence that Respondent may have violated Section 301.452(b)(10A(13), Texas Occupations Code_ Respondent waived representation
. hy

counsel, informal proceedings, notice and bearing, and agreed to the entry of this Order offered

on September 24, 2010, by Katherine A. Thomas, MN, RN, Executive Director, subject to ratification by the Board, FINDINGS OF FACT L Prior tote 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(s). Respondent waived representation bS, counsel, informal proceedings, notice and hearing, and agreed to the entry of this Order. Respondent is currently licensed to practice professional nursing in the State of Texas. Respondent received an Associate Degree in Nursing from Owens Community College, Toledo, Ohio, on June 1, 1985, Respondent was licensed to practice professional nursing in the State of Texas on April 5, 2007. Respondents nursing employment history includes: 1985-1989
739952: 3 I

2. 3. 4.

5.

Unknown
CIO

Respondent's nursing employment history continued: 1989-1994 Weekend SUpervisor Country Manor Whitehouse, OH Staff. Nurse NelIis Air Force Base Las Vegas, NV Staff Nurse Wilford Hall Medical Center San Antonio, TX Staff Nurse Wright-Patterson Air Force Base Dayton, OH Nurse Manger Dyess Air Force Base Abilene, TX Charge Nurse Wesley Court Methodist Center Abilene, Texas Unknown

-Whitehouse

1994-1998

1998-2001

2001-2004

2004-2007

2007-2008

2008- present

6.

At the time of the initial incident in Finding of Fact Number Seven (7), Respondent was employed as Registered Nurse with Wesley Court Methodist Retirement Community Center, Abilene, Texas, and had been in this position for approximately two (2) months, On or about September 10, 2007, while working at Wesley Court Methodist Retirement Community Center, Abilene, Texas, Respondent failed to completely and accurately document intake and output information for Patient MR#18243 and Patient MR1118122, as required. Respondent's failure may have exposed said patients to the risk of harm in that subsequent care givers would have had to rely on incomplete and inaccurate information on which to base their plan of care.

7.

739952:i31

- 2, "

coo

8,

In response to Finding of Fact Number Seven (7), Respondent admits to failing to document intake and output for said patients. Respondent states that she was not trained to complete the form for intake/output, and believed that the Certified Nurse Assistants were responsible for this task. Respondent adds that once she was made aware where the intake/output forms were located, she completed the forms as required thereafter. On or about December 17, 2007, while working at Wesley Court Methodist Retirement Community Center, Abilene, Texas, Respondent failed to maintain medication administration safety measures in that she left medications for Patient1M118110 unattended in said patient's room. Respondent's conduct failed to promote a safe environment for patients who would have had access to these unsecured dangerous medications. In response to Finding of Fact Number Nine (9), Respondent states that when she entered patient IOU 18130's room, he was in the bathroom. Respondent adds that she briefly left the medications for said patient on his table, and left to call a physician, at which time, the medications were found by the patient's daughter. On or about February 1, 2008, while working at Wesley Court Methodist Retirement Community Center, Abilene, Texas, Respondent exposed others to the risk of harm in that she left used uncapped' needles, lancets, and other bio-hazardous items in an open "non sharps" plastic "basket" at the Nurse's station. SubseqUently, an employee suffered a "needle stick." Respondent'S actions were a violation of standards of care, and caused physical and emotional injury to a fellow employee. In response to Finding of Fact Number Eleven (11), Respondent states that neither the patients' rooms, nor the medication carts, contained any "Sharps"oontainers. She adds that she went to dispose of the contaminated items in the "medication room," but found it locked. .Respondent admits to leaving.. a "basket" fall of used needles, lancets, and other hiohazardous items at the Nurse's station to attend to a patient; at which time, another nurse suffered the 'needle stick.' Ou or about February 3.9, 2007, while working at Wesley Court Methodist Retirement Community Center, Abilene, Texas, Respondent failed to implement measures to prevent exposure to pathogens and communicable conditions in that she failed to properly dispose of used needles, lancets, and other bio-hazardous items, as required. Instead, Respondent kept said items in a ''non sharps" plastic cup in her personal locker. Respondent's failure exposed her and others to the risk of contracting dangerous and incurable infections, ailments, and disease.

9.

10.

11.

12.

13.

739952;131

-3-

C10

14.

In response to Finding of Fact Number Thirteen (13), Respondent states that she wanted to prove to the facility's nursing administration hovtrrtuch one work shift entailed, and to justify having to Work overtime. She collected used lancets, insulin syringes, and empty respirator ampules as evidence. Respondent adds that she kept said items in a covered plastic container in her personal locker.

CONCLUSIONS OF LAW Pursuant to Texas Occupations Code, Sections 301.451-301.555, the Board has jurisdiction over this matter_ 2. 3, Notice was served in accordance with law. The evidence received is sufficient to prove vlolation of Section 301A52(h)(10)&(13), Texas Occupations Code, 22 TEL AEA. CODE 217.11(1)(A), (I )CB), (1)(D) & (1)(0), and 2.2 . TEX. ADMIN. CODE21112(I)(B), (4)&(6)(C ). The evidence received is sufficient cause pursuant to Section 301.452(b), Texas Occupations Code, to take disciplinary action against Registered Nurse License Number 739952, heretofore issued to SHERRY,L. DUFFEY, including revocation of Respondent's license(s) to practice nursing -in the State of Texas.

4.

ORDER IT IS THEREFORE AGREED and ORDERED, subject to ratification by the Temas Board of Nursing, that RESPONDENT SHALL receive the sanction of a REPRIMAND WITH STIPULATIONS, and RESPONDENT SHALL comply in all respects with the Nursing Practice Act, Texas Occupations Code, 301.001 et seq., the Rules and Regulations Relating to Nurse Bducation, Licensure and Practice, 22 TEx. ADMIN. CODE 211.1 et seq. and this Order. IT IS FURTHER AGREED and ORDERED that this Order SHALL be applicable to Respondent's nurse licenstire compact privileges, if any, to practice nursing in the State of Texas. IT IS FURTHER AGREED and ORDERED that while Respondent's license(s) isfate -4-

735952:131

C10

encumbered by this Order, Respondent may not work outside the State of Texas pursuant to a nurse li censure compact privilege without the written permission of the Texas Board of Nursing and the Board of Nursing in the party state where Respondent wishes to work. IT IS FURTHER AGREED that: (1) 'RESPONDENT SHALL, within one (1) year of entry of this Order, successfully complete a course in Texas nursing jurisprudence and ethics. 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) 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 RESPONDENTS 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.s4atx.,us/disdiplinarvactionfstipscourses.htrnL (2) RESPONDENT SHALL, within one (1) year of entry of this Order, successfully complete a course in medication administration. RESPONDENT SHALL obtain Board approval -5CIO

/39952:131

of the course prior to enrollment only if the come 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) bows 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 SHALL 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 determine 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 at the following Board' websize address: http://www.bon.state.Lzuildigciplinarvactiordstivswummittml. (3) RESPONDENT SHALL, within one (I) 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 -6-

7395'52:131

study courses and video programs wil) 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 betaken 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: ht, ../Avww..bon.state. tx.u.s/disciplinaryaction/stipscourses., (4) RESPONDENT SHALL, within one (I) year of entry of this Ordetuccessfully complete a course in "Infection Control," a 5.0 contact hours workshop presented in various locations by the Texas Department of Aging and Disability Services. In order to receive credit for completion of this workshop, RESPONDENT SHALL SUBMIT the continuing education certificate , of completion for this workshop to the Board's office, to the attention of Monitoring. This course is to be taken in addition to any continuing education 'requirements the Board may have for relicensure. Information regarding . this workshop may be found at the following website: Attp://www.dads.stare.tx.us/providers/Traininejoindraining.cfrn or by contacting (512) 438-2201. (5) RESPONDENT SHALL, within one (I) year of entry of this Order, successfully complete the course "Sharpening Critical Thinking Sldlls," a 3:6 contact hour online program provided by the National Council of State Boards ofNursing (NCSPN) Learning Extension. In order
739952:L3i

-7-

era

to receive credit for completion of this program, RESPONDENT SHALL SUBMIT the continuing education certificate of completion for this program to the Board's office, to the attention of Monitoring. This course is to be taken in addition to any continuing education requirements the Board may have for relicensure. Information regarding this workshop may be found' at the following web address: hup://nesbn.hivelive.corn/hivesla0f613e8a0/swnmarv. IT IS FURTHER AGREED, SHOULD RESPONDENT PRACTICE AS A NURSE IN THE STATE OF TEXAS, RESPONDENT WILL PRO vrDE DIRECT PATIENT CARE AND PRACTICE IN A HOSPITAL, NURSING HOME, OR OTHER CLINICAL SETTING AND RESPONDENT MUST WORK IN SUCH SETTING A MINIMUM OF SDC1Y-FOUR (64) HOURS PER MONTH UNDER THE FOLLOWING STIPULATIONS FOR TWO (2) YEAR(S) OF EMPLOYMENT. THE LENGTH. OF THE STIPULATION PERIOD WILL HE EXTENDED UNTIL SUCH TWENTY FOUR (24) ItIONTHS HAVE ELAPSED. PERIODS OF UNEMPLOYMENT OR OF EMPLOYMENT THAT DO NOT REQUIRE THE USE OF REGISTERED NURSE (RN) LICENSE WILL NOT. APPLY TO THIS STIPULATION PERIOD: (6) RESPONDENT SHALL notify each present employer in nursing of this Order of the Board and the stipulations conditions on RESPONDENTS 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 of this Order of the Board and the stipulations conditions on. RESPONDENTS license. RESPONDENT SHALL present a complete copy of this Order and all Proposals for Decision issued by the Administrative Law Judge, if any,
734952:131

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to each future employer prior to accepting an offer of employment. (7) 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) mays 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. (8)For the duration of the stipulation 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 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 unit(s). RESPONDENT SHALL NOT be employed by a nurse registry, temporary nurse employment agency, hospice, or home health agency. RESPONDENT SHALL NOT be selfemployed or contract for services. Multiple employers arc prohibited. (9) 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 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) month period for two(2) year(s) of employment as a nurse. IT IS FURTHER AGREED, that upon full compliance with the terms of this Order,

73g95"2:131

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all encumbrances will be removed from RESPONDENTS license(s) to practice nursing in. the State of Texas and RESPONDENT shall be eligible for nurse licensure compact privileges, if any. BALANCE OF THIS PAGE INTENTIONALLY LEFT BLANK. CONTINUED ON NEXT PAGE.

739932:338

CID

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 toy 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 of this Order become effective, and a copy will be mailed to me. I understand that if I 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(s) to practice nursing in the State of Texas, as a consequence of my noncompliance. Signed this,Z9 day of

SHERRY L. 1\tha:Y, Resp Mert

Sworn to and subscribed before me this gi day a SEAL

/e2,

Notary Public in and for the State of

MR52:131
F.

- 11

WHEREFORE, PREMISES CONSIDERED, the Texas Board of Nursing does hereby ratify. and adopt the Agreed Order that was signed on the

1y

day of

A 0-4-e44,461,--

20 ID , by SHERRY L, DUFFEY, Registered Nurse License Number 739952, and said Order is final, Effective this day of , 20

Katlierine A. Thomas, ION, RN Executive Director on behalf of said Board

7 WS' ..1,:13

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Case# 12-006210

Ohio Boar4 of Nursing

January 25, 2013

www.nursingohi.o.gov
(6:14) 466-3947

17 South High Street, Suite 400 Columbus, Ohio 43215-7410

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Steven Ray Elkins, L.P.N. 7255 Noll Drive North Ridgeville, Ohio '1'1039 Dear Mr. Elkins: You are hereby notified that, on or about July 27, 2012, the Ohio Board of Nursing (Board) issued an Adjudication Order (July 2012 Adjudication Order), a copy of which is attached hereto and incorporated herein, in which the Board ordered that your license to practice nursing as a licensed practical nurse in the State of Ohio be suspended indefinitely and that such suspension would be stayed subject to probationary teiins, conditions, and limitations for a minimum period of two (2) years. Attached to an incorporated within the July 2012 Adjudication Order is a June 19, 2012 Board Hearing Committee's Report and Recommendation. A. Item 6. of the July 2012 Adjudication Order states, "Within ninety (90) days of the effective date of this Order, MR. ELKINS shall, at his expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MR. ELKINS shall provide the chemical dependency professional with a copy of this Order and Notice of Opportunity for Hearing. Further, MR. ELKINS shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MR. ELKINS's license, and a statement as to whether MR. ELKINS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care." Despite this provision, you have failed to obtain a chemical dependency evaluation by a Board approved chemical dependency professional. B. Item 8. of the July 2012 Adjudication Order states, "Within sixty (60) days of the effective date of this Order and for a minimum, continuous period of six (6) months thereafter, MR. ELKINS shall submit, at his expense and on

Steven Ray Elkins, L.P.N. Page 2 the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MR. ELKINS's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR. ELKINS shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. ELKINS's history." Despite this provision, you have failed to initiate drug screening with Firstlab, the Board's random drug/alcohol screen program administrator. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the July 2012 Adjudication Order, you are hereby notified that it appears to the Board that you have violated Items 6. and 8. of the July 2012 Adjudication Order. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-116725, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a licensed practical nurse without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about July 27, 2012, the Ohio Board of Nursing (Board) issued an Adjudication Order (July 2012 Adjudication Order), a copy of which is attached hereto and incorporated herein, in which the Board ordered that your license to practice nursing as a licensed practical nurse in the State of Ohio be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. Attached to an incorporated within the July 2012 Adjudication Order is a June 19, 2012 Board Hearing Committee's Report and Recommendation. 2. Item 6. of the July 2012 Adjudication Order states, "Within ninety (90) days of the effective date of this Order, MR. ELKINS shall, at his expense, obtain a chemical dependency evaluation by a Board approved chemical

Steven Ray Elkins, L.P.N. Page 3 dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MR. ELKINS shall provide the chemical dependency professional with a copy of this Order and Notice of Opportunity for Hearing. Further, MR. ELKINS shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MR. ELKINS's license, and a statement as to whether MR. ELKINS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care." Despite this provision, you have failed to obtain a chemical dependency evaluation by a Board approved chemical dependency professional. 3. Item 8. of the July 2012 Adjudication Order states, "Within sixty (60) days of the effective date of this Order and for a minimum, continuous period of six (6) months thereafter, MR. ELKINS shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MR. ELKINS's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 472328(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR. ELKINS shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. ELKINS's history." Despite this provision, you have failed to initiate drug screening with Firstlab, the Board's random drug/alcohol screen program administrator. Section 4723 .28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in

Steven Ray Elkins, L.P.N. Page 4 writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hea nursin .ohio.00v. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, At Rhonda S. Barkheimer, R.N., C .N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1069 cc: Henry G. Appel, Senior Assistant Attorney General

Ohio Board of Nursing

1.7 South High street, Suite 400

www.nursing.ohio.gov

Columbus, Ohio 43215-741.0. 9 (614) 466-3947

BEFORE THE OHIO BOARD OF NURSING

IN THE MATTER OF: CASE It 10-1165 STEVEN ELKINS, L.P.N.

ADJUDICATION ORDER

This matter came for consideration before the Ohio Board of Nursing (hereinafter "Board") on July 27, 2012. At such time the Board verified that it reviewed the following materials prior to consideration of this matter:

Hearing Transcript; State's Exhibits; Board Hearing Committee's Report and Recommendation; and Respondent's Motion to Submit Additional Evidence dated July 11,2012.

The Board Hearing Committee, appointed by the Board, presided over the adjudication hearing in this matter pursuant to Section 119.09, Ohio Revised Code (ORC).. A true copy of the Board Hearing Committee's Report and Recommendation is attached hereto and incorporated herein. On this date, the Board denied Respondent's Motion to Submit Additional Evidence dated July 11, 2012. The Board also accepted all of the Findings of Fact and Conclusions of the Board Hearing Committee, and modified the Recommendation in the Board Hearing Committee's Report and Recommendation, and ordered that STEVEN ELKINS'S license to practice nursing as a licensed practical nurse in the State of Ohio be suspended for an indefinite period of time and that the suspension be stayed subject to the probationary terms and conditions set forth below for a minimum period of two (2) years and the peixuanent practice restrictions and temporary narcotic restrictions set forth below. The rationale for the modification is the following: The Board finds there is no evidence of harm to patients and ,there is no evidence of a police report or criminal investigation of MR. ELKINS for theft, The Board has determined that a suspension period with conditions for reinstatement is not necessary prior 'to probationary monitoring of MR. ELKINS'S nursing practice. However, the additional requirements and Page 1 of 7

restrictions set forth below are necessary for effective monitoring of MR. ELKINS'S nursing practice during the probationary period, MR.' ELKINS's license shall be subject to the following probationary terms, conditions, and limitations for not less than two (2) years. I. MR. ELKINS shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. 2. MR. ELKINS shall appear in person for interviews before the full Board or its designated representative as requested by the Board. 3. Within six (6) months of the effective date of this Order, MR. ELKINS shall complete and submit satisfactory documentation of his successful completion of the following continuing education approved in advance by the Board: eight (8) hours of Medication Administration. 4. Within six (6) months of the effective date of this Order, shall submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MR. ELKINS, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCH to submit MR. ELKINS's criminal records check reports to the Board. A request for release will not be considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board. 5. MR. ELKINS shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. ELKINS's history. MR. ELKINS shall selfadminister the prescribed drugs only in the manner prescribed. 6. Within ninety (90) days of the effective date of this Order, MR. ELKINS shall, at his expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MR. ELKINS shall provide the chemical dependency professional with a copy of this Order and Notice of Opportunity for Hearing. Further, MR. ELKINS shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MR. ELKINS's license, and a statement as to whether MR. ELKINS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 7. MR. ELKINS shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, the Board may utilize the chemical dependency

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professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MR. ELKINS's license. 8. Within sixty (60) days of the effective date of this Order and for a minimum, continuous period of six (6) months thereafter, MR. ELKINS shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MR. ELKINS's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR. ELKINS shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. ELKINS's history. 9. Within thirty (30) days prior to MR. ELKINS initiating drug screening, MR. ELKINS shall provide a copy of this Order to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MR. ELKINS. 10. After initiating drug screening, MR. ELKINS shall be under a continuing duty to provide a copy of this Order, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within fortyeight (48) hours of being treated by another practitioner. Further, MR. ELKINS shall notify the Board of any and all medication(s) or prescription(s) received within twentyfour (24) hours of release from hospitalization or medical treatment. Employment Conditions 11. Prior to accepting employment as a nurse, each time with every employer, MR. ELKINS shall notify the Board. 12. MR. ELKINS shall have his employer(s), if working in a position where a nursing license is required; submit written reports regarding job performance on a quarterly basis. MR. ELKINS shall provide her employer(s) with a copy of this Order and Notice of Opportunity for Hearing and shall have his employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Order and Notice of Opportunity for Hearing, including the date they were received. Further, MR. ELKINS is under a continuing duty to provide a copy of this Order and Notice of Opportunity for Hearing to any new employer prior to accepting employment. Reporting Requirements of MR. ELKINS 13. MR. ELKINS shall sign releases of information forms allowing health professionals and

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other organizations to submit the requested documentation directly to the Board. 14. MR. ELKINS shall submit any and all information that the Board may request regarding his ability to practice according to acceptable and prevailing standards of safe nursing practice. 15. MR. ELKINS shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. 16. MR. ELKINS shall submit the reports and documentation required by this Order on forms specified by the Board. All reporting and communications required by this Order shall be made to the Compliance Unit of the Board. 17. MR. ELKINS shall submit the reports and documentation required by this Order or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. 18. MR. ELKINS shall verify that the reports and documentation required by this Order are received in the Board office. 19. MR. ELKINS shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number. 20. Prior to working as a nurse, MR. ELKINS shall complete a nurse refresher course approved in advance by the Board.

Temporary Narcotic Restriction Unless otherwise approved in advance by the Board or its designee, MR. ELKINS shall not administer, have access to, or possess (except as prescribed for MR. ELKINS's use by another so authorized by law who has full knowledge of MR. ELKINS's history) any narcotics, other controlled substances, or mood altering drugs. In addition, MR. ELKINS shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MR. ELKINS shall not call in or order prescriptions or prescription refills. Permanent Practice Restrictions MR. ELKINS shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) as a nurse for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who

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directly engage MR. ELKINS to provide nursing services for fees, compensation, or other consideration or as a volunteer. MR. ELKINS shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. DURATION The Board may only alter the probationary period imposed by this Order if: (1) the Board determines that MR. ELKINS has complied with all aspects of this Order; and (2) the Board determines that MR. ELKINS is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MR. ELKINS and review of the reports as required herein. Any period during which MR. ELKINS does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Order. This ORDER shall become effective immediately and is hereby entered upon the Journal of the Board for the 27th day of July, 2012.

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TIME AND METHOD TO PERFECT AN APPEAL Any party desiring to appeal shall file a Notice of Appeal with the Ohio Board of Nursing, 17 S. High St., Ste 400, Columbus OH 43215-7410, setting forth the order appealed from and the grounds of the party's appeal. A copy of such Notice of Appeal shall also be filed by the appellant with the Franklin. County Court of Common Pleas, Columbus, Ohio. Such notices of appeal shall be filed within fifteen (15) days after the mailing of the notice of the Ohio Board of Nursing's Order as provided in Section 119.12 of the Ohio Revised Code.

CERTIFICATION

The State of Ohio County of Franklin

1, the undersigned Betsy J. Houchen, Executive Director for the Ohio Board of Nursing, hereby certify that the foregoing is a true and exact reproduction of the original Order of the Ohio Board of Nursing entered on its Journal, on the 27th day of July, 2012.

Betsy J. Houchen, R.N., M.S., J.D. Executive Director

July 27, 2012 Date

(SEAL)

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CERTIFICATE OF SERVICE hereby certify that a true and accurate copy of the foregoing Adjudication Order, concerning STEVEN. ELKINS was sent via certified mail; return receipt requested, this 10th day of August, 2012, to STEVEN ELKINS, 7255 Noll Drive, North Ridgeville, 011 44309.

I also certify that a copy of the same was sent via regular U.S. mail this 1Q day of August, 2012, to Lamont Pugh, SAC, Sanctions & Exclusions,. Department of Health and Human Services, Office of Inspector General, Office of Investigations, PO Box 51020, Chicago IL 60601-81020.

/)'z'll

'4nk 4

Betsy J. Houchen, R.N., M.S., JD. Executive Director

cc:

Henry G. Appel, Assistant Attorney General

Certified Mail Receipt No. 7012 1010 0002 4225 4207

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RECEIVED
State Of Ohio Board Nursing 17 SentliHigh :Street Suite 400 Columbus, Ohio ,43215-7410 In the Matter of Steven pity Elkins, L.P,N. Respondent

:4112 J1A1 19 AMID: 19 1 BOARD OF NURSING OHIO

Bertha Klovelaed, Presiding MeMber Melissa Meyer, Member TraCy Rueggi Member 'Board Hearing .Committee CUse Nos. 10-1165 Alpe 19, 2012 Report and .Recommendation

Appearmiies: For the Ohio Board ofNursing! Miehael DeWine, Olio ATTORNEY
GENERAL, and Henry G. Appel, Esq, Assistant Attorney General, Health & Human Services

Section, 30 East Broad Street 260' Floor; Colatribtis, Ohio 43215-3428, Telephone: 614-4668600; Fax: 644-466-6090, Foi the LiCenseekespondent: Steven Ray.Elkins, 7255 Noll Dk.:, North Ridgeville, Ohio : 41039...Telephone. Unknown. Fax:. "Unknown: Email: selkins77. hotroil.com.. Nature of the Case

This is an administra0eDkomeding Under Chapter 119 (the Achninistrative Precedure

Act), and .Chapter:4723 (theNurse Practice Act), of the Ohio Revised Code..('`ORO"). The caseinvolves a Notice of Oppokunity- for 'Hearing,. issued to the Respondent, 'Steven Ray Elkins:, L.P.N, ("Respondent'''. or '`Mr, Elkine), Nooliboi 18, 2011, (State Exhibit 1.) In the notice, the. Ohio Board of Nursing ("Board") informed Mr. Elkins that it intended to take .04:firmly action against. his license. for being placed .on he Ohio Department of Health ("OM') Nurse Aide Registry as not eligible to weiii/nOt' in gOed standing, for COMmitting thisapPrOpriation while working in a health tare .occuparion in a long term care facility. (Id.) In. the notice sent to Mr. Elkins,, the BOWL sat `.totthb .its reasons for the preposed action, identified the charge against him, and advised Elkins Of his light To hearing. (Id.) Mk. Elkins made S. Oniely re.lnatTpt

a bearing. (State E hibit 2:). The Beard gave Mr. Elkins written notice that it woilld consider the
Charges in pkceedings to be held before its, Board Hearing Committee; setting forth the date; time and locatien for this hearing. (State: Exhibit 5,) The Beard .appointed the Beard Hearing

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Committee, composed of three members, to hear this matter and to make a recommendation to the full Board. I have been appointed to serve as the Presiding Board Hearing Committee member in this matter. At the designated time the parties presented evidence and the testimony of witnesses on the charges during a hearing conducted on April 18, 2012. Mr. Elkins appeared at the hearing and was not represented by counsel. This report is based on the evidence and testimony presented at the hearing. Summary of the issues The Board charged Mr, Elkins with a violation of Section 4723.28(B)(1), ORC. This Section authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. The Board is required to consider the merits of each case, and may, based upon the circumstances leading to these charges, consider both aggravating and mitigating circumstances shown in the record. From the evidence before the Board Committee, we find a sufficient basis to conclude that the charge against Mr. Elkins has been proven. Because we find the evidence establishes a valid basis for disciplinary action, we recommend that Mr. Elkins's license to practice as a licensed practical nurse be suspended for a period of not less than one (1) year with conditions for reinstatement, and following reinstatement, that his license be subject to a probationary period of not less than two (2) years with permanent practice and temporary narcotic restrictions for a period of six (6) months. Our analysis follows. Evidence Examined The State presented evidence through the testimony of Board Compliance Unit Manager, Lisa Ferguson-Ramos; Ennis Court Assistant Director of Nursing for Clinical Services, Steven Alferink; and Respondent Steven Ray Elkins, as on cross-examination. The Respondent presented the testimony of Isaac Muniz, Michelle Galyen, Dennis Grabowski, Rodney Workman, Nathan Scott, Rachel Lynn Wacker, Sandra Palmer, and Christopher Kane. Mr. Elkins also testified on his own behalf. The State introduced Exhibits, identified in the record at page 5 of the transcript of proceedings. All testimony and exhibits admitted in the hearing of the matter, whether or not specifically referred to in this Report, were thoroughly reviewed and

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considered by the Board Hearing Committee prior to the entry of the findings, conclusions, and recommendations shown below. Summary of the Evidence The State presented evidence that Mr. Elkins has been licensed to practice nursing as a licensed practical nurse in the State of Ohio since September 29, 2004. (State Exhibit 13.) Mr. Elkins first came to the Board's attention when he noted on his application for licensure as an L.P.N. that he had been convicted of two (2) counts of trafficking in marijuana, a fourth-degree felony. (See State Exhibit 11.) Mr. Elkins was granted a license in September 2004, subject to a two-year probationary period. (State Exhibit 9.) In a Mach 18, 2005 Post Adjudication Order Consent Agreement, Mr. Elkins agreed to participate in random drug and alcohol screening, (Id.) On July 21, 2006, the Board granted Mr. Elkins early release from the terms and conditions of his probationary period. (State Exhibit 12.) The current situation involving Mr. Elkins occurred while he was employed as an LPN at Ennis Court, a residential and long-term care facility located in Lakewood, Ohio. (See State Exhibit 7.) On February 23, 2011, the Director of the Ohio Department of Health ("ODH") issued a notice to Mr. Elkins advising him that a "reasonable basis" existed to support an allegation that he had, between May 2009 and January 2010, wrongfully taken residents' medications while employed at Ennis Court. (Id.) On July 25, 2011, the ODE held a hearing on the allegations raised against him. (Id.) Several witnesses testified against Mr. Elkins at the ODE hearing. (See id.) Leeann Cruze, a Resident Assistant at Ennis Court, testified at the ODE hearing that she witnessed Mr. Elkins placing medication in his scrubs pockets two to three times a week. (Id, at 3.) She stated that she did not see what the medications were. (Id.) Steven Alferink, L.P.N. and Assistant Director of Nursing for Clinical Services at Ennis Court, testified at the ODE hearing that he reviewed the records as to the stock and dispensing of Tramadol. (Id., at 5.) As noted in the Report and Recommendation issued by the ODE hearing examiner, Mr. Alferink found that significant quantities of Trarnadol were missing. (Id.) The hearing examiner reported Mr. AI ferink's findings:
As to Resident CB, 96 doses of Tramadol were received from Omnicare, an outside pharmaceutical supply company, of which Resident CB received 16 doies in December 2009, 26 doses in November 2009, 7 doses in October 2009, 21 doses were still in stock, and 26 doses were unaccounted for. As to Resident MC, a dementia patient (now deceased) who resided on the first

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floor of the assisted living section, there were 207 doses unaccounted for. As to Resident JA, there were 50 doses unaccounted for. As to Resident LV, there were 152 doses unaccounted for. [. . .1 As to Resident LE, there were 89 doses unaccounted for. As to Resident CL, there were 436 doses unaccounted for. Ultimately, Mferink's investigation reflected a total of between 900 to 1,000 unaccounted doses of Tramadol.

(State Exhibit 7, p. 5.) Mr. Alferink also provided the following testimony at the ODH hearing:
came to the assisted living on one of the days as the investigation was going on and observed him [Mr. Elkins] putting something in his pocket that was like a white medicine cup and I asked him what is that and he said to me drugs and so I thought he was joking around, and I said really what is that, and again, he said drugs, no really, they're drugs, and I said let me see and he takes the white medicine cups out of his pocket and puts them on the nurses' Station, and I said you can't do that.., I asked him what the medica... who the medication was for, urn, he indicated that they were for a resident BM and resident, tun, and at the time that this occurred, they only had PRN medication orders and he hadn't been on the floors yet to determine [...1 if the medications were needed [...J.

(Id. at 6-7.) At the Board of Nursing hearing conducted on April 18, 2012, Mr. Alferink testified as follows when questioned by Mr. Elkins:
Q. You stated I had cups in my pocket. Did you actually see any pills? A. The cups that I saw you put in your pocket were crumpled-up souffl cups that you said you had that had drugs in them. Q. Right. But as far as the investigation of the Board of Health, you admitted in documentation that you did not see actual pills; you only saw cups. A. Yes. Q. And you also admitted that I jokingly said, oh, it's tramadol; is that true? Did I say that? A. I believe what you said was it's drugs, and then after that you told me it was tramadol for one of the residents.

(Tr., pp. 34-35.) At the ODH hearing, Mr. Elkins denied taking Tramadol or any other medications from residents. (State Exhibit 7, p. 8) At the ODH hearing, Mr. Elkins testified that he wrote the medications to be dispensed to the residents on a separate sheet of paper that he put inside his shirt pocket as a "back-up" to the information he would write in the narcotic medication book. (Id. at 8.) Mr. Elkins told the ODH Hearing Examiner that as a further "back-up," he would write prescribed dosages on separate paper cups and would put the paper cups in his pants. pockets. (Id.) Mr. Elkins alleged various reasons why the administrators at Ennis Court would want him to be fired. (See Tr., p. I0.) Mr. Elkins' friend, Christopher (Tyler) Kane, testified that he had made a demand against Ennis Court for a HTPAA violation, and that Mr. Elkins' termination was in retaliation for Mr. Kane's lawsuit. (See Tr., p. 94.) On February 4, 2010, Mr. Elkins was terminated from Ennis Court for actions unrelated to the allegations of theft of Tramadol. (See State Exhibit 8a, p. 10.) ODH investigator Walter
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Bradley reported that Mr. Elkins was fired because he falsely documented that he had given a resident an injection of a drug, at a time there were no doses of the resident's medication in the facility. (Id.) The ODE Hearing Officer found that Mr. Elkins has misappropriated residents' personal property, to wit, their medications. (Sate Exhibit 7, p. 18.) In his conclusions of law, the Hearing Officer wrote:
The Hearing Office is of the view that the testimony of Cruz and especially Alferink are significant. First, the testimony of Alferink that he specifically observed Respondent remove medication from his pocket leads to a reasonable conclusion that Respondent had confiscated or otherwise deprived the residents of that medication. Respondent provided a detailed explanation of the procedure he used in noting the narcotic medications, including the process of noting a medication on a cup and placing the cup in his pocket, If that was an that was involved, although perhaps an unusual approach, same is not an act of misappropriation. However, Cruz noted that medication was placed in Respondent's pants pocket and Alferink directly confronted Respondent, who removed medication from his pocket. Respondent denied that any such action occurred and contended that no medications were in his pockets. The Hearing Officer, however, credits the testimony, particularly of Alferink, as the more credible regarding the conversation that occurred between the two of them and what Alferink saw. Also, although. Respondent admitted the existence of a conversation, there was no reference by Respondent to Alferink as to his unusual pattern of writing the narcotic medications on several duplicate papers, one of which was noting the medication on a cup.

(Id. at 17.) On September 16, 2012, the Director of the Ohio Department of Health adopted the Hearing Officer's recommendation and found that Mr. Elkins misappropriated residents' medications. (State Exhibit 6.) The Director ordered that his finding be placed on the Nurse AideRegistry. (Id.) Analysis From the record now before the Board, it appears that there is a preponderance of evidence that Mr. Elkins was placed on the Ohio Department of Health's Nurse Aide Registry as not eligible to work/not in good standing, for committing misappropriation while working in a health care occupation at Ennis Court, a long term care facility located in Lakewood, Ohio. (See State Exhibit 6,) The State submitted a certified copy of ODE Director's finding. (Id.) Mr. Elkins' former co-workers testified that Mr. Elkins was not known to be a thief, and that he was a good nurse, (See, e.g., Tr., pp. 62, 68, 72, 82, 86, 90, 92.) Mr. Elkins stated that he is a good nurse and that he would "do anything to prove that I am capable, ethical and honest, to keep my license." (Tr., p. 113.) He stated, "I went into this field because I always wanted to be

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a like a cop, fireman, or something. If I got to read books, I want to read, you know, about the human body, and I want to help others. And it's just my nature. I believe I'm a helper." (Tr., p. 121.) As aggravating circumstances, the State noted that Mr. Elkins has had prior discipline issued against his license by the Board for a felony conviction that involved trafficking in narcotics. (Tr., p. 128.) The State also noted that Mr. Elkins' explanation as to why he placed medicine cups in his pants pockets was not believable and defied common sense. (See Tr., p. 132.) The State noted that the reasoning by the ODH Hearing Officer in his Report and Recommendation was "solid and credible." (Id.) Mr. Elkins also has a history of attempting to influence witnesses against him. (See State Exhibit 8a; Tr p. 26-28.) Walter Bradley, ODH Investigator, indicated in his report that LeeAnn Cruz received a voicemail from Mr. Elkins on July 25, 2010, in which Mr. Elkins told Cruz to "get [the ODH investigator] off my back. You need to tell him it was Tylenol that I was putting in the cups and it came from extra stock at Ennis Court." (State Exhibit 8a, p. 5.) Mr. Bradley also wrote, "Cruz said that Elkins demanded she call him back when she got his message. She stated that Elkins also said that she had ruined his Marriage." (Id.) Through .phone records, Mr. Bradley verified that Mr. Elldns did place a telephone call to Ms. Cruz's phone on the date and time in question. (Id.) At the Board of Nursing hearing, Steven Alferink reported that Mr. Elkins has contacted him on two occasions after he was terminated from Ennis Court. (See Tr., pp. 26, 28.) Mr. Alferink stated that Mr. Elkins contacted him at one of his children's soccer games. (Tr., p. 26.) Mr. Alferink testified that as they were discussing the ODH hearing and the cups of medication that Mr. Elkins had put into his pockets, Mr. Elkins remarked that "he couldn't he could not tell theimthat he had actually done that." (Tr, pp. 26-27.) When asked if Mr. Elkins indicated whether or not he had been untruthful in his testimony before the Department of Health, Mr. Alferink testified, "He did. [. . ,) He had indicated that he couldn't admit to that [putting the cups of medications in his pants pockets]." (Tr., p. 28.) Mr. Alferink stated that Mr. Elkins next contacted him at 10:18 p.m. on the very night before the Board of Nursing hearing. (Id.) He stated, "He [Mr. Elkins] started the conversation off by saying he just wanted to give me the heads up about today, that he was trying to help protect my license and that us meeting at the soccer sportsplex wasn't by coincidence, that there

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was a private investigator and that's how he knew I was there with my children." (Tr., pp. 28-29.) Mr. Alferink stated that he felt intimidated by Mr. Elkins comments that Mr. Elkins had a private investigator following Mr. Alferink and his children, (Tr., p. 30.) Mr. Elkins did not admit wrongdoing and continually maintained his innocence in this case. Mr. Elkins' actions were irresponsible and his misappropriation of residents' medications occurred over a significant period of time, from May 2009 through January 2010. Mr. Elkins' actions have the potential to cause harm to his patients. The State recommended that Mr. Elkins' license be permanently revoked. (Tr., p. 132,) The evidence now before the Board supports a suspension of Mr. Elkins's nursing license with conditions for reinstatement; and that following reinstatement, Mr. Elkins' license be subject to probation. Recommendations Regarding Findings of Fact and Conclusions Based on Evidence Presented HaVing heard the testimony of the witnesses and the oral argument of counsel, and having examined the exhibits admitted into evidence, the Board Committee makes the following recommended findings of fact and conclusions to the full Board. I. Respondent Steven Ray Elkins has been licensed with the Ohio State Board of Nursing as a licensed practical nurse since September 29, 2004. 2. On or about March 18, 2005, Mr. Elkins entered into a Post Adjudication Order Cobsent Agreement in which he agreed that his license to practice nursing as a licensed practical nurse would be subject to a probationary period until at least September 2006, and that he would participate in random drug and/or alcohol screening. 3. On or about July 21, 2006, Mr. Elkins was granted early release from the terms and conditions of his March 2005 Post Adjudication Order Consent Agreement, 4. The State has established by at least a preponderance of the evidence that on or about September 22, 2011, Mr. Elkins was placed on the Ohio Department of Health's Nurse Aide Registry as not eligible to work/not in good standing, for committing misappropriation while working in a health care occupation at Ennis Court, a long term care facility located in Lakewood, Ohio.

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Conclusions L Because he holds a, license as a licensed practical nurse issued by the Ohio Board of Nursing, Respondent Steven Ray Elkins, is subject to the jurisdiction of the Board in actions taken pursuant to Chapter 4723 of the Ohio Revised Code. 2. Upon sufficient cause to believe a licensee of the BOard of Nursing has violated a provision of the Nurse Practice Act, the Board is authorized to take action with respect to that licensee's nursing license. Upon his receipt of the Board's charging document, the Respondent timely requested an evidentiary hearing before the -Board took any final action based upon the Board's charges. Upon its receipt of Respondent's request for an administrative hearing, the Board set the matter for hearing, in the manner provided for by Chapter 119, ORC (Ohio Administrative Procedure Act), and provided the Respondent with an opportunity to be heard before it took any final action with respect to the Respondent's license as a licensed practical nurse, in the manner provided for by law. 3. Section 4723.28(B)(1), ORC, authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. 4. The Board is authorized to take action against Mr. Elkins's license to practice nursing as a licensed practical nurse where by at least a preponderance of the evidence the State establishes that on or about September 22, 2011, Mr.. Elkins was placed on the Ohio Department of Health's Nurse Aide Registry as not eligible to workinot in good standing, for committing misappropriation while working in a health care occupation at Ennis Court, a long term care facility located in Lakewood, Ohio. 5. Pursuant to Section 4723.28(B), ORC, upon proof that the Respondent has violated a provision of the Nurse Practice Act as set forth in Section 4723.28, ORC, the Board, by a vote of a quorum, may impose one or more of the following sanctions: it may deny, revoke, permanently revoke, suspend, or place restrictions on any nursing license issued by the Board; it ;nay reprimand or otherwise discipline a holder of a nursing license; or it may impose a fine of not more than five hundred dollars ($500.00) per violation. Upon sufficient proof, as has been shown in this evidentiary proceeding, that the Respondent

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has violated the provisions of the Nurse Practice Act and rules as concluded by the Board Hearing Coinmittee, the Board may implement any of the foregoing disciplinary actions. Recommendation Upon sufficient. proof that the Respondent, Steven Ray Elkins, has violated provisions of the Nurse Practice Act as shown above, it is the recommendation of this Board Hearing Committee that the Respondent's license to practice as a licensed practical nurse be suspended for a period of not less than one (1) year. Prior to reinstatement, the Respondent should be required to complete the following continuing nursing education course, in addition to the requirements for licensure renewal eight (8) hours of medication administration. Prior to reinstatement, the Respondent should be required to obtain a criminal background check 'and a chemical dependency evaluation. The Respondent should also be required to submit clean screens pursuant to the Board's random drug and alcohol screening process for a period of six (6) months prior to reinstatement. Should the Respondent meet these requirements, his license should be reinstated, subject to a probationary period of not less than two (2) years with permanent practice restrictions, and temporary narcotic restrictions for six (6) months. The Respondent should be required to continue random drug and alcohol screening during the first six (6) months of his probationary period. Finally, prior to working as a nurse, the Respondent should be required to complete a comprehensive nurse refresher course. This is a recommendation only; it is not a final order. Only the Board has the authority to enter a final order in this administrative action. The Board further has the authority to adopt, modify, or reject this recommendation, and this recommendation shall have no legal effect until and unless adopted by the Board, and a final order is issued by the Board as provided in Chapters 4723 and 119 of the Revised Code.

Bertha M. Lovelace, Presiding Member Melissa Meyer, Member Tracy Ruegg, Member Board Hearing Committee

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CERTIFICATE OF SERVICE I certify that the original of this report and recommendation was served upon the Ohio Board of Nursing by email delivery, with my electronic signature, on June 19, 2012.

Bertha M. Lovelace, Presiding Member

l'age 14 of 14

Case # 12-002646

Ohio Board of Nursing

17 South High Street, Suite 400

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 e (614) 466-3947

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Kimberley Lynn Elliott, L.P.N. 301 Deepwood Ln. Amherst, Ohio 44001 Dear Ms. Elliott: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: . As set forth in Attachment A, on or about June 2 and June 3, 2012, while working as a nurse at Amherst Manor Retirement Community in Amherst, Ohio, you failed to carry-out physician orders to administer medications, and falsely documented that patients had received prescribed medications. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 47234-06(G), Ohio Administrative Code (OAC), states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. Rule 47234-04(E), OAC, states that a licensed practical nurse shall, in a timely manner: (1) Implement any order or direction for a client unless the licensed practical nurse believes or should have reason to believe the order or direction is: (a) Inaccurate; (b) Not properly authorized; (e) Not current or valid; (d) Harmful, or potentially harmful to a client; or (e) Contraindicated by other documented information; and (2) Clarify any order or direction for a client when the licensed practical nurse believes or should have reason to believe the order or direction is: (a) Inaccurate; (b) Not properly authorized; (c) Not current or valid; (d) Harmful, or potentially harmful to a client; or (e) Contraindicated by other documented infolination. Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client.

Kimberley Lynn Elliott, L.P.N. Page 2

Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorn&y, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearin @nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0765

cc: Henry G. Appel, Senior Assistant Attorney General

Kimberley Lynn Elliott, L.P.N. Page 3 ATTACHMENT A PATIENT # Patient #1 Physician Order WITHDRAWAL MAR Comments

Atenolol one-half tablet by mouth every day

None

6/2/12 6/3/12

4 missed doses, falsely documented

Potassium Chloride None one tablet by mouth every day

6/2/12 6/3/12

Patient #2

Levothyroxin (Synthroid) one tablet by mouth every day Plavix One tablet by mouth every day Metoprolol (Lopressor) one tablet by mouth every day Lisinopril (Prinivil) one tablet by mouth every day Escitalopram (Lexapro) one-half tablet by mouth every day Allopurinol (Zyloprim) one tablet by mouth every day

None

6/2/12 6/3/12

2 missed doses, falsely documented

Patient #3

None

6/2/12 6/3/12

2 missed doses, falsely documented

Patient #4

None

6/2/12 6/3/12

4 missed doses, falsely documented

None

6/2/12 6/3/12

Patient #5

None

6/2/12 6/3/12

4 missed doses, falsely documented

None

6/2/12 6/3/12

Kimberley Lynn Elliott, L.P.N. Page 4 Patient #6 Sertraline (Zoloft) one tablet by mouth every day None 6/2/12 6/3/12 2 missed doses, falsely documented

Patient #7

Sertraline (Zoloft) one tablet by mouth every morning Lisinopril (Zestril) one tablet by mouth every day Plavix One tablet by mouth every day Levothyroxin (Synthroid) one tablet by mouth every day

None

6/2/12 6/3/12

8 missed doses, falsely documented

None

6/2/12 6/3/12

None

6/2/12 6/3/12

None

6/2/12 6/3/12

Patient #8

Furosemide (Lasix) one tablet by mouth every other day Levothyroxin (Synthroid) one tablet by mouth every day

None

6/3/12

3 missed doses, falsely documented

None

6/2/12 6/3/12

Patient #9

Metoprolol (Lopressor) one tablet by mouth every day Furosemide (Lasix) one tablet by mouth every day

None

6/2/12 6/3/12

4 missed doses, falsely documented

None

6/2/12 6/3/12

Kimberley Lynn Elliott, L.P.N. Page 5 Patient #10 Escitalopram (Lexapro) one tablet via enteral tube every evening Mirtazapine (Remeron) one and one-half tablet via enteral tube every evening Simvastatin (Zocor) one tablet via enteral tube every evening Patient# 11 SMZITMP DS (Bactrim DS) one tablet by mouth every other day None 6/2/12 6/3/12 6 missed doses, falsely documented

None

6/2/12 6/3/12

None

6/2/12 6/3/12

None

6/3/12

3 missed doses, falsely documented

Patient# 12

Hydrochlorothiazide (HydroDiuril) one-have tablet by mouth every day Lisinopril (Zestril) one tablet by mouth every day Actos (Pioglitazone) one tablet by mouth every day Glipizide ER one tablet by mouth every day

None

6/2/12 6/3/12

one tablet

6/2/12 6/3/12

Only one tablet removed for each medication; administration documented on two days. Total of 3 missed doses, falsely documented.

one tablet

6/2/12 6/3/12

one tablet

6/2/12 6/3/12

Patient# 13

Colcrys one tablet via enteral tube every day

one tablet

6/2/12 6/3/12--

Only one tablet removed; administration documented on two days. Total of 1 missed dose, falsely documented.

Kimberley Lynn Elliott, L.P.N. Page 6 Patient# 14 Levothyroxine (Synthroid) one tablet by mouth every day Levothyroxine (Synthroid) one tablet by mouth every day None 6/2/12 6/3/12 2 missed doses, falsely documented

Patient# 15

None

6/2/12 6/3/12

2 missed doses, falsely documented

Case# 12-005563

Ohio Board of Nursing

January 25, 2013

www.rrursing.ohio.gov
(614) 466-3947

17 South .High Street, Suite 400 Columbus, Ohio 43215-7410

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Nicholaus Gregory Evert, L.P.N. 3318 Ralph Avenue Cleveland, Ohio 44] 09 Dear Mr. Evert: You are hereby notified that, on or about March 18, 2011, you entered into a Consent Agreement (March 2011 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely, and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. Documents are redacted according to Section 2953.32, ORC. A. Item 1. of the March 2011 Consent Agreement states, "MR. EVERT shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(1), ORC, authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Despite this provision, on or about September 19, 2012, the South Carolina Board of Nursing (South Carolina Board) issued an Order of Temporary Suspension (South Carolina Board Order) in which your license to practice as a licensed practical nurse in South Carolina was suspended. A certified copy of the South Carolina Board Order is attached hereto and incorporated herein. Section 472328(B)(1), ORC, authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the March 2011 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Item 1. of the March 2011. Consent Agreement.

Nicholaus Gregory Evert, L.P.N. Page 2 YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-144233, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a licensed practical nurse without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about March 18, 2011, you entered into a Consent Agreement (March 2011 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in. the State of Ohio would be suspended indefinitely, and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of two (2) years. 2. Item 1. of the March 2011 Consent Agreement states, "MR. EVERT shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(1), ORC, authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Despite this provision, on or about September 19, 2012, the South Carolina Board of Nursing (South Carolina Board) issued an Order of Temporary Suspension (South Carolina Board Order) in which your license to practice as a licensed practical nurse in South Carolina was suspended. A certified copy of the South Carolina Board Order is attached hereto and incorporated herein. Section 4723.28(B)(1), ORC, authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice.

Nicholaus Gregory Evert, L.P.N. Page 3 You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing*nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0994 cc: Henry G. Appel, Senior Assistant Attorney General

Ohio Board of Nursing w ww,nurs ng oh i o.go v

17 South High Sheet, Suite 400 Columbux, Ohio 43215-7410 (614)466-3947

To Whom It May Concern:

You recently requested records regarding Nicholaus 0. Evert, P.N. 144233, Enclosed are records in response to your request. Information has been redacted, per Section 2953.32 of the Ohio Revised Code. If you have any further questions or concerns, please contact the Compliance Unit Manager or a Supervising Attorney,

Thank you. Compliance Unit Ohio Board of Nursing

Case #1 10-4991

Ohio oard of Nursing www.nursing.ohio_gov

17 South High Street, Suite 400 a Columbus, Ohio 43215-7410 (614) 466-3947

CONSENT AGREEMENT BETWEEN NICHOLAUS G. EVERT, L.P.N. APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between NICHOLAUS G. EVERT, L.P.N. APPLICANT (MR. EVERT) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MR. EVERT voluntarily enters into this Consent Agreement being fully informed of his rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(4), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for a conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. in September 2010, MR. EVERT submitted to the Board an Application for Licensure by Examination to Practice in Ohio as a Licensed Practical Nurse.

B.

Nick'taus G. Evert, L P.N. Applicant Page 2

C.

MR. EVERT knowingly and voluntarily admits tha MR. EVERT was convicted of one (1) amended misdemeanor count of Aggravated Disorderly Conduct in March 2008.

17.

MR. EVERT was permitted to take the NCLEX-PN, and on or about January 31, 2011, MR. EVERT passed the NCLEX-PN. AGREED CONDITIONS

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MR. EVERT knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for licensure, MR. EVERT shall be granted a license to practice nursing as a licensed practical nurse in the State of Ohio. MR. EVERT's license to practice nursing as a licensed practical nurse shall be suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions; and limitations for a minimum period of at least two (2) years: 1. MR. EVERT shall obey ail federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MR. EVERT shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. Continuing Education Hours 3. Within ninety (9D) days from the effective date of this Consent Agreement, MR. EVERT shall, in addition to the requirements of licensuie renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing education taken subsequent to the effective date of this Consent Agreement: four (4) hours of professionalism and eight (8) hours of anger management and/or conflict resolution skills.

Employment Conditions 4. Prior to accepting employment as a nurse, each time with every employer, MR. EVERT shall notify the Board.

Nicholaus G. Evert, L.P.N. Applicant Page 3

MR. EVERT is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting employment in a position in which a nursing license is required. MR. EVERT shall have his employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning May 1, 2011 or within thirty (30) days of accepting nursing employment, MR. EVERT shall have his employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received. Reporting Requirements of Licensee 6. MR. EVERT shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) clays of the occurrence of the violation. MR. EVERT shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MR. EVERT shall submit any and all information that the Board may request regarding his ability to practice according to acceptable and prevailing standards of safe nursing practice. MR. EVERT shall not submit or cause to be submitted any false, misleading, or deceptive statements, -information, or documentation to the Board or to employers or potential employers. MR. EVERT shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the, Compliance Unit of the Board. MR. EVERT shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410_ 12. MR. EVERT shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MR. EVERT shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in. residential or home address or telephone number.

7.

R.

9.

10.

13.

Nicholaus G. Evert, L.P.N. Applicant Page 4

Temporary Practice Restrictions MR. EVERT further knowingly and voluntarily agrees with the Board to the following TEMPORARY LICENSURE RESTRICTIONS for a minimum period of at least one (1) year: MR. EVERT shall not practice nursing as a licensed practical nurse (I) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or . pools; (4) as an independent provider. where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MR. EVERT to provide nursing services for lees, compensation; or other consideration or as a volunteer. MR. EVERT shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, VicePresident of Nursing, FAILURE TO COMPLY MR, EVERT agrees that his license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the 'Board that MR. EVERT has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MR. EVERT via Certified mail of the specific nature of the charges and automatic suspension of his license. Upon receipt of this notice, MR. EVERT may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 472328(B), ORC. If, in the discretion of the Board, MR. EVERT appears to have violated or breached any terms or conditions of this Consent. Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement, DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement, may be modified or terminated, in writing, at any time upon the agreement of both MR. EVERT and the Board. The Board' may only alter the probationary period imposed by this Consent Agreement if: (I) the Board determines that MR. EVERT has complied with all aspects of this Consent Agreement; and (2) the Board determines that MR. EVERT is able to practice according

03/03t.101.1 Tart, 5t11 FAX

Witoosioo6

Nicholaus CI Evert, L P N Applicant Page 5

to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an inter view with MR. EVERT and review of the reports as requited herein. Any period dating which MR. EVERT does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary pet lad imposed by this Consent Agreement NOW E MENTS/LIA.BILITY RELEASE MR. EVERT acknowledges that he has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MR, EVERT waives all of his rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent-Agreement MR. EVERT waives any and all claims or causes of action he may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement This Consent Agreement shall be considered a public record as that term is used in Section 149 43, ORC The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC, EFFECTIVE DATE MR: EVERT understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

(..)7./a
NICHOLAUS G. EVERT, L.P.N. APPLICANT DATE

dm, $8006-/Rd
RTI-IA LOVELACE, President Ohio Board of Nursing DATE

0 it

03/03/2011 TIFF) 10; 54 CTX/RX r o 5820) eCitiel

SOUTH CAROLINA DEPARTMENT OF LABOR, LICENSING AND REGULATION BEFORE THE STATE BOARD OF NURSING IN THE MA i / ER OF: NICHOLAUS GREGORY EVERT, LPN License # 44135 Respondent OIE # 2012 - 169

ORDER OF TEMPORARY SUSPENSION (PUBLIC)

'WHEREAS, the Office of General Counsel has provided probable cause warranting an Order of the Board to temporarily suspend Respondent from practice, in accordance with the S.C. Nurse Practice Act (Section 4033-5, et seq.) and S,C. Code Ann. 1-23-370(c) (1976, as amended). THEREFORE, IT IS ORDERED THAT, in accordance with S.C. Code Ann, 1-23370(e) and 40-33-110 (1976, as amended), Respondent's license to practice nursing in this State is hereby temporarily suspended, effective immediately, until further Order of-the Board. AND IT IS SO ORDERED. STATE BOARD OF NURSING 14BY; .AerAet$44-1

CAW- ill if 64

Samuel H, McNutt Jr, CRNA MESA President

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South Carolina Department of Labor, Licensing .& Regnia ion

Before the Board of Nursing In the Matter of: Nicholaus Gregory Evert, AFFIDAVIT OF'SERVICE LPN. 44135, 2012-169 Respondent.

PERSONALLY appeared before me Kevin. L. Pate, who, being duly sworn, states: 1 That /she is an investigator with the SC Department of Labor, Licensing and Regulation, Office of Invesfigations and Enforcement,

2. That@ishe hereby certifies that on September 28, :2012, at 1050 AM she served the Order of Temporary Suspension in the above-captioned matter by hand delivering to the following individual at: Nicholaus Gregory Evert 1901 Holly Drive, Unit F (45rAt-ric-4, North Myrtle Beach, SC 29582

SOUTH. CAROLINA DEPARTMENT OF LABOR, LICENSING AND REGULATION

Investigator OFFICE OF INVESTIGATIONS .& ENFORCEMENT P. O., Box 11:329 Celumbin, SC 292 -1 32 (803) 896-4470 (7)

SWORN to before me this

CZ)

rn

Oday of ,Seriern ifiati /hi",

dD(912.. (US.)

Notary Public for South Carolina

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My Commission Expires:

Cases 12-001652

Ohio Board of Nursing

www.nursing.ohio.gov 17 South High Street, Suite 400 .1 Columbus, Ohio 43215-7410 m (614) 466-3947

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Marvionne Denise Foote, R.N. 1630 East 243rd Street Euclid, Ohio 44117 Dear Ms. Foote: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about April 7, 2012, while working as a nurse at Lake Health, Willoughby, Ohio, you failed to obtain proper "hand off' from the nursing unit prior to transporting Patient #1 to surgery. Furthermore, you failed to inform the surgery team of the surgery site inconsistency between Patient #1's consent form and scheduled procedure. As a result, Patient #1 received surgery on an incorrect site. [See Attached Patient Key to Remain Confidential and Not Subject to Public Disclosure]. On or about August 2, 2012, you stated to a Board Compliance Agent that you had set up the operating room for a left hip bipolar prosthesis, based upon the scheduled procedure, prior to transporting Patient #1. You admitted that you noticed the inconsistency of the surgery site when you reviewed the consent form. You further admitted that, during the "time out" prior to incision, you made an error by audibly stating the surgery site to be the "left" hip despite you having viewed the consent form to indicate "right". You failed to take intervening steps to ensure a correct surgery site. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(C), Ohio Administrative Code (OAC), states that a registered nurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged which includes, but is not limited to, the

Marvionne Denise Foote, R.N. Page 2 following: (1) Consistent performance of all aspects of nursing care; and (2) Appropriate recognition, referral or consultation, and intervention, when a complication arises. 2. On or about April 7, 2012, while working as a nurse at Lake Health, Willoughby, Ohio, you falsely documented that: 1) Patient #1's surgical site was marked; 2) Patient #1's surgery site marking was on the correct side; 3) The scheduled surgical procedure matched Patient #1's consent form; and 4) Diagnostic x-rays were matched to Patient #1 prior to surgery. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(8)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 47234-06(E), OAC, states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-4-06(0), OAC, states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Marvionne Denise Foote, R.N. Page 3 Sincerely, >d, Rhonda S. Barkheimer, RN., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0574 cc: Henry G. Appel, Senior Assistant Attorney General A'. A/

Case# 12-005512 & 12-006228

Ohio Board of Nursing

January 25, 2013

www.nursing.ohio.gov

17 South High Street, Suite 400 el, Columbus, Ohio 43215-7410 (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Amy Michelle Frazier, L.P.N. 4805 Bott Road Bellville, Ohio 44813 Dear Ms. Frazier: You are hereby notified that, on or about January 20, 2012, you entered into a Consent Agreement (January 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of one (1) year. Attached to and incorporated within the January 2012 Consent Agreement is a July 29, 2011 Notice of Opportunity for Hearing. A. Item 1. of the January 2012 Consent Agreement states, "MS. FRAZIER shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio?' Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 5. of the January 2012 Consent Agreement states, "MS. FRAZIER shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. FRAZIER. MS. FRAZIER shall self-administer the prescribed drugs only in the manner prescribed." Item 7. of the January 2012 Consent Agreement states, "Within forty five (45) days of the effective date of the Consent Agreement and continuing throughout the probationary period, MS. FRAZIER shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. FRAZIER

Amy Michelle Frazier, L.P.N. Page 2 shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. FRAZIER." Despite these provisions, on the following dates, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Cannabinoid: September 14, 2012; September 28, 2012; and October 31, 2012. Furthermore, on September 15, 2012, you failed to call Firstlab to determine if you had been selected to provide a urine specimen. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: May 15, 2012; May 22, 2012; October 23, 2012; and October 30, 2012. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the January 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 5. and 7. of the January 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-104527, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a licensed practical nurse without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about January 20, 2012, you entered into a Consent Agreement (January 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of one (1) year. Attached to and incorporated within the January 2012 Consent Agreement is a July 29, 2011 Notice of Opportunity for Hearing.

Amy Michelle Frazier, L.P.N. Page 3

2. Item 1. of the January 2012 Consent Agreement states, "MS. FRAZIER shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 5. of the January 2012 Consent Agreement states, "MS. FRAZIER shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. FRAZIER. MS. FRAZIER shall self-administer the prescribed drugs only in the manner prescribed." Item 7. of the January 2012 Consent Agreement states, "Within forty five (45) days of the effective date of the Consent Agreement and continuing throughout the probationary period, MS. FRAZIER shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. FRAZIER shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. FRAZIER." Despite these provisions, on the following dates, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Cannabinoid: September 14, 2012; September 28, 2012; and October 31, 2012. Furthermore, on September 15, 2012, you failed to call Firstlab to determine if you had been selected to provide a urine specimen. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: May 15, 2012; May 22, 2012; October 23, 2012; and October 30, 2012. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board.

Amy Michelle Frazier, L.P.N. Page 4 Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio. 432157410, or to the e-mail address, hearing@nursing.ohio,gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1120 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 09-3438

Ohio Board of Nursing www.niggF4ghlarg

17 South Ijigh Street. Suite 400 Columbus. Ohio 43215-7* At IA44.119111751

CONSENT AGREEMENT BETWEEN AMY MICHELLE FRAZIER, L.P.N. AND OHIO BOARD OF NURSING

5A." QF1NURSING

This Consent Agreement is entered into by and between AMY MICHELLE FRAZIER, L.P.N. (MS. FRAZIER) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. For purposes of this Agreement, "Consent Agreement" shall be defined as this Agreement, and the following document, attached hereto and incorporated herein: July 29, 2011 Notice of Opportunity for Hearing (July 2011 Notice). This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723,28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723 .28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. MS. FRAZIER's license to practice nursing as a licensed practical nurse, PN104527 , in the State of Ohio is currently active. MS. FRAZIER was initially licensed as a licensed practical nurse in May 1999. MS. FRAZIER knowingly and voluntarily admits to the factual and legal allegations set forth in the July 2011 Notice. MS. FRAZIER represents that since receiving the results of the July 2009 urine drug screen, she has abstained from using marijuana or any other drugs that were not legitimately prescribed to her by a licensed healthcare

B.

C. D.

Amy Michelle Frazier, L.P.N. Page 2 professional. MS. FRAZIER further represents that on or about November 7, 2011, she was hired and began work as an operating room scrub nurse at Knox Community Hospital, and that she has provided Knox Community Hospital with a copy of the July 2011 Notice. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. FRAZIER knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. FRAZIER's license to practice nursing as a licensed practical nurse shall and suspended indefinitely. Such suspension is hereby stayed, subject to the following probationary terms, conditions, and limitations for a minimum period of one (I) year: 1. MS. FRAZIER shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. FRAZIER shall appear in person for an interview before the full Board or its designated representative, as requested by the Board or its designee. MS. FRAZIER agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. FRAZIER, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. FRAZIER's criminal records check reports to the Board. MS. FRAZIER's completed criminal records check, including the FBI cheek, must be received by the Board within six (6) months following the effective date of this Consent Agreement. Within thirty (30) days of the effective date of the Consent Agreement, in addition to the requirements for licensure renewal, MS. FRAZIER shall successfully complete and submit documentation of satisfactory completion of the following continuing nursing education taken subsequent to the effective date of this Consent Agreement: Women, Alcohol, and Drug Abuse (CD-3), or the equivalent thereof, provided the alternative course is presented to and approved by a Board representative prior to taking the course.

2,

3,

4.

MOnitoring of Rehabilitation and Treatment 5. MS. FRAZIER shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS, FRAZIER. MS. FRAZIER shall self administer the prescribed drugs only in the manner prescribed. MS. FRAZIER shall abstain completely from the consumption of alcohol.

Amy Michelle Frazier, L.P.N. Page 3 7. Within forty five (45) days of the effective date of the Consent Agreement and continuing throughout the probationary period, MS. FRAZIER shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. FRAZIER shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. FRAZIER. Within three (3) months of the effective date of the Consent Agreement, MS. FRAZIER shall, at her expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS.. FRAZIER shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. FRAZIER shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. FRAZIER's license to practice, and stating whether MS. FRAZIER is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS. FRAZIER shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. FRAZIER agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. FRAZIER's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement.

8.

9.

Treating Practitioners and Reporting Within thirty (30) days of the effective date of this Consent Agreement, MS. FRAZIER, shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. FRAZIER shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner.

Amy Michelle Frazier, L.P.N. Page 4 11. Prior to initiating drug screening and continuing throughout the probationary period, MS. FRAZIER shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. FRAZIER. After initiating drug screening and within twenty-four (24) hours of release from hospitalization or medical treatment, MS. FRAZIER shall notify the Board of any and all medication(s) or prescripdon(s) received.

12.

Employment Conditions 13. MS. FRAZIER shall notify the Board, in writing, of the name and address of any current employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to accepting nursing employment. MS. FRAZIER, within fifteen (15) days of the effective date of the Consent Agreement, if working in a position where a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS. FRAZIER is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting nursing employment. MS. FRAZIER shall have her employer(s), if working in a position where a nursing license is required submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of the effective date of this Consent Agreement or beginning within thirty (30) days of working in a nursing position. MS. FRAZIER shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date. the Consent Agreement was received.

14.

Reporting Requirements of Licensee 15, 16. MS. FRAZIER shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. FRAZIER shall submit any and all information, which the Board or its designee may request, regarding her ability to practice nursing according to acceptable and prevailing standards of safe nursing care. MS. FRAZIER shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation, to the. Board or to employers or potential employers.

17.

Amy Michelle Frazier, L.P.N. Page 5 18, MS. FRAZIER shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. FRAZIER shall submit all documentation required by this Consent Agreement or requested by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410. MS. FRAZIER shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. FRAZIER shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number,

19.

20. 21.

Nursing Refresher Course Upon request by the Board or its designee, MS. FRAZIER shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a refresher course or an extensive orientation to be approved in advance by the Board or its designee. Temporary, Practice Restrictions Unless otherwise approved in advance in writing by the Board or its designee, MS. FRAZIER shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. FRAZIER to provide nursing services for fees, compensation, or other consideration or as a volunteer, Unless otherwise approved in advance in writing by the Board or its designee, MS. FRAZIER shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities or supervising and evaluating nursing practice, Such positions include bat are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY

Amy Michelle Frazier, L.P.N. Page 6 MS. FRAZIER agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. FRAZIER has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. FRAZIER via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. FRAZIER may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. FRAZIER appears to have violated or breached any terms or conditions of the Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. PURATIONTMODIFICATION OF TERMS The terms, limitations and conditions of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MS. FRAZIER and the Board. The Board shall only alter the probationary period imposed by this Consent Agreement if: (1) MS. FRAZIER has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. FRAZIER is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring based upon an interview with MS. FRAZIER and review of the reports required herein. Any period during which MS. FRAZIER does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. FRAZIER acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. FRAZIER waives all of her rights under Chapter 119, ORC as they relate to matters that are the subject of this Consent Agreement. MS. FRAZIER waives any and all claims or causes of action she may have against the Board, and members, officers, employees and/or agents of either, arising out of matters that are the subject of this Consent Agreement. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. However, any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC.

Amy Michelle Frazier, L.P.N. Page 7 This Consent Agreement shall be considered a public record as that term is used in Section 149A3, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies.

EFFECTIVE DATE MS. FRAZIER understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

L
AMY LLE FRAZ ,P,N.

NDATE

CGOVERN, Esq. Attorney for AMY MICHELLE FRAZIER, R.N.

DATE

aotg.
BERTHA LOVELACE, President Ohio Board of Nursing DATE

Case #09-3438

Ohio Board of Nursing

17 South High Street, Suite 400

wWw.nursing:ohio.gov Columbus, Ohio 43215-7410 .4 (614) 466-3947

July 29,2011

NOTICE OF OPPORTUNITY FOR HEARING

Amy Michelle Frazier, L.P.N. 4805 Bott Rd. Bellville, Ohio 44813 Dear Ms. Frazier: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about July 2, 2009, while working as a nurse at MedCentral Health System Hospital (Mansfield, Ohio), you submitted to a urine drug screen based upon reasonable suspicion. The drug screen was positive for Marijuana. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, b earl n g4 n um in o.gov.

Amy Michelle Frazier, L.P.N. Page 2 If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation, Sincerely,

Judith A. Church, R.N,, C,N.P. Supervising Member Certified Mail Receipt No. 7011 1150 0000 9243 8916 cc: Michelle Sutter, Assistant Attorney General

Case #12-004645

Ohio Board of Nursing

17 South High Street, Suite 400

www.hurSing.Ohio.gov Columbus, Ohio 43215-7410 (614) 466-3947

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Michelle M. Frock, R.N. Applicant 143 Hugh Black Road Greensburg, PA 15601 Dear Ms. Frock: In accordance with Chapter 119 Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to permanently deny or deny your application for licensure to practice nursing in Ohio; permanently revoke, revoke, suspend or place restrictions a license granted to you to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about May 11, 2006, the Board of Nurse Examiners for the State. of Texas (Texas Board), issued an Order of Conditional Eligibility (2006 Texas Order), in which granted you eligibility to take the national nursing examination (NCLEXRN), and upon you passing the examination, granted you a license to pratice nursing with restrictions, including, but not limited to, your license would be encumbered so that you could not work outside of Texas pursuant to a multistate privilege without written permission of the Texas Board and the party state where you wished to work. A copy of the 2006 Texas Order is attached hereto and incorporated herein.

Section 4723.28(B)(1), ORC, authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. 2. In July 2012, you submitted to the Board an Application for Licensure by Endorsement to Practice in Ohio as a Registered Nurse (Application). Despite the 2006 Texas Order referenced above in Paragraph 1, you marked "No" to the question on the Compliance page of the Application that asks "Has any board, bureau, department, agency, or other public body, including those in Ohio, other than this Board, in any way limited, restricted, suspended, or revoked any professional license, certificate, or registration granted to you; placed you on probation. . .?"

Michelle M. Frock, R.N. Applicant Page 2 Section 4723.28(A) ORC, authorizes the Board to revoke the license or refuse to grant a license to a person who has been found by the Board to have committed fraud, misrepresentation, or deception in applying for or securing any license issued by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing on this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing this notice. You are hereby further informed that if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present you position, argument, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit Manager, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearing@nursing,ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the. Board may, in your absence and upon consideration of the factual and legal allegations set forth in the Notice of Opportunity for Hearing, to permanently deny or deny your application for licensure to practice nursing in Ohio; permanently revoke, revoke, suspend or place restrictions a license granted to you to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0529 cc: Henry G. Appel, Senior Assistant Attorney General

BEFORE THE ;BOARD OF NURSE. EXAMINERS FOR THE STATE OF TEXAS In the Matter of MICHELLE M. FROCK PETITIONER for Eligibility for Licensure
cD

ORDER OF CONDITIONAL ELIGIBILITY c>c,

C-)

rri

rU

-t) U) On the date entered below, the Board of Nurse Examiners for the State M Texas, .c t e hereinafter referred to as the Board, considered the Application by Examination for Licensure and supporting documents filed by MICHELLE M. FROCK, hereinafter referred to as PETITIONER, together with any documents and information gathered by staff and PETITIONER'S Certificate contained herein. Information received by the Board produced evidence that PETITIONER may have violated Section 301.452 et seq, Texas Occupations Code. PETITIONER waived representation by counsel, notice and hearing, and agreed to the entry of this Order offered on March 22, 2006, by Katherine A, Thomas, MN, RN, Executive Director. FINDINGS OF FACT On or about January 17, 2006, Petitioner submitted an Application by Examination for Licensure requesting a determination of eligibility for licensure in compliance with Section 301257 et seq., Texas Occupations Code. 2. 3. Petitioner waived representation, notice, administrative hearing, and judicial review. Petitioner is currently enrolled in an Associate Degree Nursing Program at Central Texas College, Killeen, Texas, with an anticipated graduation date of May 2006. Petitioner completed the Application by Examination for Licensure and answered "yes" to eligibility Question Number One (1), which reads as follows: "Have you ever:been convicted, adjudged guilty ley a court, pled'guilty, no contest or nolo contendere to any crime in any state, territory or country, whether or not a sentence was impose4., including any pending criminal charges or unresolved arrest (excluding minor traffic violations)? This includes
.FrOCk. i097 :Page- of 7 RI QPI.Och 22, 2006

4.

expunged offenses and deferred aclludications with or without prejudice ofguilt. Please note that Mil's, DWrs, Prs must be reported and are not considered minor traffic violations. (One time minor in possession ilifin or minor in consumption [MIC] do not need to be disclosed, therefore, you may answer "No." If you have two or more 1111P's or WC's, you must answer "Yes.")" 5. Petitioner disclosed the following criminal history, to wit: On March 30, 1997, Petitioner .was charged with the offense of Possession of a Controlled Substance-Cocaine in the Municipal Court of the City of Austin, Travis County, Texas. On September 28, 1998, the criminal action was dismissed because Petitioner completed pretrial diversion. 6. 7. There is no evidence of any subsequent criminal conduct. The Board received letters of support/recommendation for Petitioner from the following; A letter of recommendation dated April 31, 2004, was submitted to the Board on behalf of Petitioner by Edna Iris Garza-Escobedo, PhD., RN, Professor, Department of Nursing, Central Texas College, Killeen, Texas. A letter of recommendation dated November 2, 2004, was submitted to the Board on behalf of Petitioner by Susan Davis, MS., RN., ADN Faculty and Level One Coordinator, Central Texas College, Killeen, Texas, 8, 9. 10. Licensure of Petitioner poses no direct threat to the health and safety of patients or the public. The Executive Director's review of the grounds for potential ineligibility has been made on the basis of the information provided by Petitioner. Petitioner has sworn that her past behavior conforms to the Board's professional character requirements. Petitioner presented no evidence o f behavior which is inconsistent with good professional character, Petitioner has been advised that any information found to be incomplete, incorrect, or misleading will be considered and may result in an ultimate determination of ineligibility or the later revocation of a license obtained through misrepresentation, On or about March 22, 2006, the Executive Director considered evidence of Petitioner's past behavior in light of the character factors set out in 22 Texas Administrative Code 213.27 and determined that Petitioner currently demonstrates the criteria required for good professional character.

11.

12,

Michelle M. Frock :097

Page 2 of 7

RIOyMarch 22, 20915

CONCLUSIONS OF LAW I The Board of Nurse Examiners has jurisdiction over this matter pursuant to Section 301.453, Texas Occupations Code, Petitioner has submitted a petition in compliance with Section 301.257 et seq., Texas Occupations Code. Petitioner's criminal history reflects criminal conduct which is grounds for denial o fa license under Section 301.452 et seq., Texas Occupations Code, Petitioner shall immediately notify the Board of any fact or event that could constitute a ground of ineligibility for licensure under Section 301.452, Texas Occupations Code, The Board may license an individual who has been previously convicted, adjudged guilty by a court, pled guilty or pled nolo contendere to any crime whether or not a sentence was imposed upon consideration of the factors set out in 22 Texas Administrative Code 213.28 and evaluating the direct relationship to nursing according to Chapter 53, Section 53.001 et seq., Texas Occupations Code. The Board may license an individual with prior behaviors inconsistent with the Board's character requirements if, upon evaluation of the factors in 22 Texas Administrative Code 213.27, the Board is satisfied that the individual is able to consistently conform her conduct to the requirements of the Nursing Practice Act, the Board's Rules and Regulations, and generally accepted standards of nursing practice.

2.

3.

4. 5.

6.

ORDER NOW, THEREFORE, IT IS ORDERED that upon meeting the requirements for graduation and payment of any required fees, MICHELLE M. FROCK, PETITIONER, is CONDITIONALLY ELIGIBLE to sit for the National Council Licensure Examination for Registered Nurses (NCLEX-RN' Examination). PETITIONER SHALL NOT be eligible for temporary authorization to practice as a Graduate Nurse in the State of Texas. IT IS FURTHER ORDERED that PETITIONER SHALL comply in all respects with the Nursing Practice Act, Revised Civil Statutes of Texas as amended, Texas Occupations Code

Michelle M. Frock :097

Page 3 of 7

RI 0j/March 22, 2006

30l.001 et seq., the Rules and Regulations Relating to Professional Nurse Education, Licertsure and Practice, 22 TEX. ADMIN. CODE 211.01 et seq and this Order. IT IS FURTHER AGREED and ORDERED that this Order SHALL be applicable to PETITIONER'S multistate licensure privilege, if any, to practice professional nursing in the State of Texas. IT IS FURTHER AGREED and ORDERED that while PETITIONER's license is encumbered by this Order the PETITIONER may not work outside the State of Texas pursuant to a multistate licensure privilege without the written permission of the State of Texas and the Board of Nursing in the party state where PETITIONER wishes to work. IT IS FURTHER ORDERED that PETITIONER, upon attaining a passing grade on the NCLEX-RN, shall be issued a license to practice nursing in the State of Texas which shall bear the appropriate notation and PETITIONER SHALL be subject to the following stipulations, (1) PETITIONER SHALL, within one (I) year of initial licensure, successfully complete a course in Texas nursing jurisprudence. PETITIONER 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. PETITIONER 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 PETITIONER'S successful completion of the course. This course shall be taken in addition to any other courses stipulated in this Order, if

Michelle M. Frock :097 Page 4 of 7 RI0j/March 22, 2006

any, and in addition to any continuing education requirements the Board has for relicensure. Boardapproved courses may be found on the Board's website, www,bne.state.tx,us (under BNE events). (2) PETITIONER SHALL, within one (I) year of initial licensure, successfully complete a course in nursing ethics. PETITIONER 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. The course shall be a minimum of six (6) contact hours in length. In order for the course to be approved, the target audience shall include Nurses. The course shall include content on the following: principles of nursing ethics; confidentiality; and professional boundaries, PETITIONER SHALL CAUSE the sponsoring institution to submit a Verification of Course Completion form, provided by the Board, to verify PETITIONER's successful completion of the course. This course is to be taken in addition to any continuing education requirements the Board may have for relicensure, Board approved courses may be found an the Board's website, www.bne.state.tx.us (under BNE events). IT IS FURTHER AGREED, that upon full compliance with the terms of this Order, PETITIONER SHALL be issued an unencumbered license and multistate licensure privileges, if any, to practice professional nursing in the State of Texas. BALANCE OF THIS PAGE INTENTIONALLY LEFT BLANK. CONTINUED ON NEXT PAGE.

Michelle M. Frock 097

Page 5 of 7

MI/March 22, 2006

PETITIONER'S CERTIFICATION
I am the Petitioner in this matter. I have fully and truthfully disclosed all of my past criminal conduct, and I have caused a complete and accurate criminal history to be submitted to the Board of Nurse Examiners from each jurisdiction in which I have been adjudged guilty by way of conviction or deferred order. I certify that my past behavior, except as disclosed in my Application by Examination for Licensure, has been in conformity with the Board's professional character rule. I have provided the Board with complete and accurate documentation of my past behavior in violation of the penal law of any jurisdiction which was disposed of through any procedure shortof conviction, such as: conditional discharge, deferred adjudication or dismissal. I have no criminal prosecution pending in any jurisdiction. In connection with my petition, I acknowledge that I have read and I understand Section 301.257, Texas Occupations Code, Section 301.452(a), (b) and (c), Texas Occupations Code, and Chapter 53, Section 53.001 et seq., Texas Occupations Code, and Board Rules 213.27, 213.28, and 21329 at 22 Texas Administrative Code. I agree with all terms of this Order, including the Findings of Fact and Conclusions of Law and any stipulations as set out in this Order. I acknowledge that this Order is stipulated and I understand that I am not eligible to receive a Graduate Nurse Permit to practice. I agree to inform the Board of any other fact or event that could constitute a ground for denial of licensure prior to registering for the NCLEX-RN Examination or accepting any permit or license from the Board of Nurse Examiners. I understand that if I 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 professional nursing in the State of Texas, as a consequence of my noncompliance. I understand that I can be represented by an attorney in this matter. I waive representation, notice, administrative hearing, and judicial review of this Order and request that the Executive Director of the Board of Nurse Examiners enter this Order. Signed this 444'aay of 1'

&KM,

, 2006.

tiOak.01,t
MICHELLE M. FROCK, PETITIONER Sworn to and subscribed before me this 1 4 day of , 2006,

Notary Public in and for the State of

4.4,/

Michelle M. Frock :097

Page 6 of 7

RI0j/Marcli 22, 2006

WIIER.EFORE, PREMISES CONSIDERED, the Executive Director on behalf ofthe Board of Nurse Examiners for the State of Texas does hereby ratify and adopt the Order of Conditional Eligibility that was Signed on the
4th day of Mav 2006

by MICHELLE M.FROCK, PETITIONER, for Application by Examination for Licensure, and said Order is final. ,2006:.

Entered this

11th

day of May

BOARD OF NURSE EXAMINERS FOR THE STATE OF TEXAS

By:

Katherine A. Thomas, MN, RN Executive Director on behalf of said Board

001111)11.7.

certify INS to be a true copy of the records.ort file with th "feas Board of Nursihg. Date. Sigried:

Michelle M. Frock :097

Page '7 or 7

Rittinvloreb 22, 2006

Case # 2009-002057; 2012-006406

Ohio Board of Nursing

January 25, 2013

www.nursing,ohio.gov 17 South High Street, Suite 400 t Columbw. Ohio 43215-7410 4, (614) 466-3947

NOTICE OF TEMPORARY SUSPENSION AND OPPORTUNITY FOR HEARING

Nancy Ann Gerger, R.N. 225 Riverdale Drive Defiance, Ohio 43512 Dear Ms. Gerger: In accordance with Section 4723.35(D)(2) of the Ohio Revised Code (ORC), it has been determined that you were significantly out of compliance with the terms and conditions for participation in the Alternative Program for Chemical Dependency (Program) of the Ohio Board of Nursing (Board) based on the information set forth below in paragraph 2. Further, Section 4723.35(D)(2), ORC, states as follows: If the program coordinator determines that a participant is significantly out of compliance with the terms and conditions for participation, the coordinator shall notify the Board's supervising member for disciplinary matters and the supervising member shall temporarily suspend the participant's license or certificate. The program coordinator shall notify the participant of the suspension by certified mail sent to the participant's last known address and shall refer the matter to the Board for formal action under section 4723.28 or 4723.86 of the Revised Code. WHEREFORE, PURSUANT TO SECTION 4723.35(D)(2), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-146294, IS HEREBY TEMPORARILY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about May 7, 2009; you admitted to a Board Compliance Agent that, starting in or about October 2008 until in or about April 2009, while working as a nurse at the Defiance Regional Medical Center in Defiance, Ohio, you began stealing Nubian and self-administering the drug. You stated that you would inject

Nancy Ann Gerger, R.N. Page 2 yourself in the arms and/or legs, eventually up to three (3) times per day totaling 20 mgs per day. Further, you admitted that due to your usage your thinking was "clouded" at work. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 472328(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(10), ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of habitual or excessive use of drugs, alcohol, or other chemical substances that impair the ability to practice. 2. On or about September 8, 2009, effective through September 8, 2013, you entered into an Alternative Program Participant Agreement (Agreement) with the Board's Alternative Program for Chemical Dependency (Program). a. In Item A of your Agreement, you admitted that you had committed acts in violation of Sections 4723.28 (B)(8), (B)(9), (B)(13), and (B)(19), ORC.

Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(9), ORC, authorizes the Board to discipline a licensee for habitual indulgence in the use of controlled substances, other habit-forming drugs, or alcohol or other chemical substances to an extent that impairs ability to practice. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. b. Item 27 of your Agreement states, "Participant shall comply with drug testing in such a manner as the Program may request, including but not limited to submission of an unadulterated urine, hair, blood, or breath specimen, expressed or extracted directly from Participant's body to the drug testing company designated by the Board." Item 30 of your Agreement states, "Within four (4) weeks following the effective date of this Agreement, Participant shall begin daily calling to the Board's designated drug testing company and submit to drug testing within the timeframe required by the drug testing company, on the date the Participant is selected for drug testing." Despite these provisions, on or about April 11, 2011, June 20, 2011, October 9, 2012, October 31, 2012, and November 2, 2012, you were selected by FirstLab, the Board's drug screen program administrator to

Nancy Arm Gerger, R.N. Page 3 provide a urine specimen for collection, and failed to do so. In addition, on the dates as set forth in Attachment A, attached hereto and incorporated herein, you failed to call FirstLab to determine if you had been selected to provide a specimen. In a letter to the Board dated October 23, 2012 you admit, "I stopped calling the lab on October 8, 2012." d. Item 34 of your Agreement states, "Participant shall complete and submit the Personal Report Form provided by the Program in accordance with a schedule (Report Schedule) established by the Program." According to your Report Schedule, you were required to submit monthly reports. Despite this provision and your Report Schedule, you failed to turn in Personal Reports for February/March 2012, June/July 2012, and August/September 2012. e. Item 20 of your Agreement states, "Participant shall cause any and all legally authorized prescribers to complete a Healthcare Provider Evaluation form provided by the Program listing all substances and medications prescribed or authorized for the Participant. The Participant shall cause the form to be mailed or faxed by the prescriber directly to the Program within two (2) business days following Participant's receipt of any and all prescriptions or authorizations written for the Participant during the term of this Agreement." Item 22 of your Agreement states, "Within two (2) business days following the initiation of prescribed or administered alcohol, drugs of abuse and/or controlled substances, Participant shall cause all treating healthcare providers, who prescribe(d) or administer(ed) to Participant alcohol, drugs of abuse, or controlled substances, to complete and provide to the Program a Participant Treatment Plan form. The completed for will contain the following treatment plan information: a. Participant diagnosis or basis for the administration or prescription; b. The alcohol, drugs of abuse, or controlled substances that were administered or prescribed; c. Expected length of recovery and/or confinement; and d. Duration of Participant's authorized use of medication identified in (b) above." Item 37 of your Agreement states, "Participant shall have all healthcare professionals providing the Participant ongoing treatment or therapies, complete and submit the Healthcare Provider Evaluation Report Form provided by the Program in accordance with the Report Schedule." Despite these provisions, you have failed to have Dr. Barnett, your treating provider, submit any Healthcare Provider Evaluation Form, as required by your Agreement, stating you were prescribed Zolpidem on or about February 16, 2012, and Cheratussin AC on or about February 16, 2012 and May 18, 2012. Further, Dr. Barnett has not completed the start date and stop date for these medications as required by this form.

Nancy Ann Gerger, R.N. Page 4 In a letter dated October 23, 2012, you advised the Board that you wanted to withdraw from the Alternative Program. On November 6, 2012, you were teiminated from the Program based on your failure to comply with the terms and conditions of your Agreement. Section 4723.28(B)(25), ORC, authorizes the Board to discipline a licensee for failure to comply with the terms and conditions of participation in the chemical dependency monitoring program established under Section 4723.35, ORC. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-6-03(A), Ohio Administrative Code, requires a participant in the Alternative Program for Chemical Dependency to comply with all of the terms and conditions of the participant's agreement with the Alternative Program for Chemical Dependency for the time period specified in the agreement. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410, or to the e-mail address, hearino*nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Temporary Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1274

Nancy Ann. Gerger, R.N. Page 5 cc: Henry G. Appel, Senior Assistant Attorney General

Attachment A

Missed Calls Report Participant: Nancy Gorger OBN AMP - s N MP Missed Calls Report PERSONAL & CONFIDENTIAL Date: Wednesday, 12/12/2012 Name: Nancy Gerger Case ID: 133208 Status: InectIve PirstLab ID: 133258 Case ID: 133258 export to excel Stage: Phone: 419-723-7907 Email: p:oport Date: 1211212012

Called Can Date Selected No No No. No No NO No

NO

05/24/2010 No 10/23/2010 No 04/2712011 No. 05/20(2011 Ye5 06/214011 No 10/28/2011 No 02/1 :3/2012 No 05/05/2012 05/17/2012 No 07/04/2022 10 07/08/2012 No 08/17/2012 No 10/05/2012. No' 10110/2012 No. 10/1112012 No 10/2.2/2012 No 00/13/2012 No 10/14V2012. No 10/15/2012 No 10/10/2012 No 10/17/2012 No 10/18/2012 No 10/19/2012 No 10720/2012 No 10/21/7012 No 10/22/2012 No 10/23/2012 NO 10/21/2.012 No 10/25/2012 No 10/25(2512 No 10/27/2012 No 10(20/2012 No 10/20/2012 No 10/30/2002 No1001/2012 ?e9. / 11/012012 No11/0212012 Vets 11/0312012. No. 11/04/2012 No.

No. Nn No
No No No No No No No No No No No No No NO No No No No No 00' NO No NO No No NO
No

haps..//pimuser.firstlab.com/P maiseNottsberAllssedCaltsPeporttarspx

PogoI of 2

Ars11.1b Ca$414oces- .Wessed Cl Reoott sis

12/12!121:41 PM

11/06/2012 Raw Own:: 41

No No

11/0512012

no No

CaprI91;.t 2009 First 193$910311.:Sbotigdris0 ble, 09a rwstloo. at nghts reserved. carat here tor *oak.

/0101://pionoterilistlab.com/PlonCasaNulaiikildolown4Iss44C31IcOvoort.410x

Dago 2 o

Case # 11-003160

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 -0 Columbus, Ohio 43215-7419 e (614) 466-3947

January 25, 2013 NOTICE OF OPPORTUNITY FOR -FARING Robert Stewart Green, L.P.N. 1077 Woodside Drive Mansfield, Ohio 44906 Dear Mr. Green: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about August 16, 2011, you told a Board Compliance Agent that while working as a nurse at Crystal Care Center of Mansfield, in Mansfield, Ohio (Crystal Care), you smoked Marijuana and ingested your wife's prescribed Xanax medication. Section 4723.28(B)(8), ORC [as in effect prior to June 8, 2012], authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual 2. On or about August 8, 2011, while working at Crystal Care, you were confronted about administering the wrong dose of Kayexolate to Patient #1 [see attached Patient Key to remain confidential and not subject to public disclosure]. On or about August 2, 3, and 4, 2011 you gave Patient #1 7.5 mg of Kayexolate instead of the ordered 30 mg dose. Upon being confronted, you began to cry uncontrollably, became agitated, and were very anxious. You were asked to take a urine test, but you refused stating on August 5, 2011 you had smoked Marijuana and recently ingested your wife's prescribed Xanax medication. You later admitted as outlined above to a Board Compliance Agent that prior to being interviewed about the medication errors you smoked Marijuana and ingested your wife's prescribed Xanax medication. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC.

Robert Stewart Green, L.P.N. Page 2

In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing,, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,
A7

e-A/-z47. ,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0260 cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-002173

Ohio Board of Nursing

www.nursing.ohio,gov

17 South High Street, Suite 400 iP Columbus, Ohio 43215-7410 6 (614) 466-3947

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Jennifer Marie Gruver, R.N. 1651 Mentor Ave. #1201 Painesville, Ohio 44077 Dear Ms. Gruver: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about March 5, 2012, you submitted a drug screen specimen that was positive for Cocaine Metabolite, Marijuana Metabolite, and Heroin Metabolite. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 432157410, or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse;

Jennifer Marie Gruver, R.N. Page 2

reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member

Certified Mail Receipt No. 7012 2210 0000 6272 0505

cc:

Henry G. Appel, Senior Assistant Attorney General

Case # 12-002865

Ohio Board of Nursing

1.7 South High Street, Sui.te 400

www.nursing.ohio.gov
(614) 466-3947

Columbus, Ohio 43215-7410

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Stephanie Ann Harrell (aka "Stephanie Raby"), L.P.N. 798 Nawe Rd. Sabina, Ohio 45169 Dear Ms. Harrell: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons:, 1. On or about June 11, 2012, while working as a nurse at The Laurels of Hillsboro, Hillsboro, Ohio (The Laurels), you withdrew two (2) Oxycodone tablets for Patient #1 [See attached Patient Key to remain confidential and not subject to public disclosure] and documented administering them to Patient #1 at 3:10 PM. Despite this, on or about June 12, 2012 at 1:42 P.M., Patient #1 submitted a drug screen specimen that was negative for Oxycodone and Oxymorphone. On or about June 11, 2012, your employer requested that you submit to a drug screen, and the drug screen specimen was positive for Opiates, including Oxycodone and Oxymorphone. You did not have a legal, valid prescription for these drugs. Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, or selfadministering or otherwise taking into the body any drug that is a schedule I controlled substance. 2. On or about April 25, 2012, you submitted an employment application to The Laurels that required you to: "List current (or most recent) employer first and all others in reverse chronological order." Despite this, you failed to disclose your nursing employment with Pleasant Hill Manor in Piketon, Ohio. Your employment with Pleasant Hill Manor was terminated on or about March 9, 2011. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(P), Ohio Administrative Code, states .that a licensed nurse shall not make any false, misleading, or deceptive statements, or submit or cause to be submitted any false, misleading or deceptive

Stephanie Ann Harrell (aka "Stephanie Raby"), L.P.N. Page 2 information, or documentation to; (2) Current employers; (3) Prospective employers when applying for positions requiring a nursing license. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 472328, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a bearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, ColumbUs, Ohio 432157410 or to the email address, hearing@nursino.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0376

cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-001881 & 12-001897

Ohio RoanTor Nuring

January 25, 2013

www.nursing.ohio.gov

:17 South High Street, Suite 400 * Columbus, Ohio 43215-7410 0 (614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Bethany Harris, L.P.N. 591 Dryden Road Zanesville, Ohio 43701 Dear Ms. Harris: In accordance with Chapter 119, of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 10, 2012, in Muskingum County Court of Common Pleas Case No. CR2012-0110, you pled guilty to and were subsequently found guilty of one (1) count of Tampering with Evidence, a third-degree felony, in violation of Section 2921.12(A)(1), ORC. The events underlying your conviction consists of you, on or about April 27, 2012, knowing that an official proceeding or investigation was in progress, or was about to be or likely instituted, recklessly altering, destroying, concealing, or removing a purse containing FiftyNine Thousand Four Hundred Fifty Dollars ($59,450) in U.S. currency, with purpose to impair its value or availability as evidence in such proceeding or investigation. Further, these events occurred while you and your husband were at a residence in Zanesville, Ohio, for the purpose of purchasing marijuana. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. 2. On or about May 8, 2012, the Ohio Department of Job and Family Services suspended your authority to act as a health care Provider, No: 3080106, in the Ohio Medicaid Program.

Bethany Harris,, L.P.N. Page 2 Section 4723.28(B)(1), ORC, authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 472328 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Sincerely,

C.A4,
Rhonda S. Barkheimer, RN., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0741 cc: Henry G. Appel, Senior Assistant Attorney General

Cases #12-004704& 12-005020

Ohio Board of Nursing

17 South High Street, Suite 400 January 25, 2013

wwwnursing.ohio.gov

Columbus, Ohio 43215-7410 * (614) 466-3947

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Darlene M. Harrison, R.N. 5658 Bayberry Circle North Ridgeville, Ohio 44039 Dear Ms. Harrison: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about November 27, 2012, in Cuyahoga County Court of Common Pleas Case Number CR-12-566813-A, you pled guilty to seven (7) counts of Deception to Obtain a Dangerous Drug, felonies of the fifth degree, in violation of Section 2925.22(A), ORC, and were found eligible for Intervention in Lieu of Conviction. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Deception to Obtain a Dangerous Drug, felonies of the fifth degree, in violation of Section 2925.22(A), ORC, constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-160955, IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(A), ORC.

Darlene M. Harrison, R.N. Page 2 You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the folloWing reasons: 1. On or about November 27, 2012, in Cuyahoga County Court of Common Pleas Case Number CR-12-566813-A, you pled guilty to seven (7) counts of Deception to Obtain a Dangerous Drug, felonies of the fifth degree, in violation of Section 2925.22(A), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about July 10, 2011; August 1, 2011; December 16 and 26, 2011; April 12, 2012; May 20, 2012; and August 28, 2012, and involve you using deception to procure the administration of, a prescription for, or the dispensing of a dangerous drug. Section 4723 .28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. On or about September 4, 2012, you provided the following written statement regarding prescription paper you indicate you found while working as a nurse at Lutheran Hospital, Cleveland: "I found some Blank prescriptions on the floor & used them to write prescriptions for myself as I am dependent on Xanax... ."

Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held.

Darlene M. Harrison, R.N. Page 3 You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing, @nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty` (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

.162,4

A". A /

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0901 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 0918 cc: Henry G. Appel, Senior Assistant Attorney General Barry Doyle, Esq.

Case #12-003967

Obio Board.of Nursing

17 South High Street, Suite 400
'A

www.nursing.ohio.gov
(614) 466-3947

Columbus, Ohio 43215-7410

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Jola F. Hatfield, R.N. 483,1 Beechwood Farms Drive Cincinnati, Ohio 45244 Dear Ms. Hatfield: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. Your Medicaid Provider Agreement (No. 2263616) was terminated by a Voluntary Termination of Medicaid Provider Agreement entered by you on or about October 4, 2012, resulting in your inability to provide services to consumers within the Ohio Home Care Waiver program administered by the Ohio Department of Job and Family Services (ODJFS). Certified copies of the Voluntary Termination, along with the ODJFS Proposed Adjudication Order, are attached hereto and incorporated herein.

Section 4723.28(B)(1), ORC, authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you.

Jola F. Hatfield, R.N. Page 2

Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0208 cc: Henry G. Appel, Senior Assistant Attorney General

In the Matter of: Iola Hatfield, RN RN. 194511 CERTIFICATION I HEREBY CERTIFY THAT I AM THE KEEPER OF RECORDS AND DOCUMENTS MAINTAINED BY THE BUREAU OF LONG TERM SERVICES & SUPPORT OF THE OHIO DEPARTMENT OF JOB AND FAMILY SERVICES. ATTACHED TO THIS CERTIFICATION ARE COPIES OF THE FOLLOWING:
6 Proposed Adjudication Order issued to Jola Hatfield, RN, on 8/3/2012 Certified mail receipt for Proposed Adjudication Order issued to Join Hatfield, RN on 8/3/2011 Voluntary Termination of Medicaid Provider Agreement for Jola F. Hatfield dated 1014/2012.

THE DOCUMENTS DETAILED ABOVE AND A !ACHED HERETO

ARE TRUE AND AUTHENTIC COPIES OF DOCUMENTS KEPT IN THE ORDINARY COURSE OF BUSINESS AND MAINTAINED BY THE OHIO DEPARTMENT OF JOB AND FAMILY SERVICES, - BUREAU OF LONG TERM SERVICES AND SUPPORT.

gge / 740414AW . 1
Debta L. Moscardino, Acting Chief Bureau of Long Term Services & Support Ohio Department of Job and Family Services Date of S!gnature

Ohio

Department of Job and Family Services

John ft. Kesich, Goveroot-Michael O. Colbert, MI .cter

August 3, 2012

PROPOSED ADJUDICATION ORDER Jola Hatfield, RN 4831 Beechwood Farms Drive Cincinnati, OH 45244 RE; Notice of Opportunity for a Hearing regarding ODJFS' Proposed Action to Terminate Provider Agreement No. 2263616. Dear Ms. Hatfield: Pursuant to its authority under the Ohio Revised Code ("ORC") Chapter 119 and ORC 5111.03 and ORC 5111.06 the Ohio Department of Job and Family Services ("ODJFS") proposes to terminate your Provider Agreement (No. 2263616). This Proposed Adjudication Order is based on the following: VIOLATIONS: You have violated the Condition of Participation for all ODJFS Administered Waiver providers by the following violations; Emotional and financial exploitation of a consumer enrolled on the ODJFS administered waiver programs; and failure to maintain professional boundaries with a Medicaid consumer. During an investigation conducted by CareStar, the Case Management Agency (CMA) in 2011, they substantiated an allegation of exploitation and failure to maintain professional boundaries. This matter involves Ohio Home Care consumer "J. Kestler." You admitted verbally and in writing to CMA investigator Julie Stevens, RN, that you made an arrangement with the consumer to exchange vehicles. At the time of the investigation, you owned a 2000 Honda Accord. You stated that in April of 2010, the water pump on your Honda Accord went out and the engine was damaged after 290,000 miles. Instead of having the Honda repaired, you gave it to the consumer, J. Kestler, for his daughter's use. The consumer paid to have the car repaired. During this time, you were using a Volkswagen Beetle that belonged to your son, You stated that after the consumer repaired the Honda, but his daughter preferred the Volkswagen over the Honda. So, you and the consumer exchanged cars. Neither of these
30 East Broad Street Columbus, Ohio 43215 jis.ohio.gov An Equal Opportunity Employer and Service Provider 71111 297t1 00013 11198 01613

,vehicles are owned by theknsumer. At the time of the investigate , you were driving a vehicle that the consumer paid to have repaired and you are allowing the consumer's family to use a vehicle that is still owned by a member of your family. The consumer has no legal rights for either vehicle. As a result, you have obtained personal gain from your relationship with the consumer, at the expense of his health and welfare. The "Conditions of Participation" (Ohio Administrative Code (OAC) 5101:3-45.10) prohibits a provider from buying, selling or receiving anything of value from a consumer. While this incident was being investigated, both you and the consumer admitted to a romantic and intimate relationship. You are a licensed Registered Nurse (RN) in Ohio. As such, you are required to adhere to the standards of nursing practice as outlined in OAC 4723-4-06, These standards state in OAC 4723-4-06, that "A licensed nurse shall delineate, establish, and maintain professional boundaries with each client." Your romantic and intimate relationship with the consumer violates the professional boundaries and was unprofessional. Your relationship with the consumer also departs from the accepted standard of care of a Registered Nurse. OAC 4723.04.06 (L) states the following: "A licensed nurse shall not misappropriate a client's property or: (1) Engage in behavior to seek or obtain personal gain at the client's expense; (2) Engage in behavior that may reasonably be interpreted as behavior to seek or obtain personal gain at the client's expense; (3) Engage in behavior that constitutes inappropriate involvement in the client's personal relationships or financial matters; or (4) Engage in behavior that may reasonably be interpreted as inappropriate involvement in the client's personal relationships or financial matters. OAC 47234)4-06 (M) states the following: "A licensed nursing shall not: (1) Engage in sexual conduct with a client; (2) Engage in conduct in the course of practice that may reasonably be interpreted as sexual: You submitted an application to become a Medicaid provider in 2001. At the time of application, you signed a Medicaid provider agreement. By signing this form, you agreed to comply with state statutes and Ohio Administrative Code. Your actions and behavior with the consumer are in violation of Ohio Administrative Code. The violations outlined above are in direct violation of the Ohio Administrative Code. You failed to assure the health and welfare of a consumer, due to your unwillingness or inability to make the appropriate decisions, when this accident occurred, Therefore, ODJFS is proposing to terminate your Provider Agreement in accordance with the following provision(s) of the Ohio Administrative Code ("OAC"): OAC 5101:3-1-17.6(C1 States, in relevant parts: "ODJFS may terminate a provider agreement upon thirty days written notice prior to the termination date."

OAC 5101:34-17,6(D) States, in relevant parts: "ODJFS may propose termination or denial of a provider agreement at any time it is determined that continuation or assumption of provider 30 East Broad Street Columbus, Ohio 43215 ifs.ohle,gov An Equal Opportunity Employer and Service Provider

.status is not in the best inter st of consumers or the state of Ohio. phrase "not in the best interest" shall include, but not be limited to, the following circumstances or occurrences:... (5) As determined by ODJFS, the provider has departed from or failed to conform to accepted standard of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established...(10) The provider fails to abide by or have the capacity to comply with the terms and conditions of the provider agreement, and/or rules and regulations promulgated by OUIPS....(13) The provider, by any act or omission, has negatively affected the health, safety, or welfare of the medicaid consumers or the fiscal or programmatic integrity of the medicaid program..."

OAC 5101:3-45-10 (C) States, in relevant parts: "OOHS-administered waiver service providers shall not: (12) Accept, obtain or attempt to obtain money or anything of value, including gifts or tips from the consumer, authorized representative, household members or family members of the consumer,(17) Engage with the consumer in sexual activity, or in conduct that may reasonably be interpreted as sexual in nature, regardless of whether or not the contact is contact is consensual....(24) Engage in behavior that takes advantage of or manipulates the consumer..resulting in an advantage for personal gain,"

OAC 5101:3-4540 (A) States, in relevant parts: "ODJFS-Administer waiver service providers shall: (3) Deliver services professionally, respectfully and legally." When ODJFS proposes termination of an existing provider agreement, OAC 5101:6-50-01 affords the right to a hearing in accordance with Chapter 119 of the ORC, if a hearing is requested within thirty days of the mailing date of this letter, OAC 5101:6-50-03(13) explains how the thirty day period is calculated and a copy of that rule is enclosed. Please note that, under OAC 5101:6-50-05(D)(2), you may appear at the hearing in person, be represented by your attorney, except that any person not appearing pro se and any corporation, partnership, association, or other entity must be represented by an attorney admitted to the practice of law in this state. You may present your position entirely in writing. At the hearing you are entitled to examine evidence and adverse witnesses and may introduce evidence and bring forth witnesses on your behalf.

30 East Broad Street Columbus, Ohio 43215 jts.ohio.gov An Equal Opporhinity Employer and Service Provider

The rules governing the hearing are found in OAC 5101:6-50-09. If you wish to request a hearing,,send a written request to: The Ohio Department of Job and Family Services Office of Legal Services Attention Scheduling Coordinator 30 East Broad Street, 31st Floor Columbus, Ohio 43215 If you do not request a hearing within thirty days of the date of the mailing of this notice, ODJFS will implement this proposed action by issuing a final and binding order of adjudication terminating your Provider Agreement, No. 2263616. If you have arty questions regarding this Notice, please contact Rosemary Walton at (614) 4666742. Sincerely, 114 06 Debra L. Moscardino, Chief Bureau of Long Term Care Services and Supports Certified mail, return receipt request number

30 East Broad Street Columbus, Ohio 43215 jis.ohio.gow An Equal Opportunity Employer artcl Service Provider

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VOLUNTARY TERMINATION OF MEDICAID PROVIDER AGREEMENT

Date: /0/ qhZ-.. Pmvider#: 221054 P (0

To:

Standards & Services Section, Bureau of Home and Community Services

1,-6,14 l

Wn tkie-td,,,, am relinquishing my provider number and request it be terminated.

I no longer provide services to consumers on the Ohio Home Care Waiver.

Please mall this form to: Attn: Cathy Kessler Ohio Department of Job and Family Services Bureau of Community Services Policy P.O. Box 182709 514 Floor Columbus, Ohio 43218-2709

Case #12-005907

Ohio Board Of Nursing

January 25, 2013

www.nursing.ohi.o.gov

17 South High. Street, Suite 400 e Columbus, Ohio 43215-7410 4, (614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Jasmine M. Haynes 18513 County Road 424 Defiance, OH 43512 Dear Ms. Haynes: On or about November 27, 2012, the Ohio Board of Nursing (Board) issued to you a Notice of Immediate Suspension and Opportunity for Hearing, a copy of which is attached hereto and incorporated herein, You are notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28 of the Ohio Revised Code, ORC, to permanently deny or deny your application to reactivate or reinstate your nursing license; to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: la. On or about July 20, 2012, in Defiance County Court of Common Pleas Case Number 12 CR 11375, you pled no contest to and were found guilty of one (1) count of Aggravated Possession of Drugs, a felony of the fifth degree, in violation of Section 2925.11(A)(C)(1)(a), ORC. The acts underlying this case occurred on or about January 27, 2012, and involve you obtaining, possessing, or using Oxycodone. lb. On or about July 20, 2012, in Defiance County Court of Common Pleas Case No. 12 CR 11421, you pled no contest to and were found guilty of one (1) count of Possession of Heroin, a felony of the fifth degree, in violation of Section 2925.11(A)(C)(6)(a), ORC. The acts underlying this case occurred on or about March 13, 2012, and involve you obtaining, possessing, or using Heroin. lc. On or about July 20, 2012, in Defiance County Court of Common Pleas Case Number 12 CR 11467, you pled no contest to and were found guilty of one (1) count of Possession of Heroin, a felony of the fifth degree, in violation of Section 2925.11(A)(C)(6)(a), ORC.

Jasmine M. Haynes Page 2

The acts underlying this case occurred on or about July 3, 2012, and involve you obtaining, possessing, or using Heroin. Section 4723 .28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hepring@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, e...A/../9 Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1212 cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-005907

Ohio Board of Nursing www.nursing.ohio.gov

17 South High Street, Suite 400 November 27, 2012
o.

Columbus, Ohio 43215-7410

(614) 466-3947

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Jasmine M. Haynes, L.P.N. 25212 State Route 20 Fayette, Ohio 43521 Dear Ms. Haynes: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about July 20, 2012, in Defiance County Court of Common Pleas Case Number 12 CR. 11375, you pled no contest to and were found guilty of one (1) count of Aggravated Possession of Drugs, a felony of the fifth degree, in violation of Section 2925.11(A)(C)(1)(a), ORC. Further, that Board has been notified that on or about July 20, 2012, in Defiance County Court of Common Pleas Case No. 12 CR 11421, you pled no contest to and were found guilty of one (1) count of Possession of Heroin, a felony of the fifth degree, in violation of Section 2925.11(A)(C)(6)(a), ORC. Further, the Board has been notified that on or about July 20, 2012, in Defiance County Court of Common Pleas Case Number 12 CR 11467, you pled no contest to and were found guilty of one (1) count of Possession of Heroin, a felony of the fifth degree, in violation of Section 2925.11(A)(C)(6)(a), ORC. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Aggravated Possession of Drugs, a felony of the fifth degree, in violation of Section 2925.11(A)(C)(1)(a), ORC; and Possession of Heroin, felonies of the fifth degree, in violation of Section 2925.11(A)(C)(6)(a), ORC, constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC.

Jasmine M. Haynes, L.P.N. Page 2

WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE. NURSING AS A LICENSED PRACTICAL NURSE, PN-146607, IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(B), ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410, or to the e-mail address, bepripg@nursing.ohio,gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

444:4(

0,144-44.4./

Judith A. Church, R.N., C.N.P. Supervising Board Member

Certified Mail Receipt No. 7012 1010 0002 4257 4978

cc:

Henry G. Appel, Senior Assistant Attorney General

Case #12-001742 & 12-007207

Ohio .130ard Of :Nursing

17 South High Street, Suite 400 January 25, 2013

www.nursing.ohlo.gov
(614) 466-3947

Columbus, Ohio 43215-7410

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Carol Lynn Hebbeler, R.N. 511 Tuscany Valley Court #11 Crestview Hills, KY 41017-5474 Dear Ms. Hebbeler: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about October 9, 2012, in Hamilton County Court of Common Pleas Case Number B-1203396, you pled guilty to Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(A), ORC; and Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(3), ORC, and were found eligible for Intervention in Lieu of Conviction. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(A), ORC; and Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(3), ORC, constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-317909, IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(A), ORC.

Carol Lynn Hebbeler, R.N. Page 2

You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions- on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about October 9, 2012, in Hamilton County Court of Common Pleas Case Number 13-1203396, you pled guilty to Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(A), ORC; and Theft of Drugs, felonies of the fourth degree, in violation of Section 2913 .02(A)(3), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on dates in or about April 2011 and involve you making a false statement in a prescription, order, report, or record involving Oxycodone, Fentanyl, and Morphine. Further acts underlying this case involve you obtaining or exerting control over Oxycodone, Fentanyl, and Morphine belonging to Good Samaritan Hospital by deception. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. On or about May 9, 2012, you met with a Board Compliance Agent. You admitted that on or about April 9-10, 2012, while working as a nurse at Good Samaritan Hospital in Cincinnati, Ohio, you diverted Morphine and Ativan for self-administration. On an Employee Statement Form, dated April 16, 2012, you wrote, "Around 6:00, went to get Ativan for Patient in Room 7129 and Morphine for Patient in 7127. Instead of giving meds to patients, I put them in my bag. Left work at 0755. Went home and self-injected meds before going to bed." [sic]

Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for selfadministering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice.

Carol Lynn Hebbeler, R.N. Page 3

3.

On or about May 9, 2012, you admitted to the Board Compliance Agent that in or about April 2012, while working as a nurse at Good Samaritan Hospital, Cincinnati, you diverted Fentanyl.

Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Good Samaritan records indicate that Patient #1 [identified on the attached Patient Key to remain confidential and be withheld from public disclosure] was ordered to have a 25mcg Fentanyl patch applied every 72 hours. On April 6, 2012, at 21:54, and on April 9, 2012, at 22:46, you removed one (1) Fentanyl Transdermal 25mcg patch, respectively, and documented administration of these patches. However, on or about April 10, 2012, during Good Samaritan Hospital's investigation, the only Fentanyl Transdermal Patch that was on Patient #1 was dated 4/3 with the initials D.R. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(G), Ohio Administrative Code (OAC), states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. Rule 4723-406(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you.

Carol Lynn Hebbeler, R.N. Page 4 Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearin @nursin .ohio ov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, .A7A/ Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0871 cc: Henry G. Appel, Senior Assistant Attorney General

Carol Lynn Hebbeler, R.N. Page 5 PATIENT KEY TO REMAIN CONFIDENTIAL AND NOT SUBJECT TO PUBLIC DISCLOSURE 1. Mary Franzoni

Case #2012-006881

Ohio Board .of Nursing

January 25, 2013

www.nursing.oh.io.gov

17 South High Street, Suite 400 4? Columbus, Ohio 43215-7410 0, (614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Camille Renea Helsel (aka "Camille Renea Wellman Helsel"), R.N., C.N.P. Route 3 Box 238 Delbarton, West Virginia 25670 Dear Ms. Helsel: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse, your certificate to practice as a certified nurse practitioner, and your certificate to prescribe drugs and therapeutic devices in Ohio; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about November 19, 2012, the Commonwealth of Kentucky, Kentucky Board of Nursing, in Case Number: 2013-422, issued an Order of Immediate Temporary Suspension (Kentucky Board 2012 Order) in which your licenses to practice nursing as a Registered Nurse and as a Advance Practice Registered Nurse in Kentucky were immediately suspended. A certified copy of the Kentucky Board 2012 Order, along with Attachment are attached hereto and incorporated herein. Section 4723.28(B)(1), ORC, authorizes the Board to deny a license and/or a certificate(s) or otherwise discipline a licensee and/or a certificate holder for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you.

Camille Renea Helsel (aka "Camille Renea Wellman Helsel"), R.N., C.N.P. Page 2

Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 432157410, or to the email address, hearin @ nursin .ohio. ov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse, your certificate to practice as a certified nurse practitioner, and your certificate to prescribe drugs and therapeutic devices in Ohio; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0383 cc: Henry G. Appel, Senior Assistant Attorney General

COMMONWEALTH OF KENTUCKY KENTUCKY BOARD OF NURSING Case Number: 2013-422 In The Matter Of: CAMILLE RENEA WELLMAN HELSEL RN LICENSE NO. 1087509 APRN LICENSE NO. 3003139 ROLI1E 3 BOX 238 DELBARTON WV 25670

Date ) ) 3D certify this to be a true copy of the record(s) on file. ' h the Kentucky sing Board

ORDER OF IMMEDIATE TEMPORARY SUSPENSION Pursuant to KRS 314.089, KRS 13B.125, and the additional provisions of law cited below, and in order to protect the public, the Kentucky Board of Nursing ("the Board") hereby issues the following Order fox the immediate temporary suspension of the licenses of Camille Renea Wellman Helsel ("Respondent") to practice as a Registered Nurse ("RN") and a Advance Practice Registered Nurse ("APRN") in the Commonwealth of Kentucky. Pursuant to the above-cited statutes, the basis for this Order is as follows: FINDINGS OF FACT 1. The Respondent is both a RN, first licensed by the Board by endorsement

on December 4, 1997, RN license number 1087509, and a APRN, first licensed by the Board by application on February 24, 2000, APRN license number 3003139; as such, the Board has jurisdiction in this matter pursuant to KRS Chapter 314. 2. On March 7, 2012, the Board received the Respondent's application for

reinstaternent of her lapsed RN and APRN licenses.: On or about April 2, 2012, prior to Board approval related to the reinstatement application, Respondent unlawfully began . . practicing nursing in Kentucky without a active Kentucky RN or APRN nursing license,_

In the Matter of CAMILLE RENEA WELLMA.N HELSEL RN LICENSE NO. 1087509 APFN LICENSE NO. 3003139

At no time relevant to this matter was the Respondent granted a provisional license or a temporary work permit by the Board. 3. On or about April 2, 2012, Respondent began prescribing and/or refilling

prescriptions for controlled substances in Kentucky without first notifying the Board of her completion of a Collaborative Agreement for the Advanced Practice Registered Nurse's Prescriptive Authority for Controlled Substances ("CAPA-CS"). In addition, Respondent 'did not hold a Kentucky United States Drug Enforcement Administration ("DEA") registration at any time during this period. 4. When Respondent completed her March 7, 2012, reinstatement

application, she was apprised that the jurisprudence examination was a prerequisite for the reinstatement of her license. She acknowledged on her reinstatement application that she had not yet completed the jurisprudence examination. She began practicing nursing in Kentucky on or about April 2, 2012, but she did not complete the jurisprudence examination until April 30, 2012. Having been apprised of the jurisprudence examination requirement, Respondent was thereby on notice that she practiced nursing unlawfully from April 2, 2012, to April 30, 2012; however, the Respondent failed to self-report her unlawful practice of nursing to the Board. Similarly, Respondent did not notify the Board of any of the other violations identified in this Order. 5. On or about June 3, 2012, Respondent completed 44 hours of continuing

education, which she needed as a prerequisite for the reinstatement of her Kentucky RN and APRN licenses; however, Respondent began practicing nursing in Kentucky approximately 2 months prior to this date.

In the Matter of: CAMILLE RENEA WELLMAN HELSEL RN LICENSE NO. 108'7509 APRN LICENSE, NO. 3003139

6.

On or about June 5, 2012, Respondent's reinstatement application was

approved by the Board; however, this occurrence was the direct result of the Respondent's fraud by omission. While Respondent communicated with the Board regarding her completion of the jurisprudence examination and her continuing education; she did not notify the Board of her knowing unlawful practice of nursing from April 2, 2012, to June 4, 2012. 7. On November 1, 2012, Board staff conducted an unannounced site visit in

accordance with 201 ICAR 20:057 Section 8. On this date, the Respondent provided to Board staff, for the first time, notification of the existence of a CAP A-CS signed by the Respondent and a physician, Dr. Mark McDaniel. This form lists the address of Dr. McDaniel's practice as 1340 US Highway 460, Staffordsville, Kentucky 41256; however,' this information is directly contradicted by the website of the Kentucky Board of Medical Licensure, which indicates that Dr. McDaniel `practices at 709 Jefferson Street, South Charleston, West Virginia 25309. 8. During the November 1, 2012, site visit, Respondent provided' Board staff

with true copies of the complete patient chart maintained by the Respondent regarding 13 patients, as well as a copy of the Respondent's calendar for the period October 22-28, 2012. On the same date, Respondent made all of her patient files available for inspection. Review of these records identifies numerous violations of nursing practice standards by the Respondent. 9. During the period April 2,2012, to October 31, 2012, the treatment of

pain was a primary practice component of the Respondent's nursing practice, as demonstrated by the frequency and overall amount of the Respondent's controlled

to the Matter of: CAMILLE RENEA WELLMAN HELSEL RN LICENSE NO. 1087509 APRN LICENSE NO. 3003139

substance prescribing activity. During ail or part of this period, the Respondent's clinic, East Kentucky Healthcare, did not:.(a) hold a pain management facility license from the Kentucky Cabinet for Health and Family Services; (b) have physician ownership; and (c) have a physician onsite at least 50% of facility operating hours. 10. During the period April 2, 2012, to July 19, 2012, Respondent failed to

record and/or retain essential records regarding prescriptions and prescription refills that she authorized, including prescriptions and refills that involved significant quantities of Lorcet (h.ydrococione/acetaminophen). 11. During the period July 20, 2012, to October 31, 2012, Respondent's

practice records related to patients prescribed controlled substances for treatment of pain did not identify or indicate consideration of any exit strategy related to the use of controlled substances for treatment of pain, including both prescriptions and refills that involved significant quantities of Lorcet (hydrocodone/acetaminophen). 12. During the period of July 20, 2012, to September 30, 2012, Respondent

repeatedly: (a) treated patients whose primary complaint was chronic pain in instances where referral of such patients to a chronic pain specialist was warranted; and (b) prescribed controlled substances, including prescriptions and refills that involved significant quantities of Lorcet (hydrocodone/acetaminophen), without consistently conducting and documenting an appropriate examination, 13. During the period of April 2, 2012, to September 30, 2012, Respondent

repeatedly failed to: (a) obtain appropriate lab tests related to her treatment of pain and a variety of other conditions and diagnoses; (b) obtain and/or document a complete medical history from patients; (c) obtain medical records from other providers related to her

In the Matter of CAMILLE RENEA WELLMAN HELSEL RN LICENSE NO. 1087509 APRN LICENSE NO. 3003139

patients; (d) follow through or request additional information as appropriate regarding orders and notations in patient records and patient's medical histories; (e) order, conduct, or inquire into needed mammograins, breast exams and/or pap smears; and (1) discharge patients who failed to comply with orders or instructions. 14. During the period of April 2, 2012, to October 31, 2012, Respondent at

times scheduled 2 patients every 15 minutes, with appointments for 30 or more patients in a single day. Attached is Exhibit A is a photograph taken immediately outside of Respondent's practice location indicating the large number of patients congregating while awaiting medical care froth the Respondent.

CONCLUSIONS OF LAW As explained in the following chart, the Respondent's above-mentioned conduct and omissions constitute violations of numerous statutes and regulations. Each entry on the following chart includes a cross reference that identifies releVant numerical paragraph section from the Statement of Facts that substantiates the specific violation(s) at issue.

Citation KRS 314.091(1)(x)

Summary Fraud or deceit in procuring a license. See also, Rivermonann, Inc. v. Bass Hotels & Resorts, L'w, 113 S.W.3d 636, 641 (Ky.App. 2003) (fraud by omission), and Giddings & Lewis, Inc, v. Industrial Risl ansurers, 348 S.W.3d 729, 747 (Ky. 2011) (fraud by omission). Negligent or willful acts inconsistent with the practice of nursing. Failure to make essential entries on records. Violation of provisions of KRS Chapter 314 other than KRS 314.091. .

Cross reference

2-6

KRS 314,091(1)(d) KRS 3 4.091(I)(h) KRS 314_091(1)(D

2-7, 9-14 2-4, 10-13 2-7, 9-14

In the Matter of: CAMILLE RENEA WELLMAN HELSEL RN LICENSE NO. 1087509 APRN LICENSE NO. 3003139 Citation KRS 314.091(1)0) Summary Cross reference 2-6, 10-14 2-6 3, 7 2-7, 9-14

Violation of administrative regulations promulgated by the Board. KRS 314.041(9,11) Active license and completion of jurisprudence examination are prerequisites for engaging in the practice of nursing. APRN shall notify the Board of the existence of KRS 314.042(8-9) the CAPA-CS and the name of the collaborating physician. KRS 314.021(2) Duty to practice nursing with reasonable skill and safety and to be responsible for making decisions that are based upon the individuals' educational preparation and experience in nursing. Duty to report violations of KRS Chapter 314, KRS 314.031(4) including duty to self-report such violations. Any person practicing on a lapsed license shall be KRS 314.071(4) considered an illegal practitioner. Completion of continuing competency KRS 314.073 requirements are prerequisite for license renewal. A "pain management facility" as a facility which KRS 218A.175 has the treatment of pain as its primary practice component. Such facilities must be licensed by the Kentucky Cabinet for Health and Family Services. 21 C.F.R. 1301.12(b)(3) Controlled substance prescriber must hold separate location specific DEA registration in each state in which they practice. APRN who fails to renew license shall not 201 KAR 20:056 5(3) practice until his or her license is reinstated. 201 KAR 20:057E CAPA-CS notification requirement and prescribing standards related to controlled substances. Prerequisites for reinstatement of lapsed license, 201 KAR 20:225 including continuing education and jurisprudence examination.

2-6 , 2-6 2-6 9, 12

3 2-6 3, 7, 10-14 2-6

Considered in its entirety, the above-mentioned list of violations demonstrates Respondent's knowing and blatant disregard for the legal requirements and standards of practice which govern nursing in the Commonwealth of Kentucky. Moreover, the abovementioned list of violations demonstrates a pattern of disregard which constitutes a clear and present danger to the health and safety of the Respondent's patients.

In the Matter of: CAMILLE RENEA WELLMAN HELSEL RN LICENSE NO. 1087509 APRN LICENSE NO. 3003139

In light of the Respondent's duty to self-report her unlicensed practice to the Board pursuant to KRS 314.031(4), the Respondent's evident knowledge of prerequisites to practice such as the jurisprudence exam and the completion of continuing education requirements, it is .clear that the Board's approval of the Respondent's licensure application was the product of the Respondent's fraud by omission. Had the RespOndent properly disclosed her unlawful nursing practice prior to licensure, the Respondent's reinstatement application would not have been approved by the Board on June 5, 2012. A claim of fraud by omission is based upon a party's failure to disclose to another a fact that the party knows may justifiably induce the other to act or refrain from acting. See, e.g., Restatement (Second) of Torts 551 (1976) (cited in the context of fraudulent omissions in Giddings & Lewis, Inc. v. Industrial Risk Insurers, 348 S.W.3d 729, 747 (K.37 2011)). The facts of the present case demonstrate: (a) that the Respondent had a duty to disclose her unlicensed practice of nursing; (b) that Respondent failed to disclose that fact; (c) that the Respondents failure to disclose the material fact induced the Board to approve her reinstatement application. See, Riverrnont Inn, Inc. v. Bass Hotels & Resorts, Inc., 113 S.W.3d 636, 641 (Ky.App. 2003). In addition, the facts and circumstances set forth above indicate that the continued practice of nursing by the Respondent poses an immediate danger to the public health, safety, or welfare. Accordingly, Respondent is hereby ORDERED to CEASE AND DESIST from practicing as a RN and a APRN in the Commonwealth of Kentucky, effective immediately. Any such practice after the date of this Order shall constitute grounds for further disciplinary action. The Respondent's RN and APRN licenses are immediately suspended on a temporary basis.

In the Matter of: CAMILLE RENEA WELLMAN HELSEL RN LICENSE NO. 1087509 APRN LICENSE NO. 3003139

Pursuant to KRS 138,125(3), the Respondent may request a hearing in regard to this Order. Any such request must be in writing and sent to the attention of the Hearing Officer, Kentucky Board of Nursing, Suite 300, 312 Whittington Parkway, LouisVille, Kentucky 40222. A request for a hearing does not stay the effect of this Order.

This I

#1

day of

2012.

Nathan Goldman, Acting Executive Director Kentucky Board of Nursing

Certificate of Service This is to certify that a true and correct copy of the foregoing &der of Immediate Temporary "Suspension was served upon the Respondent, CAMILLE RENEA WELLMAN HELSEL, ROUTE 3 BOX 238, -DELBARTON WV 25670, her address of record pursuant to KRS 314.107, via certif d U.S. ail, return receipt requested, 2012. postage pre-paid, all on this the /day of

'& 1-t,OCe41. 1 Morgan G. Ransdell, Prosecuting Attorney Kentucky Board of Nursing 312 Whittington Parkway, Ste. 300 Louisville, Kentucky 40222 Direct dial: (502) 429-3339 Fax (502) 429-3353 E-mail: morgan.ransdell@ky.gov

EXHIBIT A

Case #12-005119

Ohio Board ofNursing

January 25, 2013

www.nursing.ohio.gov

17 South High Street, Suite 400 . Columbus. Ohio 43215-7410 e (614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Robin Diane Hicks, L.P.N. 5045 St. James Road Waldo, Ohio 43356 Dear Ms. Hicks: In accordance with Chapter 119 Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about January 20, 2012, you entered a Consent Agreement with the Board under which your license was placed on probation for a minimum period of one (1) year. On or before September 1, 2004, you submitted an application for the renewal of your license to practice as a licensed practical nurse (2004 Application). Under the Compliance section of the 2004 Application, you were asked: Have you been convicted of, found guilty of, pled guilty to, pled no contest to, entered an Alford plea, received treatment or intervention in lieu of conviction or received diversion for . . . A felony in Ohio, another state or US territory. You did not mark "Yes" to this question on the 2004 Application. However, on or about September 13, 2002, in Marion County Common Pleas Court Case No. 02-CR-287, you pled guilty and were subsequently convicted of one (1) count of Theft, a felony of the second degree, in violation of Section 2913.02(A)(2)(B)(3). The acts underlying your conviction occurred on or about the period of February 2001 through February 2002, and involve you, by deception, obtaining or exerting control over property of the owner valued at $25,000.00 or more. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Section 4723.28(B)(16),

Robin Diane Hicks, L.P.N. Page 2 ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(P), OAC [as in effect in 20041 states that a licensed nurse shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the board, to current employers, or to any future employers for positions requiring a nursing license. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing on this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing this notice. You are hereby further informed that if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present you position, argument, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit Manager, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in the Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

A/
Rhonda S. Barkheimer, RN., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0369 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 12-007077

Ohio Board of Nursing

www.nursing.ohio.gov
(614) 466-3947

17 South High Street, Suite 400 joi Columbus, Ohio 43215-7410

January 25; 2013

NOTICE OF OPPORTUNITY FOR HEARING

Amy Hurst, L.P.N. P.O. Box 207 Summerfield, Ohio 43788 Dear Ms. Hurst: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: . On September 1, 2012, your license to practice nursing as a licensed practical nurse in Ohio lapsed. Despite this, while employed by Advanced Home Health, (dba "Brightstar Care"), a home health agency, you provided nursing care to Patient #1 [see attached Patient Key to Remain Confidential and Not Subject to Public Disclosure] on or about the following dates: September 3 6, September 10-13 and September 17-20, 2012. Section 4723.28(B)(2), ORC, authorizes the Board to discipline a licensee for engaging in the practice of nursing having failed to renew a nursing license issued under this chapter, or while a nursing license is under suspension. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for Violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Section 4723.03(B), ORC, states that no person shall engage in the practice of nursing as a licensed practical nurse, represent the person as being a licensed practical nurse, or use the title "licensed practical nurse," the initials "L.P.N." or any other title implying that the person is a licensed practical nurse, for a fee, salary, or other consideration, or as a volunteer, without holding a current, valid license as a licensed practical nurse under this chapter. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to

Amy Hurst, L.P.N. Page 2 practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0819 Attorney's Certified Mail Receipt No. 7012 2210 0000 6272 0826 cc: Henry G. Appel, Senior Assistant Attorney General Bradley N. Frick, Attorney at Law

Cases # 2007-1789; 12-004516

Ohio Board of Nursing

January 25, 2013

www..nursing.ohip.gov 17 South High Street, Suite 400 * Columbus, Ohio 43215-7410 * (614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Wendelin M. Jacobson-Priddy, L.P.N. 6202 Pelham Drive Parma, Ohio 44129 Dear Ms. Jacobson-Priddy: In accordance with. Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about April 3, 2008, you requested that your license to practice as a licensed practical nurse be placed on inactive status, after receiving information from a Board attorney regarding the incident described in the paragraph below. On or about August 30, 2012, you called the Board and requested that your license be reactivated/reinstated. On or about May 7, 2007, while working as a nurse at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland {Medical Center), your employer requested that you submit a urine specimen for drug testing. You urine tested positive for Morphine and Codeine. You did not have a legal, valid prescription for Morphine. During an interview with a Board Compliance Agent, on or about July 18, 2007, you stated that you were prescribed Tylenol #3 (with Codeine) one (1) tablet per day, but despite this, on May 6, 2007, prior to going to bed, and on May 7, 2007, prior to going to work at the Medical Center, you consumed two (2) tablets of Tylenol #3. Section 4723.28(B)(8), ORC [as in effect prior to June 8, 2012], authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not "in accordance with a legal, valid prescription issued for that individual. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice.

Wendelin M. Jacobson-Priddy, L.P.N. Page 2

You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. S incerely

..62-4 1--/-z-j7,e...0
Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0307 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 12-001825

Ohio Board of Nursing

17 South High Street, Suite 400

www.nursing,ohiosgov

Columbus, Ohio 43215-7410 4. (614) 466-3947

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Brenda D. Jarvis, R.N. 5869 Tomberg Street Huber Heights, Ohio 45424 Dear Ms. Jarvis: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723 28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about April 26, 2012, you told a Board Compliance Agent that beginning in or about July 2011 while working as a registered nurse at Miami Valley Hospital in Dayton, Ohio you stole Dilaudid on numerous occasions and consumed the medication. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. 2. On or about April 26, 2012, you told a Board Compliance Agent that while working as a registered nurse at Miami Valley Hospital in Dayton, Ohio at times you did not give patients their prescribed dose of Dilaudid. In a written statement dated April 26, 2012, you indicate that you did this by "not pushing the plunger so hard so that there was just a little more" of the drug left. You would then self-administer the remainder. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(8)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC.

Brenda D. Jarvis, R.N. Page 2 In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.Gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0253 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 11-003523

h. fN . )0 io Board o ursing

www.nursing.ohio.gov
(614) 466-3947

17 South High Street, Suite 400 4i. Columbus, Ohio 43215-7410

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Jaime Lyn Johnson, R.N. 3512 Trails End Dr. Medina, Ohio 44256 Dear Ms. Johnson: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. As set forth in Attachment A, while working as a nurse at the Cleveland Clinic Foundation in Cleveland, Ohio, you failed to account for the disposition of narcotics you withdrew from the Pyxis. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723,28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(E), Ohio Administrative Code, states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you.

Jaime Lyn Johnson, R.N. Page 2 Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, head g nursi n .ohio.gov If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0772 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 0789

cc:

Henry G. Appel, Senior Assistant Attorney General Steven A. Sindell, Esq.

Jaime Lyn Johnson, R.N. Page 3 ATTACHMENT A PATIENT # Patient #1 Physician Order WITHDRAWAL FROM PYXIS Oxycodone-IR (Percolone) MAR Comments

Oxycodone-IR (Percolone)

No waste. 2-3 5 mg. tablets 7/6/11 every 4 hours as 15-5 mg tablets at needed 18:18 Patient #1 Ativan (Lorazepam) 0.5 mg. injection every 4 hours as needed Ativan (Lorazepam) 7/6/11 2 mg. at 18:19 Tylenol #3 (Acetaminophen-Codeine) 7/8/11 1 tablet at 20:28 Tramadol (Ultram) 7/8/11 1 tablet at 21:00 Fentanyl 8/5/11 100 mcg at 13:29 Fentanyl 8/4/11 100 meg at 19:33 75 meg waste. 25 meg unaccounted for No waste. 1 tablet unaccounted for None No waste. 1 tablet unaccounted for None 15 tablets (75 mg) unaccounted for

None

None

15 mg waste 0.5 mg unaccounted for

Patient #2

Tylenol #3 (AcetaminophenCodeine) 1 to 2 tablets every 4 hours as needed

Patient #3

Tramadol (Ultram) one tablet every 6 hours as needed

Patient#4

Fentanyl 25 mcg every 2 hours as needed

None

Patient#5

Fentanyl 100 mcg every hour

50 meg at 19:50

No waste. 50 mcg unaccounted for

Case #12-002468

Ohio Board of Nursing

January 25, 2013

wwW.nursing.ohio.gov

17 South High Street, Suite 400 ffi Columbus, Ohio 43215-7410 (614) 466-3947

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Kari Ann Johnson, RN. 16825 State Route 694 Ottawa, Ohio 45875 Dear Ms. Johnson: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about November 14, 2012, in Allen County Court of Common Pleas Case Number CR2012 0318, you pled guilty to one (1) count of Theft of Drugs, a felony of the fourth degree, in violation of Section 2913.02(A)(1) & (B)(6), ORC, and were found eligible for Intervention in Lieu of Conviction [corrected entry date]. Further, the Board has been notified that on or about November 14, 2012, in Van Wert County Court of Common Pleas Case Number CR 12-07-128, you pled guilty to one (1) count of Theft of Drugs, a felony of the fourth degree, in violation of Section 2913.02(A)(1), ORC, and were found eligible for Intervention in Lieu of Conviction. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Theft of Drugs, felonies of the fourth degree in violation of Section 2913.02(A)(1) & (B)(6), ORC, and Section 2913.02(A)(1), ORC, constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-323401, IS HEREBY SUSPENDED. Continued practice after receipt of this

Kari Ann Johnson, R.N. Page 2 notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: la. On or about November 7, 2012, in Allen. County Court of Common Pleas Case Number CR2012 0318, you pled guilty to one (1) count of Theft of Drugs, a fourth-degree felony, in violation of Section 2913.02(A)(1) & (B)(6), ORC, and were found eligible for Intervention in Lieu of Conviction [corrected entry date]. The acts underlying this case occurred on or about May 28, 2012, and involve you obtaining or exerting control over a dangerous drug without the consent of the owner or person authorized to give consent. lb. On or about November 14, 2012, in Van Wert County Court of Common Pleas Case Number CR 12-07-128, you pled guilty to one (1) count of Theft of Drugs, a felony of the fourth degree, in violation of Section 2913.02(A)(1), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about May 31, 2012, and involve you obtaining or exerting control over Percocet without the consent of the owner or person authorized to give consent. Section 4723 .28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. On or about May 29, 2012, you submitted a specimen for drug testing. The specimen that you submitted tested positive for Lorazepam, Alprazolam, Hydrocodone, and Oxycodone without a valid legal prescription. On May 31, 2012, you stated to a Board Compliance Agent that you had a prescription for Percocet (Oxycodone/Acetaminophen) from November 14, but that prescription had run out prior to the drug test.

Kari Ann Johnson, R.N. Page 3 Section 4723.28(B)(8), ORC [as in effect prior to June 8, 20121, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. 3. On May 31, 2012, you admitted to a Board Compliance Agent that, in or about May 2012, you self-administered Xanax that was prescribed to your husband.

Section 4723.28(13)(8), ORC [as in effect prior to June 8, 20121, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. 4. On May 31, 2012, you admitted to a Board Compliance Agent that in or about April 2012, while working as a home health care nurse with St. Rita's hospital, you diverted Hydrocodone and Percocet from clients' supplies of medication for self-administration. You admitted to diverting up to ten (10) pills at one time approximately two (2) times per week.

Section 4723.28(B)(8), ORC [as in effect prior to June 8, 2012], authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(L), Ohio Administrative Code (OAC), states that a licensed nurse shall not misappropriate a client's property or: (1) Engage in behavior to seek or obtain personal gain at the client's expense; (2) Engage in behavior that may reasonably be interpreted as behavior to seek or obtain personal gain at the client's expense; For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or infotuied consent to the behaviors by the nurse set forth in this paragraph. 4. On May 31, 2012, you admitted to a Board Compliance Agent that on or about May 26-27, 2012, you diverted a bottle of Flexeril from a client in Spencerville. You also admitted to diverting a bottle of Naprosyn from a client.

Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(4 OAC, states that a licensed nurse shall not misappropriate a

Kari Ann Johnson, R.N. Page 4 client's property or: (1) Engage in behavior to seek or obtain personal gain at the client's expense; (2) Engage in behavior that may reasonably be interpreted as behavior to seek or obtain personal gain at the client's expense; For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or informed consent to the behaviors by the nurse set forth in this paragraph. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing@nursing,,ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0888 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 0895 cc: Henry G. Appel, Senior Assistant Attorney General Scott E. Welch, Esq.

Cases #2012-007525, #2012-000732, #2012-006061, #2012-006459

Ohio Board of Nursing

17 South High Street, Suite 400 January 25, 2013

www.nursing.ohio.gov
(614) 466-3947

Columbus, Ohio 43215-7410

NOTICE OF OPPORTUNITY FOR HEARING

Audra Elizabeth Jones, R.N. 12121 tad Avenue Cincinnati, Ohio 45249 Dear Ms. Jones: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse in Ohio; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about October 2, 2012, the Indiana State Board of Nursing, in Case Number: 2011 NB 497, issued a Finding of Fact, Ultimate Findings of Fact, Conclusions of Law, and Order (Indiana Board 2012 Order) in which you were found in Default and your license to practice nursing as a registered nurse in Indiana was placed on indefinite suspension. A copy of the Indiana Board 2012 Order, along with the Attachment are attached hereto and incorporated herein. 2. On or about October 10, 2012, the Commonwealth of Virginia Department of Health Professions issued an Order (Virginia Board 2012 Order) in which your license to practice nursing as a registered nurse in Virginia was suspended. A copy of the Virginia Board 2012 Order, along with Attachment are attached hereto and incorporated herein. On or about October 12, 2012, the State of Florida Board of Nursing, in Case No. 2012-00707 issued a Final Order (Florida Board 2012 Order) in which your license to practice nursing as a registered nurse in Florida was suspended. A copy of the Florida Board 2012 Order, along with Attachments are attached hereto and incorporated herein. On or about December 26, 2012, the Board of Nursing of the State of North Dakota issued an Order of Emergency Suspension (North Dakota Board 2012 Order) in which your license to practice nursing as a registered nurse, in North Dakota was suspended. A copy of the North Dakota Board 2012 Order, along with Attachments are attached hereto and incorporated herein.

3.

4.

Audra Elizabeth Jones, R.N. Page 2

Section 4723.28(8)(1), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are, hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, 011 432157410, or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse in Ohio; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars (S500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0406' cc: Henry G. Appel, Senior Assistant Attorney General

We work to keep you working

www.PLA.IN.gov
Governor Mitchell E. Daniels, Jr.

Professional Licensing Agency 402 W. Washington St Room W072 Indianapolis, IN 46204 Tel: (317) 2344043 Fax: (317) 233.4236

Cry

October 15, 2012 Ohio Board of Nursing Compliance Unit 17 South High St., Ste. 400 Columbus, OH 43215-7410

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STATEMENT OF CERTIFICATION
I, Elizabeth Kiefner Crawford, Director of the Indiana Board of Nursing, through the Indiana Professional Licensing Agency, being duly sworn upon my oath, depose and say: I certify that the Indiana Professional Licensing Agency is the record-keeping agency for the Indiana Board of Nursing, which is responsible for the licensing of registered and practical nursing licensees in the State of Indiana. As Director, I am the keeper of the records of all administrative proceedings before the Indiana Board of Nursing. I further certify that the attached documents are all official copies of documents related to disciplinary action taken against the Indiana nursing license of Audra Jones R.N. license number 2819239IA.

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Elizabeth Kiefner Crawford, Director Indiana Board of Nursing Indiana Professional Licensing Agency

A %, 00,1

STATE OF INDIANA COUNTY OF MARION

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DAWN FL SHAFFER Marion Count! My Commission Expires August 23, 2014

Elizabeth Kiefner Crawford personally appeared before me, Dawn Shaffer, and acknowledged the foregoing statements as true this 15th day of October, 2012. Dawn Shaffer, Notary Public County of Residence: Marion

s\rvx-Lbe-k

Commission Expires: August 23, 2014

RECEIVED 2012 OCT 18 em 04 RE THE INDIANA STATE

`BO IN THE MATTER OF HE LME MOO ) AUDRA ELIZABETH JONES, LICENSE NO: 28192391A FINDINGS OF FACT, ULTIMATE FINDINGS OF FACT, CONCLUSIONS OF LAW, AND ORDER OF NURSING

of NuRMSTSE NUMBER: 2011 Pat 497F

!LED

OCT 0 2 2012
flcbna Professional Licensing Agency

A hearing was scheduled to be held on September 20, 2012, before the Indiana State Board of Nursing ("Board") in the Auditorium of the Indiana Government Center South, 302 West Washington Street, Indianapolis, Indiana 46204, regarding the Order to Show Cause filed against Andra Elizabeth Jones, R.N. ("Respondent"). The State of Indiana ("Petitioner") was represented by Patricia Gibson, Deputy Attorney General. Respondent failed to appear in person or by counsel. On or about March 22, 2012, an Order to Show Cause hearing was scheduled to be heard. Respondent did not appear in person or by counsel, A Notice of Proposed Default was issued to which Respondent replied. On or about June 27, 2012, the Indiana Professional Licensing Agency ("IPLA") sent notice to Respondent's last reported address informing Respondent of tlie date, time, and place of the hearing scheduled for July 19, 2012, regarding the second Order to Show Cause Bled against Respondent. Petitioner was represented by Patricia Gibson, Deputy Attorney General. Respondent failed to appear in persbn or by counsel for the scheduled Order to Show Cause hearing and a Notice of Proposed Default was issued by the Board on July 19, 2012. A Notice of Proposed Default Order Was sent by U.S. mail to Respondent on or about, August 7, 2012. Respondent did not respond to the Order within the time specified by Indiana law.

The Board, after considering the evidence presented and taking official notice of its file in this matter, by a vote of 5-0-0, finds Respondent to be in DEFAULT. The Board, by another vote of 5-0-0, issues the following Findings of Fact, Ultimate Findings of Fact, Conclusions of Law, and Order: FINDINGS OF FACT 1. Respondent is a Registered Nurse ("RN") in the State of Indiana having been

issued license number 28192391A on July 29, 2010. Respondent's address on file with the Indiana Professional Licensing Agency ("IPLA") is 12128 2nd Avenue, Cincinnati; Ohio 45249. 2. In July 2011, Respondent was convicted for driving under the influence of alcohol

in Ohio. Respondent had a breathalyzer result of 0.2. 2. On or about November 3, 2011, Respondent had a personal appearance before the

Board and agreed to an evaluation by the Indiana State Nurses Assistance Program ("ISNAP"). 3. On or about December 2, 2011, the Board renewed Respondent's Indiana nursing

license on probation. The Terms and Conditions of Respondent's probation required her to be evaluated. by ISNAP and enter into a recovery monitoring agreement ("RMA") if ISNAP determined that one was required. 4. On or about January 6, 2012, Respondent was diagnosed with alcohol abuse.

ISNAP recommended a one (1) year RMA. 5. On or about January 12, 2012, Respondent orally appealed the length of her RMA

Respondent submitted an evaluation by her employer and proof of completion of her criminal probation. Respondent informed ISNAP that she works for an insurance company and was licensed in thirty-tbree (33) states. 6. On or about January 12, 2012, ISNAP agreed to reduce the length of

Respondent's RMA to six (6) months. 2

7.

On or about February 20, 2012, Respondent informed ISNAP she resigned her

employment with the insurance company and no longer needs Indiana Iicensure. 8. into a RMA. 9. During April and May, 2012, Respondent and counsel for Petitioner exchanged On or about February 20, 2012, Respondent informed ISNAP she would not enter

emails concerning her refusal to enter a RMA. Respondent was informed Indiana does not accept the surrender of licenses. 10. On or about May 24, 2012, Respondent informed counsel for Petitioner she would

not enter into an ISNAP RMA as required by her probationary order. CONCLUSIONS OF LAW 1. 2. Respondent's conduct is in violation of hid. Code 25-1-9-4(a)(10). Respondent's conduct is in violation of hid. Code 25-1-9-4(a)(4)(D). ULTIMATE FINDINGS OF FACT Respondent's violation is cause for disciplinary sanctions which may be imposed singly or in combination such as censure, a letter of reprimand, probation, suspension, or revocation and a fine up to the amount of one thousand dollars ($1,000) per violation as detailed in hid. Code 25-1-9-9. ORDER Based upon the above Findings of Fact, the Board issues the following Order: Respondent's Indiana nursing license is hereby placed on INDEFINITE SUSPENSION. 1. Prior to petitioning for reinstatement,Respondent shall contact ISNAP, enter into

a RMA and have six (6) months full and continuous compliance with her RMA.

2.

Respondent shall, within ninety (90) days of the Final Order, pursuant to Ind.

Code 4-644-10(b), pay a FEE of FIVE DOLLARS ($5.00) to be deposited into the Health Records and Personal Identifying Information Protection Trust Fund. This fee shall be paid by check or money order payable to the State of Indiana, and submitted to the following address: Office of the Indiana Attorney General Attn: Katie Thorpe 302 West Washington Street, 5th Floor Indianapolis, IN 46204 3. Respondent shall, within ninety (90) days of the Final Order, pay COSTS in the

amount of One Hundred Eighty Seven Dollars and Fifty Six Cents ($187.56) payable to the Indiana Professional Licensing Agency. The costs, payable by check or money order, should be sent to: Indiana Professional Licensing Agency Attn: Nursing, Group 2 402 West Washington Street, Room W072 Indianapolis, Indiana 46204 4. Respondent shall, within ninety (90) days of the Final Order, pay COSTS in the

amount of WE DOLLARS ($5.00) payable to the Office of the Indiana Attorney General. The costs, payable by check or money order, should be sent to: Office of the Indiana Attorney General Attn: Katie Thorpe 302 West Washington Street, 5th Floor Indianapolis, IN 46204 5. Respondent's violation of this Final Order or any non-compliance with the

statutes or regulations regarding the practice of nursing may result in Petitioner requesting a summary suspension of Respondent's license, an Order to Show Cause as may be issued by the Board, or a new cause of action pursuant to Ind. Code 25-1-9-4, any or all of which could lead to additional sanctions, up to and including a revocation of Respondent's license.

SO ORDERED this N'tlay of October, 2012.

INDIANA STATE BOARD OF NURSING B ces L. Kelly xecutive Director ana Professional Licensing Agency

CERTIFICATE OF SERVICE I certify that a copy of the "Findings of Fact, Ultimate Findings of Fact, Conclusions of T 2W and Order" has been duly served upon: Audra Elizabeth Jones, RN 12128 2nd Avenue Cincinnati, Ohio 45249 Service by U.S. Mail Patricia Gibson Indiana Government Center South, Fifth Floor 302 West Washington Street Indianapolis, Indiana 46204-2770 Service by Email Date Indiana State Board of Nursing Indiana Government Center South 402 West Washington St., Room W072 Indianapolis, IN 46204 Phone: 317-234-2043 Fax: 317-2334236 Email: pla2@pialn.gov
Explanation of Service Methods Personal Service: by delivering a true copy of the aforesaid documents) personally. Service by U.S. Mail: by serving a true copy of the aforesaid document(s) by First Class U.S. Mail, postage prepaid. Service by Email: by sending a true copy of the aforesaid document(s) to the individual's electronic mail address.

BEFORE THE INDIANA STATE BOARD OF NURSING CAUSE NUMBER: 2011 NB 497 IN THE MATTER OF THE LICENSE RENEWAL APPLICATION OF: AUDRA JONES LICENSE NUMBER: 28192391A

FILED
)

DEC 0 2 2011
Indiana Professional Licensing Agency

DECISION ON APPLICATION TO RENEW LICENSE The Indiana State Board of Nursing ("Board") requested that Andra Jones ("Applicant") personally appear before Jerry Burgliduff, a member of the Board, on November 3, 2011, for the purpose of providing information and answering questions concerning her application to renew her license as a nurse. The Applicant appeared in person. Burghduff interviewed the Applicant and made a recommendation concerning the application to the full Board at its meeting on November 17, 2011. The Board, after considering the information presented by the Applicant and reviewing its file in this matter, voted 8 to 0 with 0 abstentions, to issue the following decision: FACTS 1. The Applicant, whose mailing address is 12128 2nd Avenue, Cincinnati, Ohio 45249, submitted an application to the Board to renew her license as a registered nurse. 2. During the application process, Jones revealed that while in Ohio she had been, convicted of operating a vehicle while intoxicated in July 2011. She maintains this is an isolated incident but she will be on criminal probation until August 2012. 3. Jones is willing to be evaluated by the Indiana State Nurses Assistance Program ("ISNAP").

4. The Applicant has demonstrated to the Board that she is able to practice competently and safely in the future if she complies with the probationary terms set out below. 5. The Applicant is in agreement with the Board that her license as a registered nurse be renewed and that the license be placed on probationary status. TERMS AND CONDITIONS Based upon the foregoing, the Board renews the license of the Applicant pursuant to Ixtd. Code 25-1-5-4(g)(5) as follows: I. The Applicant's license as a registered nurse will be renewed on INDEFINITE PROBATION. The Applicant may petition to have the probationary order withdrawn after the successful completion of her criminal probation. 2. The Applicant's practice as a nurse shall be governed by the following TERMS AND CONDITIONS: a) The Applicant must keep the Board apprised of the following information in writing and update it as necessary: 1. The Applicant's current home address, mailing address, e-mail address, and residential telephone number. 2. The Applicant's place of employment, employment telephone number, employment e-mail address, and name of supervisor. b) The Applicant must be evaluated by ISNAP and sign a recovery monitoring agreement with that program if ISNAP concludes that she is a candidate for monitoring. If she signs an agreement she must comply with its terms.

c) The Applicant shall comply with all statutes and rules regulating the practice of nursing as well as the terms of her criminal probation and report any future arrests to the Board. 3. The failure of the Applicant to comply with the terms of this decision may subject her to a show cause hearing and the imposition of further sanctions, including emergency suspension of her license. SO ORDERED, this (/)., day of December, 2011.

INDIANA STATE BOARD OF NURSING

By: F ces L; Kelly xecutive Director diana Professional Licensing Agency

NOTICE OF RICH I TO PETITION FOR REVIEW OF THIS DECISION You may petition for review of this decision under IC 4-21.5-3-7. The petition must be filed with the Indiana State Board of Nursing in writing, identifying the reasons for review and demonstrating,that you have been aggrieved or adversely affected by the Board's decision. The petition for review must be filed no later than eighteen days from the issuance of this decision unless such date is a Saturday, a Sunday, a legal holiday under state statute or a day that the Indiana Professional Licensing Agency's offices are closed during regular business hours in which case the deadline would be the first day which is not a Saturday, a Sunday a legal holiday under state statute or a day that the Indiana Professional Licensing Agency's offices are closed during regular business hours. If your petition for review is timely filed and review granted, you will receive notification of an administrative hearing You or your representative must be present at that hearing. You have the right to be represented by an attorney at your own expense. A deputy attorney general may be present to represent the State of Indiana. As petitioner, you will have the burden of proving that the Board's decision is incorrect. Copies to: Audra Jones 12128 2nd Avenue Cincinnati, Ohio 45249 CERTIFIED MAIL NUMBER: 91 7190 0005 2720 0013 8849 RETURN RECEIPT REQUESTED

Certifi By Virginia

e Copy.
of Nursing

VA BD OF NURSING

COMMONWEALTH of Vi1"\ QINIA

Dianne L. Reynolds-Cane, M.D. Director

Department of Health Professions

Perimeter Center 9960 Mayland Drive, Suite 300 Henrico, Virginia 23233-1463

wirtivv.dhp.Virginia.gov TEL (804) 367- 4400 FAX (804) 527- 4475

October 10, 2012 Audra Elizabeth Jones 12128 Second Avenue Cincinnati, OH 45249 RE: License No.: 0001-225645 Dear Ms. Jones: Pursuant to Section 54.1-2409 of the Code of Virginia (1950), as amended, ("Code"), you are hereby given notice that your license to practice nursing in the Commonwealth of Virginia has been mandatorily suspended by the enclosed Order entered October 10, 2012. You are hereby advised that, pursuant to Section 54.1-2409.1 of the Code, any person who practices a profession or occupation after having their license or certificate to do so suspended shall be guilty of a felony. Please return your license to Jay P. Douglas, Executive Director of the Virginia Board of Nursing, at the above address, immediately upon receipt of this letter. Section 54.1-2409 of the Code further provides that you may apply to the Board of Nursing ("Board") for reinstatement of your license, and shall be entitled to a hearing not later than the next regular meeting of the Board after the expiration of sixty days from .the receipt of such reinstatement application. You have the following rights, among others: to be represented by legal counsel, to have witnesses subpoenaed on your behalf, to present documentary evidence and to cross-examine adverse witnesses. The reinstatement of your license shall require the affirmative vote of three-fourths of the members present of the Board of Nursing. Should you wish to petition the Board of Nursing for reinstatement of your license, contact Jay P. Douglas,. Executive Director, at the above address or (804) 367-4599. Sincerely,
cD.

CERTIFIED MAIL

DUPLICATE COPY
VIA FIRST CLASS MAIL DATE

irz lip 11D

cp ice. Dianne L. ynolds-Cane, M* actor 1.Pt Department of Health Professions rtt

Cr)

Enclosures Case # 147026

Board of Audiology & Speech-Language Pathology-Board of Counseling-Board of Dentistry,- Board of Funeral Directors & Embalmers Board of Long-Term Care Administrators - Board of Medicine - Board of Nursing - Board of Optometry -, Board of Pharmacy Board of Physical Therapy - Board of Psychology - Board of Social Work - Board of Veterinary Medicine Board of Health Professions

VIRGINIA: BEFORE THE DEPARTMENT OF HEALTH PROFESSIONS IN RE: AUDRA. ELIZABETH JONES, R.N. License No.: 0001-225645 ORDER In accordance with Section 54.1-2409 of the Code of Virginia (1950), as amended, ("Code"), I, Dianne L. Reynolds-Cane, M.D., Director of the Virginia Department of Health Professions, received and acted upon evidence that the Iowa State Board of Nursing accepted the voluntary surrender, in lieu of further disciplinary action, from Audra Elizabeth Jones, R.N., of her license to practice nursing in the State of Iowa by a Settlement Agreement and Final Order dated May 16, 2012. A certified copy of the Settlement Agreement and Final Order is attached to this Order and is marked as Commonwealth's Exhibit No. 1. WHEREFORE, by the authority vested in the Director of the Department of Health Professions pursuant to Section 54.1-2409 of the Code, it is hereby ORDERED that the privilege of Audra Elizabeth Jones, R.N., to reactivate her license to practice nursing in the Commonwealth of Virginia be, and hereby is, SUSPENDED. Upon entry of this Order, the license of Andra Elizabeth Jones, R.N., will be recorded as suspended. Should Ms. Jones seek reinstatement of her license pursuant to Section 54.1-2409 of the Code, she shall be responsible for any fees that may be required for the reinstatement and renewal of her license prior to, issuance oilier license to resume practice. Pursuant to Sections 2.2-4023 and 54.1-2400.2 of the Code, the signed original of this Order shall remain in the custody of the Department of Health Professions as a public record and shall be

Mandatory Suspension Order-Audra Elizabeth Jones, R.N.

page 2 of.2 .

made available for public inspection and copying upon request.

Dianne L. Reyn -Cane,MD., Director Delmrftnentof lthProfessions' ENTERED:

/010

Certified True Copy By ,24//0 /-41W ( 1 Vii ii is Board of Nuraing

C MMONWEALTH of VI ligiNIA
Dianne L. Reynolds-Cane, M.b. Director

Department of Health Professions

Perimeter Center 9960 ;Wayland Drive, Suite 300 Henrico, Virginia 23233-1463

www.citip.virginia,gov TEL (504) 367-4400 FAX (804) 527-4475

CERTikICATION OF DUPLICATE RECORDS I, Dianne L. Reynolds-Cane, M.D., Director of the Department of Health Professions, hereby certify that the attached Settlement Agreement and Final Order dated May 16, 2012, regarding Audra Elizabeth Jones, R.N., is a -true copy of the records received from the Iowa State Board of Nursing.

Date: Dianne L. Re ds-Cane, M.D.

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Board of Audiology & Speech-Language Pathology Board of Counseling Board of Dentistry Board of Funeral Directors & Embalmers Board of Long-Term Care Administrators Board of Medicine Board of Nursing Board of Optometry Board of Pharmacy Board of Physical Therapy Board of Psychology Board of Social Work Board of Veterinary Medicine Board of Health Professions

BEFORE THE-BOARD OF NURSING, OF THE STATE OF IOWA IN THE MATTES OF: AIJDRA ELIZABETH JONES 12128 2nd Avenue Cincinnati, OH 45249 Certificate and License No. 126353, RESPONDENT, CASE NO. 12-057 NOTICE OF HEARING, STATEMENT OF CHARGES, SETTLEMENT AGREEMENT AND FINAL ORDER (Combined)

COMES NOW the Iowa Board of Nursing and Audra Elizabeth Jones, Respondent, to enter into this combined Notice of Hearing, Statement of Charges, Settlement Agreement and Final Order in accordance with the provisions of Iowa Code 17A.10(2) and 272C.3(4). NOTICE OF HEARING 1. A hearing in this matter will not beheld, as the Board and Respondent have entered into the following consent agreement in lieu of scheduling a contested case hearing. 2. Respondent was issued license no. 126353, by the Board to engage in the practice of nursing, subject to the laws of the state of Iowa and the rules of the Board.. 3. License no. 126353 is active until June 15, 2013. LEGAL AUTHORITY AND JURISDICTION Jurisdiction. The Board has jurisdiction in this matter pursuant to Iowa Code Chapters 147,152, and 272C. COMMONWEALTH'S EXHIBIT

Lem! Authority.. If any of the allegations against you are founded, the Board has authority to take disciplinary action against you under Iowa Code Chapters 17A, 147, 152, (152E when applicable) 272C and 655 Iowa Administrative Code , Chapter 4. SECTIONS OF STATUTES AND RULES INVOLVED COUNT I The Respondent is charged in violation of Iowa Code 152.10(2rd"(1) for having a license to practicenursing as a registered nurse or licensed practical nurse revoked or suspended, or having other disciplinary action taken by a licensing authority of another state, territory, or country. FACTUAL CIRCUMSTANCES On December 02, 2011, the Respondent's Indiana Nursing license was placed on indefinite probatian for receiving a criminal conviction for Operating While intoxicated. SETTLEMENT AGREEMENT 1. Respondent agrees to immediately relinquish all right, title, and privilege to practice nursing in the state of Iowa by voluntarily surrendering all Iowa nursing licenses. 2. Respondentwillimmediately return the license renewal cardis to the Board office. 3. Respondent may ,not make application for reinstatement of ticensure until, a minimum period of twelve (12) months has elapsed from the date of this order. An application for reinstatement must be made in accordance with the requirements set forth in the board's administrative rules.

12-0,67 A Jones

FINAL ORDER By entering into this combined Notice of Hearing, Statement of Charges, Settlement Agreement and Final Order, Respondent voluntarily waives any rights to a contested case hearing on the allegations contained herein and waives any objections to the terms of this Settlement Agreement. This combined Notice of Hearing, Statement of Charges, Settlement Agreement and Final Order Is voluntarily submitted by Respondent to the Board for consideration. Respondent is fully aware of the right to be represented by counsel in this matter. Respondent understands documents related to discipline are public record and will be made available for inspection and copying in accordance with the requirements of Iowa Code chapter 22 and 272C. Respondent understands the Board is , required by Federal law to report any ad-. verse action to the National Practitioner Data Bank and Healthcare Integrity and Protection Data Bank_

This combined Notice of Hearing, Statement of Charges, Settlement Agreement and Final Order is subject to approval by the Board. If the Board fails, to approve this proposed resolution, this document will have no force or effect to either party. The Board's approval of this combined Notice of Hearing, Statement of Charges, Settlement Agreement and Final Order shall constitute a written decision of the Board and will be filed as resolution of this disciplinary matter

12-057 A Junes

1 Date

-11as4.
Audra Elizabeth Jones Respondent

bah

iz)Y1.1_,4

This combined Notice of Hearing, Statement of ChargeS, Settlement Agreement and Final Order is approved by the Board on this 16th of May, 2012.

Jane Hasek, RN, EdD Chairperson Iowa Board of Nursing Copies to: Department of Justice Licensing & Administrative Law Division Hoover Building; 2nd Floor Des Moines, IA 50319 Audra Elizabeth Jones Respondent

12-057 A Jones

Rick Scott Governor

John H. Armstrong, MD, FACS Surgeon General& Secretary 1=z7 tw

CERTIFICATION
(I> co
menwer

I, Lawanda Bell, Deputy Agency Clerk and Custodian of Records, HEREEngertify th following to be true and correct as on file with the Department of Health -; Attached is a true and correct copy of the Final Order from Case Number 2012-00707 as maintained by the Department of Health. The attached is a regularly received and retained record of the Board of Nursing vs. Audra Elizabeth Jones RN93211979 and is received and retained in the ordinary course of business of the Depatiment of Health.

Deputy Agency Clerk STATE OF FLORIDA COUNTY OF LEON Before me, personally appeared Lawanda Bell whose identity is personally known to me as Deputy Agency Clerk, and who, acknowledges that his/her signature appears above. Sworn and subscribed to, before me, this 7th day of December, 2012.

Note Public-State of Florida

Division of Medical Quality Assurance, Central Records Unit 4052 Bald Cypress Way, Bin C 01 Tallahassee, FL. 32390-3261 Telephone (850) 245-4121 Fax: (850) 414-7819 haFt/www.floridashealth.corn

Final Order No. DOH-11-2163FILED DATE Deport cot

-MQA

STATE OF FLORIDA BOARD OF NURSING DEPARTMENT OF HEALTH, Petitioner,

vs.

Case No. 2012-00707 License No. ; RN 9311979 Respondent. FINAL ORDER This matter appeared before the Board of Nursing at a

EN.4

AUDRA ELIZABETH JONES,

CD

c, C )

rn

duly-noticed public meeting on October 5, 2012 in Tallahassee, Florida, for a hearing not involving disputed issues of material fact pursuant to Sections 120.569 and 120.57 (2 ) , Florida Statutes. Petitioner has filed an Administrative Complaint seeking disciplinary action against the license. A copy of the Administrative Complaint is attached to and made a part of this Final Order. Service of the Administrative Complaint was made upon Respondent by certified mail, return receipt requested. Respondent has not filed an Election of Rights. Petitioner has filed a Motion for Determination of Waiver and Entry of Final Order. Petitioner was represented by William Miller, Assistant: General Counsel, Florida Department of Health. Respondent was not present. FINDINGS OF FACT Since the licensee has not replied to the Administrative Complaint nor contested the factual allegations, the prosecuting

Case NO. 2012-00707

attorney offered the investigative file to prove the facts as alleged. The investigative file was received into evidence and the Bnard finds the uncontested facts adequately support the allegations. Therefore, the Board adopts as its finding of facts the facts set forth in of the Administrative Complaint. CONCLUSIONS OF LAW Based upon the Findings of Fact, the Board concludes the licensee has violated Section, 464.018(1)(b), Florida Statutes. The Board is empowered by Sections 464.018(2) and 456.072(2), Florida Statutes, to impose a penalty against the licensee. Therefore it is ORDERED that: The licensee must pay investigative costs of $190.13 within 12 months from the date of entry of this Order. Payment shall be made to the Board of Nursing and mailed to, DOH-Compliance Management Unit,4052 Bald Cypress Way, Tallahassee, Florida 32399-3276, Attention: Nursing Compliance Officer. Payment must be made by

cashier's check or money order ONLY. Personal checks will NOT be accepted. The license of AUDRA ELIZABETH JONES is suspended and shall remain suspended until such time that she enters into the Intervention Project for Nurses (IPN) and complies with any and all te ms and conditions imposed by IPN. At such time the suspension shall be stayed and remain stayed as long as the licensee participates in the IPN. It is the duty of the licensee to contact the IPN at P.O. Box

Case No. 2012-00707

49130, Jacksonville Beach, Florida 32249-9130, (904) 2'70-1620 within 30 days from the date of entry,of this order. The licensee shall comply with all conditions of the IPN Advocacy Contract or will be in violation of the Board Order. Termination from IPN shall result in the immediate lifting of the stay of suspension. Reinstatement will require compliance with all terms and conditions set forth in this and any previous Board Order, and the licensee's appearance before the Board to demonstrate her present ability to engage in the safe practice of nursing. The Board reserves the right to impose reasonable conditions of reinstatement at the time of appearance before the Board. This Final Order shall become effective upon filing with the .Clerk of the Department of Health. DONE AND ORDERED this (Iday of
. 6)

, 2012.

BOARD OF NURSING

, JR. JOE R. rector for Executi Ann-Lynn Denker, ARNP, CHAIR

NOTICE OF APPEAL RIGHTS Pursuant to Section 120.569, Florida Statutes, the parties are hereby notified that they may appeal this Final Order by filing one

Case No. 2012-00707

copy of a notice of appeal with the clerk of the department and by filing a filing fee and one copy of a notice of appeal with the District Court of Appeal within thirty days of the date this Final Order is

CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by U.S. Mail to AURA ELIZABETH JONES, 12128 2n4 Avenue, Cincinnati, OH 45249 and Intervention Project for Nurses, P.O. Box 49130, JacksonVille Beach, Florida 32240-9130; by interoffice mail to Lee Ann Gustafson, Assistant Attorney General, PL-01, The Capitol, Tallahassee, Florida 32399-1050; and William Miller, Assistant General Counsel, Department of Health, 4052 Bald Cypress Way, Bin # C-65, Tallahassee, Florida 32399-3265 on this ri day of G. . , 2012.

Deputy Agency Clerk

7012 164D 000E1 3561 4220
eallISECM

Case No. 2012-00707

STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, v. AUDRA ELIZABETH JONES, R.N., RESPONDENT. CASE NO. 2012..00707

I
ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Nursing against Respondent, Audra Elizabeth Jones, R.N., and in support thereof alleges: 1. Petitioner is the state department charged with regulating the

practice of nursing pursuant to Section 20 43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 464, Florida Statutes. 2. At all times material to this Administrative Complaint,

Respondent was a licensed registered nurse (R.N.) within the state of Florida, having been issued license number RN 9311979.

3.

Respondents address of record is 12128 2nd Avenue,

Cincinnati, Ohio 45249. 4. On or about Detember 2, 2011, the Indiana State Board of

Nursing entered an order that acted against Respondent's Indiana nursing license in case 2011 NB 497 by placing Respondent's Indiana nursing license on indefinite probation. 5. The Indiana State Board of Nursing is the nursing licensing

authority for the State of Indiana. 6. Section 464.018(1)(b), Florida Statutes (2011), provides that

having a license to practice nursing revoked, suspended, or otherwise acted against, including denial of licensure, by the licensing authority of another state, constitutes grounds for disciplinary action. 7. On or about December 2, 2011, the licensing authority of the

State of Indiana entered an order affecting Respondent's Indiana nursing license as set forth above in paragraph four. B. Based on the foregoing, Respondent violated Section 464.018(10), Florida Statutes (2011), for having a license ix) practice nursing revoked, suspended, or otherwise acted against including denial of licensure, by the licensing authority of another state.

Department of Health v. Audis Elizabeth Jones, RN Case Number 2012-00707

WHEREFORE, the Petitioner respectfully requests that the Board of Nursing enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate.

SIGNED this 04' day of

4kX.\

2012.

)OHN H. ARMSTRONG, MD State Surgeon General and Secretary of Health

FILED
DEPARTMENT OF HEALTH DEPUTY CLERK CLERK Angel Sanders DATE JUL 2 0 2012

301:141 TRUFTT Assistant General Counsel Fla. Bar No. 0084752 Rohde Department of Health Office of the General Counsel 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Telephone: (850) 245-4640 Facsimile; (850). 245-4683 Email: john truitt@doh.statenus

PCP: -4.1tA PCP Members:

Mpurtment of Health v. Audra Elizabeth .lont=s, RN Case Number 201.2.015707 3

NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may Include attorney hours and costs, on the Respondent in addition to arty other discipline imposed.

Department of Heaitit v. Audra Eltabeth }min, RN Case Number 2i112OO7O7

BEFORETHE BOARD OF NURSING QF THE 'STATE OF NORTH DAKOTA STATE OF NORTH DAKOTA and the BOARD OF NURSING. OF- THE STATE OF NORTH DAKOTA, Plaintiff,
VS,

ORDER: OP EMERGENCY SUSPENSION

Audra Jones:, RN, Respondent. DO M'. 6/39/1979 TO: Aedra Jones YOU WILL PLEASE TAKE NOTICE that the Nett Dakota BOard of Nursing, hereinafter referred to as the 'Board,' by and through its EKecutive Director, and pursuant to 02,07,05.2, has SUSPENDED your nursing license ori the following grounds WHEREAS, the Board is duly authorized by law to regulate the profession of nursing pursuant to Chapter 43-12.1: of the. North 'Dakota Century Code, and related statutes, rules, policieS and procedures; and WHEREAS, Audra Jones, hereinafter- referred to as the "Respondent," is: a Registered NurSe posseSSing a license to practice in North Dakota as a Registered Nurse (License, 4R3'6026) WHEREAS, Respondent's profession and the practice thereof is governed by the Boert and WHEREAS, on or about October 2, 2012, the Indiana Board of Nursing issued :an Indefinite Suspension of the Indiana nursing license .ofthe .Rapondent for- refusing to enter into e Indiana State Nurses ikssistante Program recovering Monitoring 'agreement as recrufred.by tidnan;i4der previously issued by the Indiana Board of Nursing;; and 54-

. ..,Aar.1404,40ailaggigAikA405ARAVFACia =sWIL-alReis.akvrAmielauXia.u44.9.6.eaLic.. Litt anaiNgioN62001.4ffagaVie,

Aafic*dagiaoliaaltfororatmagitr414eati51: 144:304.5ASN:FsakvAaiveji .

WHEREAS, on or about October 12, 2012, the Florida Board of Nursing issued -a Suspension of: the Florida nursing license: of the Respondent until she enters into the Florida . Intervention Project. for Nurses and complies with ail terms and conditions thereof; and. WHEREAS, on or about November 3, 2012, a letter was sent to the Respondent by the Board informing' Respondent of the disciplinary action taken against her by' the Florida. and Indiana boards of Nursing and requesting a written response as to why she :was not 'following through with the Florida and Indiana Orders;: however, Respondent failed to respond to the Board; and WHEREAS, on or about November 30; 201.2, a letter wassent tothe Respondent by the Board With a seterid reduest fOr written response; however, ReSpondent again failed to respond' to the Board; and WHEREAS, unsuccessful attempts were also. made by Beard staff to contact the Respondent by email and phone; however, no responSe from. Respondent has been received in the Board office. WHEREAS., the conduct described above is conduct that violates the Nurse: Practices Mt -as found in Section -43-12,1-14, Subsection 2, of the North Dakota Century Codes. in that suan acts constitute having been disciplined by a board of nursing in. another jurisdiction, or. having. had. a license or registration 'to practice nursing or to atstet in the :practice...Of Nrsitv:pr_ to pt*;i0 in another health care oc'cupa'tion or profession otherwise sanctioned; and WHEREAS, given the conduct described above, continued practice as a Regiatere.d. Nurse in North Dakota by Respondent would. constitute a continuing and imminent threat to thepublic welfare; and WHEREAS; in .accordance with N..D..A.C. 54-02-07-05.2., R'espondent's license to practice as a Registered Nurse in the state of North Dakota May be suspended upon notice to . ..
2

pMysiiaciggvalxair4011Eiii.ee...WA;IrAtis4.0mmttpzmiziugmeW _ Mpnassattylagfea,MV,Abra(01311.0141aSitapgagatiacbkArifejailakplikEaSk34a041:6.%P.*...a4;a6A3Z-VveNOHWU+MoRtraregit4ravwejaleiall'

Respondent when continued practice by Respondent as a iiCeriS0d nurse would constitute a continuing and imniinent threat to the public welfare, NOW, THEREFORE, pursuant to the terms_ of N.DA,C. 54.02-07-05.2.: 1. Responderift license it. hereby SUSPENDED, effective upon Written notice. to .

the Respondent. The suspension shall remain in effect until it is retracted, modified., superseded by final disciPlinary action by the Board or upon agreement by' the Board and ReSpondent. If a hearing is riot. requested by Respondent within. twenty (20) days of the notice, SUSpensieh shall becdMe effective as a final order,forsuspension fora Ve"(5) years, without further notice: The emergency suspension shall further coritinuein. until the later of expiration of the time permitted for sp peal' or termination of the appellate process, 2. Respondent shall not Work in any nursing role, including that of a nurse alder

nurse assistant, or medication assistant/aide. to whom nursing intervehtions may be delegated,, duHrIg the period Of her license suspension', 8, 'This distiplinary adtiOri and the other matters 'contained in this Order Will be

.,.,,oported to health care agencies. in 'North DakOta and to. the boards of-nursing Of other states via the Nursys Data Bank of the National council of State Boards of Nursing, as. required by. Nppc Section. a and to data banks as required by federal iaWk PeOtilt1060iil "86 , P

integrity' and lzri'ytedtiOn Data Bani< (HIPDB) and the Mat

All provisions and conditions. of this Order, shall carry over to any license or privilege to practice nursing in North Dakota that Respondent_ snail receive, including pursuant. to any mufti-state. nursing licens.ure. compact with the Board. .5. If Respondent should choose to seek reinstatement of her license at the

,..'clution. of her. suspension, she shall' submit a written' request arid apPlicatiOn for

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aivimke.W.M.12.4.timia;,XAMAKW.taikruaamilig.Itsiii7.3.2.4;A:NaggiUitarsakaWaa-ZItgai*EadatteinaRg404:41WatallsalWagg,f4SAIE402,

reinstatement, and Shall personaity appear before. the Beard. Respondent maintains the burden to prove to the satisfaction of the Board that the conditions that led to the suspension of her license no longer exist or no longer have material bearing on her professional ability, or.both. The Board may order the reinstatement of ResPorident's license to probationary stati:is for a specified period of time, with the license marked "encumbered" with identified specific requirements as determined by the Board; or under other terms and conditions as may be set out by the Board. O. Respondent:must Submit to a criMinal history record check CCIIRCI in ,c

seek reinstatement of her license. For reinstatement purposes, the CHRC no sooner. than sixty (60) days prier to the termination date of the suspension and must be conducted Within sixty (60) days prier to..seekin-g reinstatement of her license, The, CHRG results. must be received in the E3card's office a mit-lin-1w) of thirty (30) days prior to Resporident!S request for reinstatement being presented to the Board. 7. Upon seeking.rehstaternent of her license, Respondent Shall obtain a cher/Agar

dependency evaluation perfonted by a licensed addictiOn dounSeler,Within thirty (30) dare prior to her personal appearance before' the Beard and have Copy of the evalliation.Oent directly to the Board prior to her personal appearante. Such evaluation. Shalt include:. A. B. C, D, E. Dated this. VerifiCatiPh thgthe OVAIL,E.Pter has reyiewed a copy of- this Board. Order, .DiagrioSisand any recommended treatment plan, LiceriSees ability to safely .practice nursing, Recommendations. for additiortal:00000, ,0000tmpr" Any other infcirrhatiOn thereyaluatOr'beifeVektit010. uitirriat reView, of this iti6.tW r. day Of Decernber, 201.2. NORTH DAKOTA BOARD Or NURSING. By:

4
otintarico Kalanak, Ph.D., R: N. Executive Director

Apotovede d 411:4

Bergeso, Special Assists Attorney General ID #05780 919 South 7fil Street, Suite 504, Biernarck, ND 58504 Phone: (701) 328-9783 (701);328,;9785 FaX: ATTORNEY FOR NORTH DAKOTA EOARD: OF NORSING

53ria

.. 1: ^. . NeAvv41,144gx.C.TaugrA..:.q.l.peot.v.V.6916itiarevassig.415. . ,14fig..17,m4.ag-iixv4::11;,.:FZINI:IFIvIvo.,:xeeiai,2;.WifyravOnia.id, eac , 400)Miaw,42k441,aim'Atanalt.iillliMatilbnig4233.6.1.r 4.A, rift

ialTrat4.,

BEFORE THE BOARD OF NURSING OF THE STATE OF NORTH DAKOTA STATE OF NORTH DAKOTA and the BOARD OF NURSING OF THE STATE OF NORTH DAKOTA, AFFIDAVIT OF MAILING'
S

Audra Jones, RN, Respondent. At.: 0Opt1 979 STATE:OF NORTH DAKOTA ) ss COUNTY OF BURLE1GH
141 66:h being -fir-St cluly sworn- deposes, and says: AtrIPrit Is a 0itizen. of -E. the United States,. of legal age, and riot e party nor-interested inthe abtive-entitled Matter,

That upon the oi< `..7.dey of &A/W-4NA 2012, this affiant seyved upon the :patten . hereinafter named .a true and correct copy of the folloWing documents: Order ptEIriPtiric.y $u4pqnt:14pn, Notice of Entry of OrdOr of EmorgenPy .Suspension and this 1411110.v..it ,Of Meiling, by. depositing -the same in the United States tall at :Eisinarck, NOrth Dakota, securely enclosed in a. sealed enVelOpe, With postage duly prepaid, mailed certified, return:, receipt reqUested, end addressed to the following party:, Audra ,torlet. 1.2128 2nd'Averili6 Cincinnati OH 45249 Certificate # INt> kg:Ye6 600-P ? 41 22 ,V6 1 1. That to the best of affiarts knoWledge, information arid belief, such address. as: given above was the actual post Office address of the party intended to be so served: Dated this-. 424 day of

Subscribed, acknowledged and sworn to before methis teA day of dtec''460eer , 2012. ,
4.2A)

,IVLIE A. SCHWAN: !: Rotary Public A Slate 01 tiiiItttirOOtta 4:0pm:tilt-tic* pires, Nt=i.. X); 414

Notar#

wee,p

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must be conducted in accordance with the: North, Dakota Administrative Agencies Practice Act designated as ,Chapter 28-32 of.the North Dakota Century Code. Dated this

g -

day of .

..\le-C

2012.

Brian ergesp Special Assi:Stan Attorney General 11 #05780 919 South 7th Street, Suite. 504, Bismarck, ND 58504: Phone: (701) 328-9783 Fax: (701) 328-9785 ATTORNEY FOR NORTH DAKOTA BOARD OF NURSING

fAi&Walgillailiielearcr=a0,11MSM4sallorawroalw.lvAa'.4441445hoaksiNkfiwzogoGraJANAS;REFJPP.41.WitaizSZWia,..bmti,;Me.ossioa.:^4.1.-Lasaa7-itorauvafties.VgarFthiairwial-lamzeili '

Case #12-00/12123

Ohio Board of Nursing

17 South High Street, Suite 400
'6

www.nursing.ohio.gov
(614) 466-3947

Columbus, Ohio 43215-7410

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

'Christina Marie Jones, L.P.N. 5618 Linton Ave Cleveland, Ohio 44105 Dear Ms. Jones: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or, about April 15, 2011, in Tazewell County (Virginia) Circuit Court Case No. CR11000185-00, you were found guilty of one (1) count of Eluding Police (Elude Law Enforcement Officer), a felony offense, in violation of Section B.46.2-817, Code of Virginia. Section 4723.28(B)(6), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, an act in another jurisdiction that would constitute .a felony or a crime of moral turpitude in Ohio. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, headig i @nursing.ohio.gov.

Christina Marie Jones, L.P.N. Page 2 If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Sincerely, 4r c.) /V. z x Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0604 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 12-002635

Ohio Board of Nursing

17 South High Street, Suite 400

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 (614)466,3947

Jarivary 25, 2013 NOTICE OF OPPORTUNITY FOR HEARING

Adrienne Ann Kamerick, R.N. 1160 Nautilus Place Westerville, Ohio 43082 Dear Ms. Kamerick: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. As set forth in Attachment A, while working as a registered nurse at Mount Carmel St. Ann's Hospital in Columbus, Ohio, regarding Patient #2 you failed to account for the disposition of narcotics you signed out from the scheduled drug record. In addition, regarding Patients #1 through #6, as set forth in Attachment A, you repeatedly failed to administer medication according to physician's orders. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing. care. Section 4723.28(B)(20), ORC, authorizes the Board to discipline a licensee for, in the case of a registered nurse, engaging in activities that exceed the practice of nursing as a registered nurse. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(C), Ohio Administrative Code (OAC), states that a registered nurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged which includes, but is not limited to, the following: (1) Consistent performance of all aspects of nursing care. Rule 4723-403(E), OAC, states that a registered nurse shall, in a timely manner: (1) Implement any order for a client unless the registered nurse believes or should have reason to believe the order is: (a) Inaccurate; (b) Not properly authorized; (c) Not current or valid; (d) Harmful, or potentially harmful to a client; or (e) Contraindicated by other documented information; and (2) Clarify any order for a client when the registered nurse believes or should have reason to believe the order is: (a) Inaccurate; (b) Not properly authorized; (c) Not current or valid; (d) Harmful, or potentially harmful to a client; or (e) Contraindicated by other documented information. Rule 4723-406(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client.

Adrienne Ann Kamerick, R.N. Page 2 Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further infouned that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.phjo.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0277 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 0284 cc: Henry G. Appel, Senior Assistant Attorney General Steven A. Sindell, Esq.

Adrienne Ann Kamerick, R.N. Page 3 ATTACHMENT A PATIENT # Patient #1 Physician Order WITHDRAWAL (Pyxis) Hydromorphone MAR ' Comments

Hydromorphone

Hydromorphone

On 4/1.6/12:

On 4/16/12:

On 4/16/12: a. 0.5 mg given @ 2135

-- Medication given every 19 21 minutes and at lower doses than ordered [19 minutes]

- 1-2 mg IV/IM a. 2 mg @ 2140 (Wasted every 4 hours as 1.5 mg @ 2147) needed b. 2 mg @ 2158 (Wasted 1.5 mg @ 2202) c. 2 mg @ 2218 (Wasted 1.5 mg @ 2226 d. 2 mg @ 2239 (Wasted 1.5 mg @ 2243) Patient #2 Hydromorphone On 4/19/12: - 1-2 mg IV every 4 hours as needed Hydromorphone On 4/19/12: a. 2 mg @ 0010 (Wasted 1.5 mg @ 0017) b. 2 mg @ 0032 (Wasted 1.5 mg @ 0040) c. 2 mg @ 0056 (Wasted 1.5 mg @ 0100 d. 2 mg @ 0121 (Wasted 1.5 mg 0131 - VO from Dr. for e. 2 mg @ 0205 (no lx order of 1 mg waste recorded)

b. 0.5 mg given @ 2154 [21 minutes] c. 0.5 mg given @ 2215 [19 minutes] d. 0.5 mg given @ 2234

Hydromorphone On 4/19/12: a. 0.5 mg given @ 0005

-- Medication given every 23 25 minutes and at lower doses than ordered [23 minutes]

b. 0.5 mg given @ 0028 [23 minutes] c. 0.5 mg given @ 0051 [25 minutes] d. 0.5 mg given @ 0116 e. 1 mg given @ 0202 ** Missing 1 mg of Hydromorphone

Adrienne Ann Kamerick, R.N. Page 4 Patient #3 Hydromorphone On 3/28/12: - 1-2 mg IV every 4 hours as needed Hydromorphone On 3/28/12: a. 2 mg @ 2119 (Wasted 1.5 mg @ 2131) b. 2 mg @ 2157 (Wasted 1.5 mg @ 2201) c. 2 mg @ 2223 (Wasted 1.5 mg @ 2227) d. 2 mg @ 2244 (Wasted 1.5 mg @ 2248) Patient #4 Hydromorphone On 1/31/12: Hydromorphone On 1/31/12: Hydromorphone On 3/28/12: a. 0.5 mg given @ 2118 [34 minutes] b. 0.5 mg given @ 2152 [26 minutes] c. 0.5 mg given @ 2218 [21 minutes] d. 0.5 mg given @ 2239 -- Medication given every 21 - 34 minutes and at lower doses than ordered

Hydromorphone On 1/31/12: a. 0.5 mg given @ 1930

-- Medication given every 23 - 25 minutes and at lower doses than ordered [25 minutes] (Outside 15 minute order) [25 minutes]

-- 1-2 mg IV every a. 2 mg @ 1940 (Wasted 4 hours as needed 1.5 mg @1947 (@1910) b. 2 mg @ 2005 (Wasted -- 0.5 mg IV, may 1.5 mg @ 2012) repeat in 15 minutes, every e. 2 mg @ 2023 (Wasted hour as needed for 1.5 mg @ 2031) breakthrough pain (@1930) d. 2 mg @ 2047 (Wasted 1.5 mg @ 2053) Patient #5 Hydromorphone On 3/30/12: -- 1-2 rng every 2 hours as needed Hydromorphone On 3/30/12:

b. 0.5 mg given @ 1955 c. 0.5 mg given @ 2020

[23 minutes] d. 0.5 mg given at 2043

Hydromorphone On 3/30/12:

-- Medication given every 19 - 21 minutes and at lower doses than ordered [19 minutes]

a. 2 mg @ 1918 (Wasted a. 0.5 mg given @ 1915 1.5 @ 1924) b. 2 mg @ 1939 (Wasted 1.5 mg @ 1945) c. 2 mg @ 1959 (Wasted 1.5 mg @ 2011) b. 0.5 mg given @ 1934 [21 minutes] c. 0.5 mg given @ 1955 [15 minutes]

Adrienne Ann Kamerick, R.N. Page 5 d. 2 mg @ 2019 (Wasted d. 0.5 mg given @ 2010 1.5 mg @ 2023) e. 2 mg @ 2033 (Wasted e. 0.5 mg given @ 2029 1.5 mg @ 2038) f. 2 mg @ 2051 (Wasted f. 0.5 mg given @ 2048 1.5 mg @ 2101

119 minutes]

[19 minutes]

Patient #6

Hydromorphone On 1/23/12: -- 1-2 mg IV every 4 hours as needed

Hydromorphone On 1/23/12: a. 2 mg @ 1925 (Wasted 1.5 mg @ 1931)

Hydromorphone On 1/23/12: a. 0.5 mg given @ 1921

- -- Medication given every 14 - 19 minutes and at lower doses than ordered [14 minutes]

b. 2 mg @ 1940 (Wasted. b. 0.5 mg given @ 1935 1.5 mg @ 1945) c. 2 mg @ 1944 (Wasted 1.5 mg @ 2001) d. 2 mg @ 2013 (Wasted 1.5 mg @ 2030) c. .0.5 mg given @ 1950

[15 minutes]

[19 minutes] d. 0.5 mg given @ 2009

Case 12-005029

Ohio Board of Isitirsing

w ww.nursing.ohio.gov

17 South High Street, Suite 400 4, Columbus, Ohio 43215-7410 (614) 466-3947

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Kelly Michel Kerchief, R.N. 10129 Meadow Glen Drive Independence, Kentucky 41051 Dear Ms. Kerchief: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny or permanently deny your application for renewal/reinstatement of your license to practice nursing as a registered nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about May 15, 2009, you entered into a Consent Agreement (May 2009 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended for a period not less than eighteen (18) months from July 25, 2008 and that such suspension may be stayed after January 25, 2010, subject to reinstatement and probationary terms, conditions, and limitations for a minimum period of three (3) years. Attached to and incorporated within the May 2009 Consent Agreement is a January 16, 2009 Notice of Immediate Suspension and Opportunity for Hearing. Documents are redacted according to Sections 2953.32 and/or 2953.52, ORC. On or about August 13, 2012, the Board received your request for an application to renew/reinstate your license. On or about March 30, 2011, the Kentucky Board of Nursing (Kentucky Board) issued a Notice (March 2011 Kentucky Notice) in which your Kentucky license to practice nursing as a registered nurse was denied reinstatement for a period of at least one (1) year based upon your violations of the October 15, 2009 Agreed Order (2009 Agreed Order) you had entered with the Kentucky Board: A copy of the March 2011 Kentucky Notice, along with the 2009 Agreed Order are attached hereto as Attachment A and incorporated herein. Section 4723 .28(B)(1), ORC, authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction:

Kelly Michel Kerchief Page 2

Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearin' @nursin' .ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny or permanently deny your application for renewal/reinstatement of your license to practice nursing as a registered nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member. Certified Mail Receipt No. 7012 2210 0000 6272 0352 cc: Henry G. Appel, Senior Assistant Attorney General

Board of

11

wviri,v.nursing.ohio.sov

17 South High Street, Suite 400 .4. ColurnbW, Ohio 43215-7410 -0. (614) 466-3947

To Whom It May Concern: You recently requested records regarding Kelly Michel Kerchief, RN. Enclosed are records in response to your request. Information has been redacted, per Sections 2951.041 and 2953.51 et seq. of the Ohio Revised Code. If you have any further questions or concerns, please contact the Compliance Unit Manager or a Supervising Attorney. Thank you. Compliance Unit Ohio Board of Nursing

Case #08-2285

hio Board of Nursing

www.nursing.ohio.go-v

17 South High Street, Suite 400 44. Columbus, Ohio 43215-7410

CONSENT AGREEMENT BETWEEN KELLY MICHEL KERCHIEF, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between KELLY MICHEL KERCHIEF, R.N. (MS. KERCHIEF) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. KERCHIEF voluntarily enters into this Consent Agreement being fully informed of her tights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(8)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, ajudicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee

Kelly Michel Kerchief, R.N. Page 2 for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. B. C. MS. KERCHIEF has been licensed to practice nursing as a registered nurse in the State of Ohio, RN308234, since August 2003. MS. KERCHIEF knowingly and voluntarily admits to the factual and legal allegations set forth in the Notice of Immediate Suspension and Opportunity for Hearing issued to her by the Board on or about January 2009 (January 2009 Notice), a copy of which is attached hereto and incorporated herein. MS. KERCHIEF states that she began experiencing depression in 2004 after the birth of her first child and received treatment from her family physician. In January 2008, MS. KERCHIEF began fertility treatment. In March 2008, MS.. KERCHIEF began experiencing panic attacks. After her miscarriage in May 2008, MS. KERCHIEF states her depression worsened and with its lowest point occurring in July 2008. MS. KERCHIEF explains that on July 24, 2008, she experienced a panic attack at work and self-administered Versed at work. MS. KERCHIEF states she believed self-medication was the only way to stop the panic attack. MS. KERCHIEF placed her license on inactive status on July 25, 2008. MS. KERCHIEF commenced Intensive Outpatient services at Bethesda Drug and Alcohol Center on August 1, 2008. MS. KERCHIEF's assessment completed at Bethesda dated July 30, 2008 indicates that MS. KERCHIEF's diagnosis is Opiate Dependence without physiological dependence, and Alcohol Abuse. MS. KERCHIEF explains that she attended the HOP to address her mental health concerns and prevent any chemical use, not because she was chemically dependent. MS. KERCHIEF completed Bethesda's HOP and still attends TriHealth Community Involvement Program for mental health support. In September of 2008, MS. KERCHIEF began counseling with Ronald A. Sachs, M.D., an addiction psychiatrist. MS. KERCHIEF states that she attends sessions with Dr. Sachs once a month. Dr. Sach's correspondence to the Board, dated March 16, 2009, indicates that MS. KERCHIEF regularly attends his sessions. Dr. Sachs states that "MS. KERCHIEF has no chemical dependency diagnosis. She bas had Depressive Disorder, not otherwise specified and Panic Disorder, which are responding well to treatment at present." MS. KERCHIEF has provided the Board wi

D.

E.

F. G.

H.

Kelly Michel Kerchief, R.N. Page 3

AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. KERCHIEF knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. KERCHIEF's license to practice nursing as a registered nurse shall be SUSPENDED for a period not less than. eighteen (18) months from July 25, 2008, the date she placed her license as inactive. After January 25, 2010, such suspension may be stayed. MS. KERCHIEF shall be subject to the following REINSTATEMENT AND PROBATIONARY terms, conditions, and limitations for a minimum of three years; 1. MS. KERCHIEF shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. M.S. KERCHIEF shall comply with all

2. 3.

MS. KERCHIEF shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. Within six (6) months prior to requesting reinstatement, MS. KERCHIEF agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCH) to conduct a criminal records check of MS. KERCHIEF, including a check of Federal Bureau of Investigation (FBI) records, and request 801 to submit MS. KERCHIEF's criminal records check reports to the Board. MS. KERCHIEF agrees that a request for reinstatement will not be considered by the Board until the completed criminal records check, including the H3I check, has been received by the Board. Within six (6) months of requesting reinstatement, in addition to the requirements of licensure renewal, MS. KERCHIEF shall successfully complete and submit satisfactory documentation of successful completion of the following continuing education: ten (10) hours of Patient Safety; and ten (10) hours of Ethics, all taken after the effective date of this Consent Agreement. MS. KERCHIEF shall not request reinstatement of her license until after January 25, 2010. Prior to requesting reinstatement, MS. KERCHIEF must be in full compliance with this Consent Agreement and must obtain written approval in advance from the Board or its designee.

4.

5.

Psychiatric Evaluation 6. Within three (3) months prior to requeNting reinstatement, MS. KERCHIEF shall, at her own expense, obtain a psychiatric evaluation from a Board approved

Kelly Michel Kerchief, R.N. Page 4 psychiatrist and shall provide the Board with complete documentation of such evaluation. Prior to the evaluation, MS. KERCHIEF shall provide the psychiatrist with a copy of this Consent Agreement, the attached January 2009 Notice; and records from her previous mental health treatment from Dr. Sachs. MS, KERCHIEF shall execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. KERCHIEF's license, and a statement as to whether MS. KERCHIEF is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 7. MS. KERCHIEF shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the psychiatrist until released. Further, MS. KERCHIEF agrees that the Board may use the psychiatrist's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. KERCHIEF's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

Monitoring 8. MS. KERCHIEF shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. KERCHIEF's history. MS. KERCHIEF shall self-administer the prescribed drugs only in the manner prescribed. Upon request of the Board or its designee, and within thirty (30) days of that request, MS. KERCHIEF shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request Upon and after MS. KERCHIEF's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(13), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. KERCHIEF shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. KERCHIEF's history. a. Within thirty (30) days prior to M.S. KERCHIEF initiating drug screening, MS. KERCHla shall provide a copy of this Consent Agreement and the January 2009 Notice to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. KERCHIEF.

9.

Kelly Michel Kerchief, RN. Page 5 b. After initiating drug screening, MS. KERCHIEF shall be under a continuing duty to provide a copy of this Consent Agreement and the January 2009 Notice, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. KERCHIEF shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. Employment Conditions 10. 11. Prior to accepting employment as a nurse, each time with every employer, MS. KERCHIEF shall notify and obtain approval from the Board. MS. KERCHIEF is under a continuing duty to provide a copy of this Consent Agreement with the January 2009 Notice to any new employer prior to accepting employment. MS. KERCHIEF shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis. MS. KERCHIEF shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement and the January 2009 Notice, including the date they were received.

Reporting Requirements 12. 13. MS. KERCHIEF shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. KERCHIEF shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board. MS. KERCHIEF shall submit any and all information that the Board may request regarding his ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. KERCHIEF shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. KERCHIEF shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board.

14.

15.

16.

Kelly Michel Kerchief, R.N. Page 6 17. MS. KERCHIEF shall submit the reports and documentation required by this Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. KERCHIEF shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. KERCHIEF shall inform the Board within five (5) business days, in writing, of any change in address and/or telephone number.

18. 19.

PERMANENT PRACTICE RESTRICTIONS MS. KERCHIEF further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS Unless otherwise approved in advance by the Board or its designee, MS. KERCHIEF shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's-residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. KERCHIEF to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance by the Board or its designee, MS. KERCHIEF shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities; or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. Unless otherwise approved in advance by the Board or its designee, M.S. KERCHIEF shall not work in a nursing position, which would require MS. KERCHIEF to provide direct, hands-on patient care or management or supervision of direct, hands-on patient care to pediatric patients. For the purposes of this Consent Agreement, pediatric patients shall include patients under the age of 18, and between the ages of newly born through age 17. FAILURE TO COMTLY MS. KERCHIEF agrees that her license to practice as a nurse will be automatically suspended if it appears to the Board that MS, KERCHIEF has violated or breached any terms or conditions of the Consent Agreement Following the automatic suspension, the Board shall notify MS. KERCHIEF via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. KERCHIEF' may request a hearing regarding the charges.

Kelly Michel Kerchief, R.N. Page 7 The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. KERCHIEF appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION / MODIFICATION OF TERMS The terms, limitations, and conditions of this Consent Agreement, other than the permanent practice restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. KERCHIEF and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. KERCHIEF has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. KERCHIEF is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. KERCHIEF and review of the reports as required herein. Any period during which MS. KERCHIEF does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS I LIABILITY RELEASE MS. KERCHIEF acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. KERCHIEF waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. KERCHIEF waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Agreement. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies.

Kelly Michel Kerchief, RN. Page 8

EFFECTIVE DATE
MS. KERCHIEF understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

11.11 4 1 001ht

4 capOCI
DATE

LISA KLEMM,. Presiant Ohio Board of Nursing

DATE

Case #08-2285 www.rnirsing.ohio.gay 17 South High Street, Suite 400 .k Columbus, Ohio 43215-7410 (614) 466-3947
. _ .
. .

.hio Board of Nursing

January 16, 2009

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Kelly Michel Kerchief, R.N. 3943 Deer Walk Court Erlanger, Kentucky 41018 Dear Ms. Kerchief: In accordance with Sections 2929.42 andior 3719.12 of the Ohio Revised Code (ORC), the ed at Board has bee Ohio Board

Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719,12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are hereby ordered to surrender your Ohio license to practice nursing as a registered nurse, RN-308234, to the Board within ten (10) days of receipt of this notice.

Kelly Michel Kerchief, R.N. Page 2 You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons:

Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. On or about July 24, 2008, while working as a nurse in the Pediatric Intensive Care Unit (PICU) at Cincinnati's Children's Hospital, you were observed to be incoherent with red eyes and slurred speech. You reportedly fell on the floor after exiting a staff bathroom and had blood on your arm. Subsequently, you admitted to the PICU Clinical Manager that you stole Versed from Patient #1's room and self-administered it as an injection in your arm. The PICU Clinical Manager found that the seal on Patient #1's bottle of Versed (Midazalem) was torn on one side, (Patient #1 is identified on the Patient Key, which is confidential and to be withheld from public disclosure). On or about August 1, 2008, your employment at Cincinnati's Children Hospital was terminated for violation of its drug-free workplace policy. On or about August 5, 2008, you admitted to a Board Investigator that you stole the Versed. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for selfadministering or otherwise taking into the body any dangerous drug, as defined in Section

Kelly Michel Kerchief, R.N. Page 3 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723 28(B)(13), ORC, authorizes the Board to discipline a "licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing_ At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence 'regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215.7410. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

ait-itt.

444.-,,666

Anne Barnett, B.S.N., R.N.C., C.W.S. Supervising Member Certified Mail Receipt No. 7008 2810 0000 5362 7593 cc: Leah O'Carroll, Assistant Attorney General

ATTACHMENT

KENTUCKY BOARD OF NURSING Stei'en L, Beskeur Governor Via Certified Mail March 30, 2011 KELLY MICHEL KILLEBREW KERCHIEF 3943 DEER WALK CT ERLANGER KY 41018 RE:
312 Whittington Parktyny, Suite 300 [Anti xv it le, Kentucky 4(222-5 t 72 Phone (302) 429-3300 (800) 305-2042 Fax (502) 429-3311 -AMW kbn Ity.nov

. certify this to he a true copy of the record(s)

I

Date

on file / %aid c

tie Kentucky

DENIAL OF REINSTATEMENT OF RN LICENSE NO. 1110092 (LAPSED 10131/2010)

You are hereby given official Notice by the Kentucky Board of Nursing that, pursuant to the provisions of KRS 314.091 and Provision #11 of the Agreed Order entered by the Kentucky Board of Nursing on October 15, 2009, your license to practice is immediately DENIED REINSTATEMENT for a period of at least one (1) year, A copy of the Agreed Order is enclosed for your reference, The Board has obtained information indicating violations of the Agreed Order, specifically #8 a), I), m), n), and q), as follows: Documentation from Affinity Online Services (AOS), the drug testing program utilized by the Board, indicates that Ms, Kerchief has failed to contact AOS on a daily basis, as required, on the following dates: February 2 and 7, 2010; March 3, 2010; October 4 - 31, 2010; and November 1 - 30, 2010; December 1 31, 2010; January 1 31, 2011; February 1 28, 2011; and March 1 25, 2011, Documentation from ACS indicates that Ms. Kerchief was randomly selected for drug testing and failed to provide a specimen, as required, on the following dates February 17, 2010; May 3, 2010, July 6, 2010; August 11, 2010; October 5, 8, and 15, 2010; November 30, 2010; December, 17, 23 and 29, 2010; January 21 and 25, 2011; February 22 and 25, 2011; and March 16, 2011.

o Documentation from A08 Indicates a positive drug screen result for morphine (541 ng/ml; cutoff level =.100 ngirril) collected on June 21, 2010.. To date, Ms. Kerchief has failed to provide the Board with written verification from an authorized prescriber for a medication which would explain this positive drug screen result. This written verification was to have been submitted to the Board within five (5) days of the prescription being issued; and

KentitekyUnbridleciSpirit.coin

t11,081711:11.. en SPIRIT

..

A41 1:41.M Oppottunity Employer (WM)

Kelly Michel Killebrew Kerchief Denial of Reinstatement of RN License # 1110092 (LAPSED 10/31/2010) Page 2
a

The Agreed Order required that Ms. Kerchief earn twenty (20) contact hours on the topic of depression by no later than March 30, 2010. To date, Ms, Kerchief has submitted continuing education certificates of completion documenting earning only ten (10) of the required twenty (20) contact hours on the topic of depression.

On October 4, 2010, you submitted a request to surrender your registered nursing license via an electronic mail message. An Agreed Order for voluntary surrender ()flour registered nursing license was prepared and mailed to your address of record on December 2, 2010, To date, you have failed to submit the signed and properly notarized Agreed Order. Pursuant to this Notice, your registered nurse license is DENIED REINSTATEMENT and you are prohibited from engaging in the practice of nursing within the Commonwealth of Kentucky for a period of at least one (1) year. A civil penalty in the amount of six hundred dollars ($600) is imposed. Any continued practice of nursing on your part will be In violation of KRS 314.031(1) which is punishable by criminal sanctions under KRS 314.991.

charlotte F, Beasain, Ed.D., RN, IDEA 'Executive Director Kentucky Board of Nursing cc: Pile (PSS)

38-10-10

KENTUCKY BOARD OF NURSING AGREED ORDER CASE # 2009-1546 IN RE; KELLY M. KILLEBREW KERCHIEF RN LICENSE ft 1110092

The. Kentucky Board of Nursing, hereinafter referred to as the Board, has probable cause to believe that Kelly M. Killebrew Kerchief has violated KRS Chapter 314. Kelly M. Killebrew Kerchief, desiring to avoid a formal administrative hearing, cot= into this Agreed Order with the Board, The Board acknowledges receipt of a mental healtbkhemical dependency evaluation, dated June 25, 2009, from Ronald A. Sachs, M.D with a diagnosis of Depression and Panic Disorder; verification of a diagnosis of opiate dependence and alcohol abuse from Bethesda Drug and Alcohol Center, Cincinnati, Ohio; verification of completion of the Bethesda Alcohol and Drug Intensive Outpatient `freatmct Program, Cincinnati, Ohio in September 2008; and a letter of explanation from Kelly M. KillebreW Kerchief.
z_..,

Kelly M. Killebrew Kerchief, hereinafter referred tt4i1V1s, Iccrchief, grecs and stipulates to the following facts for the limited purpose of this AgmaliOr
f

On January 16, 2009, the Ohip.Boald'oaitirsing ent Ms. Kerchief's Ohio register6d nurse license after sh , diverted the medicatiq*.JOiazalein, for her own us 4 intensive care unitgaIldren's Hospital, Cincinnati '0

diate uspension on July 2472008, she yed in -the pediatric /

,Agreeficent that continued the On May 0;_:4,p, Ohl okt,NT.pfNurAmmtt.51r%:P9psent7 ciVotgliteen (18) months, beginning Tune suspensioot 25, 2o0.8Ara.104,0rreinetkeili6n tatib Prolititi6n for a period of at least three (3) years.' On June 29, 2009, Ms. Kerchief submitted a reinstatement application to the Kentucky Board of Nursing on which she reported the disciplinary action taken by the Ohio Board of Nursing. Ms. Kerchief acknowledges these actions are in violation of KRS 314.091(1): The board shall have the power to reprimand, deny, limit, revoke, probate, or suspend any license or credential to practice nursing issued by the board or applied for in accordance with this chapter or the privilege to practice as a nurse recognized by the board in Accordance with this chapter, or to otherwise discipline a lieensee,,credential holder, privilege holder, or applicant, or to deny admission to the licensure examination, or to require evidence of evaluation and therapy upon proof that the person: has negligently or willfully acted in a manner inconsistent with the practice of nursing; (d) ,(g) lags misused or misappropriated any drugs placed in the custody, of the nurse for administration, or for arse of others; Date

certify this to be e true copy of the record(s) on file with the Kentucky Board all ur,,ing

Kelly M, Killebrew Kerchief Agreed Order , Page 2

(i)

has a license, privilege, or credential to practice as a nurse denied, limited, suspended, probated, revoked, or otherwise disciplined in another jurisdiction on grounds sufficient to cause a license or privilege to be denied, limited, suspended, probated, revoked, or otherwise disciplined in this Commonwealth, including action by another jurisdiction for failure to repay a student loan; and has violated any of the provisions of this chapter,

She has read and reviewed this Agreed Order and has had the opportunity to consult with legal counsel, if desired, She understands and agrees to the following conditions for the limited purpose of this Agreed Order: . By entering into this Agreed Order, she waives the full panoply of rights of hearing and appeal as authorized by statute, regulation, or court decision, These rights include_ the right to be present with counsel, to subpoena witnesses, to confront those against her, and the right to an administrative hearing or appeal on the violation or non-compliance with any of the conditions or provisions of this Order. 2. When this Agreed Order becomes effective, Ms. Kerchiefs nursing license will be reinstated on limited/probated status for a period of at least three (3) years of employment as a registered nurse, or for a period of time concurrent with the probationary period required by the Ohio Board of Nursing. 3. All terms of this Agreed Order will begin immediately upon notification that the Board has entered this Order, 4. The period of limitation/probation will continue until she has been employed as a registered nurse for a period of at least three (3) years, or for a period of -time concurrent with the probationary period required by the Ohio Board of Nursing, and until all terms of this Order are met, 5. Periods of time in which Ms, Kerchief is not employed as a nurse will be excluded from the computation of probationary time, 6. Employment in fields other than nursing or a period of unemployment does not relieve her of compliance with all other terms and conditions of this Order, 7. If she has not obtained employment as a nurse within one (I) year of the date of the entry er of this ordthe Board may consider the matter for re-evaluation or amendment of this Order, A report form will he made available for this purpose, Ms, Kerchief agrees to abide by the Board-directed determination.

Kelly M, Killebrew Kerchief Agreed Order Page 3 8. While on limitation/probation; a) she agrees to maintain a current nursing license in Kentucky or another jurisdiction while under the terms of this Order; and acknowledges that the inability to obtain a license or privilege to practice in another jurisdiction may subject her to additional disciplinary action; b) she agrees not to practice nursing in any other state which is a party state to the Nurse Licensure Compact without prior written authorization by the Board and the nursing regulatory authority in the party state in which she wishes to practice; c) she may not be employed in a nursing position that requires her to provide direct patient care in the following settings; nurse registry, temporary nurse employment agency, or home health care; d) she may Trot be scheduled to work more than eighty-eight (88) hours per two-week period, The nursing position may he a hill-time or a part-time position but must require her to work at least thirty-two (32) hours per month; e) she will provide a complete copy of this Order to all potential nursing employers including, but not limited to, nursing recruiters or human resources staff during the interview process; f) she will provide a complete copy of this Order to her immediate nursing manager and will have the manager acknowledge to Board staff irk writing that she has provided them a copy of this Order within fourteen (14) days, she will have the nursing manager discuss the terms of this Order with Board staff, within fourteen (14) days of employment. Ms. Kerchief will notify Board staff in writing if there is a change of nursing managers; g) she will provide a complete copy of this Order immediately to the program of nursing administration, if enrolled in such, and will have the program_ acknowledge to Board stuff in writing that she has provided the school with a complete copy of the Order; h) during the entire period of practice on limited/probated status, she may not be employed in a nursing position that requires her to provide direct pediatric patient care; i) during the first two (2) years of practice, on limitation/probation, she may not be employed in a managerial or supervisory position;

Kelly M, Killebrew Kerchief Agreed Order Page 4

j) she will have written reports submitted as determined by Board staff by her nursing employer(s). Report forms will be made available for this purpose. The employer will verify.Ms. Kerchief's compliance with each practice limitation on each report; k) she will have written reports submitted as determined by Board staff by her therapeutic counselor(s) or primary therapist, until documented release from counseling; 1) an employer report of substantiated unsafe nursing practice, noncompliance with any of the limitations placed on her practice, or evidence of substance abuse; or a counselor's or primary therapist's report of noncompliance with the therapeutic plan of care constitutes evidence of a violation of the terms of this Order; m) she will submit random body fluid samples for drug/alcohol testing utilizing the drug screen program designated by the Board and as requested by her employer(s),.Board staff; counselor(s), or therapist(s). She will comply with all requirements of the drug screen program concerning random alcohol and drug testing. 'AU testing will be at Ms. Kerchief's expense. A 0(2/MS (gas chromatographylmass spectrometry) or LC/MS (liquid chromatography/mass spectrometry) confirmed drug screen indicating the use of alcohol or any unprescribed mood-alleting substance constitutes evidence of violation of the terms of this Order; n) she will remain free of alcohol and all mood-altering substances, including over-thecounter medications containing alcohol or mood-altering substances. She must obtain from the prescribing practitioner written verification of any prescription medication and submit to Board staff within five (5) days if there is a continued need for the medication on a monthly basis. Report forms will be made available for this purpose. A consultation with an advanced registered nurse practitioner who specializes in chemical dependency, a physician who specializes in chemical dependency, or a physician addictionologist may be required; o) she will submit a list of the health practitioners who are providing health care to her and who are prescribing any medication for her use; p) she will meet with Board staff in the Kentucky Board of Nursing office or at a designated location as requested. The Board staff will determine the frequency of the meetings and Ms. Kerchief will abide by that determination; q) she will provide evidence. df suceessful completion of at least twenty (20) contact hours on depression by March 30, 2010. The twenty (20) contact hours are to be in addition to the continuing education requirement for reinstatement or renewal of the nursing license;

Kelly M. Killebrew Kerchief Agreed Order Page 5

r) she will pay a civil penalty of one thousand eight hundred dollars ($1800) to the Board by the end of the probationary period; s) she will notify Board staff in writing of any change of name, address, nursing employment, termination, or disciplinary action as a nurse in another jurisdiction within fifteen (15) days of the event; and t) she will notify Board staff in writing of any criminal arrest, charge,, indictment, or conviction within fifteen (15) days of the event, 9. Submission of fraudulent documents or reports; misrepresentation of facts relating to the terms and conditions of this Order; or failure or inability to comply with any requirement of this Order will constitute violation of the Order. 10. Ms. Kerchief agrees and acknowledges that she may make a written request for voluntary suurender of the nursing license during the period of time she is under the terms of the Order, indicating that she is unable to comply with the terms of the Order. Any written request for voluntary surrender will subject Ms. Kerchief to additional disciplinary action pursuant to the terms of this Order, 11, M.S. Kerchief agrees and acknowledges that her failure or inability to comply with any of the . conditions and provisions of this Agreed Order, will result in. immediate suspension or voluntary surrender if applicable, of the nursing license or denial of reinstatement of a lapsed, invalidated, or expired license, with notification by mail. The suspension, voluntary surrender, or denial of reinstatement will begin on the date of the notification letter and will continue for a period of at least one (1) year, Implementation of the suspension, voluntary surrender, or denied reinstatement will result in an additional civil penalty of six hundred dollars ($600). Reinstatement of the nursing license after such a suspension, voluntary surrender, or denial of reinstatement will be in accordance with the Board's Guidelines for Reinstatement, that may include but not be limited to the terms and conditions as set out in this Order. 12, Removal of the nursing license from limitation/probation will depend on compliance with all terms stated in this Order. If all terms are met, and if she has not committed any act during the limited/probated period that would be grounds for disciplinary action pursuant to KRS Chapter 314, no hearing wilt be required for removal of the nursing license from limitation/probation. 13, This Agreed Order, when signed by Ms. Kerchief and an authorized agent for the Kentucky Board of Nursing, shall be public information and can be disseminated aceording to the

Kelly M, Killebrew Kerchief Agreed Order Page 6

regulations of the Board, the Kentucky Open Records Act, and any other state or federal law as required. 14. All provisions and conditions of this Order shall carry over to any license' or privilege to practice nursing in Kentucky that she receives, including pursuant to any multi-state nursing licensure compact with the Board, 15, This Agreed Order shall be effective and binding immediately on Ms, Kerchief and the Kentucky Board of Nursing when signed by both parties,

Subscribed and Sworn to eamitle this by Kelly M. Killebrew Kerchief:

2,

Notary Public SEAL

D.Tywa,tiv\., t(0, State of eo+-ux_k My Commission expires 1/10/0 12_

Kelly M. Killebrew Kerala Agreed Order . Page 7

,,F-IARf OTTE FAVASON, Bd.D., RN, NBA EXECUTIVE DIRECTOR KENTUCKY BOARD OF NURSING (BOARD SEAL)

Agreed to and entered by the Board on,

, 2009

Case #12-002188

Ohio Board of Nursing

January 25, 2012

www.nursing.ohio.gov

17 South High Street, Suite 400 e Columbus, Ohio 43215-7410 (614) 466-3947

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Cassandra F. Lahetta, L.P.N. 14520 Garfield Road Wakeman, Ohio /11889 Dear Ms. Lahetta: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about November 16, 2012, in Lorain County Court of Common Pleas Case Number 12CR085377, you pled guilty to one (1) count of Theft to wit: a dangerous drug, a felony of the fourth degree, in violation of Section 2913 .02(A)(1), ORC, and were found eligible for Intervention in Lieu of Conviction. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Theft to wit: a dangerous drug, a felony of the fourth degree, in violation of Section 2913.02(A)(1), ORC, constitutes a "felony drug abuse offense" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-131322, IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(B), ORC.

Cassandra F. Lahetta, L.P.N. Page 2 You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about November 16, 2012, in Lorain County Court of Common Pleas Case Number 12CR085377, you pled guilty to one (1) count of Theft to wit: a dangerous drug, a felony of the fourth degree, in violation of Section 2913.02(A)(1), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred in or about December 2011, and involve you obtaining or exerting control over a dangerous drug without the consent of the owner or person authorized to give consent. Section 4723 .28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. On or about June 1, 2012, you met with a Board Compliance Agent. You admitted to diverting a card of Oxycodone from Center Ridge Health Campus in North Ridgeville, Ohio, where you worked as a nurse.

Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or

Cassandra F. Lahetta, L.P.N. Page 3 contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, ,2( .4z, Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0857 cc: Henry G. Appel, Senior Assistant Attorney General A'. A/

Case# 12-006135

Ohio Board of- Nursing

January 25, 2013

www.nursing.ohlogOv (614) 466-394.7 17 South Hiah Street, Suite 400 4. Columbus, Ohio 43215-7410

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

James Redfern Laycoek, R.N. 865 B. North Point Drive Akron, Ohio '11313 Dear Mr. Laycock: You are hereby notified that, on or about July 30, 2010, you entered into a Consent Agreement (July 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed, subject to probationary terms, conditions, and limitations until at least July 1, 2013. Attached to and incorporated within the July 2010 Consent Agreement is a September 25, 2009 Notice of Opportunity for Hearing. Documents are redacted according to Section 2953.52, ORC. A. Item 1. of the July 2010 Consent Agreement states, "MR. LAYCOCK shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 7. of the July 2010 Consent Agreement states, "MR. LAYCOCK shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to him by another so authorized by law who has dull knowledge of MR. LAYCOCK's history. MR. LAYCOCK shall self-administer the prescribed drugs only in the manner prescribed." Item 12. of the July 2010 Consent Agreement states, "Beginning within sixty (60) days of the effective date of the Consent Agreement and continuing throughout the probationary period, MR. LAYCOCK shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MR. LAYCOCK's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process.

James Redfern Laycock, R.N. Page 2 The specimens submitted by MR. LAYCOCK shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. LAYCOCK's history." Despite these provisions, on or about September 13, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, tested positive for Cannabinoid (Marijuana metabolite). In an October 11, 2012 statement you provided to the Board, you admitted that " . . . a friend offered to bring over some marijuana and share it with me . . . " Furthermore, on or about the dates set forth below, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis: November 25, 2010; January 1, 2011; March 27, 2011; June 19, 2011; July 24, 2011; August 2, 2011; September 18, 2011; October 20-24, 2012. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: October 24, 2012. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the July 2010 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 7. and 12. of the July 2010 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-286561, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about July 30, 2010, you entered into a Consent Agreement (July 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject'to probationary terms, conditions, and limitations until at least

James Redfern Laycock, R.N. Page 3 July 1, 2013. Attached to and incorporated within the July 2010 Consent Agreement is a September 25, 2009 Notice of Opportunity for Hearing. Documents are redacted according to Section 2953.52, ORC. 2. Item 1. of the July 2010 Consent Agreement states, "MR. LAYCOCK shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 472328(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 7. of the July 2010 Consent Agreement states, "MR. LAYCOCK shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to him by another so authorized by law who has dull knowledge of MR. LAYCOCK's history. MR. LAYCOCK shall self-administer the prescribed drugs only in the manner prescribed." Item 12. of the July 2010 Consent Agreement states, "Beginning within sixty (60) days of the effective date of the Consent Agreement and continuing throughout the probationary period, MR. LAYCOCK shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MR. LAYCOCK's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR. LAYCOCK shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. LAYCOCK's history." Despite these provisions, on or about September 13, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, tested positive for Cannabinoid (Marijuana metabolite). In an October 11, 2012 statement you provided to the Board, you admitted that " . a friend offered to bring over some marijuana and share it with me . . " Furthermore, on or about the dates set forth below, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis: November 25, 2010; January 1, 2011; March 27, 2011; June 19, 2011; July 24, 2011; August 2, 2011; September 18, 2011; October 20-24, 2012. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: October 24, 2012. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the

James Redfern Laycock, R.N. Page 4 Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing@pursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1014 cc: Henry G. Appel, Senior Assistant Attorney General

Ohio Board of Nursing vww.nui,si ng.ohio.gov

17 South High Street. Suile 400 a Columbus, Ohio 43215-74 10 9 (6 141 466-1947

To Whom It May Concern:

You recently requested records regarding James Redfern haycock, R.N. # 286561. Enclosed are records in response to your. request. Information has been redacted, per Section' 295152 of the Ohio Revised Code. If you :have any further questions or concerns, please contact the Compliance Unit Manager or a Supervising Attorney,

Thank you, Compliance Unit Ohio Board of Nursing

Case 08-1439

Ohio Board of Nursing www,ursing.ohio.gov

17 South High Street_ Suite 400 4. Columbus,-Ohio 43215-7410 a (614) 466-3947

CONSENT AGREEMENT BETWEEN JAMES REDFERN LAYCOCK, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and. between JAMES REDFERN LAYCOCK, R.N. (MR. LAYCOCK) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MR. LAYCOCK voluntarily enters into this Consent Agreement being fully informed of his rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation, Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. MR, LAYCOCK has been licensed to practice nursing as a registered nurse in the State of Ohio, RN-28656I, since 1999. MR. LAYCOC1C knowingly and voluntarily admits to the factual and legal allegations set forth in the Notice Opportunity for

B.

C.

James Redfern Laycock, R.N. Page 2 Hearing issued to his by the Board on or about September 25, 2009 (September 2009 Notice), a copy of which is attached hereto and ineor pot ated herein

.67,k174r-WiUr .

F.

MR. LAYCOCK states that he is seeking employment with Accessible Home Health Cate of Alcion (Accessible Home. Health). MR. LAYCOCK has provided the Board with a correspondence from Accessible Home Health stating that it is aware _of the facts underlying the September 2009 Notice Further Accessible Hon-le Health states that it . remains willing to employ MR. LAYCOCK as a home care registered nurse and kvii) provide periodic peiformance updates as may be required by the Board. AGREED CONDITIONS.

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MR, LAYCOCK knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MR. LAYCOCK's license to practice nursing as a registered nurse shall be stispended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY [elms, conditions, and limitations until at least July 1, 2013: MR. LAYCOCK shall obey all federal, state, and local laws, and all laws and rules governing the practice of musing in Ohio 2. MR. LAYCOCK shall appear in person I'm interviews before the full Board or its designated representative as iequested by the Board or its designee.

James Redfern 'Aycock, R N. Page 3

MR. LAYCOCK shall, in addition to the requirements of tiCennile renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education taken subsequent to the effective date of this Consent Agreement: twelve. (12) hours of Substance Abuse. 4.. MR. LAYCOCK agrees that he will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MR. LAYCOCK, including a check of Federal Bureau of Investigation (FBI) records, and shall request BOB to submit MR. LAYCOCK's criminal records check reports to the Board. MR. LAYCOCK's completed criminal records check, including the FBI check, must be received by the Board within six (6) months following the effective date of the Consent Agreement.

Restricted Employment 5. MR. LAYCOCK's employment as a registered nurse is RESTRICTED to working as a nurse at ACCESSIBLE HOME HEALTH CARE OF AKRON, Akron, Ohio for a rnirrirrrtanr period of six (6) months. After the minimum period of six (6) months, MR. LAYCOCK may request modification of this employment testriction, in writing, by the Board or its designee, as long as MR. LAYCOCK is in full compliance with this Agreement. The Board may, as a condition of employment approval, impose additional monitoring terms, including but not limited to, a refresher course or an extensive orientation, psychiatric evaluation, and licensure restrictions. Such terms shall be set forth in an addendum to this Consent Agreement.

6.

Monitoring of Rehabilitation and Treatment 7. MR. LAYCOCK shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or diSpensed to him by another so authorized by law who has full knowledge of MR. LA.YCOCK's history. MR, LAYCOCK shall self-administer the prescribed drugs only in the manner prescribed. MR. LAYCOCK shall abstain completely from the use of alcohol. Within three (3) months of the effective date of this Consent Agreement, MR. LAYCOCK shall, at his own expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete

8. 9.

James Redfern Laycock, R.N. Page 4 documentation of this evaluation. Prior to the evaluation, MR. LAYCOCK shall provide the chemical dependency professional with a copy of this Consent Agreement and the September 2009 Notice. Further, MR. LAYCOCK shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate The chemical dependency and necessary for the evaluation professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions to be placed on MR. LAYCOCK's license to practice, and stating whether M.R. LAYCOCK is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 10. 11R. LAYCOCK shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MR. LAYCOCK agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MR. LAYCOCK's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent. Agreement. Beginning within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MR. LAYCOCK shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board; or a Twelve Step program, and MR. LAYCOCK shall provide satisfactory documentation of such attendance to the Board on a quarterly basis thereafter. Beginning within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MR. LAYCOCK shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request Upon and after MR. LAYCOCK's initiation of .drug screening, refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR. LAYCOCK shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge. of MR, LAYCOCK's history

11.

James Redfern Laycock, Page 5

a, Within thirty (30) days prior to MR. LAYCOCK initiating drug screening, MR. LAYCOCK shall provide a copy of this Consent Agreement and the attached September 2009 Notice to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MR. LAYCOCK. b. After initiating drug screening, M.R. LAYCOCK shall be under a continuing duty to provide a copy of this Consent Agreement and the attached September 2009 Notice, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MR. LAYCOCK shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment Employment Conditions 13 Prior to accepting employment as a nurse, each time and with every employer, MR. LAYCOCK shall notify the Board, in writing. MR. LAYCOCK, within fifteen (15) days of the effective date of the Consent Agreement, shall provide his employer, the ACCESSIBLE HOME HEALTH CARE OF AKRON, Akron, Ohio, with a copy of this Consent Agreement and the September 2009 Notice. Further, MR. LAYCOCK is under a continuing duty to provide a copy of this Consent Agreement and the September 2009 Notice to any new employer prior to accepting employment. MR. LAYCOCK shall have his employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning September 1, 2010. MR. LAYCOCK shall have his employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement and the September 2009 Notice, including the date they were received.

14.

James Redfern 'Aycock, R.N. Page 6

Reporting Requirements of MR. LA' COCK 15. MR. LAYCOCK shall report.lo the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MR. LAYCOCK shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MR. LAYCOCK shall submit any and all information that the Board may request regarding his ability to practice according to acceptable and prevailing standards of safe nursing practice. MR. LAYCOCK shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers MR. LAYCOCK shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MR. LAYCOCK shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MR. LAYCOCK shall verify that the reports and documentation ,required by this Consent Agreement are received in the Board office. M.R. LAYCOCK shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number

16.

17.

t8.

19.

20.

21.

22.

Nursing Refresher Course Upon the request of the Board or its designee, MR. LAYCOCK shall complete and submit satisfactory documentation of completion of nurse refresher courses or an extensive orientation to be approved in advance by the Board, or its designee.

James Redfern haycock, R,N Page 7

Terriporary Practice Restrictions MR. LAYCOCK further knowingly and voluntarily agrees with the Board to . the following TEMPORARY LICENSURE RESTRICTIONS for a minimum of three (3) years in which MR. LAYCOCK is working in a position that requires a nursing license. At any time after the. three year period previously described, MR. LAYCOCK may submit a written request to the Board to have this restriction re-evaluated, Unless otherwise approved in advance by the Board or its designee, MR. LAYCOCK shall not practice nursing as a registered nurse (I) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) as a nurse for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MR. LAYCOCK to provide nursing services for fees, compensation, or other consideration or as a volunteer, with the EXCEPTION of his position at ACCESSIBLE HOME HEALTH CARE OF AKRON, Akron, Ohio Unless otherwise approved in advance by the Board or its designee, MR. LAYCOCK shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE, TO COMPLY MR. LAYCOCK agrees that his license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MR. LAYCOCK has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, .the Board shall notify MR. LAYCOCK via certified mail of the specific nature of the charges and automatic suspension of his license. Upon receipt of this notice, MR. LAYCOCK may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MR. LAYCOCK appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement.

James Redfern Laycock, R. N. Page 8

DURATJONIALOMFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MR. LAYCOCK and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MR. LAYCOCK has complied with all aspects of this Consent Agreement; and (2) the Board determines that MR, LAYCOCK is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MR. LAYCOCK and review of the reports as required herein. Any period during which MR. LAYCOCK does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MR. LAYCOCK acknowledges that he has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MR. LAYCOCK waives all of his rights under Chapter 119. ORC, as they relate to matters that are the subject of this Consent Agreement. MR. LAYCOCK waives any and all claims or causes of action he may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC.

Janes Redfern Laycock, Page 9

EFFECTIVE DATE MR. LAYCOCK understands that this Consent AgJeernent is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

DATE

BERTHA LOVEL Ch, President Ohio Board of Nursing

DATE

lo

4")

Case //08-1439

Ohio Board of Nursing

17 Staub High Street, Suite 400

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 0, (614) 466-3947

September 25,2009

NOTICE OF OPPORTUNITY FOR HEARING

James Redfern Laycock, R.N 994 Blossom Drive Akron, Ohio, 44319 Dear Mr. L.aycock: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723 28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons:

Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter If you wish to request such hearing, the request must be made in writing and must be r eceived in the Board office within thirty (30) days of the time of mailing of this notice. You rue hereby further informed that, if you timely request a heating, you are entitled to appear at such hearing in person, by your attorney, or, by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in

James RecIfetn Laycock, R,N. Page 2 writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail of deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Fergustm-Ramos, Compliance Unit

Manager, Ohio Board of Nursing, 17 South High Street, Suite 40D, Columbus OH 432157410, or hearing@nursing,ohio.gby.
If the Board fails to receive a request for a heating within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; eprimand or otherwise discipline you; or impose a fine of not more than five hunched dollars ($500.00) per violation, Sincerely,

Z1E4-

4z4.7.4266

Anne Barnett, RN, BSN, CWS Super vising Board Member

Certified Mail Receipt No. 7009 0820 0002 3386 5038 cc: Melissa Wilburn, Assistant Attorney General

Case #12-003127

Ohio Board of Ncirsing

January 25, 2013

www. nursing. ohio. gov

(614) 466-3947

17 South High Street, Suite 400 .# Columbus, Ohio 43215-741.0

NOTICE OF OPPORTUNITY FOR HEARING

Andrea D. Lively 630 Wisteria Drive Troy, Ohio 45373 Dear Ms. Lively: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse, your certificate of authority to practice as a certified nurse practitioner, and your certificate, to prescribe drugs and therapeutic devices; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about October 25, 2012, in Greene County Court of Common Pleas Case No. 2012 CR 0248, you pled guilty to, and were convicted of, one (1) count of Forgery, in violation of Section 2913.31, ORC, being a felony of the fifth degree. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 472328 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 432157410, or to the email address, hearing@nursing.ohio.gov.

Andrea D. Lively Page 2

If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse, your certificate of authority to practice as a certified nurse practitioner, and your certificate to prescribe drugs and therapeutic devices; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely;

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0536 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 0543

cc:

Henry G. Appel, Senior Assistant Attorney General Kenneth D. Myers, Esq.

Case #12-005912

Ohio Board of Nursing

17 South High Street, Suite 400

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 0 (614) 466-3947

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Tiffiny Erin Lively (fka "Tiffiny Erin Campbell") 3199 Osborn Rd Newark, Ohio 43055 Dear Ms. Lively: On or about September 21, 2012, the Ohio Board of Nursing (Board) issued an Adjudication Order that suspended your license to practice nursing as a licensed practical nurse and denied your application for licensure by examination to practice as a registered nurse in Ohio. Now, in accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Board proposes under the authority of Section 4723.28, ORC, to deny or permanently deny your application for licensure by examination to practice as a registered nurse; permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about September 28, 2012, the Ohio Department of Health, in Case No. 11-A-03726, issued a Journal Entry (Finding of Abuse), in regard to your Nurse Aide Registry Number. Section 4723.28(B)(1), ORC, authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a heating, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance

Tiffiny Erin Lively (flea "Tiffiny Erin Campbell") Page 2 Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny or permanently deny your application for licensure by examination to practice as a registered nurse, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0758 cc: Henry G. Appel, Senior Assistant Attorney General

Case 12-005992

Ohio .Board of Nursing

17 South High Street, Suite 400

www.nursing.ohi.o.gov
(614) 466-3947

Columbus, Ohio 43215-7410

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Troy Preston Lowe, L.P.N. 100 Lincoln Circle Marietta, Ohio 45750 And 48590 Sunfish Creek Road Clarington, Ohio 43915 Dear Mr. Lowe: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about March 17, 2006, you entered into a Consent Agreement (March 2006 Consent Agreement) with the Ohio Board of Nursing (Board), in which you agreed with the Board that your license would be suspended for an indefinite period of time but for not less than two (2) years and that upon meeting the requirements for reinstatement, your license to practice nursing as a licensed practical nurse in the State of Ohio would be reinstated and suspended indefinitely and that, such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. On or about October 12, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator that tested positive for Oxycodone/Oxymorphone. You did not have a legal, valid prescription for Oxycodone/Oxymorphone. Section 4723.28 (B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual, or selfadministering or otherwise taking into the body any drug that is a schedule I controlled substance.

Troy Preston Lowe Page 2 Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 472328, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0390 Second Address Certified Mail Receipt No. 7012 2210 0000 6270 6769 cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-005996

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 9 Columbus, Ohio 43215-7410 9 (614) 466-3947

January 25,2013

NOTICE OF OPPORTUNITY FOR HEARING

Jennifer Lynn Lupo (fka "Jennifer Hemrick"), R.N. RR 1 Box 865 Sugar Grove, Ohio 43155 Dear Ms: Lupo.: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny or permanently deny your request to reactivate or reinstate a license to practice nursing in Ohio as a registered nurse; revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. Your license to practice as a registered nursing in Ohio lapsed September 1, 2001. On or about October 15, 2012, you submitted a Request for Application to reactivate or reinstate your license to practice nursing as a registered nurse to the Board. a) On or about August 9, 2002, the Missouri State Board of Nursing issued a Findings of Fact, Conclusions of Law and Order in which your license to practice nursing as a registered professional nurse was revoked (Missouri Board 2002 Order). A certified copy of the Missouri Board 2002 Order, along with the Attachments are attached and incorporated herein. Section 4723.28(B)(1), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you.

Jennifer Lynn Lupo (fka "Jennifer Hemrick"), R.N. Page 2

Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 432157410, or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, to deny or permanently deny your request to reactivate or reinstate a license to practice nursing in Ohio as a registered nurse; revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, KR/ e_iv.,,f? Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0734 cc: Henry G. Appel, Senior Assistant Attorney General

f4W :
r61.

RECEI VE D
2012 OCT 31 PM 1: Oil

Jeremiah W. (Jay) Nixon Governor State of Missouri

Jane A. Rackers, Division DirectB OARD OF NUR S uL DIVISION OF PROFESSIONAL REGISTRATIONOW

1144

Department of Insurance Financial Institutions nd Professional Registration John M. Huff, Director Lori Scheidt Executive Director Telephone: 573-751-0681

Web Site: http://pr.mo.go-vinursing.asp STATE BOARD OF NURSING P.O. BOX 656, Jefferson City, MO 65102-0656 800-735-2966 TTY Relay Missouri 600-735-2466 Voice Relay Missouri

CERTIFICATION 1, Lori Scheidt, BS, ExectitiVe Director, of the Missouri State Board of Nursing certify that the document(s) which is/are attached is/are true and correct copy(s) of the information contained in the file of: Jennifer Lupo; RN 145968

BOARD SEAL

Missouri State Board of Nursing Lori Scheidt, MBA-HCM Executive Director. October 29, 2012

AL lila

DOCUMENTS ATTACHED

1Transcript
Examination Scores DAgreements

[ljbsciplinary Documents
IJOther

BEFORE THE STATE BOARD OF NURSE N lY3 l IV ID04 I RCt 'E PME STATE OF MISSOURI BOARD OF NURSING 1-110 MISSOURI STATE BOARD OF NURSING Petitioner; v. , JENNIFER HEIVIRICK Respondent. FINDINGS OF FACT. CONCLUSIONS OF-LAW AND ORDER Statement of the Case This matter appears before the Missouri State Board of Nursing pursuant to a. Complaintlalleging violation of the terms of a disciplinary order. Pursuant to a Notice of Hearing issued by the Missouri State Board ofNursing, a hearing was held on June 5, 2002, at the Truman State Office Building, Jefferson City, Missouri. The Board was represented by Loretta ,Schouten, Assistant Attorney General. Respondent was not present at the hearing and was ndt represented by counsel. Findings of Fact 1. i Petitioner, the State Board ofNursing ("the Board"), is an agency of the state of Missouri created and established pursuant to 335.021, RSMo 2000, for the purpose of executing and enforcing provisions of Chapter 335, RSMo, the Nursing Practice Act. 2. Respondent, Jennifer Herrick, was licensed by the Board as a registered Case No. 02-0I5NUR

professional nurse, License No. RNI45958. Respondent's license was current and active

until May !I, 2001, at which time Respondent allowed her license to lapse. 3. , On March 9, 2001, the Board issued Findings of Fact, Conclusions ofLaw and Order ("Ofder") wherein Respondent's license was placed on three years probation. The 1 terms of Respondent's discipline included: I. MEETINGS WITH THE BOARD: ReSpondent shall appear before the Board twice annually at the Board's regular spring and fall meetings or, as desipated by the Board, shall meet with a member of the Board's professional staff within a period of six (6) weeks prior to the Board's regular sprig and fall meetings. II. REQUIREMENTS REGARDING EMPLOYMENT: A. Respondent shall cause an evaluation form from each and every employer to be submitted to the Board six (6) weeks prior to the Board's regular spring and fall meetings. The evaluation form shall be completed by Respondent's supervisor within a four (4) week period prior to the date it is due. If Respondent ends employment with an employer, Respondent shall, in addition, cause a final evaluation form from that supervisor to be submitted to the Board within a six (6) week period following the last day of employment.

C. I If Respondent is not employed at any time during the period of discipline, Respondent shall instead submit six (6) weeks prior to the Board's regular spring and fall meetings, an affidavit signed before a notary public stating the period(s) of unemployment.

REWIREMENTS REGARDING CHEMICAL DEPENDENCY TREATMENT AND REHABILITATION: A. Respondent shall, within six (6) weeks from the effective date of this agreement, undergo a thorough evaluation for chemical dependency performed by a licensed chemical dependency professional Respondent shall have the chemical dependency professional mail the results of the evaluation directly 2

to the Missouri. State Board ofNursing, P.O. Box 656, Jefferson City, Missouri 65102 within ten working days after the evaluation is complete. . . .

'

Respondent shall cause a letter of ongoing treatment evaluation from the chemical dependency professional to be submitted to the Board six (6) weeks prior to the Board's regular spring and fall meetings.

F.

Respondent shall submit evidence of weekly (or recommended) attendance at Alcoholics Anonymous, Narcotics Anonymous or other support group meetings to the Board six (6) weeks prior to the Board's regular spring and fall meetings. The documentation shall be on forms provided by the Board and shall include the date, time and place of the meeting, and shall bear a signature or abbreviated signature of another person verifying attendance.

IV.

DRUG SCREENS Respondent shall contract with a third party acceptable to the Board to schedule random witnessed screening for alcohol and other drugs of abuse or serum screening for alcohol or other drugs of abuse at least once per quarter, (i.e. four times per year). Resjondent shall be given no more than 24 hours notice when a screen is to be performed. The random urine/serum screens shall be at the expense of Licensee, Written results, of the screens shall be sent directly to the Missouri State Board of Nursing, P.O. Box 656, Jefferson City, Missouri 65102, by the party administering the screen within ten (10) working days after the screen. Respondent shall show this ov:Idr to the third party who is scheduling the random screens, Within twenty (20) working days of the effective date of this agreement, Respondent shall submit to the Boak for approval the name of the third party the licensee intends to use for random screens.

V.

GEITERAL REQUIREMENTS A. Respondent shall meet with the Board or its representatives at such times and places as required by the Board after notification of a required meeting. 3

B. C.

Respondent shall immediately submit documents showing compliance with the requirements of this agreement to the Board when requested. Respondent shall inform. the Board within ten days of any change of home address or home telephone number.

F.

If Respondent fails to comply with the terms of this agreement, in any respect, the Board may impose such additional or other discipline which it deems appropriate, including imposition of the Revocation. On March 9, 2001, the Board mailed a true and accurate copy of the Board

4.

Order via certified mail, return. receipt requested, to Respondent at her last known address of 4416 Ttotter Drive, Columbus, Ohio. The notice was returned to the Board marked "Unclaimed", but contained notice of a new address in Kerrville, Texas. 5. On March 14, 2001, the Board mailed notice to Respondent that a meeting with

a representative of the Board was scheduled for May 7, 2001. The notice was sent via certified mail, return receipt requested, to Respondent at 9822 Woodland road, Hillsboro, Missouri. The notice was returned to the Board marked"Attempted-Not Known". 6. On April 2, 2001, Petitioner mailed a reminder notice of the May 7, 2001

meeting to Respondent via first class mail at 9822 Woodland Road, Hillsboro, MiSSOUri, The notice was:returned to the Board marked "Return to Sender-not deliverable as addressed". 7. On April 24, 2001, Petitioner mailed a second reminder notice of the May 7,

2001 meeting to Respondent via first class mail at 128 Methodist Encampment Road, Kerrville, Texas. This notice was not returned to the Board as undeliverable. 4

8.

On April 25, 2001, Petitioner mailed a third copy of the Board's Order and

notice of the May 7, 2001 meeting to Respondent via first class mail at 128 Methodist Encampment Road, Kerrville, Texas. The notice was returned to the Board marked "Return to Sender". 9. On April 25, 2001, the Board mailed another copy of the Board's Order and

sent notice to Respondent that a meeting with a representative of the Board was scheduled for May 7; 2001 and. that she was required to submit to thei Board an employer evaluation, a chemical dependency evaluation, a urine drug screen, and proof that she had attended support grup meetings to the Board prior to April 21, 2001. The notice was sent via certified mail, return receipt requested, to Respondent at 128 Methodist Encampment Road, Kerrville, Texas. The notice was returned to Petitioner stamped "Unclaimed". 10. Respondent failed to provide any ofthe requested documentation to the Board

prior to April 21, 2001, failed to appear for her May 7, 2001 meeting, and failed to notify the Board that ,she would be unable to attend. 11. On May 15, 2001, Petitioner received a letter from Respondent, dated May 8,

2001, with a return address of Dresden, Ohio. Respondent indicated she was aware disciplinary action had been pursued against her license, but was not aware of the outcome. 12. On June 11, 2001, the Board sent notice to Respondent that a meeting with a

representative of the Board was scheduled for August 8, 2001 and that she was required to submit to the Board an employer evaluation, a chemical dependency evaluation and a urine

drug screen to the Board prior to July 20, 2001. The notice was sent via certified mail, return receipt requested, to Respondent at 1323 Main Street, Dresden, Ohio. The notice was received and signed for by an. undetermined individual. 13. Respondent failed to provide any of the requested documentation to the Board

prior to July 20, 2001, failed to appear for her August 8, 2001 meeting, and failed to notify the Board that she would be unable tb attend. 14. On September 11, 2001, the Board sent notice to Respondent that a meeting

with a representative of the Board was scheduled for November 9, 2001 and that she was required td submit to the Board an employer evaluation, a chemical dependency evaluation and a urine drug screen to the Board prior to October 19, 2001. The notice was sent via certified mail, return receipt requested, to Respondent at 1323 Main. Street, Dresden, Ohio. The notice was received and signed for by Respondent on September 21, 2001, and indicated a new addiess for future mailings of 128 Methodist Encampment Road, Kerrville, Texas, 78028. 15. ; Respondent failed to provide any ofthe requested documentation to the Board prior to Ocober 19, 2001, failed to appear for her November 9, 2001 meeting, and failed to notify the Board that she would be unable to attend. 16. On December 12, 2001, the Board entered an Order ("Modification Order")

modifying the Board Order dated March 9, 2001. Pursuant to the Modification Order, Respondent shall submit documentation two (2) times annually at the Board's regular spring

and fall meetings or as requested. Respondent no longer has to appear at the Board's regular spring and fall Meetings, unless requested by the Board. 17. On December 12, 2001, the Board mailed notice of the Board's Modification

Order and notice that she was required to submit to the Board an employer evaluation., a chemical dependency evaluation and a urine drug screen to the Board prior to January 23, 2002. The notice was sent via certified mail, return receipt requested, to Respondent at 128 Mehtodist Encampment Road, Kerrville, Texas. The notice was received and signed for by Greg Head on December 15, 2001. 18. Respondent failed to provide any of the requested documentation to the Board

prior to January 23, 2002. 19. On March 25, 2002, the Board sent notice to Respondent that she was required

to submit to the Board an employer evaluation, a chemical dependency evaluation and a urine drug screen to the Board prior to April 24, 2002. The notice was sent via certified mail, return receipt requested, to Respondent at 128 Methodist Encampment Road, Kerrville, Texas. The notice was received and signed for by Respondent on March 28, 2002. 20. Respondent failed to provide any ofthe requested documentation to the Board

prior to April 24, 2002. 21., Respondent's conduct is in violation of Sections, I, 11, III, IV and V of the ,Order.

Conclusions of Law I. The Board has jurisdiction over this proceeding in that the Complaint presents

a ease in which the Board must determine whether a Respondent has violated a condition or conditionS of discipline. Section 620.153, Cum. Supp. 1999. Mendelsohn v. State Bd. of Registration for the Healing Arts, 3 S.W.3d 783 (Mo. bane 1999). 2.. Order. 3. The Order entitles the Board to take suoh disciplinary action as the Board Respondent's conduct is in violation of the terms of discipline set forth in the

deems appropriate if Respondent fails to comply with the terms of the Order. 4. The findings of fact show cause for this Board to impose such disciplinary

' action as this Board deems appropriate. Decision and Order It is: the decision of the Missouri State Board ofNursing that Respondent has violated the terms of her discipline and that Respondent's license is, therefore, subject to further disciplinary action. It is the Order of the Missouri State Board of Nursing that Respondent's license to practice as, a registered professional nurse in the state of Missouri, License No. RN145958, is hereby REVOKED. Upon receipt of this Order, Respondent, Jennifer Helmick, shall immediately return all evidence of Missouri licensure to the Missouri State Board ofNursing.

The Board of Nursing will maintain this Order as an open and public record of the Board as provided in Chapters 335, 610, and 620, RSMo. Entered this day of August, 2002. STATE139ARI) OF NURSING

Lori Scheidt Acting Executive Director

7CEIVD
'#)12i0CT 31 PM I: 04 BEFORE THE MISSOURI STATE BOARD OF NURSING 50ARD OF NURSING OHIO STATE BOARD O' NURSING ) ) Petitioner )Case No. NM-1299-349/00-1643 BN ) ) ) ) ) Jennifer Hem rich ) RN 145958 ) ) Respondent )

FINDINGS OF FACT, CONCLUSIONS OF LAW AND DISCIPLINARY ORDER Statement of the Case On November 3, 2000 the Administrative Hearing Commission entered its Memorandum and Order in the case of State Board of Nursing v. Jennifer Hexurick Case No. NETT-1299-349/004643 BN, In that Memorandum and Order, the AdMinistrative Hearing Commission found that Respondent's license to practice as a Registered Professional Nurse is subject to disciplinary action by the Missouri State Board of Nursing ("Board") for violation of Section 335.066,2 (1) (5) (12) (14) RSA. 1994.

The Board has received and reviewed the record of the proceedings before the Administrative Hearing Commission and the Memorandum and Order, The

Page 1

Memorandum and Order by the Administrative Hearing Commission is incorporated herein by reference.

The Board set this matter for disciplinary hearing and served notice of the disciplinary hearing upon Respondent in a proper and timely fashion.

Pursuant to notice and Sections 621.110 and 335.066.3, RSMo 1994, the Board held a hearing on December 7, 2000 at the Truman State Office Building, Jefferson City, Missouri, for the purpose of detamining the appropriate disciplinaryaction against Respondent's license. The Board was represented by Chris Watson, Assistant Attorney General. Respondent was not present for the hearing and was not represented by counsel.

Nine Members of the Board were present and participated in the Board's deliberation, vote, and order.

Findings of Fact

. 1.

Respondent, Jennifer Efemrielt, is licensed by the Petitioner as a

Registered Professional Nurse License No. RN 145958. Respondent's Missouri license is now current and active and was so at all times relevant herein. In accordance with the Administrative Hearing Commission's November 3, 2000 Memorandum and Order, Respondent's license is subject

Page 2

to disciplinary action by this Board pursuant to Section 335.066.2 (1) (5) (12) (14) RSMo 1994. Conclusions of Law 2. The Board has jurisdiction over this proceeding pursuant to Sections 621,110, RSMo 1994 and 335.066.3, RSMo 1994. Order 1. THEREFORE, having fully considered all the evidence before this Board, and giving full weight to the Memorandum and Order of the Administrative Hearing Commission, it is the ORDER of the Board that, License No. RN 145958 be immediately placed on probation for a period of 3 years. The terms of the probation shall be: MEETINGS W1111 THE BOARD Respondent shall appear before the Board twice annually at the Board's regular Spring and fall meetings or, as designated by the Board, shall meet with a member of the Board's professional staff within a period of six (6) weeks prior to the. Board's regular Spring and fall meetings. REQUIREMENTS REGARDING EMPLOYMENT A. Respondent shall cause an evaluation form from each and every employer to be submitted to the Board six (6) weeks prior to the Board's regular Spring and fall meetings. The evaluation form shall be completed by Respondent's supervisor within, a four (4) week period prior to the date it is due. if Respondent ends employment with an employer, Respondent shall, in addition, cause a final

Page 3

evaluation form from that supervisor to be submitted to the Board within a six (6) week period following the last day of employment. B. The evaluation shall be an evaluation of Respondent's job performance using a form prescribed by the Board and shall be sent by the supervisor addressed to: Missouri State Board of Nursing, P.O. Box 656, Jefferson City, Missouri 651.02. C. If Respondent is not employed at any time during the period of discipline, Respondent shall instead submit six (6) weeks prior to the Board's regular Spring and fall meetings, an affidavit signed before a notary public stating the periods of unemployment 1), Respondent shall execute any release or provide any other authorization necessary for the Board to obtain records of Respondent's employment during the period covered by this agreement E Respondent shall keep the Missouri State Board of Nursing informed of his/her current place of employment or of any changes in his/her place of employment by notifying the Board within ten (10) working days of such a change. F. Respondent may not serve on the administrative staff, as a member of the faculty, or as a preceptor at any accredited school of professional or practical nursing.

Page 4

REQUIREMENTS REGARDING alLMICAL DEPENDENCY TREATMENT AND REHABILITATION

A.

Respondent shall, within six (6) weeks from the effective date of this

agreement, undergo a thorough evaluation for chemical dependency performed by a licensed chemical dependency professional. Respondent shall have the chemical dependency professional mail the results of the evaluation directly to the Missouri State Board of Nursing, PO Box 656 Jefferson City, Missouri 65102 within ten (10) working days after the evaluation is complete. Each written evaluation shall include a description of the tests performed and test results; discussion of relevant clinical interview findings/interpretations/specification of DSM IV diagnosis/es; and discussion of appropriate treatment recommendations/plan. IF there is no diagnosis requiring treatment this should be specified in the evaluation. Respondent shall follow any recommendations for treatment made by that chemical dependency professional. Respondent shall comply with paragraphs I through J if treatment is recommended. If the chemical dependency professional determines that treatment is not recommended, Respondent shall execute a release so that the Board can obtain the evaluation and supporting documents. If treatment is not recommended, paragraphs D through I do not apply to Respondent. Respondent shall show this agreement to the chemical dependency professional before the evaluation is performed.

Page 5

B.

The chemical dependency professional shall submit to the Board evidence that he or she is licensed or certified in the treatment of chemical dependency.

C.

If treatment is recommended, Respondent shall execute a medical release or other appropriate release which shall remain in effect for the entire period covered by this agreement authorizing the Missouri State Board of Nursing to obtain records of Respondent's treatment for chemical dependency. Respondent shall not take any action to cancel this release. Respondent shall take any and all steps necessary to continue the release in effect and shall provide a new release when requested.

IX

Respondent shall cause a letter of ongoing treatment evaluation from the chemical dependency professional to be submitted to the Board six (6) weeks prior to the Board's regular spring and fall, meetings.

(I)

The letter shall include an evaluation of Respondent's current progress and status related to the treatment recommendations/plan and Respondent's current prognosis and treatment recommendations/plan.

(2)

The letter shall be sent by the chemical dependency professional addressed to: Missouri State Board of Nursing, PO Box 656, Jefferson City, Missouri 65102.

Page 6

1.

If the treatment of Respondent is successfully completed at any time during the period covered by this agreement, Respondent shall cause the chemical dependency professional to submit a letter of final evaluationkanunary which includes a statement that Respondent has successfully completed treatment and indicates whether Respondent should continue in a twelvestep program. If continuance in a twelve-step program is recommended, Respondent shall comply with terms of documentation as outlined in paragraph F.

IF.

.Respondent shall submit evidence of weekly (or recommended) attendance at Alcoholics Anonymous, Narcotics Anonymous or other support group meetings to the Board sic (6) weeks prior to the Board's regular Spring and fall meetings. The documentation shall be on forms provided by the Board and shall include the date, time, and place of the meeting, and shall bear a signature or abbreviated signature of another person verifying attendance.

G.

Respondent shall not use alcohol. Respondent shall not use any controlled substances or other drug for which a prescription is required unless that use of the drug has been prescribed by a person licensed to prescribe such drug and with whom Respondent has a bona tide relationship as a patient.

l.

Respondent shall inform any professional preparing a prescription for Respondent that Respondent is chemically dependent. Respondent shall provide the Board with documentation of any prescription upon request.

Page 7

IV.

DRUG SCREENS

Respondent shall contract with a third party acceptable to the Board to schedule random witnessed screening for alcohol and other drugs of abuse or serum screening for alcohol or other drugs of abuse at least once per quarter, i.e. four times per year. Respondent shall be given no more than 24 hours notice when a screen is to be performed. The random urinefserum screens shalt be at the expense of Respondent. Written results of the screens shall be sent directly to the Missouri State Board of Nursing, PO Box 656, Jefferson City, Missouri 65102; by the party administering the screen within ten (10) working days after the screen. Respondent show this agreement to the third party that is scheduling the random screens. Within twenty (20) working days of the effective date of this agreement, Respondent shall submit to the Board for approval the name of the third party Respondent intends to use for random screens. V. GENERAL REQUIREMENTS Respondent shall meet with the Board or its representatives at such times and places as required by the Board after notification of a required meeting. B. Respondent shall immediately submit documents showing compliance with the requirements of this agreement to the Board when requested. C. Respondent shall inform the Board within ten (10) days of any change of home address or home telephone number.

Page 8

D.

Respondent shall not violate the Nursing Practice Act, Chapter 335, RSMo, shall renew or place inactive his/her license immediately and shall not allow his/her license to lapse.

E.

The terms of discipline apply even if Respondent places his/her license on inactive status.

F.

If Respondent fails to comply with the terms of this agreement, in any respect, the Board may impose such additional or other discipline which it deems appropriate,

2 TheBoard will maintain this Order al an open and public record of the Board as provided in Chapters 335,610, and 620, RSMo. 3.. Upon the determination of the Board that Respondent has failed to comply with the terms of this Order, the Board may revoke Respondent's license or may take such other or additional disciplinary action against Respondent or Respondent's license as the Board deems appropriate. No order shall be entered by the Board pursuant to this paragraph without notice and an opportunity for hearing before the Board of Nursing in accordance with the provisions of Chapter 536,.RS1Vio. 4, Upon the expiration and successful completion of the period of probation, Respondent's license as a Registered Professional Nurse in Missouri shall be fully restored if all other requirements of law have been satisfied. 5. If the Board determines that Respondent has violated a term or condition of this Order, which violation would also be actionable in a. proceeding before the Administrative Hearing Commission or the circuit court, the

Page 9

Board may elect to pursue any lawftd remedies or procedures'afforded it and is not bound by this Order in its determination of appropriate legal actions concerning that violation.

ENTERED ON THIS 974 DAY OF MARCH 2001

MISSOURI STATE BOARD OF NURSING . BOARD SEAI.,

Calvina Thomas, PhD, RN Executive Director

Page 10

Before the Administrative Hearing Commission State f Missouri

STATE BOARD OF NURSING., Petitioner,

'vs.

No. 00-1643 BN

JENNIFER L. HEMRICK, Respondent MEMORANDUM AND ORDER On June 15, 2000, the State Board of Nursing (Board) filed a complaint seeking to discipline the registered professional nurse (RN) license of Jennifer L. Hemxick for her use of drags and alcohol. On September 29, 2000, the Board. filed a motion for summary determination with supporting exhibits. Our Regulation 1 CSR 15-2,450(4)(C) provides that we may decide this case-without a heari,ng if the Board establishes facts that (a) Hernriek does not dispute and (b) entitle the Board to a favorable decision. ITT Commercial Fin. Corp. v. Mid-Am. Marine

Supply Corp., 854 S.W.2d 371, .80-82 (Mo. banc 1993).

The Board cites the request for admissions that it served on Hennick on August 14, 2000. Under Supreme Court Rule 59.01, the failure to answer a request for admissions establishes the matters in the request conclusively. The party making the request is entitled to rely upon the facts asserted in the request, and no further proof in required. Killian Constr. Co. v. Pi-City

Constr. Co., 693 S.W.2d 819, 827 (Mo. App., W.D. 1985). Such a deemed admission can

establish any fact or any application of law to fact. Linde v. Kilbourne, 543 S.W.2d 543, 545-46 (MO. App., W.D. 1976). That lige applies to all parties, including those actingpro se. Research Hosp., v. Williams, 651 S.W.2d 667, 669 (Mo App., W.D. 1983). Section 536.073' and our Regulation 1 CSR 15-2.420(1)' apply that rule to this case. We gave Hemrick until October 23, 2000, to file a response to the motion, but she did not respond. Therefore, the following facts are undisputed. Findings of Fact 1. Hernrick is licensed by the Board as an RN, License No. RN145958. Her license is

current and active. 2. In November and December of 1998, Hemrick was employed as an RN at St. Louis Children's Hospital (Children's) in St. Louis, Missouri. Hemrick was assigned to work in the Pediatric Intensive Care Unit (PICU) at Children's. 3, On December 3, 1998, Hemrick smelled of alcohol when she reported for her shift

at Children's. 4. On December 3, 1998, Hemrick submitted blood and urine samples for screening of

alcohol and, drugs. Hemrick's samples were positive for alcohol and cocaine. Her blood alcohol level was measured at .09. A blood alcohol content of .09' is sufficient to impair the ability of a nurse to adequately perform the functions and duties of a PICU nurse. .5. Upon reviewing the results, Herrick refused to enter a drug treatment program. Conclusions of Law .We have jurisdiction to hear the Board's complaint. Sections 335.066.2 and 621.045. The Board has the burden of proVing that Hemrick has committed an act for which the law

,Statutory references are to the 1999 Supplement to the Revised Statutes of Missouri, unless otherwise noted.

- allowS discipline. Missouri Real Estate Conanen v. Berger, 764 S.W.2d 706, 711 (Ivlo. App,, E.D. 1989). The Board cites section 335.066.2(1), (5), (12) and (14), which provide: 2. The board may cause a complaint to be filed with the administrad-ve hearing connnission as provided by chapter 621, RSMo, against any bolder of any certificate of registration or authority, permit or license required by sections 335.011 to 335.096 or any person who has failed to renew or has surrendered his or her certificate of registration or authority, permit or license for any one or any combination of the following causes: (1) Use or unlawful possession of any controlled substance, as defined in. chapter 195, RSMo, or alcoholic beverage to an extent that such use impairs a person's ability to perform the work of any profession licensed or regulated by sections 335,011 to 335.096;
* * *

(5) Incompetency, misconduct, gross negligence, fraud, misrepresentation or dishonesty in the performance of the functions or duties of any profession licensed or regulated by sections 335.011 to 355.096;

(12) Violation of any professional trust or confidence;

(14) Violation of the drug laws or rules and regulations of this state, any other state or the federal government] L Section 335.066.2(1) ,Section 335.066.2(1) provides cause for discipline if liemrick used a controlled substance or used alcohol to such an extent that it impaired her ability to perform her professional work. By failing to respond to. the Board's request for admissions, Her rick is deemed to have admitted that she used cocaine and that she used alcohol to an extent that it impaired her ability to perform her professional work. Cocaine is a controlled substance. Section 195.017. Based ondiemrick's 3

admissions, we conclude that she unlawfully used a controlled substance and that her use of alcohol impaired her ability to perform her professional work in violation of section 335,066.2(1). H. Section 335.066.2(5) Section 335.066,2(5) provides cause for discipline for "Mncompetency, misconduct, gross negligence, fraud, misrepresentation or dishonesty in the performance of the functions or duties" of an RN. Incorapetence is a general lack of, or a lack of disposition to us; a profesSional ability. Forbes v. Missouri Real Estate Contm'n, 798 S.W.2d 227, 230 (Mo. App., W.D. 1990). Misconduct is defined as "the willful doing of an act with a wrongful intention{;) intentional wrongdoing." Missouri Ed. for Areit'ts, Prof' Eners & Land Surv'rs v. Duncan, No. AR-84-0239 (Mo. Admin. Hearing Comen Nov. 15, 1985) at I25, ciff4 744 S.W.2d 52.4 (Mo. App., E.D. 1988). Gross negligence is a deviation from professional standards so egregious that it demonstrates a conscious indifference to a professional duty. Id. at 533. Fraud is an intentional, perversion of truth to induce another, in reliance on it, to part with some valuable thing belonging to him. State ex rel. Wilikans v. Purl, 128 S.W. 196, 201 fivio. 1910). It necessarily includes dishonesty, which is a lack of integrity or a disposition to defraud or deceive, MERRIAM-WEBSTER'S COLLEGIATE DICTIONA.RY 333 (10th ed., 1993). Misrepiesentation is falsehood or untruthmade with the intent and purpose of deceit. MERRIAMWEESTER'S COLLEGIATE DICTIONARY 711 (101' ed. 1993). Hemrick's admissions establish intentional wrongdoing by her use of drugs and alcohol to the extent that it impaired her ability to perform her work. We conclude that cause exists to discipline Herorick's license under section 335,066.2(5) for rniSconduct. Intent and indifference are mutually exclusive. Hem.rick did not act with mere indifference, conscious or otherwise. Therefore, her admissions do not establish gross 4

negligence. Further, her admissions do not establish incompetency, fraud, misrepresentation or dishonesty in the performance of her duties. Therefore, we conclude that Hemrick is not subject to discipline for gross negligence, incompetency, fraud, misrepresentation or dishonesty in the performance of her duties. III. Section 335.066.2(12) Section 335.066.2(12) provides cause for discipline if Hemrick violated "any professional trust o confidence." A professional trust or confidence arises when a person relies on the special knowledge and skills of a professional that are evidenced: b professional licensure. State Board of Nursing v. Morris, B1+1-85-1498, at 11 (Mo. Admin. Hearing Comrren Jan. 4, 1988). flex arick's admissions establish her use of chugs and alcohol to an extent that it impaired her ability to perform her work as a PICU nurse. Hemrick violated the professional trust and confidence placed in her by her patients and her employer. We conclude that cause exists to discipline Hemxick's license under section 335.066.2(12) for a violation of professional trust or confidence. 111. Section 335.066.2(14) By failing to respond to the Board's request for admissions, Herdrick is deemed to have admitted that she violated the drug laws of this state. Possession of a controlled substance such as cocaine is a violation of section 195,202.1, RSMo 1994, which provides: EXcept as authorized by sections 195,005 to 195.425, it is unlawful for any person to possess or have -ander his control a controlled substance. Hemricies admissions establish that she consumed and possessed cocaine. Hemrick did not establish that she was authorized to possess that substance. We therefore conclude that Her Trick's license is subject to discipline under section 335.066.2(14).

Summary We grant the Board's motion and enter our decision in the Board's favor. We conclude that Hernrick's license is subject to discipline for her use of cocaine and alcohol under section 335.066.2(1), for naiscairdikt under section 335.066.2(5), for a violation of professional trust or confidence under section 335.066.2(12), and for a violation of the drug laws of this state under section 335.066.2(14). Heinrich isnot subject to discipline for gross negligence, incompetency, fraud, misrepresentation or dishonesty in the performance of her duties under section 335.066.2(5). We cancel the healing. SO ORDERED on. Novernber 3, 2000.

Commissioner

Case# 12-007022

Ohio Board Of NUrsing

17 South High. Street, Suite 400
a

www.nursing.ohlo.gov

Columbus, Ohio 43215-7410- 0 (614) 466-3947

January 25,2013

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Cari Coreen McDermott, R.N. 118 Trotters Circle Delaware, Ohio 43015 Dear Ms. McDermott: You are hereby notified that, on or about March 14, 2008, the Ohio Board of Nursing (Board) issued an Adjudication Order (March 2008 Adjudication Order), a copy of which is attached hereto and incorporated herein, in which the Board ordered that your license to practice nursing as a registered nurse in the State of Ohio be suspended for not less than two years, with conditions for reinstatement, and probationary terms, conditions, and limitations for a minimum period of three (3) years. On November 23, 2011, the Board notified you that your license to practice nursing as a registered nurse was reinstated, subject to the terms and conditions of probation set forth in the March 2008 Adjudication Order. A copy of the November 23, 2011 Reinstatement Letter is attached hereto and incorporated herein. A. Item 1. of the March 2008 Adjudication Order probationary tetnis states, "MS. MCDERMOTT shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(8), Ohio Revised Code (ORC), authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 5. of the March 2008 Adjudication Order probationary terms states, "During the probationary period, MS. MCDERMOTT shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. MCDERMOTT shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. MCDERMOTT's history."

Carl Coreen McDermott, R.N. Page 2

Despite this provision, on September 10, 2012, you submitted a specimen to Firstlab, the Board's random drug/alcohol screen program administrator, which tested positive for Oxazepam. You did not have a legal, valid prescription for Oxazepam. Furthermore, on the following dates, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis: November 2, 2012; and December 7-19, 2012: Additionally, on August 22, 2012, you were selected to provide a specimen for analysis and failed to do so. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the March 2008 Adjudication Order, you are hereby notified that it appears to the Board that you have violated probationary Items 1. and 5. of the March 2008 Adjudication Order. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-207170, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about March 14, 2008, the Ohio Board of Nursing (Board) issued an Adjudication Order (March 2008 Adjudication Order), a copy of which is attached hereto and incorporated herein, in which the Board ordered that your license to practice nursing as a registered nurse in the State of Ohio be suspended for not less than two years, with conditions for reinstatement, and probationary teims, conditions, and limitations for a minimum period of three (3) years. On November 23, 2011, the Board notified you that your license to practice nursing as a registered nurse was reinstated, subject to the terms and conditions of probation set forth in the March 2008 Adjudication Order. A copy of the November 23, 2011 Reinstatement Letter is attached hereto and incorporated herein.

Cari Coreen McDermott, R.N. Page 3 2. Item 1.. of the March 2008 Adjudication Order probationary terms states, "MS: MCDERMOTT shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for selfadministering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 5. of the March 2008 Adjudication Order probationary terms states, "During the probationary period, MS. MCDERMOTT shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. MCDERMOTT shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. MCDERMOTT's history." Despite this provision, on September 10, 2012, you submitted a specimen to Firstlab, the Board's random drug/alcohol screen program administrator, which tested positive for Oxazepam. You did not have a legal, valid prescription for Oxazepam. Furthermore, on the following dates, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis: November 2, 2012; and December 7-19, 2012. Additionally, on August 22, 2012, you were selected to provide a specimen for analysis and failed to do so. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice.

Can Coreen McDermott, R.N. Page 4 You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments; or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing@nursing.ohio.00v. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, A". Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1021 cc: Henry G. Appel, Senior Assistant Attorney General

Ohio Board of Nursing

17 South High Street, Suite 400

www.nursing.ohio.gov (6141466-3947 Columbus, Ohio 43215-7410

BEFORE THE OHIO BOARD OF NURSING

IN THE MATTER OF:

ORDER: 1547 CASE # 02-2197

CART MCDERMOTT, R.N.

ORDER
By letters dated August 3, 2007, and October 1, 2007 notice was given to CART MCDERMOTT, R.N., that the Ohio Board of Nursing intended to consider disciplinary action regarding MS. MCDERMOTT's license to practice nursing as a registered nurse in the State of Ohio, and that MS. MCDERMOTT was entitled to a hearing if such hearing was requested within thirty (30) days of the mailing of said notice. In accordance with Section 119.07, Ohio Revised Code, said notice was sent via certified mail, return receipt requested, to the address of record of MS. MCDERMOTT. No hearing request has been received from MS. MCDERMOTT and more than thirty (30) days have now elapsed since the mailing of the notice. Upon consideration of the charges stated against CARI MCDERMOTT in the August 3, 2007 Notice of Immediate Stispension and Opportunity for Hearing and in the October 1, 2007 Notice of Opportunity for Hearing and evidence supporting the charges, the Board finds that MS. MCDERMOTT has committed acts in violation of the Nurse Practice Act, Ohio Revised Code Chapter 4723, as stated in the Notice of Immediate Suspension and Notice of Opportunity for Hearing and the Ohio Board of Nursing Orders that MS. MCDERMOTT's license to pradtice nursing as a registered nurse is hereby suspended for an indefinite period of time, but not less than two (2) years, with the conditions for reinstatement set forth below, and that following reinstatement, MS. MCDERMOTT shall be subject to a stayed suspension under the probationary terms, conditions, and limitations set forth below for a minimum period of three (3) years and the permanent narcotic and temporary practice restrictions set forth below. REQUIREMENTS AND CONDITIONS FOR REINSTATEMENT 1. MS. MCDERMOTT shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. 2, MS. MCDERMOTT shall appear in person for interviews before the full Board or its designated representative as requested by the Board.

Monitoring 3. MS. MCDERMOTT shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. MCDERMOTT's history. MS. MCDERMOTT shall self-administer the prescribed drugs only in the manner prescribed. 4. MS. MCDERMOTT shall abstain completely from the use of alcohol. 5. Prior to seeking reinstatement by the Board, MS. MCDERMOTT shall, at her own expense, seek a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. MCDERMOTT shall provide the chemical dependency professional with a copy of this Order, Notice of Immediate Suspension, and Notice of Opportunity for Hearing: Further, MS. MCDERMOTT shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses and recommendations for treatment and monitoring. 6. MS. MCDERMOTT shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, the Board may, utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. MCDERMOTT's license. 7. For a minimum, continuous period of twelve (12) months immediately prior to requesting reinstatement, MS. MCDERMOTT shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. MCDERMOTT's initiation of drug screening, refusal to submit such specimen, or failure to submit Slidh specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC.' This screening shall require a daily call-in process. The specimens subMitted by MS. MCDERMOTT shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. MCDERMOTT's history. 8. Within thirty (30) days prior to MS. MCDERMOTT initiating drug screening, MS. MCDERMOTT shall provide a copy of this Order to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. MCDERMOTT. 9. After initiating drug screening, MS. MCDERMOTT shall be under a continuing duty to provide a copy of this Order, prior to initiating treatment, to additional treating

practitioners, and to update the list of treating practitioners with the Board within fortyeight (48) hours of being treated by another practitioner. Further, MS. MCDERMOTT shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. 10. For a minimum, continuous period of twelve (12) months immediately prior to requesting reinstatement, MS. MCDERMOTT shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. MCDERMOTT shall provide satisfactory documentation of such attendance to the Board prior to reinstatement. 11, Prior to seeking reinstatement by the Board, MS. MCDERMOTT shall submit to a Ba criminal records check. Reporting Requirements of MS. MCDERMOTT 12. MS. MCDERMOTT shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board. 13.MS. MCDERMOTT shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. 14.MS. MCDERMOTT shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. 15.MS. MCDERMOTT shall submit the reports and documentation required by this Order on forms specified by the Board. All reporting and communications required by this Order shall be made to the Compliance Unit of the Board. 16.MS. MCDERMOTT shall submit the reports and documentation required by this Order to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. 17.MS. MCDERMOTT shall verify that the reports and documentation required by this Order are received in the Board office. 18.MS. MCDERMOTT shall inform the Board within three (3) business days, in writing, of any change in address and/or telephone number. URATION The Board may only alter the indefinite suspension imposed if: (1) MS. MCDERMOTT submits a written request for reinstatement; (2) the Board determines that MS. MCDERMOTT has complied with all conditions of reinstatement; (3) the Board determines that MS. MCDERMOTT is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. MCDERMOTT and review of the documentation specified in this Order. Following reinstatement, MS. MCDERMOTT shall be subject to the following

probationary terms, conditions, and limitations for a minimum period of three (3) years. 1. 2. MS. MCDERMOTT shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. MCDERMOTT shall appear in person for interviews before the full Board or its designated representative as requested by the Board.

Monitoring 3. MS. MCDERMOTT shall abstain completely from the personal use or poSsession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. MCDERMOTT's history. MS. MCDERMOTT shall self-administer prescribed drugs only in the manner prescribed. MS. MCDERMOTT shall abstain completely from the use of alcohol. 5. During the probationary period, MS. MCDERMOTT shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis,at a collection site specified by the Board at such times as the'Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily callin process. The specimens submitted by MS. MCDERMOTT shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. MCDERMOTT's history. MS. MCDERMOTT shall attend a minimum of one (I) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. MCDERMOTT shall provide satisfactory documentation of such attendance to the Board every six (6) months.

6.

Treating Practitioners and Reporting 7. Within sixty (60) days of the execution of the probationary period, MS. MCDERMOTT shall provide'a copy of this Order to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. MCDERMOTT shall be under a continuing duty to provide a copy of this Order, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. MS. MCDERMOTT shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board, The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. MCDERMOTT throughout the duration of this Order. Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. MCDERMOTT shall notify the Board of any and all medication(s) or prescription(s) received.

8.

9.

Employment Conditions

N.

Prior to accepting employment as a nurse, each time with every employer, MS. MCDERMOTT shall notify the Board. MS. MCDERMOTT shall have her employer(s), if working in a position where a nursing license is required; submit written reports regarding job performance on a quarterly basis, MS. MCDERMOTT shall provide his employer(s) with a copy of this Order, Notice of Immediate Suspension, and Notice of Opportunity for Hearing and shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Order, Notice of Immediate Suspension, and Notice of Opportunity for Hearing. Further, MS. MCDERMOTT is under a continuing duty to provide a copy of this Order, Notice of Immediate Suspension, and Notice of Opportunity for Hearing to any new employer prior to accepting employment,

Reporting Requirements of MS. MCDERMOTT 12, MS. MCDERMOTT shall sign releases of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. 13. MS. MCDERMOTT shall submit any and all information that the Board may request regarding his ability to practice according to acceptable and prevailing standards of safe nursing practice. 14, MS. MCDERMOTT shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers.

15. MS. MCDERMOTT shall submit the reports and documentation required by this Order on forms specified by the Board. All reporting and communications required by this Order shall be made to the Compliance Unit of the Board. 16. MS. MCDERMOTT shall submit the reports and documentation required by this Order or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. 17. MS. MCDERMOTT shall verify that the reports and documentation required by this Order are received in the Board office. 18. MS. MCDERMOTT shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number. 19. Prior to working as a nurse and if requested by the Board or its designee, MS. MCDERMOTT shall complete a nurse refresher course or extensive orientation approved in advance by the Board.

Temporary Practice Restrictions MS. MCDERMOTT shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the

nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. MCDERMOTT to provide nursing services for fees, Compensation, or other consideration or as a volunteer, MS. ,MCDERMOTT shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. Permanent Narcotic Restriction MS. MCDERMOTT shall not administer, have access to, or possess (except as prescribed for MS. -MCDERMOTT's use by another so authorized by law who has full knowledge of MS. MCDERMOTT's history) any narcotics, other controlled substances, or mood altering drugs. In addition, MS. MCDERMOTT shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. MCDERMOTT shall not call in or order prescriptions or prescription refills, FAILURE TO COMPLY The stay of MS. MCDERMOTT's suspension shall be lifted and MS. MCDERMOTT's license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. MCDERMOTT has violated or breached any terms or conditions of this Order. Following the automatic suspension, the Board shall notify MS. MCDERMOTT via certified mail of the specific nature of the charges and automatic suspension of her license, Upon receipt of this notice, MS. MCDERMOTT may request a hearing regarding the charges. DUR TION The Board may only alter the probationary period imposed by this Order if: (1) the Board determines that MS. MCDERMOTT has complied with all aspects of this Order; and (2) the Board determines that MS. MCDERMOTT is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. MCDERMOTT and review of the reports as required herein. Any period during which MS. MCDERMOTT does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Order.

The Board further Orders CART MCDERMOTT to surrender her registered nurse license #R.N. 207170 immediately. This ORDER shall become effective immediately upon the date of mailing indicated on the attached Certificate "of Service and is hereby entered upon the Journal of the Board for the 14th day of March, 2008.

TIME AND METHOD TO PERFECT AN APPEAL

Any party desiring to appeal shall file a Notice of Appeal with the Ohio Board of Nursing, 17 S. High St., Ste 400, Columbus OH 43215-7410, setting forth the order appealed from and the grounds of the party's appeal. A copy of such Notice of Appeal shall also be filed by the appellant with the Franklin County Court of Common Pleas, Columbus, Ohio. Such notices of appeal shall be filed within fifteen (15) days after the mailing of the notice of the Ohio Board of Nursing's Order as provided in Section 119.12 of the Ohio Revised Code.

CERTIFICATION

The State of Ohio County of Franklin

I, the undersigned Betsy J. Houchen, Executive Director for the Ohio Board of Nursing, hereby certify that the foregoing is a true and exact reproduction of the original 'Order of the Ohio Board h of Nursing entered on its journal, on the 14t day of March 2008.

Betsy J. Houchen, 2N., M.S., J.D. Executive Director

Date

(SEAL)

CERTIFICATE OF SERVICE
I hereby certify that a true and accurate copy of the foregoing Order concerning, CARI MCDERMOTT, was sent via certified mail, return receipt requested, this day of

(11) to CARI MCDERMOTT, 3844 Mariner's Way, Lewis Center

OH 430'5 and by certified mail to Michael Oser counsel of record for CARI MCDERMOTT, 35 E. Livingston Ave., Columbus OH 43215.

day of Iltf) to David Krupnick, SAC, Sanctions & Exclusions, Departm rrf of Health and Human Services, Office of Inspector General, Office of Investigations, PO Box 81020, Chicago IL 60601-81020.

I also certify that a copy of the same was sent via regular U.S. mail this

Betsy J. Houchen, R.N., M.S., J.D. Executive Director

LFR/djf cc: Leah Basobas O'Carroll Assistant Attorney General

Certified Mail Receipt No. 7007 3020 0000 7377 9879 Attorney Certified Mail Receipt No. 7007 3020 0000 7377 9893

Case #06-2197

Ohio Board of Nursing

www.nursing.oIlio.gov

17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947

November 23, 2011

Cari McDermott 118 Trotters Circle Delaware, OH 43015

Ref: Adjudication Order #1547 of March 14, 2008 License #R.N. 207170 Dear Ms. McDermott: On November 18, 2011, the Board approved your request for reinstatement of your nursing license, Your license is therefore reinstated subject to the terms and conditions of probation.

Sincerely,

Betsy J. Houchen, R.N., Executive Director LFR/mam

Cases # 12-000260 & 12-005607

Ohio Board of Nursing

17 South High Street, Suite 400 January 25, 2013

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 (614) 466-3947

NOTICE OF TEMPORARY SUSPENSION AND OPPORTUNITY FOR HEARING

Andrea Jean Mehlman, R.N. 4260 Bennett Drive Hamilton, Ohio 45011 Dear Ms. Mehlman: In accordance with Section 4723.35(D)(2) of the Ohio Revised Code (ORC), it has been determined that you were significantly out of compliance with the terms and conditions for participation in the Alternative Program for Chemical Dependency (Program) of the Ohio Board of Nursing (Board) based on the information set forth below in Item 3. Further, Section 4723.35(D)(2), ORC, states as follows: If the program coordinator determines that a participant is significantly out of compliance with the terms and conditions for participation, the coordinator shall notify the Board's supervising member for disciplinary matters and the supervising member shall temporarily suspend the participant's license or certificate. The program coordinator shall notify the participant of the suspension by certified mail sent to the participant's last known address and shall refer the matter to the Board for formal action under section 4723.28 or 4723.86 of the Revised Code. WHEREFORE, PURSUANT TO SECTION 472335(D)(2), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-305991, IS HEREBY TEMPORARILY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, peananently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about May 23, 2012, in Butler County Court of Common Pleas Case No. CR2012-02-0269, you pled guilty to one (1) count of Theft of Drugs, a felony of the fourth degree, in violation of Section 2913.02(A)(1)&(B)(6), ORC, and were found eligible for Intervention in Lieu of Conviction.

Andrea Jean Mehlman, R.N. Page 2 The acts underlying your conviction occurred on or about January 25, 2012, and involve you obtaining, or exerting control, over property, to wit: dangerous drugs, without the consent of the owner or person authorized to give consent. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. On or about February 6, 2012, you admitted to a Board Compliance Agent that, while working as a nurse at Fort Hamilton Hospital, Hamilton, Ohio, you began diverting narcotics, specifically Dilaudid, for self-administration. In a written statement to the Board dated February 12, 2012, you admitted that, beginning in or about November 2011, you were "curious how it would be to take the wasted medicine at work" and that you would take [the medicine] "from time to time." Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. 3. On or about July 11, 2012, you entered into an Alternative Program Participant Agreement (Agreement) with the Board's Alternative Program for Chemical Dependency (Program). The Agreed Conditions, Page 2, provide that the Agreement would be for a period of four (4) years, unless early release was granted. a. Item 27. of your Agreement states, "Participant shall comply with drug testing in such a manner as the Program may request, including but not limited to submission of an unadulterated urine, hair, blood, or breath specimen, expressed or extracted directly from Participant's body, to the drug testing company designated by the Board." Despite this provision, on the dates set forth in Attachment A, attached and incorporated herein, you failed to call FirstLab, the Program's designated drug testing company, to determine if you had been scheduled to provide a specimen. Furthermore, on the following dates, you were scheduled to provide a urine specimen to FirstLab and failed to do so: August 10, 2012; August 31, 2012; and September 10, 2012.

Andrea Jean Mehlman, R.N. Page 3 b. On or about October 2, 2012, you were terminated from the Program based on your failure to comply with the terms and conditions of your Agreement.

Section 4723.28(B)(25), ORC, authorizes the Board to discipline a licensee for failure to comply with the terms and conditions of participation in the chemical dependency monitoring program established under Section 4723.35, ORC. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-6-03(A), Ohio Administrative Code, requires a participant in the Alternative Program for Chemical Dependency to comply with all of the terms and conditions of the participant's agreement with the Alternative Program for Chemical Dependency for the time period specified in the agreement. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410 or to the e-mail address, hearing(Omrsing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Temporary Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1267 cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-007092

Ohio Board of Nursing

January 25, 2013

www.nursing.ohlo.gov 17 South High Street, Suite 400 4' Columbus, Ohio 43215-7410 (614) 466-3947

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Linda Jeanne Moore, L.P.N. 128 Sterling Street Creston, Ohio 44217 Dear Ms. Moore: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about October 24, 2012, in Cuyahoga County Court of Common Pleas Case Number CR-12-564087-A, you pled guilty to four (4) counts of Receiving Stolen Property, to wit: Hydrocodone, Oxycodone, and Diazepam, felonies of the fourth degree, in violation of Section 2913.51(A), ORC, and were found eligible for Intervention in Lieu of Conviction. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Receiving Stolen Property, to wit: Hydrocodone, Oxycodone, and Diazepam, felonies of the fourth degree, in violation of Section 2913.51(A), ORC, constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-130457, IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(B), ORC.

Linda Jeanne Moore, L.P.N. Page 2 You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about October 24, 2012, in Cuyahoga County Court of Common Pleas Case Number CR-12-564087-A, you pled guilty to four (4) counts of Receiving Stolen Property, to wit: Hydrocodone, Oxycodone, and Diazepam, felonies of the fourth degree, in violation of Section 2913.51(A), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying the above case occurred on or about August 16, 2011, and involve you receiving, retaining, or disposing of Hydrocodone, Oxycodone, and Diazepam, which were the property of Life Care Center. Section 4723 .28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723 28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing@nursingAbAgov.

Linda Jeanne Moore, L.P.N. Page 3 If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0840

cc:

Henry G. Appel, Senior Assistant Attorney General

Case# 12-007219, 12-005160

Ohio Board of Nursing

17 South High. Street, Suite 400 January 25, 2013

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 t. (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Monica Angelique Nettles, L.P.N. 1449 Knuth Avenue, Apt. 807 Euclid, Ohio 44132 Dear Ms. Nettles: You are hereby notified that, on or about May 18, 2012, you entered into a Consent Agreement (May 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minumum period of one (1) year. A. Item 4. of the May 2012 Consent Agreement states, "Within six (6) months of the effective date of this Consent Agreement, MS. NETTLES shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education, or another comparable course approved in advance by the Board or its designee, taken subsequent to the effective date of this Consent Agreement: eight (8) hours of Anger Management and two (2) hours of Law and Rules governing the practice of nursing in Ohio." Despite this provision, as of January 11, 2013, you have failed to submit to the Board satisfactory documentation of successful completion of the following continuing nursing education, or other comparable courses approved in advance by the Board: eight (8) hours of Anger Management and two (2) hours of Law and Rules governing the practice of nursing in Ohio. On or about January 3, 2013, you submitted a written statement to the Board regarding your non-compliance with the May 2012 Consent Agreement, stating you failed to comply with the educational requirements for financial reasons. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. B. Item 5. of the May 2012 Consent Agreement states, "Within ninety (90) days following the effective date of this Consent Agreement, MS. NETTLES shall, at her expense, obtain a psychiatric evaluation from a Board approved

Monica Angelique Nettles, L.P.N. Page 2 psychiatrist and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. NETTLES shall provide the psychiatrist with a copy of this Consent Agreement and shall execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. NETTLES's license, and whether MS. NETTLES is capable of practicing as a nurse according to acceptable and prevailing standards of nursing care." Despite this provision, as of January 11, 2013, you have failed to obtain a psychiatric evaluation from a Board approved psychiatrist and failed to cause to a report to be submitted to the Board by that psychiatrist as required. On January 3, 2013, you submitted a written statement to the Board regarding your non-compliance with the May 2012 Consent Agreement, stating you failed to comply with these requirements for financial reasons. Section 4723 .28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the May 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 4. and 5. of the May 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-118420, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a licensed practical nurse without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about May 18, 2012, you entered into a Consent Agreement (May 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely and that such suspension would, be stayed subject to probationary terms, conditions, and limitations for a minumum period of one (1) year.

Monica Angelique Nettles, L.P.N. Page 3 2. Item 4. of the May 2012 Consent Agreement states, "Within six (6) months of the effective date of this Consent Agreement, MS. NETTLES shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education, or another comparable course approved in advance by the Board or its designee, taken subsequent to the effective date of this Consent Agreement: eight (8) hours of Anger Management and two (2) hours of Law and Rules governing the practice of nursing in Ohio." Despite this provision, as of January 11, 2013, you have failed to submit to the Board satisfactory documentation of successful completion of the following continuing nursing education, or other comparable courses approved in advance by the Board: eight (8) hours of Anger Management and two (2) hours of Law and Rules governing the practice of nursing in Ohio. On or about January 3, 2013, you submitted a written statement to the Board regarding your non-compliance with the May 2012 Consent Agreement, stating you failed to comply with the educational requirements for financial reasons. Section 4723 .28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 3. Item 5. of the May 2012 Consent Agreement states, "Within ninety (90) days following the effective date of this Consent Agreement, MS. NETTLES shall, at her expense, obtain a psychiatric evaluation from a Board approved psychiatrist and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. NETTLES shall provide the psychiatrist with a copy of this Consent Agreement and shall execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. NETTLES's license, and whether MS. NETTLES is capable of practicing as a nurse according to acceptable and prevailing standards of nursing care." Despite this provision, as of January 11, 2013, you have failed to obtain a psychiatric evaluation from a Board approved psychiatrist and failed to cause to a report to be submitted to the Board by that psychiatrist as required. On January 3, 2013, you submitted a written statement to the Board regarding your non-compliance with the May 2012 Consent Agreement, stating you failed to comply with these requirements for financial reasons.

Monica AngeliqUe Nettles, L.P.N. Page 4 Section 4723.28(8)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 4. On or about, April 30, 2007, in Cleveland Heights Municipal Court Case Number 06-CRB-0602963, you were found guilty of one (1) count of Criminal Mischief, a misdemeanor of the third degree, in violation of Section 2909.07, ORC. Despite this, on or about August 25, 2008, you submitted to the Board an Application for Renewal of Licensure (application). In your application, when asked whether you had a "misdemeanor in Ohio, another state, commonwealth, territory, province or country," you responded "No." You failed to disclose your misdemeanor conviction in Cleveland Heights Municipal Court Case Number 06-CRB-0602963, referenced above. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Ohio Administrative Code (OAC), Rule 4723-4-06(P) [as in effect prior to February 1, 2009], states that a licensed nurse shall not submit or cause to be submitted any false, misleading, or deceptive statements, infotination, or documentation to the board, to current employers, or to any future employers for positions requiring a nursing license. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing(&,nursing.ohio., ov. w If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal ,allegations set forth in this Notice of Automatic Suspension and. Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Monica Angelique Nettles, L.P.N. Page 5

Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1182 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 11-003133

Ohio Board of Nursing

17 South High Street, Suite 400
G

WWW. 11 u rs i ng. oh io.gov

Columbus, Ohio 43215-7410 0 (614) 466-3947

CONSENT AGREEMENT BETWEEN MONICA ANGELIQUE NETTLES, L.P.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between MONICA ANGELIQUE NETTLES, L.P.N. (MS. NETTLES) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder, This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. B. MS. NETTLES was initially licensed to practice nursing as a licensed practical nurse in the State of Ohio, PN# 118420, in April 2005. C. MS. NETTLES knowingly and voluntarily admits to the following: 1) On or about April 13, 2011, in Lyndhurst Municipal Court Case No. 1 I CRB0010 , MS. NETTLES was convicted of Domestic Violence, a fourth-degree misdemeanor, in violation of Ordinance 537.14(C) of the Richmond Heights Codified Ordinances. 2) MS. NETTLES submitted a statement to the Board indicating that the underlying facts in the case involve her confronting her son about his behavior and the confrontation subsequently escalated to a physical altercation. MS. NETTLES

Monica Angelique Nettles, L.P.N. Page 2

reports that she has completed the terms and conditions of her case, including court ordered parenting classes. 3) M.S. NETTLES apologizes for her actions and is willing to cooperate with the Board in order to maintain her nursing license. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter- set forth, and in lieu of any formal proceedings at this time, MS. NETTLES knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. NETTLES's license to practice nursing as a licensed practical nurse shall be suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum period of one (1) year: -MS. NETTLES shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. NETTLES shall comply with all terms and conditions imposed upon her by the Lyndhurst Municipal Court in case number ICRB00101. 2. MS. NETTLES shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. MS. NETTLES agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. NETTLES, including a check of Federal Bureau of Investigation (FBI) records, and shall request BCII to submit MS. NETTLES's criminal records check reports to the Board, MS. NETTLES's completed criminal records Check, including the FBI check, must be received by the Board prior to release from these probationary terms.

3.

Educational Requirement 4. Within six (6) months of the effective date of this Consent Agreement, MS. NETTLES shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education, or another comparable course approved in advance by the Board or its designee, taken subsequent to the effective date of this Consent Agreement: eight (8) hours of Anger Management and two (2) hours of Law and Rules governing the practice of nursing in Ohio.

Psychiatric Evaluation 5. Within ninety (90) days following the effective date of this Consent Agreement, MS. NETTLES shall, at her expense, obtain a psychiatric evaluation from a Board approved .psychiatrist and shall provide the Board with complete documentation of this evaluation.

Monica Angelique Nettles, L.P.N. Page 3 Prior to the evaluation, MS. NETTLES shall provide the psychiatrist with a copy of this Consent Agreement and shall execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that .should be placed on MS. NETTLES's license, and whether MS. NETTLES is capable of practicing as a nurse according to acceptable and prevailing standards of nursing care. 6. MS. NETTLES shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the psychiatrist until released. Further, MS. NETTLES agrees that the Board may use the psychiatrist's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. NETTLES's license and that the terms, conditions, and limitations maybe incorporated in an addendum to this Consent Agreement.

Employment Conditions 7. MS. NETTLES shall notify the Board, in writing, of the name and address of any current employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to accepting nursing employment. MS. NETTLES, within fifteen (15) days of the effective date of the Consent . Agreement, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement.' Further, MS. NETTLES is under a continuing duty to proVide a copy of this Consent Agreement to any new employer prior to accepting nursing employment. MS. NETTLES shall have her employer(s), if working in a position where a nursing license' is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of the effective date of this Consent Agreement or beginning within thirty (30) days of working in a nursing position. MS. NETTLES shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date Consent Agreement was received.

8.

Reporting Requirements 9. MS. NETTLES shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. NETTLES shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. NETTLES shall submit any and all inforMation that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice.

10.

11.

Monica Angelique Nettles, L.P.N. Page 4 12. MS. NETTLES shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. NETTLES shall submit the reports and documentation required by. this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board: MS. NETTLES shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. NETTLES shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. NETTLES. shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

13.

14.

15. 16.

Temporary Practice Restrictions Unless otherwise approved in advance, in writing, by the Board or Its designee, MS. NETTLES shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. NETTLES to provide nursing services for fees, compensation, or other consideration or who engage MS. NETTLES as a volunteer. Unless otherwise approved in advance, in writing, by the Board or its designee, MS. NETTLES shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing FAILURE TO COMPLY MS. NETTLES agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if ituppears to the. Board that MS. NETTLES has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall . notify MS. NETTLES via certified mail of the specific nature of the charges and automatic suspension of her license. MS. NETTLES may request a hearing regarding the charges.

Monica Angelique Nettles, L.P.N. Page 5

The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of. Section 4723.28(B), ORC. If, in the discretion of the Board, MS. NETTLES appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MS. NETTLES and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. NETTLES has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. NETTLES is able to practice according - to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. NETTLES and review of the reports as required herein. Any period during which MS. NETTLES does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDCIVIENTS/LIABILITY RELEASE MS. NETTLES acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. NETTLES waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. NETTLES waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement, This Consent Agreement shall be considered a public record as that term is used in Section 149,43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC.

MAY-04-2012 16:13 From:EUCLID PUBLIC LIB

To:Ell 995 3696

P.2/2

' Monica Angelique Nettles, L,P,N, Page 6 EFFECTIVE DATE MS, NETTLES understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of sigrlature below,

MO

A. ANC; LANE NETTLES, L.P.N.

DATE

s-I fei 111

RA LOVELACE, President Ohio Board of Nursing DATE

05/04/2012 FRI 18:45 [IX/RX NO 75713 l 002

Case # 12-001171

Ohio Board of Nursing

17 South High Street, Suite 400

www.nursing.ohio.gov Columbus, Ohio 43215-7410 * (614) 466-3947

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Patricia Ann O'Husky, R.N. 6368 Montford Rd. E. Westerville, Ohio 43081 Dear Ms. O'Husky: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing. (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about February 29, 2012, you told a Riverside Methodist Hospital, Columbus Investigator that starting in or about March 2011, while working as a registered nurse at Riverside Methodist Hospital in Columbus, Ohio, you stole Dilaudid and consumed the medication. You stated that you did this by diverting the waste after giving patients their dose and you would obtain verbal orders from physicians so that you could divert the waste. Section 4723 .28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723 .28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. 2. As set forth in Attachment A, while working as a nurse at Riverside Methodist Hospital in Columbus, Ohio, you failed to account for the disposition of narcotics you signed out from the scheduled drug record. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(E), Ohio Administrative Code (OAC), states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client.

Patricia Ann O'Husky, R.N. Page 2 Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC . In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position; arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0215 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 0222 cc: Henry G. Appel, Senior Assistant Attorney General Jeremy Dodgion, Esq.

Patricia Ann O'Husky, R.N. Page 3 ATTACHMENT A PATIENT Physician Order WITHDRAWAL MAR Comments

Patient #1

Morphine Order given on 2/11/12: -2 mg via IV every 4 hours as needed

Morphine 10 mg/ml: On 2/12/12: a. 3:46 (8mg wasted) b. 5:51 (8mg wasted) c. 6:12 (8mg wasted)

Morphine 2 mg: On 2/12/12: a. 3:49 -- No physician order (administered doses within 4 hrs)

b. 6:14

Patient #2

Dilaudid Order given on 2/9/12: - 0.5 mg via IV every 3 hours as needed

Hydromorphone (Dilaudid) 1 mg/1 ml: On 2/10/12: a. 1:34

c. No documentation that dose given Regarding 6:12 withdrawal, no documentation, 2 mg unaccounted for Dilaudid given: 0.5 mg: On 2/10/12 a. 1:35 Did not document waste, 0.5 mg unaccounted for

Patient #3

Dilaudid Order given on 1/25/12: - I mg via IV every 1 hour as needed

Hydromorphone (Dilaudid) 1 mg/1 ml: On 1/25/12: a. 20:23

Dilaudid given: 1 mg: On 1/25/12: a. No documentation that dose given No documentation, I mg unaccounted for

Patricia Ann O'Husky, R.N. Page 4 Patient #4 Dilaudid Order started 2/19/12 through 2/29/12: - 1 mg via IV every 3 hours as needed Hydromorphone (Dilaudid) 1 mg/1 ml: On 2/29/12: a. 2:11 Dilaudid given:

On 2/29/12: a. No documentation dose was given b. No documentation dose was given -- No documentation, missing 2 mg unaccounted for

b. 6:46

Case #12-006496

Ohio Board of Nursing

17 South High Street, Suite 400 January 25, 2013

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 m (614) 466-3947

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Barbara J. Oliver, L.P.N. 6030 6th Avenue Miamisburg, Ohio 45342 Dear Ms. Oliver: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that: 1. On or about October 3, 2005, in Montgomery County Court of Common Pleas Case Number 2005 CR 02723/2, you pled guilty to one (1) count of Possession of Heroin, a felony of the fifth degree, in violation of Section 2925.11(A), ORC; and one (1) count of Possession of Cocaine, a felony of the fifth degree, in violation of Section 2925.11(A), ORC, and were found eligible for Intervention in Lieu of Conviction. You were subsequently ordered to serve a term of incarceration in a state penal institution. 2. On or about December 13, 2011, in Warren County Court of Common Pleas Case Number 09CR25856, you pled guilty to and were found guilty of one (1) count of Possession of Heroin, a felony of the fifth degree, in violation of Section 2925.11(A), ORC. 3. On or about January 3, 2012, in Montgomery County Court of Common Pleas. Case Number 2009 CR 02242, you pled guilty to and were found guilty one (1) count of Possession of Heroin, a felony of the fifth degree, in violation of Section 2925.11(A), ORC. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction.

Barbara J. Oliver, L.P.N. Page 2

Possession of Heroin, felonies of the fifth degree, in violation of Section 2925.11(A), ORC; and Possession of Cocaine, a felony of the fifth degree, in violation of Section 2925.11(A), ORC, constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-058181, IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: la. On or about October 3, 2005, in Montgomery County Court of Common Pleas Case Number 2005 CR 02723/2, you pled guilty to one (1) count of Possession of Heroin, a felony of the fifth degree, in violation of Section 2925.11(A), ORC; and one (1) count of Possession of Cocaine, a felony of the fifth degree, in violation of Section 2925.11(A), ORC, and were found eligible for Intervention in Lieu of Conviction. You were subsequently ordered to serve a term of incarceration in a state penal institution. The acts underlying this case occurred on or about June 28, 2005, and involve you obtaining, possessing, or using Heroin and Cocaine. lb. On or about December 13, 2011, in Warren County Court of Common Pleas Case Number 09CR25856, you pled guilty to and were found guilty of one (1) count of Possession of Heroin, a felony of the fifth degree, in violation of Section 2925.11(A), ORC; and one (1) count of Possession of Drug Abuse Instruments, a misdemeanor of the second degree, in violation of Section 2925.12(A), ORC. The acts underlying this case occurred on or about April 1, 2009, and involve you obtaining, possessing, or using Heroin and any instrument, article, or thing, for the administration or use of a dangerous drug. lc. On or about January 3, 2012, in Montgomery County Court of Common Pleas Case Number 2009 CR 02242, you pled guilty to and were found guilty one (1) count of Possession of Heroin, a felony of the fifth degree, in violation of Section 2925.11(A), ORC. The acts underlying this case occurred on or about June 8, 2009, and involve you obtaining, possessing, or using Heroin.

Barbara J. Oliver, L.P.N. Page 3 Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearin @nursin .ohio ov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not Dore than five hundred dollars ($500.00) per violation. Sincerely,

R.At
Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0864 cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-003441

Ohio Board :of Nursing'

17 South High. Street, Suite 400

www.nursing.ohlo.gov
(614) 466,3947

Columbus, Ohio 43215-7410

January 25, 2013_

NOTICE OF OPPORTUNITY FOR HEARING

Jeffrey James Olmstead, R.N. 542 Twp Road 1151 Nova, Ohio 44859 Dear Mr. Olmstead: In accordance with Chapter 119, Ohio Revised Code (hereinafter "ORC"), you are hereby notified that the Ohio Board of Nursing (hereinafter "Board") proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about March 16, 2012, the Ohio Board of Nursing (Board) issued an Adjudication Order (March 2012 Adjudication Order), a copy of which is attached hereto and incorporated herein, in which the Board ordered that your license be fined two hundred fifty dollars ($250.00) and subject to random drug screens for a period of three (3) months. Attached to an incorporated within the March 2012 Adjudication Order is a January 6, 2012 Board Hearing Committee's Report and Recommendation. 2. Item 1. of the March 2012 Adjudication Order states, "For a minimum, continuous period of ninety (90) days, MR. OLMSTEAD shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MR. OLMSTEAD's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call4n process. The specimens submitted by MR. OLMSTEAD shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. OLMSTEAD's history." Despite this provision, as of January 15, 2013, you have failed to register with Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen.

Jeffrey James Olmstead, R.N. Page 2 3. Item 4. of the March 2012 Adjudication Order states, "By July 1, 2012, MR. OLMSTEAD shall pay the fine of two hundred and fifty dollars ($250.00), by certified check, cashier check, or money order, made payable to the "Treasurer, State of Ohio," to the Board. Payment shall be mailed to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South la Street, Suite 400, Columbus, OH 43215-7410." Despite this provision, as of January 15, 2013, you have failed to pay the two hundred fifty dollar ($250.00) fine. Section 4723.28(8)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, heatg l @nursing,goy. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Jeffrey James Olmstead, R.N. Page 3 Sincerely, >41', Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0833 cc: Henry G. Appel, Senior Assistant Attorney General

Ohio Board of Nursing www.nursing.ohio.gov

17 South High Street, Suite 400 * Columbus, Ohio 43215-7410 (614) 466-3947

BEFORE THE OHIO BOARD OF NURSING IN THE MATTER OF: CASE # 08-2483 JEFFREY OLMSTEAD, RN

ADJUDICATION ORDER

This matter came for consideration before the Ohio Board of Nursing (hereinafter "Board") on March 16, 2012. At such time the Board verified that it reviewed the following materials prior to consideration of this matter: Hearing Transcript; State's Exhibits; Respondent's Exhibits; and Board Committee's Report and Recommendation. The Board Hearing Committee, appointed by the Board, presided over the adjudication hearing in this matter pursuant to Section 119.09, Ohio Revised Code (ORC). A true copy of the Board Hearing Committee's Report and Recommendation is attached hereto and incorporated herein. On this date, the Board accepted all of the Findings of Fact, Conclusions of Law, and the Recommendation in the Board Hearing Committee's Report and Recommendation and Ordered that Jeffrey Olmstead's license to practice nursing as a registered nurse in the . State of Ohio be fined two hundred and fifty dollars ($250.00) and subject to random drug screens for a period of three (3) months. TERMS 1. For a minimum, continuous period of ninety (99) days, MR. OLMSTEAD shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MR. OLMSTEAD's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 472328(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR.. OLMSTEAD shall be negative,i_except for substances prescribed, administered, or dispensed to him by another

Page 1 of 5

so authorized by law who has full knowledge of MR. OLMSTEAD's history. 2. Within thirty (30) days prior to MR. OLMSTEAD initiating drug screening, MR. OLMSTEAD shall provide a copy of this Order to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MR. OLMSTEAD. 3. After initiating drug screening, MS. OLMSTEAD shall be under a continuing duty to provide a copy of this Order, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within fortyeight (48) hours of being treated by another practitioner. Further, MR. OLMSTEAD shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from.hospitalization or medical treatment, 4. By July 1, 2012, MR. OLMSTEAD shall pay the fine of two hundred and fifty dollars ($250.00), by certified check, cashier check, or money order, made payable to the "Treasurer, State of Ohio," to the Board. Payment shall be mailed to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. Reporting Requirements of MR. OLMSTEAD 5. MR. OLMSTEAD shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board. 6. MR. OLMSTEAD shall submit any and all information that the Board may request regarding his ability to practice according to acceptable and prevailing standards of safe nursing practice. 7. MR. OLMSTEAD shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. 8. MR. OLMSTEAD shall submit the reports and documentation required by this Order on forms specified by the Board. All reporting and communications required by this Order shall be made to the Compliance Unit of the Board. 9. MR. OLMSTEAD shall submit the reports and documentation required by this Order to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. 10. MR. OLMSTEAD shall verify that the reports and documentation required by this Order

Page 2 of 5

are received hi the Board office. 11. MR. OLMSTEAD shall inform the Board within three (3) business days, in writing, of any change in address and/or telephone number.

This ORDER shall become effective immediately and is hereby entered upon the Journal of the Board for the 16th day of March, 2012.

Page 3 of 5

TIME AND METHOD TO PERFECT AN APPEAL Any party desiring to appeal shall file a Notice of Appeal with the Ohio Board of Nursing, 17 S. High St., Ste 400, Columbus OH 43215-7410, setting forth the order appealed from and the grounds of the party's appeal. A copy of such Notice of Appeal shall also be filed by the appellant with the Franklin County Court of Common Pleas, Columbus, Ohio. Such notices of appeal shall be filed within fifteen (15) days after the mailing of the notice of the Ohio Board of Nursing's Order as provided in Section 119.12 of the Ohio Revised Code.

CERTIFICATION

The State of Ohio County of Franklin

I, the undersigned Betsy J. Houchen, Executive Director for the Ohio Board of Nursing, hereby certify that the foregoing is a true and exact reproduction of the original Order of the Ohio Board of Nursing entered on its journal, on the 16th day of March, 2012.

Betsy .1. Houchen, R.N., M.S., 3,D. Executive Director

March 16, 2012 Date

(SEAL)

Page 4 of 5

CERTIFICATE OF SERVICE I hereby certify that a true and accurate copy of the foregoing Adjudication Order, concerning JEFFREY OLMSTEAD was sent via certified mail; return receipt requested, this 5th day of April, 2012 to JEFFREY OLMSTEAD 542 Township Road 1151, Nova, 011 44859.

I also certify that a copy of the same was sent via regular US, mail this 5th day of April, 2012 to Lamont Pugh, SAC, Sanctions & Exclusions, Department of Health and Human Services, Office of Inspector General, Office of Investigations, PO Box 81020, Chicago IL 60601-81020.

Betsy J. Houchen, R.N., M.S., J.D. Executive Director

cc:

Henry Appel, Assistant Attorney General

Certified Mail Receipt No. 7011 2970 0003 1733 3302

Page 5 of 5

1-

State of Ohio jAn _S pm 1: 03 Board of Nursing 17 South High Street, Suite 19 A'0 OF )iURS1NG Columbus, Ohio 43215-7410 wito . In the Matter of Jeffrey J. Olmstead, R.N.. Respondent

Bertha M. Lovelace, Presiding Member Tracy Ruegg, Member Johnnie A. Maier, Jr., Member Board Hearing Committee Cases No. 08-2483 Jemmy 6, 2012 Report and Recommendation

Appearances: For the Ohio Board of Nursing: Michael DeWine, OHIO ATTORNEY GENERAL, and Henry Appel., Esq., Assistant Attorney General, Health & Human Services Section, 30 East Broad Street, 26th Floor, Columbus, Ohio 43215-.3428, Telephone: 614-4668600; Fax: 614-466-6090. For the Licensee/Respondent: Jeffrey J. Olmstead, 542 Township Road 1151, Nova, Ohio 44859: 419-496-3286, Fax! None provided. Nature of the Case This is an administrative proceeding under Chapter 119 (the Administrative Procedure Act), and Chapter 4723 (the Nurse Practice Act), of the Ohio Revised Code ("ORC"), The case involves a Notice of Opportunity for Hearing ("Notice") issued to the Respondent, Jeffrey J. Olmstead, R.N. ("Respondent" or "Mr. Olmstead"), on January 21, 2011. (State Exhibit I.) In the Notice, the Ohio Board of Nursing ("Board") informed Mr. Olmstead that it intended to take disciplinary action against his license based on his testing positive for Marijuana on a preemployment drug screen. (1d.)- In the Notice sent to Mr. Olmstead, the Board set forth its reasons for the proposed action, identified the charges against him, and advised Mr. Olmstead of his right to a hearing. (M.) Mr. Olmstead made a timely request for a hearing. (State Exhibit 2.) The Board gave Mr. Olmstead written notice that it would consider the charges in proceedings to be held before its Board Hearing Committee, setting forth the date, time and location for this hearing. (State Exhibit 3.) The Board appointed the Board Hearing Committee, composed of three members, to hear this matter and to make a recommendation to the full Board. I have been

Page i of 6

appointed to serve as the Presiding Board. Hearing Committee member in this matter.. At the designated time the parties presented evidence and testimony on the charges-during a hearing conducted on October 12, 2011, Mr. Olmstead was present at the hearing and was not represented by counsel. This report is based on the evidence and testimony presented at the hearing.

Summary of the Issues The. Board charged Mr, Olmstead with testing positive for Marijuana on a preemployment drug screen. (State Exhibit 1.) Self-administration of a dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription, is ,grounds for disdiplinary action pursuant to Section 4723,28(B)(8), ORC, The Board is required to consider the merits of each case, and may, based upon the circumstances leading to the charges, Consider both aggravating and mitigating circumstances shown in the record. From the evidence before the Board Committee, we find a sufficient basis to conclude that Mr. Olmstead tested positive for Marijuana on a pre-employment drug screen. Because the evidence establishes a valid basis for disciplinary action, we recommend that Mr. Olmstead's license to practice as a Registered Nurse be fined two hundred and fifty dollars ($250.00), and that Mr. Olmstead be subject to random drug screening for a period of three (3) months. Our analysis follows.

Evidence Examined The parties presented evidence in the form of exhibits, identified in the record at page 3 of the transcript of proceedings. The State called Mr, Olmstead to testify as on crossexamination; Mr. Olmstead provided testimony on his own behalf. All testimony and exhibits admitted in the hearing of this matter, Whether or not specifically referred. to in this Report, were thoroughly reviewed and considered by the Board Hearing. Committee prior to the entry of the findings, conclusions and recommendations shown below.

Summary of the Evidence The State presented evidence that Mr. Olmstead has been licensed to practice nursing as a Registered Nurse in the State of Ohio since January 22, 1997. (State Exhibit 6.) Mr. Olmstead

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of 6

testified that in May of 2008, he was laid off from his job as a crew member for Omniflight, (See Tr,, p. 10, 13.) He also stated that he was involved hi a custody battle for his children and faced foreclosure of his home during this time period. (Tr., p. 10.) Mr. Olmstead testified that in July 2008, he went home to Michigan "to the comfort of friends and family." (Id) While in Michigan, Mr. Olmstead went camping and to a concert. (See Id., State Exhibit 5.) Mr. Olmstead stated, "Someone passed a joint down the line and in the midst of the moment, I made the mistake of taking a hit or two. It was an isolated event and a stupid mistake. . (State Exhibit 5,) A few weeks later, Mr. Olmstead applied for a position with AMN Healthcare and on July 21, 2008, submitted to a pre-employment drug screen. (See State Exhibit 4.) Mr. Olmstead's specimen tested positive for Marijuana. (1d) On September 7,2008, Mr, Olmstead submitted a statement to the Board in which he admitted he smoked Marijuana in July 2048. (Id.) Analysis From the record now before the Board, it appears that there is a preponderance of evidence that Mr. Olmstead underwent a pre-employment drug screen and tested positive for Marijuana. (State Exhibit 4.) Mr. Olmstead submitted three (3) letters of recommendation from former supervisors and/or colleagues. (Respondent Exhibits B, C, D.) In the letters, Mr. Olmstead's co-workers .described his high level of professionalism, his communication skills, his expertise in the nursing field, and his energy and enthusiasm for his work. (See id.) Mr. Olmstead also submitted certificates of completion for the following programs: Air Evac Aeromedical Academy, EMS Instructor Training, CCT-RN, Air Medical Resource Management, and Hazmat Materials and Flight Safety. (Respondent Exhibits E, F, G, H, I.) Mr. Olmstead has also been accepted to and is taking classes from Marshall Community & Technical College to further his education and training. (See Respondent Exhibit A.) The Cominittee notes that Mr. Olmstead's infraction is a single event over a fourteenyear career. (See State Exhibit 6.) Mr. Olmstead has bad no prior disciplinary action taken against him by the Board. Mr. Olmstead's violation caused no harm to any of his patients; Mr. Olmstead was not working as a nurse at the time of this occurrence. (See Tr., p. 10.) Mr.

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 Olmstead was cooperative and candid in his testimony at the hearing, accepted responsibility for his actions, and expressed genuine remorse. (See Tr., p. 11, 16, State Exhibit 4.) The evidence now before the Board supports discipline against Mr. Olmstead in the form of a fine and random drug screens for a period of three (3) months. Recommendations Regarding Findings of Fact and Conclusions Based on evidence Presented Having heard the testimony of the witnesses and the oral argument of counsel, and having examined the exhibits admitted into evidence, the Board Hearing Committee makes the following recommended findings of fact and conclusions to the full Board. 1. Respondent Jeffrey J. Olmstead holds an active license with the Ohio Board of Nursing as a Registered Nurse, He has been so licensed hi Ohio since January 22, 1997. 2. The State has established by at least a preponderance of the evidence, that on or about July 21, 2008, while applying for a position as a Registered Nurse at AMN Healthcare, Mr. Olmstead underwent a pre-employment drug screen and tested positive for Marijuana. 3. The State has established by at least a preponderance of the evidence, that on or about September 7, 2008, Mr. Olmstead submitted a statement to the Board in which he admitted to consuming Marijuana at a concert with friends. 4. On or about January 21, 2011, the Board issued a Notice of Opportunity for Hearing to Mr. Olmstead. Conclusions 1. Because he holds a license as a Registered Nurse issued by the Ohio Board of Nursing, Respondent Jeffrey J. Olmstead, .R,N is subject to the jurisdiction of the Board in actions taken pursuant to Chapter 4723 of the Ohio Revised Code. 2. Upon sufficient cause to believe a licensee of the Board of Nursing has violated a provision of the Nurse Practice Act, the Board is authorized to take action with respect to that licensee's nursing license. Upon his receipt of the Board's charging document, the Respondent timely requested an evidentiary hearing before the Board took any final action based upon the Board's charges. Upon its receipt of Respondent's request for an

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administrative hearing, the Board set the matter for hearing, in the manner provided for by Chapter 119, ORC (Ohio Administrative Procedure Act), and provided the Respondent with an opportunity to be heard before it took any final action with respect to the Respondent's license as a Registered Nurse, in the manner provided for by law. 3. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for selfadthinistering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal valid prescription issued for that individual. Marijuana is a Schedule I controlled substance (Section 3719.41(C), ORC), which in turn is a dangerous drug (Section 4729.01(F), ORC). 4, Where by at least a preponderance of the evidence the State establishes, as is the case here, that the Respondent self-administered Marijuana, as demonstrated through his positive drag screen, and through his admission that he consumed Marijuana, the State has proved the Respondent violated Section 4723.28(B)(8), ORC. 8. Pursuant to Section 4723.28(B), ORC, upon proof that the Respondent has violated a provision of the Nurse Practice Act as set forth in Section 4723.28, ORC, the Board, by a vote of a quorum, may impose one or more of the following sanctions: it may deny, permanently revoke, revoke, suspend, or place restrictions on any nursing license issued by the Board; it may reprimand or otherwise discipline a holder of a nursing license; or it may impose a fine of not more than five hundred dollars per violation. Upon sufficient proof, as has been shown in this evidentiary proceeding, that the Respondent has violated the provisions of the Nurse Practice Act and rules as concluded by the Board Hearing Committee, the Board may implement any of the foregoing disciplinary actions. Recommendation Upon sufficient proof that the Respondent, Jeffrey J. Olmstead, has violated provisions of the Nurse Practice Act as shown above, it is. the Board Committee's recommendation that the Respondent'S license to practice as a Registered Nurse be fined in the amount of two hundred and fifty dollars ($250.00), and that the Respondent be subject to random drug screens for a period of three (3) months. This is a recommendation only; it is not a final order. Only the full Board has the authority to enter - a final order in this administrative action. The Board has the authority to

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adopt, modify, or reject this recommendation, and this recommendation shall have no legal effect until and unless adopted by the Board, and a final order is issued by the Board as provided for by Chapters 4723 and 119 of the Revised Code.

Bertha M. Lovelace, Presiding Member Tracy Ruegg, Member Johnnie Maier, Jr., Member Board Hearing Committee

CERTIFICATE OF SERVICE 1 certify that the original of this report and recommendation was served upon the Ohio Board of Nursing by email delivery, with my electronic signature, on January 6, 2012.

Bertha M. Lovelace, Presiding Member

Page 6 of 6

Case #12-001100

Ohio Board of Nursing

January 25, 2013

www.nursing.ohio.gov

17 South High Street, Suite 400 4 Columbus, Ohio 43215-7410 o.. (614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Gina Ann Parks (A.K.A. "Gina A. Schibi") 813 St. James Avenue Park Hills, KY 41011 Dear Ms. Parks: On or about November 27, 2012, the Ohio Board of Nursing (Board) issued to you a Notice of Immediate Suspension and Opportunity for Hearing, a copy of which is attached hereto and incorporated herein. You are notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28 of the Ohio Revised Code, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about July 20, 2012, in Hamilton County Court of Common Pleas Case Number B 1203015-A, you pled guilty to six (6) counts of Deception to Obtain a Dangerous Drug, felonies of the fifth degree, in violation of Section 2925.22(A), ORC, and were subsequently found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred in or about September and October 2010, March and August 2011, and February 2012 and involve you using deception to procure the dispensing of Hydrocodone and Diazepam. Section 4723 .28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723 .28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. On or about April 2, 2012, the Office Manager at The Dermatology Laser and Vein Center in Montgomery, Ohio, where you worked as a nurse, reported to the City of Montgomery Police Department that after the doctor left the office for the day, you performed late evening

Gina Ann Parks (A.K.A. "Gina A. Schibi") Page 2

procedures on people without the knowledge or permission of the doctor. The Office Manager reported that you paid the Office Manager a small amount to "turn his head" while you performed these procedures. On or about April 19, 2012, you spoke with a Board Compliance Agent about your actions while employed as a licensed practical nurse at The Dermatology Laser and Vein Center. You admitted that you performed a hair removal procedure on a friend, without a physician's order and in the friend's home. You also admitted to performing Botox and filler procedures on four (4) other individuals, without physician's orders, in exchange for cash. You submitted a written statement, dated April 19, 2012, in which you wrote, "I also did filler and in home botox to other staff members and friends in compensation of cash or other services (etc haircut and color) which was not in my scope of practice. ... I also did laser hair removal for a friend in exchange for 2 prescriptions called in under her name that she gave to me." [sic] Section 4723.28(B)(21), ORC, authorizes the Board to discipline a licensee for, in the case of a licensed practical nurse, engaging in activities that exceed the practice of nursing as a licensed practical nurse. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-04(D), Ohio Administrative Code, states that a licensed practical nurse may provide nursing care in accordance with division (F) of section 4723.01 of the Revised Code which is beyond basic preparation for a licensed practical nurse provided: (1) The nurse obtains appropriate education which emanates from a recognized' body of knowledge relative to the nursing care to be provided;. (2) The nurse demonstrates appropriate knowledge, skills, and abilities to perform the nursing care; (3) The nurse maintains documentation satisfactory to the board of meeting the requirements set forth in paragraphs (D)(1) and (D)(2) of this rule; (4) When the nursing care to be provided is in accordance with division (F)(3) of section 4723.01 of the Revised Code, the nurse has a specific current valid order or direction from an individual who is authorized to practice in this state and is acting within the course of the individual's professional practice; and (5) The nursing care does not involve a function or procedure which is prohibited by any other law or rule. 3. On or about April 19, 2012, you admitted to a Board Compliance Agent that while working as a nurse at The Dermatology Laser and Vein Center, you called in prescriptions for Ativan and Vicodin without a doctor's order. You admitted that you self-administered these medications. You submitted a written statement, dated April 19, 2012, in which you wrote, "I admit to in 2009 I did call in prescriptions or write a

Gina Ann Parks (A.K.A. "Gina A. Schibi") Page 3

presigned script in to numerous pharmacies under my name, my husbands name or other family members name. I also want to let the board no I obtained all the pills and take them myself. All of the above prescriptions we for Vicodin 5/500mg and Valium 5mg, or 10mg tablets." [sic] You submitted a written statement, dated April 20, 2012, in which you wrote, "I felt my pain physically and emotionally so I started taking the Vicodin to mask the feelings." Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for selfadministering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at, such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearinanursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Gina Ann Parks (A.K.A. "Gina A. Schibi") Page 4

/V ,/, Rhonda S. Barkheimer, C.N.P. Supervising Board Member

Certified Mail Receipt No. 7012 2210 0000 6272 1229 Attorney 1 Certified Mail Receipt No. 7012 2210 0000 6272 1236 Attorney 2 Certified Mail Receipt No, 7012 2210 0000 6272 1243 cc: Henry G. Appel, Senior Assistant Attorney General Stacey A. Borowicz, Esq. Eric J. Plinke, Esq.

Case #12-001100

Ohio Board :of Nursing.

November 27, 2012

www.nursing.oh.i.o.gov

17 South High Street, Suite 400 m Columbus, Ohio 43215-7410 .0. (614) 466-3947

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Gina Ann Parks (A.K.A. "Gina A. Schibi"), L.P.N. 813 St. James Avenue Park Hills, KY 41011 Dear Ms. Parks: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about July 20, 2012, in Hamilton County Court of Common Pleas Case Number B 1203015-A, you pled guilty to six (6) counts of Deception to Obtain a Dangerous Drug, felonies of the fifth degree, in violation of Section 2925.22(A), ORC, and were subsequently found eligible for Intervention in Lieu of Conviction. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Deception to Obtain a Dangerous Drug, felonies of the fifth degree, in violation of Section 2925.22(A), ORC, constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-086681, IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered, engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(B), ORC.

Gina Ann Parks (A.K.A. "Gina A. Schibi"), L.P.N. Page 2 In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.12I(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410, or to the e-mail address, hcaring@nursing.ohio.gpv. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Judith A. Church, R.N., C.N.P. Supervising Board Member

Certified Mail Receipt No. 7012 1010 0002 4257 4985 Attorney 1 Certified Mail Receipt No. 7012 2210 0000 6270 5021 Attorney 2 Certified Mail Receipt No. 7012 2210 0000 6270 5038 cc: Henry G. Appel, Senior Assistant Attorney General Stacey A. Borowicz, Esq. Eric J. Plinke, Esq.

Case # 11-005050

Ohio Board .of Nursing

17 South High Street, Suite 400

www.nursing.ohio.gov (614) 466-3947 Columbus, Ohio 43215-7410

January 25,2,013

NOTICE OF OPPORTUNITY FOR HEARING

Lisa Ann Peoples, R.N. 4670 Harmony Township Rd. 161 Marengo, Ohio 43334 Dear Ms. Peoples: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about October 28, 2011, while working as a nurse at Morrow County Hospital in Mount Gilead, Ohio (MCH), you pre-charted Patient#1's [See attached Patient Key to remain confidential and not subject to public disclosure] surgical notes, including final sponge counts, skin closure, dressings applied, post-operative condition, where the patient had been transported to, who did the transport, and who you gave report to after the case. You left the operating room at 12:15 PM and the surgery was not complete until 12:49 PM. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(E), Ohio Administrative Code (OAC), states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-4-06(G), OAC, states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. 2. On or about July 11, 2011, while working as a nurse at MCH, you pre-charted Patient#2's surgical notes, including final sponge counts, skin closure, dressings applied, post-operative condition, where the patient had been transported to, and who did the transport. You left the operating room at 3:58 PM and signed out of work at 4:06 pm, when the surgery was not complete until 4:15 PM.

Lisa Ann Peoples, R.N. Page 2 Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(E), OAC, states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-4-06(G), OAC, states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursina.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, R. At cfiV,,A? / Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0499 cc: Henry G. Appel, Senior Assistant Attorney General

Case# 12-006506

Ohio Board .of Nursing

17 South High Street, Suite 400

www.nursing

Columbus, Ohio 43215-7410 .4 (614) 466-3947

January 25, 2013

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Christopher Michael Peugh, R.N. 19 Highland Drive Mount Vernon, Ohio 43050 Dear Mr. Peugh: You are hereby notified that, on or about January 22, 2010, you entered into a Consent Agreement (January 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that upon meeting the requirements for reinstatement your license to practice nursing as a registered nurse in the State of Ohio would be reinstated and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of at least three (3) years. Attached to the January 2010 Consent Agreement are release letters from the Board dated August 11,2011 and August 4,2010. A. Item 6. of the January 2010 Consent Agreement states, "For a minimum, continuous period of nine (9) months immediately prior to requesting reinstatement and continuing throughout the probationary period, MR. PEUGH shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR. PEUGH shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. PEUGH's history of chemical dependency and recovery status." Despite this provision, on the following dates you were selected by Firstlab, the Board's random drug/alcohol screen program administrator, to provide a urine specimen and failed to do so: November 22, 2011, July 25, 2012, and September 24,2012. Section 4723 .28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board.

Christopher Michael Peugh, R.N. Page 2 In accordance with the paragraph under "FAILURE TO COMPLY" of the January 2010 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Item 6. of the January 2010 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-302645, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about on or about January 22, 2010, you entered into a Consent Agreement (January 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that upon meeting the requirements for reinstatement your license to practice nursing as a registered nurse in the State of Ohio would be reinstated and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of at least three (3) years. Attached to the January 2010 Consent Agreement are release letters from the Board dated August 11,2011 and August 4,2010. 2. Item 6. of the January 2010 Consent Agreement states, "For a minimum, continuous period of nine (9) months immediately prior to requesting reinstatement and continuing throughout the probationary period, MR. PEUGH shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in. such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MR. PEUGH shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. PEUGH's history of chemical dependency and recovery status." Despite this provision, on the following dates you were selected by Firstlab, the Board's random drug/alcohol screen program administrator, to provide a urine specimen and failed to do so: November 22, 2011, July 25, 2012, and September 24, 2012.

Christopher Michael Peugh, R.N. Page 3

Section 4723 .28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that,you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearingAnursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Sincerely, >09 , Rhonda S. Barkheirner, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1137 cc: Henry G. Appel, Senior Assistant Attorney General

Cs #09-4792

Ohio Board of Nursing

www.nutsing.ohio.gov

17 South High Street, Suite 400 4, Columbus, Ohio 43215.-7410 e (614) 466-3947

August 08, 2011

Christopher Peugh, R.N. 425 Baldwin Heights Circle Howard, OH 43028 Ref: Consent Agreement of January 22, 2010 License # R.N. 302645 Dear Mr. Peugh: On July 29, 2011, the Board considered and approved your request to be released from the temporary narcotic restriction that was imposed by your Consent Agreement of January 22, 2010. Sincerely,

Betsy J. Houchen, R.N., US., J.D. Executive Director LFRJmam

Case #09-4792

Ohio Board of Nursing www.nursing.ohio,gov

7 South High Street, Suite 400 Colunthus. Ohio 43215-1410 o (614) 466.-3947

August 4, 2010

Christopher Peugh, 425 Baldwin Heights Circle Howard, OH 43028 Ref: Consent Agreement of January 22, 2010 License # R.N. 302645 Dear Mr. Peugh: The Board considered and approved your request for reinstatement of your nursing license having met the requirements for reinstatement contained within your Consent Agreement of January 22, 2010, Your license is therefore reinstated subject to the terms and conditions of probation including the THE PERMANENT PRACTICE AND TEMPORARY NARCOTIC RESTRICTION(S) effective July 30, 2010. Sincerely,

etsy J. Houck R N., M.S., J.D. Executive Director LFR/djf

Case # 09-4792

Ohio Board of Nursing

CONSENT AGREEMENT BETWEEN CHRISTOPHER M. PEUGH, R.N. AND OHIO BOARD OF NURSING

www,nursing.ohio.gov

17 South High Street. Suite 400 6 Columbus. Ohio 43215-7410 (614) 466-3947

This Consent Agreement is entered into by and between CHRISTOPHER M. PEUGH, R.N. (MR. PEUGH) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MR. PEUGH voluntarily enters into this Consent Agreement being fully informed of his rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500,00) or less per violation. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(9), ORC, authorizes the Board to discipline a licensee for habitual indulgence in the use of controlled substances, other habit-forming drugs, or alcohol or other chemical substances to an extent that impairs ability to practice. Section 4723.28(B)(19), ORC, authorizes the Board to discipline' a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(25), ORC, authorizes the Board to discipline a licensee for failure to comply with the terms and conditions of participation in the chemical dependency monitoring program established under Section 4723.35, ORC. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-6-03(A), Ohio Administrative Code, requires a participant in the Alternative Program for Chemical Dependency to comply with all of the terms and conditions of the participant's agreement with the

Christopher M. Perigh; R.N. Page 2 Alternative Program for Chemical Dependency for the time period specified in the agreement_ B. MR. PEUGH's license to practice nursing as a registered nurse in the State of Ohio, RN302645, is inactive. MR. PEUGH also has a license to practice nursing as a licensed practical nurse in the State of Ohio, PN-103713, which is lapsed. MR. PEUGH's Ohio practical nursing license was issued in 1998 and his registered nursing license was issued in 2002. MR. PEUGH knowingly rind voluntarily admits to the following: I. In November 2008, while employed as a registered nurse in the Emergency Department at Knox County Hospital in Mount Vernon, Ohio, MR. PEUGH reported to his employer that for several months, he had been abusing Vice:dirt and Percocet prescribed for himself and for a family member, and that he had sought treatment for his chemical dependency. MR. PEUGH was subsequently allowed to return to work under a Last Chance Agreement. On or about December 18, 2008, MR. PEUGH was terminated from his employment at Knox County Hospital after he tested poSitive for Dilaudid, in violation of his Last Chance Agreement. MR. PEUGH denied stealing any drugs from work. Audits of MR. PEUGH's administration of drugs while working at Knox Community Hospital were completed after the incidences discussed above. While some discrepancies were found, MR. PEUGH's supervisors indicated that they did not believe MR. PEUGH diverted drugs from work. MR. PEUGH indicated to Board staff that he also occasionally used Dilaudid and Percocet given to him by others, and that he abused medications to treat his depression and insomnia. MR. PEUGH has not worked as a nurse since December 2008 and voluntarily made his nursing license inactive in February 2009, MR. PEUGH was diagnosed with Opiate Dependence and completed intensive Outpatient treatment at the Alcohol anti Drug Freedom Center of Knox County in March 2009. On. April 6, 2009, effective through April 6, 2013, MR. PEUGH entered into an Alternative Program Participant Agreement (Agreement) with the Board's Alternative Program for Chemical Dependency (Alternative Program). a. On or about July 8, 2009, MR.- PEUGH tested positive for Morphine, in violation of his Agreement. MR. PEUGH admitted that he had a bad Fourth of July and took a pill given to him by a friend, MR. PEUGH met with his chemical dependency counselor and MR. PEUGH's treatment

C_

2.

.3.

4.

5.

6.

Christopher M. Peugh, R.N, Page 3 plan was revised to include additional individual counseling, group counseling, and NA meetings. b. On or about August 24, 2009, MR. PEUGH tested positive for Oxycodone, in violation of his Agreement, MR. PEUGH admitted that he self-administered Vicodin prescribed for a family member. MR. PEUGH Met with his chemical dependency counselor and was approved to enter a Suboxone program at the Alcohol and Drug Freedom Center of Knox County. On September 25, 2009, MR. PEUGH was terminated from the Alternative Program based on his noncompliance with his Agreement.

c. 7.

MR. PEUGH was otherwise compliant with his Alternative Program Agreement. Since August 2009, MR. PEUGH has had four negative drug and alcohol screens. MR. PEUGH has continued his individual counseling, group counseling, and NA meetings. AGREED CONDITIONS

8.

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MR. PEUGH knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MR. PEUGH's licenses to practice nursing as a registered nurse and licensed practical nurse shall be suspended indefinitely, but for a minimum period of nine (9) months, retroactive to September 1, 2009. (MR, PEUGH's nursing license has been inactive and he has continued to submit drug and alcohol screens,) After May 2010, such suspension may be stayed after MR. PEUGH has submitted a written request to stay the suspension. The Board or its designee may stay the suspension as long as MR. PEUGH is in full compliance with this Consent Agreement, MR. PEUGH shall be subject to the following REINSTATEMENT and PROBATIONARY terms, conditions, and limitations for a minimum period of three (3) years: I 2. 3. MR. PEUGH shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MR. PEUGH shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee, Within three (3) months prior to requesting reinstatement, MR. PEUGH agrees that he will submit a request to. the Bureau of Criminal Identification - and Investigation (BCII) to conduct a criminal records check of MR. PEUGH,

Christopher M. Peugh, R,N Page 4 including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MR. PEUGH's criminal records check reports to the Board, MR. PEUGH's completed criminal records check, including the FBI check, must be received by the Board prior to MR. PEUGH requesting reinstatement. Monitoring of Rehabilitation and Treatment 4. MR. PEUGH shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. PEUGH's history of chemical dependency and recovery status. MR. PEUGH shall self-administer prescribed drugs only in the manner prescribed. MR. PEUGH shall abstain completely from the use of alcohol. For a minhnum, continuous period of 'nine (9) months immediately prior to requesting reinstatement and continuing throughout the probationary period, MR. -PEUGH shall submit, at his expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day he is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), CRC. This screening shall require a daily call-in process. The specimens submitted by MR. PEUGH shall be negative, except for substances prescribed, administered, or dispensed to him by another so authorized by law who has full knowledge of MR. PEUGH's history of chemical dependency and recovery status. a. Within thirty (30) days prior to MR. PEUGH initiating drug screening, MR. PEUGH shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MR, PEUGH. After initiating drug screening, MR. PEUGH shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner, Further, MR. PEUGH shall notify the Board of any and all medication(s) or prescription(s)

5. 6.

b.

Christopher M. Peugh, Page 5 received within twenty-four (24) hours of release from hospitalization or medical treatment. 7. For a minimum, continuous period of three (3) months immediately prior to requesting reinstatement and continuing throughout the probationary period, MR. PEUGH shall attend a minimum of one (I) meeting per week of a support or peer group meeting approved in advance by the Board, or a TWelve Step program, and licensee shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning prior to requesting reinstatement. Within three (3) months prior to requesting reinstatement, MR. PEUGH shall, at his own expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MR. PEUGH shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MR. PEUGH shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MR. PEUGH's license to practice, and stating whether MR. PEUGH is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MR. PEUGH shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MR. PEUGH agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MR. PEUGH's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

8.

9.

Evaluation and Treatment 10. Upon request by the Board or its designee and within sixty (60) days of such request, MR. PEUGH shall, at his own expense, obtain a chemical dependency and/or psychiatric evaluation from a Board approved professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MR. PEUGH shall provide the professional with a copy of this Consent Agreement and shall execute releases to permit the professional to obtain any information deemed appropriate and necessary for the evaluation. The professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MR.. PEUGH's license, and

Christopher M. Peugh, R.N. Page 6 whether MR. PEUGH is capable of practicing nursingaecording to acceptable and prevailing standards of safe nursing care. 11. MR. PEUGH shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the professional until released. Further, MR. PEUGH agrees that the Board may use the, professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MR. PEUGH`s license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

Employment Conditions 12. MR. PEUGH shall notify the Board, in writing, of the name and address of any employer prior to beginning nursing employment. MR. PEUGH is under a continuing duty to provide a copy of this Consent Agreement to any new employer. prior to accepting employment in a position where a nursing license is required. MR. PEUGH. shall have his employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning ,within thirty (30) days of working in a nursing position. MR. PEUGH shall have his employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received.

13.

Reporting Requirements of Licensee 14. MR. PEUGH shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MR. PEUGH shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MR. PEUGH shall submit any and all information that the Board may request regarding his ability to practice according to acceptable and prevailing standards of safe nursing practice. MR. PEUGH shall not submit or cause to be submitted any false, misleading, or deceptive statements; information, or documentation to the Bbard or to employers or potential employers, MR. PEUGH shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and

15.

16.

17.

18.

ChriStopher M. Peugh, R.N. Page 7 communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. 19. MR. PEUGH shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MR, PEUGH shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MR. PEUGH shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

20.

21.

Nursing Refresher Course Upon request by the Board or its designee, MR. PEUGH shall, prior to working in a- position where a nursing license is required, complete and submit satisfactory documentation of completion of a refresher course or an extensive orientation to be approved in advance by the Board or its designee. Temporary Narcotic Restrictions MR. PEUGH shall not administer, have access to, or possess (except as prescribed for MR. PEUGH's use by another so authorized by law who has full knowledge of MR.' PEUGH's history of chemical dependency) any narcotics, other controlled substances, or mood altering drugs for a minimum period of six (6) months in which MR. PEUGH is working in a position that requires a nursing license. At any time after the six-month period previously described, MR. PEUGH may submit a written request to the Board to have this restriction re-evaluated. In addition, MR. PEUGH shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers, MR. PEUGH shall not call in or order prescriptions or prescription refills for any narcotics, other controlled substances, or mood altering drugs. permanent Practice Restrictions MR. PEUGH further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: Unless otherwise approved in advance in writing by the Board or its designee, MR. PEUGH shall not practice nursing (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group

Christopher M. Peugh; Page 8 of individuals who directly engage MR. PEUGH to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwiSe approved in advance in writing by the Board or its designee, MR. PEUGH shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, and Vice President of Nursing, FAILURE TO COMPLY MR. PEUGH agrees that his licenses to practice nursing as a registered nurse and licensed practical nurse will be automatically suspended if it appears to the Board that MR. PEUGH has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MR. PEUGH via certified mail of the specific nature of the charges and automatic suspension of his licenses. Upon receipt of this notice, MR. PEUGH may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC, If, in the discretion of the Board, MR. PEUGH appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODELCA,TION OF TERMS The terms, limitations and conditions of this Consent Agreement, other than the permanent lieensure restrictions, may be modified or terminated in writing at any time upon the agreement of both MR. PEUGH and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that M.R. PEUGH has complied with all aspects of this Consent Agreement; and (2) the Board determines that MR. PEUGH is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MR. PEUGH and review of the reports as required herein. Any period during which MR, PEUGH does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MR. PEUGH acknowledges that he has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner

Ckaiscopticr h Penh, ?ago 9 vntivts ell of bis rg&tc wider Chapter 119, OkC, as try relate to matfers that are, the subject of this Coosent Wit. PlAlGH v may= and all dab= or aausir.s of Potion ha may have against the Bowl, and it: members, officers, employees art.dior agents whirls out of Isamu which art sloe subject OAS COMDC Agmcananf. This Co sAllt Agent:writshstit be coosidc=1. a public rnoord n that term is useki fn won 144,43, ORC, The 101ormatioa nout2thwd barrio atay ba Mf>eirtrgi to appropriate organtzininets, ArA banks and governmental homes. This Conssnat Agreement ie not at oitudiesiitto order as. disnussad in Chapter 119. MC, My action initiated by the. Boa ix-v.4 co alleged violations of [ilk Consent Agreement sball 7mp1y with ilia Adnainisnofte Noe-affirms Act; Chnpie.r 119, On. REIMTIMpAZ FEUG1:1 soils/stands that this Corre-no. Amt is subjest totatZettion by the Board prior to signaturo by toe Nand Preside:at and strap b000ma affantivn upon tba Iasi. date of sivostore below.

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DATE

Attorney For MR. 117,11GF1

AtirdmG AA, )&,r) 6m.aa,fablo tolv,vat,,,,,,Board of Naming Pr %idiot DATE 's'Aio hip

Case #2011-3254

Ohio Board .of Nursing-

www.nursing.olaio.gov

17 South High Street, Suite 400 q, Columbus, Ohio4N.15-7410 . (614) 466-3947

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Lisa Elizabeth Randall, L.P.N. 145 S. Lathrop Road Swanton, Ohio 43558 Dear Ms. Randall: In accordance with Chapter 119, Ohio Revised Code (hereinafter "ORC"), you are hereby notified that 'the Ohio Board of Nursing (hereinafter "Board") proposes under, authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about July 20, 2011, while employed as a nurse by ProMedica Toledo Hospital, you were confronted by your employer as to information that you had removed an external pneumatic compression (EPC) pump from the Hospital without authorization. You admitted in a written statement dated August 2, 2011, that you "borrowed" the EPC pump "for my Uncle's girlfriend who is dying of cancer because she didn't have the means of getting one on her own, but stated that it helps to provide her comfort and relaxation in her present state." In a statement to the Board, dated May 1, 2012, you indicate that the "ordeal with the pump was unfortunate . . . the person never used it . just thought I could help comfort her with the ease of that machine at that time." You did not have any physician's order to provide your Uncle's girlfriend with an EPC pump. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(21), ORC, authorizes the Board to discipline a licensee for, in the case of ;a licensed practical nurse, engaging in activities that exceed the practice of nursing as a licensed practical nurse. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in

Lisa Elizabeth Randall, L.P.N. Page 2 writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing@nursing.gov. If the Board fails to receive a request for a hearing within thirty. (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, R..(// Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0291 cc: Henry G. Appel, Senior Assistant Attorney General

Case# 12-005881

Ohio Board of Nursing

January 25, 2013

www.nursing.ohio.gov

17 South High Street, Suite 400 0 Columbus, Ohio 43215-7410 0 (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Ashly Lynn Reda, TC1 and L.P.N. Applicant 4130 Southern Blvd. Youngstown, Ohio /11512 Dear Ms. Reda: You are hereby notified that, on or about January 20, 2012, you entered into a Consent Agreement (January 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your temporary dialysis certificate one to practice as a dialysis technician in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to the following probationary terms, conditions and limitations for a minimum period of one (1) year. A. You wre issued a temporary dialysis certificate one to practice as a dialysis technician in the State of Ohio on January 25, 2012. You currently have an application to practice nursing as a licensed practical nurse pending before the Board. B Item l.. of the January 2012 Consent Agreement states, "MS. REDA shall obey all federal, state, and local laws, and all laws and rules governing the practice of dialysis care in Ohio." Section 4723.28(B)(18), ORC, authorizes the Board to discipline a licensee or certificate holder for failure to use universal blood and body fluid precautions established by rules adopted under section 4723,07, ORC. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee or certificate holder for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-20-06, Ohio Administrative Code (OAC), states that during the delivery of healthcare, licensees and certificate holders shall follow acceptable and prevailing standards precautions regarding the use of personal protective equipment, including at least the following: (A) Gloves: (1) A licensee or certificate holder shall wear disposable gloves when performing or participating in an exposure-prone invasive procedure; (2) The licensee's or certificate holder's hands shall be washed when gloves are. removed; (3) Before performing or participating in an exposure-prone invasive procedure on another client, the licensee or certificate holder shall wash hands and reglove with another pair of disposable gloves; (4) If a glove is torn or a needlestick or other injury occurs, the glove shall be removed and a new glove put on as promptly as client safety permits. The needle or instrument involved in the incident shall be

Ashly Lynn Reda, TC1 and L.P.N. Applicant Page 2 removed from the sterile field; (B) Masks and protective eyewear. A licensee or certificate holder shall use personal protective equipment such as masks and protective eyewear during patient procedures and activities that are likely to generate splashes or sprays of blood, body fluids and excretions; and (C) Gowns or aprons. A gown or apron made of material that provides an effective barrier shall be worn by a licensee or certificate holder who is performing or participating in an exposure-prone activity if during the procedure there is a possibility of spattering or splashing of blood or other body fluid. Despite the above provision, on or about July 28, 2012, while working as a dialysis technician at Fresenius Medical Care (Fresenius) in Austintown, Ohio, you failed to wear personal protective equipment while disassembling a dirty dialysis machine. You had a similar prior violation at Fresenius, on or about May 30, 2012, when you failed to wear gloves when disassembling a dirty dialysis machine. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-20-06, OAC, states that during the delivery of healthcare, licensees and certificate holders shall follow acceptable and prevailing standards precautions regarding the use of personal protective equipment, including at least the following: (A) Gloves: (1) A licensee or certificate holder shall wear disposable gloves when performing or participating in an exposure-prone invasive procedure; (2) The licensee's or certificate holder's hands shall be washed when gloves are removed; (3) Before performing or participating in an exposure-prone invasive procedure on another client, the licensee or certificate holder shall wash hands and reglove with another pair of disposable gloves; (4) If a glove is torn or a needlestick or other injury occurs, the glove shall be removed and a new glove put on as promptly as client safety permits. The needle or instrument involved in the incident shall be removed from the sterile field; (B) Masks and protective eyewear. A licensee or certificate holder shall use personal protective equipment such as masks and protective eyewear during patient procedures and activities that are likely to generate splashes or sprays of blood, body fluids and excretions; and (C) Gowns or aprons. A gown or apron made of material that provides an effective barrier shall be worn by a licensee or certificate holder who is performing or participating in an exposure-prone activity if during the procedure there is a possibility of spattering or splashing of blood or other body fluid. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a certificate holder for violation of any restrictions placed on a dialysis technician certificate by the Board. Section 4723.28(B)(18), ORC, authorizes the Board to discipline a licensee for failure to use universal blood and body fluid precautions established by rules adopted under section 4723.07, ORC. C. Item 14. of the January 2012 Consent Agreement states, "MS. REDA shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number."

Ashy Lynn Reda, TC1 and L.P.N. Applicant Page 3 Despite the above provision, on or about December 5, 2012, you informed the Board of your termination from Fresenius Medical Care, which had occurred on or about August 1, 2012. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a certificate holder for violation of any restrictions placed on a dialysis technician certificate by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the January 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1. and 14. of the January 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR TEMPORARY DIALYSIS ONE CERTIFICATE TO PRACTICE AS A DIALYSIS TECHNICIAN, TC1-03786, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in dialysis care without a current, valid certificate, which is a violation of Section 4723.73(C), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to permanently deny or deny your application for licensure to practice nursing in Ohio as a licensed practical nurse; permanently revoke, revoke, suspend or place restrictions on a license granted to you to practice nursing as a licensed practical nurse; to deny, permanently revoke, revoke, suspend or place restrictions on your temporary dialysis one certificate to practice as a dialysis technician; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about January 20, 2012, you entered into a Consent Agreement (January 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your temporary dialysis certificate one to practice as a dialysis technician in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to the following probationary terms, conditions and limitations for a minimum period of one (1) year. 2. You were issued a temporary dialysis certificate one to practice as a dialysis technician in the State of Ohio on January 25, 2012. You currently have an application to practice nursing as a licensed practical nurse pending before the Board. 3. Item 1. of the January 2012 Consent Agreement states, "MS. REDA shall obey all federal, state, and local laws, and all laws and rules governing the practice of dialysis care in Ohio." Section 4723.28(B)(18), ORC, authorizes the Board to discipline a licensee or certificate holder for failure to use universal blood and body fluid precautions established by rules adopted under section 4723.07, ORC. Section 4723,28(B)(16), ORC, authorizes the Board to discipline a licensee or certificate holder for violation of Chapter 4723, ORC,

Ashly Lynn Reda, TC1 and L.P.N. Applicant Page 4 or any rules adopted under it. Specifically, Rule 4723-20-06, OAC, states that during the delivery of healthcare, licensees and certificate holders shall follow acceptable and prevailing standards precautions regarding the use of personal protective equipment, including at least the following: (A) Gloves: (1) A licensee or certificate holder shall wear disposable gloves when performing or participating in an exposure-prone invasive procedure; (2) The licensee's or certificate holder's hands shall be washed when gloves are removed; (3) Before performing or participating in an exposure-prone invasive procedure on another client, the licensee or certificate holder shall wash hands and reglove with another pair of disposable gloves; (4) If a glove is torn or a needlestick or other injury occurs, the glove shall be removed and a new glove put on as promptly as client safety permits. The needle or instrument involved in the incident shall be removed from the sterile field; (B) Masks and protective eyewear. A licensee or certificate holder shall use personal protective equipment such as masks and protective eyew ear during patient procedures and activities that are likely to generate splashes or sprays of blood, body fluids and excretions; and (C) Gowns or aprons. A gown or apron made of material that provides an effective barrier shall be worn by a licensee or certificate holder who is performing or participating in an exposure-prone activity if during the procedure there is a possibility of spattering or splashing of blood or other body fluid. Despite the above provision, on or about July 28, 2012, while working as a dialysis technician at Fresenius Medical Care (Fresenius) in Austintown, Ohio, you failed to wear personal protective equipment while disassembling a dirty dialysis machine. You had a similar prior violation at Fresenius, on or about May 30; 2012, when you failed to wear gloves when disassembling a dirty dialysis machine. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-20-66, OAC, states that during the delivery of healthcare, licensees and certificate holders shall follow acceptable and prevailing standards precautions regarding the use of personal protective equipment, including at least the following: (A) Gloves: (1) A licensee or certificate holder shall wear disposable gloves when performing or participating in an exposure-prone invasive procedure; (2) The licensee's or certificate holder's hands shall be washed when gloves are removed; (3) Before performing or participating in an exposure-prone invasive procedure on another client, the licensee or certificate holder shall wash hands and reglove with another pair of disposable gloves; (4) If a glove is torn or a needlestick or other injury occurs, the glove shall be removed and a new glove put on as promptly as client safety permits. The needle or instrument involved in the incident shall be removed from the sterile field; (B) Masks and protective eyewear. A licensee or certificate holder shall use personal protective equipment such as masks and protective eyewear during patient procedures and activities that are likely to generate splashes or sprays of blood, body fluids and excretions; and (C) Gowns or aprons. A gown or apron made of material that provides an effective barrier shall be worn by a licensee or certificate holder who is performing or participating in an exposure-prone activity if during the procedure there is a

Ashly Lynn Reda, TC1 and L.P.N. Applicant Page 5 possibility of spattering or splashing of blood or other body fluid. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a certificate holder for violation of any restrictions placed on a dialysis technician certificate by the Board. Section 4723.28(B)(18), ORC, authorizes the Board to discipline a licensee for failure to use universal blood and body fluid precautions established by rules adopted under section 4723.07, ORC. 4. Item 14. of the January 2012 Consent Agreement states, "MS. REDA shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number." Despite the above provision, on or about December 5, 2012, you informed the Board of your termination from Fresenius Medical Care, which had occurred on or about August 1, 2012. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a certificate holder for violation of any restrictions placed on a dialysis technician certificate by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearingAnursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, permanently deny or deny your application for licensure to practice nursing in Ohio as a licensed practical nurse; permanently revoke, revoke, suspend or place restrictions on a license granted to you to practice nursing as a licensed practical nurse; to deny, permanently revoke, revoke, suspend or place restrictions on your temporary dialysis one certificate to practice as a dialysis technician; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Ashly Lynn Reda, TC1 and L.P.N. Applicant Page 6

Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No, 7012 2210 0000 6272 1007 cc: Henry G. Appel, Senior Assistant Attorney General

Case #11-004845

Ohio Board of Nursing

www.nursing,ohio.gov

17 South High Street, Suite 400 0 Columbus, Ohio .4.215-7410 o (614) 466-3947

CONSENT AGREEMENT BETWEEN ASHLY L. REDA, Tel APPLICANT, OCDT APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between ASHLY L. REDA, TCI APPLICANT, OCDT APPLICANT (MS. REDA) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any certificate issued by the Board; reprimand or otherwise discipline a certificate holder; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(4), ORC, authorizes the Board to deny a certificate or otherwise discipline a certificate holder for a conviction of, a plea of guilty to, a. judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. On or about November 14, 2011, MS. REDA submitted to the Board an Application for a Temporary Certificate and Certificate to Practice as a Dialysis Technician in Ohio (Dialysis Application). MS. REDA knowingly and voluntarily admits that in 2010, in Ohio, she was convicted of one (1) amended minor misdemeanor count of Disorderly Conduct stemming from a misdemeanor charge of retail theft in September 2009.

B.

C.

Ashly L. Reda, TC1 Applicant, OCDT Applicant Page 2

D.

In MS. REDA's personal statement, she expressed deep remorse regarding her earlier actions. Prior to submitting her Dialysis Application, MS. REDA submitted an Application to Practice as a Licensed Practical Nurse and that Application remains pending. AG REED CONDITIONS

B.

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. REDA knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon completion of the application process, MS. REDA's temporary certificate one and any future certificates to practice as a dialysis technician in the State of Ohio shall be granted and that certificate(s) shall be suspended indefinitely. Such suspensions shall be stayed, subject to the following probationary terms, conditions, and limitations for a minimum period of one (1) year: MS. REDA shall obey all federal, state, and local laws, and all laws and rules governing the practice of dialysis care in Ohio. MS. REDA shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. Criminal Records Check 3, Within ninety (90) days prior to submitting a request for release from the probationary terms, conditions and limitations of this Consent Agreement, MS. REDA agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. REDA, including a check of Federal Bureau of Investigation (19iI) records, and shall cause BCII to submit MS. REDA's criminal records check reports to the Board. MS. REDA agrees that a request for release from the probationary terms of this Consent Agreement will not be considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board.

Continuing Education Hours 4. Within ninety (90) days from the effective date of this Consent Agreement, MS. REDA, in addition to fulfilling the requirements necessary to maintain a certificate to practice as a dialysis technician, shall successfully complete and submit satisfactory documentation of

Ashly L. Reda, TCI Applicant, OCDT Applicant Page 3

successful completion of the following continuing education, or other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: two (2) hours of maintaining professional boundaries; two (2) hours of stress management; and, two (2) hours of professionalism/ethics. Employment Conditions 5. Prior to accepting employment as a dialysis technician, each time with every employer, MS. REDA shall notify the Board of the name and address of the employer in writing. MS. REDA is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting employment in a position in which a certificate as a dialysis technician is required, MS, REDA shall have her employer(s), if working in a position where a certificate to practice as a dialysis technician is required, submit written reports regarding job performance on a quarterly basis within thirty (30) days of accepting employment as a dialysis technician. MS. REDA shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received,

6.

Reporting Requirements of Certificate Holder 7. MS. REDA shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. REDA shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. REDA shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe dialysis care. MS. REDA shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. REDA shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and

8.

9.

10,

11.

Ashly L. Reda, TC1 Applicant, OCDT Applicant Page 4

communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. 12. MS. REDA shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. REDA shall verify that the reports and documentation required by this Consent Agreement are received in the Board office, MS. REDA. shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

13.

14.

Temporary Practice Restrictions MS. REDA further knowingly and voluntarily agrees with the Board to the following TEMPORARY CERTIFICATE RESTRICTIONS: MS. REDA shall not practice as a dialysis technician (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the dialysis technician provides dialysis care and is reimbursed for services by the State of Ohio through State agencies or agents of the State. MS. REDAS shall not function as a supervisor or as a manager while working in a position for which a certificate to practice as a dialysis technician is required. FAILURE TO COMPLY MS. REDA agrees that her temporary certificate one and any future certificates to practice as a dialysis technician will be automatically suspended if it appears to the Board that MS. REDA has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. REDA via certified mail of the specific nature of the charges and automatic suspension of her temporary certificate one and any future certificate(s). Upon receipt of this notice, MS. REDA may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a dialysis technician certificate" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. REDA appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement.

Ashly L. Reda, TC I Applicant, OCDT Applicant Page 5

DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement, may be modified or terminated, in writing, at any time upon the agreement of both MS. REDA and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. REDA has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. REDA is able to practice according to acceptable and prevailing standards of safe dialysis care without Board monitoring, based upon an interview with MS. REDA and review of the reports as required herein. Any period during which MS. REDA does not work in a position for which a certificate to practice as a dialysis technician is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. REDA acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. REDA waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. REDA waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 14943, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC.

The remainder of this page has been intentionally left blank

Ashly L. Reda, TC1 Applicant. OCDT Applicant Page 6

MS. 'VEDA u4lerstands that this Consent Agreement is subject to ratification by the Board prior to iiignatute by the Board President and shall become effective upon the last date of signattnie below.

AS APPLI

APPLICANT, OCDT

DA E

110.0 /do ica

BERTHA LOiVELACE, President Ohio Board o Nursing DATE

Case# 12-007093

Ohio Board of Nursing

17 South High Street, Suite 400 January 25, 2013

www.nursing.oh..i.o.gov

Columbus, Ohio 43215-7410 4, (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Violet Jane Reid, L.P.N. 615 Van Roberts Place Cincinnati, Ohio 45215 Dear Ms. Reid: You are hereby notified that, on or about May 16, 2008, you entered into a Consent Agreement (May 2008 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that upon meeting the requirements for renewal, your license to practice nursing as a licensed practical nurse in the State of Ohio would be reinstated and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. Attached to and incorporated within the May 2008 Consent Agreement is a May 18, 2007 Consent Agreement, a September 22, 2006 Notice of Automatic Suspension and Opportunity for Hearing, and November 18,2005 Consent Agreement. A. Your license to practice nursing as a licensed practical nurse in the State of Ohio was reinstated on June 3, 2010. B. Item 5. of the May 2008 Consent Agreement states, "MS. REID shall continue to submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. REID shall be negative,' except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REID's history of chemical dependency and recovery status." Despite these provisions, on or about the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. Furthermore, on the following dates, you were selected to provide a specimen for analysis and failed to do so: October 26, 2012; November 14, 2012; and December 3, 2012.

Violet Jane Reid, L.P.N. Page 2 In a written statement received by the Board on November 29, 2012, you reported that your father stopped payment to Firstlab. You added "I didn't break the law and so far it is not illegal to drink beer." Section 4723.28(8)(1'7), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the May 2008 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 5. of the May 2008 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-111429, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a licensed practical nurse without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about May 16, 2008, you entered into a Consent Agreement (May 2008 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that upon meeting the requirements for renewal, your license to practice nursing as a licensed practical nurse in the State of Ohio would be reinstated and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years. Attached to and incorporated within the May 2008 Consent Agreement is a May 18, 2007 Consent Agreement, a September 22, 2006 Notice of Automatic Suspension and Opportunity for Hearing, and November 18,2005 Consent Agreement. 2. Your license to practice nursing as a licensed practical nurse in the State of Ohio was reinstated on June 3, 2010. 3. Item 5. of the May 2008 Consent Agreement states, "MS. REID shall continue to submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by

Violet Jane Reid, L.P.N. Page 3 MS. REID shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REID's history of chemical dependency and recovery status." Despite these provisions, on or about the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. Furthermore, on the following dates, you were selected to provide a specimen for analysis and failed to do so: October 26, 2012; November 14, 2012; and December 3, 2012. In a written statement received by the Board on November 29, 2012, you reported that your father stopped payment to Firstlab. You added "I didn't break the law and so far it is not illegal to drink beer." Section 4723 .28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearingnursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Violet Jane Reid, L.P.N. Page 4 Sincerely,

Rhonda S. Barldieimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1175 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 08-0383

Ohio Board of Nursing

CONSENT AGREEMENT BETWEEN VIOLET J. REID, L.P.N. AND OHIO BOARD OF NURSING

www.n ursing.ohio,gov

17 South High Street, Suite 400 a Columbus, Ohio 43215-7410 A (614} 466-3947

This Consent Agreement is entered into by and between VIOLET J. REID, L.P.N. (MS. REID) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. REID voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement, BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($5.00.00) or less per violation. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. MS. REID's license to practice nursing as a licensed practical nurse, PN111429, in the State of Ohio is suspended.

C.

On November 18, 2005, MS. REID entered into a Consent Agreement with the Board (November 2005 Consent Agreement) in which MS. REID's nursing license was suspended and such suspension was stayed subject to probationary terms, conditions, and limitations until at least November 2006. On September 22, 2006, the Board issued a Notice of Automatic Suspension and Opportunity for Hearing (September 2006 Notice) to MS. REID based upon her noncompliance with the November 2005 Consent Agreement. As a result of the September 2006 Notice, on May 18, 2007, MS. REID entered into a second Consent Agreement with the Board (May

Violet I Reid, L.P.N. Page 2 2007 Consent Agreement) in which MS. REID's nursing license was suspended for a minimum period of fifteen (15) months, retroactive to September 2006, with specified conditions for reinstatement. Copies of the November 2005 Consent Agreement, September 2006 Notice, and May 2007 Consent Agreement are attached hereto and incorporated herein, D. MS. REID submitted a written request to the Board to reinstate her license and provided the Board with the following: 1. Evidence of a chemical dependency evaluation: According to a letter from a Clinical Assessor at the Recovery Health Access Center of the Alcoholism Council of the Cincinnati Area, NCADD, MS. REID participated in a drug and alcohol assessment on August 7, 2007. MS. REID was diagnosed with Alcohol Dependence in sustained full remission. The Clinical Assessor indicated that, based on MS. REID's self-report and the assessment, no services Were recommended at that time and there was no indication that MS. REID would be unable to effectively perform her nursing duties, Evidence of negative screens for drugs and alcohol from August 2007 through February 2008. A personal statement. An in-person interview on October 17,2007.

2.

3. 4. E.

Despite item 10 of the May 2007 Consent Agreement requiring one (1) support or peer group meeting each week, MS. REID submitted documentation of attendance at one (1) meeting each month in September, October and November 2007, and two (2) meetings in December 2007, MS. REID subsequently discussed the requirements of the May 2007 Consent Agreement with her Monitoring Agent and submitted documentation of more frequent meeting attendance beginning in January 2008. AGREED CONDITIONS

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. REID knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for renewal, MS. REID's license to practice nursing as a licensed practical nurse shall be reinstated and suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum of three (3) years until at least March 2011:

Violet J. Reid, L.P.N. Page 3 1. MS. REID shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. REID shall appear in person for interviews before the full Board or its designated representative as requested by the Board.

2.

Monitoring of Rehabilitation and Treatment 3. MS. REID shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REID's history of chemical dependency and recovery status. MS. REID shall self-administer the prescribed drugs only in the manner prescribed. MS. REID shall abstain completely from the use of alcohol. MS. REID shall continue to submit, at her expense and on the day selected, blood or urine specimens for drug .and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(8), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. REID shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REID's history of chemical dependency and recovery status. MS. REID shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program. MS. REID shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning within thirty (30) days of the effective date of this Consent Agreement, Upon request by the Board or its designee and within thirty (30) days of the request, MS. REID shall, at her own expense, seek a chemical dependency and/or psychiatric evaluation from a Board approved evaluator and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. REID shall provide the evaluator with a copy of this Agreement and all attachments and shill execute releases to permit the evaluator to obtain any information deemed appropriate and necessary for the evaluation. The evaluator shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. REID's license, and whether MS. REID is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.

4. 5.

6.

7.

Violet J. Reid, L.P.N. Page 4 8. MS. REID shall provide the Board with satisfactory documentation of 'compliance with all aspects of the treatment plan developed by the chemical dependency professional/psychiatrist until released. Further, MS. REID agrees that the Board may use the evaluator's recommendations and conclusions from the evaluation as a basis for additional terms, conditions and limitations on MS. REID's license and that the terms, conditions, and limitations shall be incorporated by an addendum to this Consent Agreement,

Treating Practitioners and Reporting 9. Within thirty (30) days of the execution of this Consent Agreement, MS. REID shall provide a copy of this Consent Agreement and all attachments to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresseS and telephone numbers. Further, MS. REID shall be under a continuing duty to provide a copy of this Consent Agreement and all attachments, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. MS. REID shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. REID throughout the duration of this Consent Agreement. Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. REID shall notify the Board of any and all rnedication(s) or prescription(s) received.

10.

11.

Employment Conditions 12. MS. REID shall notify the Board, in writing, of the name and address of any current employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to beginning employment. MS. REID shall have her employer(s), if working in a position where a nursing license is required, submit Written reports regarding job performance on a quarterly basis beginning within thirty (30) days following the effective date of this Consent Agreement. MS. REID shall provide her employer(s) with a copy of this Consent Agreement and all attachments. Further, MS. REID shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement and all attachments, Further, MS. REID is under a continuing duty to provide a copy of this Consent Agreement and all attachments to any new employer prior to accepting employment.

13:

Violet J. Reid, L.P.N. Page 5 Reporting Requirements of Licensee 14. MS. REID shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. REID shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board. MS. REID shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. REID shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. REID shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. REID shall submit the reports and documentation required by this Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. REID shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. REID shall inform the Board within five (5) business days, in writing, of any change in address and/or telephone number.

15.

16.

17.

18,

19.

20.

21.

Nursing Refresher Course or Orientation Upon request by the Board or its designee, MS. REID shall, prior to working in a position where a nursing license is required,. complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation to be approved in advance by the Board or its designee. ,Permanent Practice Restrictions MS. REID further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: Unless otherwise approved in advance by the Board or its designee, MS. REID shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patiene.s residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) as a nurse for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for

Violet J. Reid, L.P.N. Page 6 services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. REID to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance by the Board or its designee, MS. REID shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY MS. REID agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. REID has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. REID via certified mail of the specific nature of the charges and automatic suspension of his license. Upon receipt of this notice, MS. REID may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. REID appears to have violated or breached any terms or conditions-of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/MODIFICATION OF TERMS The terms, limitations, and conditions of this Consent Agreement, other than the permanent licensure restrictions, may be modified or terminated in writing at any time upon the agreement of both MS. REID and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (I) the Board determines that M&REID- has complied with all aspects of this. Consent Agreement; and (2) the Board determines that MS. REID is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. REID and review of the reports as required herein. Any period during which MS. REID does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIARILITY RELEASE MS. REID acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreeinent and that all questions asked have been answered in a satisfactory manner.

03/13/2008 13:55 614 486-2129

CSC

53/13/2553 12:41

5137715073

188TR ICOUNTY

#0135 P.008 /008 VI-vat to

Violet I. Reid, LPN. Page 7 MS. REID waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement, MS, REID waives any and all claims or causes of action she may have against the 13oard, and its members, officers, employees and/or agents arising oat of 'flatten that are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent 4i-cement shall comply with the Administrative Procedures Act, Chapter 119, ORC. EFFECTIVE DA.TE MS. REID understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

VIOLET J. AD, L.P.N.

Og
DA. DATE

r
EuzmiETH Y. COLLIS, ESQ.
Attorney For Ms. Reid

m
LISA KLEMM, Pre.sident Ohio Board of Nursing

6Hb-t DATE

03/1 3/2008 THU 14:09 [TX/RX NO 72511 a008

Case #06-2025

Ohio Board of Nursing

www,nursiog.oltio.gov

17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947

CONSENT AGREEMENT VIOLET J. REID, L.P.N. AND OHIO BOARD OF NURSING

This Consent Agreement is entered into by and between VIOLET J. REID, L.P.N. (MS. REID) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC); and all administrative rules promulgated thereunder. MS. REID voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. I3ASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500,00) or less per violation. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board MS. REID's license to practice nursing as a licensed practical nurse in the State of Ohio, PN-111429, was automatically suspended by the Board on or about September 22, 2006. MS. REID's nursing license was initially issued in September 2002. MS. REID knowingly and voluntarily admits to the factual and legal allegations set forth in the Notice of Automatic Suspension and Opportunity for Hearing issued to her by the Board on or about September 22, 2006 (September 2006 Notice). A copy of the September 2006 Notice and a copy of the Consent Agreement between MS. REID and the Board, effective November 18, 2005 (November 2005 Agreement) are attached hereto and incorporated herein.

B.

C.

Violet J. Reid, L.P.N. Page 2 D. In letters, dated August 7 and 25, 2006, submitted to the Board, MS. REID explained that she attended Having the Courage to Change, an inpatient treatment program, for almost eleven months, but did not complete the program for the following reasons: 1) 2) 3) 4) she was "over the alcoholic problem," and had "no further desire to use Alcohol;" she wanted to return to work; her case manager had not sent her evaluation to the Board; all of her urine screens, conducted as part of the program since August 8, 2005, and the two (2) screens conducted as part of her November 2005 Agreement were negative; she could get counseling from her church and family; and she wanted to take care of her mother who has a physical
disability.

5) 6)

E.

The Board received a letter, dated October 10, 2006, from C.J. Little, LSW, LCDC III, who conducted a chemical dependency assessment of MS. REID on August 25, 2005. Ms. Little informed the Board that she had made five treatment recommendations that MS. REID did not comply with. Ms. Little further expressed that MS. REID "does not appear to internalize the need to participate in the recovery process." Ms. Little also noted that MS. REID reported an eight (8) year history of alcohol use and drinking in isolation. MS. REID, through her attorney, reports that she has been sober since in or around August 2005. MS. REID now understands the importance of the recovery process and acknowledges that any further noncompliance with the Board may result in permanent revocation of her nursing license. AGREED CONDITIONS

F.

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. REID knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: SUSPENSION OF LICENSE MS. REID's license to practice nursing as a licensed practical nurse is hereby suspended for an indefinite period of time, but not less than fifteen (15) months, retroactive to September 2006 when the Board automatically suspended her nursing license. MS. REID may submit a written request for reinstatement anytime after the conditions for reinstatement have been satisfied.

Violet J. Reid, L.P.N. Page 3

CONDITIONS FOR REINSTATEMENT 2. MS. REID shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. REID shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. Prior to reinstatement, MS. REID shall enter into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of three (3) years following reinstatement.

3.

4.

Monitoring of Rehabilitation and Treatment 5. MS. REID shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REID's history of chemical dependency and recovery status. MS. REID shall self-administer the prescribed drugs only in the manner prescribed. MS. REID shall abstain completely from the use of alcohol and/or substances containing alcohol. Within three (3) months prior to seeking reinstatement by the Board, MS. REID shall, at her own expense, seek a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. REID shall provide the chemical dependency professional with a copy of this Consent Agreement, the September 2006 Notice and the November 2005 Agreement. Further, LICENSEE shall execute releases to permit the chemical dependency professional to obtain her treatment records from Having the Courage to Change and any other information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions to be placed on MS. REID's license to practice, and stating whether MS. REID is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS. REID shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released: Further, MS. REID agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. REID's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement.

6.

7.

8,

Violet J. Reid, L.P.N. Page 4

9.

For a minimum., continuous period of six (6) months immediately prior to requesting reinstatement, MS. REID shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request: Upon and after MS. REID's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may requeSt, shall constitute a violation of a restriction placed on a license for purposes of SectiOn 4723.28(5), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. REID shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REID's history of chemical dependency and recovery status. a. Within thirty (30) days prior to MS. REID initiating drug screening, MS. RIED shall provide a copy of this Consent Agreement, the September 2006 Notice, and November 2005 Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. REID. b. After initiating drug screening, MS. REID shall be under a continuing duty to provide a copy of this Consent Agreement, the September 2006 Notice, and the November 2005 Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. REID shall notify the Board of any and all inedication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment.

10.For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement, MS. REID shall attend a minimum of one (I) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. REID shall provide satisfactory documentation of such attendance to the Board prior to reinstatement. Reporting Requirements of Licensee MS. REID shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. 12. MS. REID shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board.

Violet J. Reid, L.P.N. Page 5

13.

MS. REID shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. REID shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. REID shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. REID shall submit the reports and documentation required by this Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. REID shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. REID shall inform the Board within three (3) business days, in writing, of any change in address and/or telephone number.

14.

15.

16.

17,

18.

Nursing Refresher course or Orientation Upon request by the Board or its designee, MS. REID shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation approved in advance by the Board or its designee. Permanent Practice Restrictions Unless otherwise approved in advance by the Board or its designee, MS. REID shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) as a nurse for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of indiViduals who directly engage MS. REID to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approv6d in advance by the Board or its designee, MS. REID shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or stIperviSing and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing.

Violet../. Reid, L.P.N. Page 6 FAILURE TO COMPLY The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. REID appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION / MODIFICATION OF TERMS The terms, limitations, and conditions of this Consent Agreement, other than the permanent licensure restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. REID and the Board. The Board may only alter the indefinite suspension imposed if: (1) MS. REID submits a written request for reinstatement; (2) the Board determines that MS. REID has complied with all conditions of reinstatement; (3) the Board determines that MS. REID is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. REID and review of the documentation specified in this Consent Agreement; and (4) MS: REID has, entered into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of three (3) years following reinstatement. ACKNOWLEDGMENTS / LIABILITY RELEASE, MS. REID acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. REID waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. REID waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Agreement. This Consent Agreement is not an adjudication order within the meaning of Section 119.01(D), ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies.

05/1 5/2007 07:55 6144862129 . . 1 'May, 11, 2007:10:25MV 914 596 3359

COLLIS SMILES COLLIS OHIO BOARD OF ti tIRStiS

PAGE 02

No. 4177

P.

305/005

Violet/. Reid, L.P.N. Pap 7

umaraucon.

MS. REID underGt4da that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effeotive upo the last data of signature below,

VIOLET

ID, L.P.N.

Qu-r9_

- 0_k7
DATE 77 (--. /4S,4 5 DATE

EL Z THY. Pi LIS, ESQ Attorney Far Ms. et i

inSA) RA)
CYNTHIA Ak. XR'UEGER, President Ohio Dealt of Nursing

5\ k)bul DvrE

05/15/2007 TUE 05:10 [TX/RX NO 9700] 1002

Case# 06-2025

Ohio Board of Nursing

September 22, 2006

www.nursing.ohio.gov

17 South High Street, Suite 400 * Columbus, Ohio 43215-7410 (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Violet J. Reid, L.P.N. 615 Van Roberts Place Cincinnati, Ohio 45215 Dear Ms. Reid: You are hereby notified that on or about November 18, 2005, you entered into a Consent Agreement (November 2005 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be indefinitely suspended and that such suspension would be stayed subject to probationary terms, conditions, and limitations until at least November 2006. A. Item 5. of the November 2005 Consent Agreement states, "Beginning January 1, 2006, MS. REID shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process, The specimens that MS. REID submits shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REID's history." Despite this provision, on the following dates you failed to provide a specimen to FirstLab on the date you were selected to do so: May 11, 2006; June 2, 2006; and July 2, 2006. In addition, on the following dates you failed to call FirstLab to determine if you had been selected to provide a urine specimen: January 7-9, 2006; January 11-19, 2006; January 24, 2006; January 26-27, 2006; February 1, 2006; February 5, 2006; February 8, 2006; February 10, 2006; February 12-15, 2006; February 17-19, 2006; February 22, 2006; February 25, 2006; March 2, 2006; March 4-8, 2006; March 12, 2006; March 17-31, 2006; April 1-24; 2006; June 9-12, 2006; June 14-30, 2006; July 1-7, 2006; and July 9, 2006.

Violet J. Reid, L.P.N. Page 2 Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. B. Item 6. of the November 2005 Consent Agreement states, "Within ninety (90) days of the effective date of this Consent Agreement, MS. REID shall, at her own expense, seek a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board complete documentation of this evaluation. Prior to the evaluation, MS. REID shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. REID shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions to be placed on MS. REID's license to practice, and a statement as to whether MS. REID is capable of practicing nursing according to prevailing and acceptable standards of nursing." You submitted a statement, dated August 25, 2006, to the Board indicating that you had left the Having The Courage to Change center on July 6, 2006, after having started the program in August 2005, because you knew that you were "over the alcoholic problem" and that you wanted to return to work. However, you have failed to date to provide the Board with any documentation of a chemical dependency evaluation from a Board approved chemical dependency professional. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the November 2005 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 5. and 6, of the November 2005 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(B), Ohio Revised Code (ORC). You are hereby ordered to surrender your Ohio license to practice nursing as a licensed practical nurse, PN-111429, to the Board within ten (10) days of receipt of this notice. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 472328, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons:

Violet J. Reid, L.F.N. Page 3

1. On or about November 18, 2005, you entered into a Consent Agreement with the Board, a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be indefinitely suspended and that such suspension would be stayed subject to probationary terms, conditions, and limitations until at least November 2006. 2. Item 5. of the November 2005 Consent Agreement states, "Beginning January 1, 2006, MS. REID shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC, This screening shall require a daily call-in process. The specimens that MS. REID submits shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REID's history." Despite this provision, on the following dates you failed to provide a specimen to FirstLab on the date you were selected to do so: May 11, 2006; June 2, 2006; and July 2, 2006, In addition, on the following dates you failed to call FirstLab to determine if you had been selected to provide a urine specimen: January 7-9, 2006; January 1149, 2006; January 24, 2006; January. 26-27, 2006; February 1, 2006; February 5, 2006; February 8, 2006; February 10, 2006; February 12-15, 2006; February 17-19, 2006; February 22, 2006; February 25, 2006; March 2, 2006; March 4-8, 2006; March 12, 2006; March 17-31, 2006; April 1-24; 2006; June 9-12, 2006; June 14-30, 2006; July 1-7, 2006; and July 9, 2006. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 3. Item 6, of the November 2005 Consent Agreement states, "Within ninety (90) days of the effective date of this Consent Agreement, MS. REID shall, at her own expense, seek a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board complete documentation of this evaluation. Prior to the evaluation, MS. REID shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. REID shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions to be placed on MS. REID's license to practice, and a statement as

Violet J. Reid, L.P.N. Page 4 to, whether MS. REID is capable of practicing nursing according to prevailing and acceptable standards of nursing." You submitted a statement, dated August 25, 2006, to the Board indicating that you had left the Having The Courage to Change center on July 6, 2006, after having started the program in August 2005, because you knew that you were "over the alcoholic problem" and that you wanted to return to work. However, you have failed to date to provide the Board with any documentation of a chemical dependency evaluation from a Board approved chemical dependency professional. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to; Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

seti0Jfi-I RA)
Bertha Lovelace, RN., B.A., C.R.N.A. Supervising Member

Violet J. Reid, L.P.N. Page 5 Certified Mail Receipt No. 7006 0810 0004 4840 6725 cc: Katherine Bockbrader, Assistant Attorney General Leah V. B. O'Carroll, Assistant Attorney General

Violet Reid, L.P.N. Page 2

AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. REID knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. REID's license to practice nursing as a licensed practical nurse is hereby suspended indefinitely. Such suspension is hereby stayed, subject to the following probationary terms, conditions, and limitations until at least November 2006. 1. 2. MS. REID shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. REID shall appear in person for an interview before the full Board or its designated representative, as requested by the Board.

Monitoring 3. MS. REID shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by Iaw who has full knowledge of MS. REID's history. MS. REID shall self-administer prescribed drugs only in the manner prescribed. MS. REID shall abstain completely from the use of alcohol. Beginning January 1, 2006, MS. REID shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens that MS. REID submits shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REID's history. Within ninety (90) days of the effective date of this Consent Agreement, MS. REID shall, at her own expense, seek a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board complete documentation of this evaluation. Prior to the evaluation, MS. REID shall provide the chemical dependency professional with a copy of this Consent Agreement. Further,

4. 5.

6.

Violet Reid, L.P.N. Page 3 MS. REID shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the. evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions to be placed on MS. REID's license to practice, and a statement as to whether MS. REID is capable of practicing nursing according to prevailing and acceptable standards of nursing. 7. MS. REID shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional until released. Further, MS. REID agrees that the Board may use the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. REID's license and that the terms, conditions, and limitations shall be incorporated by an addendum to this Consent Agreement.

Treating Practitioners and Reporting 8. MS. REID shall cause all treating practitioners to complete a medication prescription report, which is to be mailed by the practitioners directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. REID throughout the term of this Consent Agreement.

Employment Conditions 9. MS. REID shall notify the Board in writing, of the name and address of any current employer or any new employer prior to beginning employment. MS. REID shall provide her employer(s) with a copy of this Consent Agreement and shall have her employer(s) send documentation to the Board, of receipt of a copy of this Consent Agreement. Further, MS. REID is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting employment. If at anytime during the effective period of this Consent Agreement, the Board's Supervising Member or designee determine that the Board should receive reports from MS. REIM employer, MS. REID shall have her employer(s), submit written reports regarding job performance on a quarterly basis or as otherwise requested by the Board.

10.

11.

Violet Reid, L.P.N. Page 4

Reporting Requirements of Licensee 12. MS. REID shall report to the Board in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. REID shall sign release of information foinis allowing health professionals and other organizations to submit the requested documentation directly to the Board, MS. REID shall submit any and all information, which the Board or its designee may request, regarding her ability to practice nursing according to acceptable and prevailing standards of safe nursing care. MS. REID shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers, MS. REID shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Monitoring Unit of the Board. MS. REID shall submit all documentation required by this Consent Agreement or requested by the Board to the attention of the Monitoring Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-3413, MS. REID shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. REID shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number,

13.

14,

15.

16.

17.

18.

19.

Temporary Practice Restrictions MS. REID shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) as a nurse for staffing agencies as an independent provider where the nurse provides nursing care and is or pools; reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. REID to provide nursing services for fees, compensation, or other consideration or as a volunteer.

Violet Reid, L.P.N. Page 5 MS. REID shall not function in a position or employment where the job duties or requirements involve management of nursing, nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY MS. REID agrees that her license to practice nursing as a. licensed practical nurse will be automatically suspended if it appears to the Board that MS. REID has violated or breached any terms or conditions of the Consent Agreement. 'Following the automatic suspension, the Board shall notify MS. REID via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. REID may request a hearing regarding the charges. The abovddescribed terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723,28(B), ORC. If, in the discretion of the Board, MS. REID appears to have violated or breached any terms or conditions of the Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. AURA ION/MODIFICATION OF TERMS The terms, limitations and conditions of this Consent Agreement may be modified or terminated in writing at any time upon the agreement of both MS. REID and the Board. The Board shall only alter the probationary period imposed by this Consent Agreement if: (1) MS. REID has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. REID is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring based upon an interview with MS. REID and review of the reports required herein. Any period during which MS. REID does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. &CKNOWLEDGMENT_S/LIABILITY RELEASE MS. REID acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. REID waives all of her rights under Chapter 119, ORC as they relate to matters that are the subject of this Consent Agreement.

Violet Reid, L,P.N, Page 6

MS. REID waives any and all claims or causes of action she may have against the Board, and members, officers, employees and/or agents of either, arising out of matters that are the subject of this Consent Agreement, This Consent Agreement is not an adjudication order within the meaning of Section 119.01(D), ORC. However, any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies.

EFFECTIVE DATE
MS. REID understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

VIOLET REID, .N.

U1/4)4 p

DATE

(_21TONNE SMITH, President Ohio Board of Nursing

DATE

ATTACHMENT A
05/16/2008 -12/11/2012
Mt

Missed Cali History: Date 07/16/2008 07/22/2008 08/07/2008 12/14/2008 02/01/2009 02/05/2009 02120/2009 03/01/2009 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Wails

03/06/2009 Missed Call 04/30/2009 06/28/2009 06/29/2009 Missed Call Missed Call Missed Call

08/02/2009 08/13/2009 09/13/2009 05/20/2010 05/23/2010 06/09/2010 08/22/2010 09/24/2010 09/25/2010 09/26/2010 10/10/2010 11/22/2010 12/25/2010 12/28/2010 02/21/2011 02/25/2011 03/29/2011 04/01/2011 04/22/2011 04/23/2011 06/27/2011 10/18/2011 12/02/2011 01/26/2012 04/13/2012 05/06/2012

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

05/1512012 05/24/2012 06/06/2012 06/10/2012 07/24/2012 08109/2012 10/14/2012 10/17/2012 10/18/2012 10/20/2012 10/21/2012 10/22/2012 10/23/2012 10/24/2012 10/25/2012 10/26/2012 10/27/2012 10/28/2012 10/29/2012 10/30/2012 10/31/2012 11/01/2012 11/02/2012 11/03/2012 11/04/2012 11/05/2012

Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call .

11/0612012 11/07/2012 11/08/2012 11/09/2012 11/10/2012 11/11/2012 11/12/2012 11/13/2012 11/14/2012 11/15/2012 11/18/2012 11/17/2012 11/18/2012 11/19/2012 11/20/2012 11/21/2012 11/22/2012 11/23/2012 11/24/2012

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Calf Missed Call Missed Call

11/25/2012 Missed Call 11/26/2012 11/27/2012 11/28/2012 11/29/2012 11/30/2012 12/01/2012 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

12/02/2012 12/03/2012 12/04/2012 12/05/2012 12/06/2012 12/07/2012 12/08/2012 12/09/2012 12/10/2012 12/11/2012

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cali

Row Count: 100

Case# 12-006670

Ot:ice Board of - Nursing

17 South High Street, Suite 400 January 25, 2013

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 0 (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Linda Marie Reynolds, R.N. 3990 East 58 Cleveland, Ohio 44105 Dear Ms. Reynolds: You are hereby notified that, on or about September 24, 2010, you entered into a Consent Agreement (September 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that upon meeting the requirements for renewal, your license to practice nursing as a registered nurse in the State of Ohio would be reinstated and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations until at least September 2013. Attached to and incorporated within the September 2010 Consent Agreement is a July 24, 2009 Consent Agreement and a March 20, 2009 Notice of Opportunity. Also attached hereto and incorporated herein is a release letter you received from the Board dated September 26, 2012. Documents are redacted according to Section 2953.52 of the Ohio Revised Code. A. Item 1. of the September 2010 Consent Agreement states, "MS. REYNOLDS shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 4. of the September 2010 Consent Agreement states, "MS. REYNOLDS shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REYNOLDS's history of chemical dependency and recovery status. MS. REYNOLDS shall self-administer prescribed drugs only in the manner prescribed." Item 7. of the September 2010 Consent Agreement states, "Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. REYNOLDS shall continue submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a

Linda Marie Reynolds, R.N. Page 2 restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. REYNOLDS shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REYNOLDS's history of chemical dependency and recovery status." Despite these provisions, on October 3, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Hydrocodone. Furthermore, on or about the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: January 24, 2012, June 4, 2012, November 26, 2012, and December 5, 2012. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. B. Item 12. of the September 2010 Consent Agreement states, "Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. REYNOLDS shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. REYNOLDS shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner." Item 13. of the September 2010 Consent Agreement states, "MS. REYNOLDS shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. REYNOLDS." Item 14. of the September 2010 Consent Agreement states, "Within twenty-four hours of release from hospitalization or medical treatment, MS. REYNOLDS shall notify the Board of any and all medication(s) or prescription(s) received." Despite these provisions, you initiated treatment with an additional practitioner, Dr. Stephen Ross Bernie, of Chagrin Medical Center, Beachwood, Ohio, on or about April 27, 2012 and failed to have Dr. Bernie submit a medication report to

Linda Marie Reynolds, R.N. Page 3 the Board for medication prescribed by him to you. You failed to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by an additional practitioner; and failed to notify the Board of medical treatment and receipt of a prescription within twenty-four hours of those events. On October 26, 2012 in an e-mail to your Board Monitoring Agent, you stated you were "very sorry to have lied about the visit to another doctor," Dr. Bernie, and you acknowledged that you failed to meet your obligations to inform the Board of the additional practitioner and of the prescription you received. Section 4723.28(8)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the September 2010 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 4., 7., 12., 13., and 14. of the September 2010 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-240923, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 24, 2010, you entered into a Consent Agreement (September 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that upon meeting the requirements for renewal, your license to practice nursing as a registered nurse in the State of Ohio would be reinstated and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations until at least September 2013. Attached to and incorporated within the September 2010 Consent Agreement is a July 24, 2009 Consent Agreement and a March 20, 2009 Notice of Opportunity. Also attached hereto and incorporated herein is a release letter you received from the Board dated September 26, 2012. Documents are redacted according to Section 2953.52 of the Ohio Revised Code. 2. Item 1. of the September 2010 Consent Agreement states, "MS. REYNOLDS shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723 .28(B)(8), ORC, authorizes the

Linda Marie Reynolds, R.N. Page 4 Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 4. of the September 2010 Consent Agreement states, "MS. REYNOLDS shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REYNOLDS's history of chemical dependency and recovery status. MS. REYNOLDS shall self-administer prescribed drugs only in the manner prescribed." Item 7. of the September 2010 Consent Agreement states, "Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. REYNOLDS shall continue submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. REYNOLDS shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REYNOLDS's history of chemical dependency and recovery status." Despite these provisions, on October 3, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Hydrocodone. Furthermore, on or about the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: January 24, 2012, June 4, 2012, November 26, 2012, and December 5, 2012. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule. I controlled substance. Section 4723.28(3)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 3. Item 12. of the September 2010 Consent Agreement states, "Within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. REYNOLDS shall provide a copy of this Consent Agreement to all treating practitioners and shall provide

Linda Marie Reynolds, R.N. Page 5 to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. REYNOLDS shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner." Item 13. of the September 2010 Consent Agreement states, "MS. REYNOLDS shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. REYNOLDS." Item 14. of the September 2010 Consent Agreement states, "Within twenty-four hours of release from hospitalization or medical treatment, MS. REYNOLDS shall notify the Board of any and all medication(s) or prescription(s) received." Despite these provisions, you initiated treatment with an additional practitioner, Dr. Stephen Ross Bernie, of Chagrin Medical Center, Beachwood, Ohio, on or about April 27, 2012 and failed to have Dr. Bernie submit a medication report to the Board for medication prescribed by him to you. You failed to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by an additional practitioner; and failed to notify the Board of medical treatment and receipt of a prescription within twenty-four hours of those events. On October 26, 2012 in an e-mail to your Board Monitoring Agent, you stated you were "very sorry to have lied about the visit to another doctor," Dr. Bernie, and you acknowledged that you failed to meet your obligations to inform the Board of the additional practitioner and of the prescription you received. Section 4723 .28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit

Linda Marie Reynolds, R.N. Page 6 Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing(&,nursing,.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S, Barkheimer, R.N., C.N.P . Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 11/H cc: Henry G. Appel, Senior Assistant Attorney General

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947

Enclosed are records regarding Linda Marie Reynolds, R.N. Information has been redacted, per Section 2953.52 of the Ohio Revised Code. If you have any further questions or concerns, please contact the Compliance Unit Manager or a Supervising Attorney.

Thank you. Compliance Unit Ohio Board of Nursing

Cs # 10-3857

Ohio Board, of Nursing

www.nursing.ohio.gay
(614) 466-3947

17 South High Street, Suite 400 Columbus, Ohio 43215-7410

September 26, 2012

Linda M Reynolds, R.N. 3990 East 58th Cleveland, OH 44105 Ref: Consent Agreement of September 24, 2010 License if R.N. 240923 Dear Ms. Reynolds: On September 21, 2012, the Board approved your request to be released from the temporary narcotic restriction that was imposed by the September 24, 2010 Consent Agreement. Sincerely,

Betsy J. Houchen, R.N., M.S., J.D. Executive Director

LFR/mam

Case #10-3857

Ohio Board of Nursing

www,nursing.ohio.gov

17 South High Street, Suite 400 4 Columbus, Ohio 43215-7410 m (614) 466-3947

REINSTATEMENT CONSENT AGREEMENT BETWEEN LINDA MARIE REYNOLDS, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between LINDA MARIE REYNOLDS, R.N. (MS. REYNOLDS) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. REYNOLDS voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation, MS. REYNOLDS admits to violating Section 4723.28, ORC, as set forth in her March 20, 2009 Notice of Opportunity for Hearing (March 2009 Notice) and July 24, 2009 Consent Agreement (July 2009 Consent Agreement). B. MS. REYNOLDS's July 2009 Consent Agreement resolved her March 2009 Notice in which MS. REYNOLDS's license to practice nursing in Ohio as a registered nurse, RN-240923, was indefinitely suspended. Copies of the March 2009 Notice and the July 2009 Consent Agreement are attached hereto and incorporated herein.

Linda Marie Reynolds, R.N. Page 2

C.

Under the terms of her July 2009 Consent Agreement, MS. REYNOLDS is now eligible to request reinstatement of her license to practice as a registered nurse and has submitted such a request in writing, On or about June 15, 2010, MS. REYNOLDS obtained an addiction psychiatric evaluation from Dr. Michael A. Gureasko. MS. REYNOLDS was diagnosed with Opiate Dependence-in remission and Dysthythic Disorder-in remission and was previously diagnosed with Depression. MS. REYNOLDS is prescribed antidepressant medication from her family physician and is prescribed Suboxone, a narcotic blocker, from Dr. Alan H. Shein. Dr. Gureasko opined that MS. REYNOLDS has a good support system and has made a good recovery and may safely return to the practice of nursing with continuing narcotic restrictions. Dr. Gureasko recommended that MS. REYNOLDS continue to attend Alcoholics Anonymous meetings, comply with the Board and continue with Suboxone therapy for at least another year.

D.

F.

MS. REYNOLDS understands that violations of the terms, conditions and limitations of this Consent Agreement may result in further suspension and possible permanent revocation of her license to practice nursing as a registered nurse in Ohio. AGREED CONDITIONS

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. REYNOLDS knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for renewal, MS. REYNOLDS's license to practice nursing as a registered nurse shall be reinstated and suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations until at least September 2013: 1. MS. REYNOLDS shall obey all federal, state, and local laws, and all laws and rules overnin the ractice of nursing in Ohio and

Linda Mark Reynolds, R.N. Page 3

2.

MS. REYNOLDS shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.

Monitoring of Rehabilitation and Treatment 4. MS. REYNOLDS shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REYNOLDS's history of chemical dependency and recovery status. MS. REYNOLDS shall self-administer prescribed drugs only in the manner prescribed. Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. REYNOLDS shall continue to obtain Suboxone treatment at intervals deemed appropriate by Dr. Shein or another physician approved in advance by the Board or its designee until released. MS. REYNOLDS shall have the physician submit written reports regarding MS. REYNOLDS's progress, status, and compliance with her Suboxone treatment plan to the Board on a quarterly basis beginning November 1, 2010. MS. REYNOLDS shall provide the physician with a copy of this Consent Agreement, the attached July 2009 Consent Agreement, and the attached March 2009 Notice prior to October 22, 2010. MS. REYNOLDS shall inform the Board, in writing, within five (5) business days of discontinuing treatment, and prior to said discontinuation, shall inform the Board, in writing, of the name(s) of another physiciari(s) and intervals of treatment for approval by the Board or its designee. MS. REYNOLDS shall abstain completely from the use of alcohol. Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. REYNOLDS shall continue submitting, at her expense and on the

5.

6. 7.

Linda Marie Reynolds, R.N. Page 4

day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. REYNOLDS shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REYNOLDS's history of chemical dependency and recovery status. 8. Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. REYNOLDS shall continue attending a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. REYNOLDS shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning November 1, 2010.

Evaluations 9. Upon request by the Board or its designee, MS. REYNOLDS shall, at her own expense, and within sixty (60) days of the request by the Board or its designee, obtain a comprehensive evaluation by a psychiatrist who is certified by the American Board of Medical Specialties (ABMS) in Addiction Psychiatry and who is approved in advance by the Board, Prior to the evaluation, MS. REYNOLDS shall provide the evaluating psychiatrist with a copy of this Consent Agreement, the attached July 2009 Consent Agreement, and the attached March 2009 Notice. Further, MS. REYNOLDS shall execute releases to permit the evaluating psychiatrist to obtain any information deemed appropriate and necessary for the evaluation, The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. REYNOLDS's license, and whether MS. REYNOLDS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care, Upon request by the Board or its designee and within sixty (60) days of such a request, MS. REYNOLDS shall, at her own expense, obtain a comprehensive physical examination by a Board approved physician for the purposes of evaluating MS. REYNOLDS's fitness of duty and safety to practice nursing as a registered nurse. This Board

10.

Linda Marie Reynolds, R.N. Page 5

approved physician shall provide the Board with complete documentation of MS. REYNOLDS's comprehensive physical examination and with a comprehensive assessment regarding MS. REYNOLDS's fitness for duty and safety to practice nursing as a registered nurse. Prior to the examination, MS. REYNOLDS shall provide the Board approved physician with a copy of this Consent Agreement, the attached July 2009 Consent Agreement and the attached March 2009 Notice. Further, MS. REYNOLDS shall execute releases to permit the Board approved physician performing the comprehensive physical examination and assessment to obtain any information deemed appropriate and necessary for the assessment. This Board approved physician shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. REYNOLDS's license to practice, and a statement as to whether MS. REYNOLDS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 11. if the above evaluations are requested, MS. REYNOLDS shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the physician(s) described above until released, Further, MS. REYNOLDS agrees that the Board may utilize the physician(s)'s recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. REYNOLDS's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

Treating Practitioners and Reporting 12. Within sixty (60) days of the effective date of this Consent Agreement, MS. REYNOLDS shall provide a copy of this Consent Agreement, the attached July 2009 Consent Agreement, and attached March 2009 Notice to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. REYNOLDS shall be under a continuing duty to provide .a copy of this Consent Agreement and the attachments, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. MS. REYNOLDS shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any

13.

Linda Marie Reynolds, R.N. Page 6

and all substances prescribed, administered, or dispensed to MS. REYNOLDS throughout the duration of this Consent Agreement, 14. Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. REYNOLDS shall notify the Board of any and all rnedication(s) or prescription(s) received.

Employment Conditions 15. Prior to accepting employment as a nurse, each time with every employer, MS. REYNOLDS shall notify the Board in writing. MS. REYNOLDS is under a continuing duty to provide a copy of this Consent Agreement, the attached July 2009 Consent Agreement, and the attached March 2009 Notice to any new employer prior to accepting employment as a nurse. MS. REYNOLDS shall, have her employer(s) submit written reports regarding job performance on a quarterly basis beginning November 1, 2010 or within thirty (30) clays of accepting nursing employment. Further, MS. REYNOLDS shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement and the attachments, including the date they were received.

16.

Reporting Requirements of Licensee 17. MS. REYNOLDS shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. REYNOLDS shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. REYNOLDS shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. REYNOLDS shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. REYNOLDS shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board.

18.

19.

20.

21.

Linda Marie Reynolds, R.N. Page 7 22, MS. REYNOLDS shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. REYNOLDS shall verify that the reports and documentation required by this Consent Agreement are received in the Board office, MS. REYNOLDS shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number,

23. 24.

Nursing Refresher Course or Orientation Prior to working in a position where a nursing license is required, MS. REYNOLDS shall complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation to be approved in advance by the Board or its designee. Temporary Narcotic Restriction MS. REYNOLDS shall not administer, have access to, or possess (except as prescribed for MS. REYNOLDS's use by another so authorized by law who has full knowledge of M.S. REYNOLDS's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum of six (6) months in which MS. REYNOLDS is working in a position that requires a nursing license. At any time after the six-month period previously described, MS. REYNOLDS may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. .REYNOLDS shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. REYNOLDS shall not call in or order prescriptions or prescription refills. Permanent Practice Restrictions M.S. REYNOLDS further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: MS. REYNOLDS shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. REYNOLDS to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. REYNOLDS shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the

Linda Marie Reynolds, R.N. Page 8 following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, VicePresident of Nursing. FAILURE TO COMPLY MS. REYNOLDS agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. REYNOLDS has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS,. REYNOLDS via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. REYNOLDS may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. lf, in the discretion of the Board, MS. REYNOLDS appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement, other than the permanent practice restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. REYNOLDS and the Board, The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. REYNOLDS has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. REYNOLDS is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. REYNOLDS and review of the reports as required herein. Any period during which MS. REYNOLDS does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ' ACKNOWLEDGMENTS/LIABILITY RELEASE MS. REYNOLDS acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. REYNOLDS waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement.

Linda Marie Reynolds, R.N. Page 9 MS. REYNOLDS waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, OR.C. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Arl.irtintstrative Procedures Act, Chapter 119, ORC. EFFECTIVE, DATE MS. REYNOLDS understands that this Consent Agreement b subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

LINDA RIE REYNOLDS, R.N.

Atoi R.N.

1117
DATE

/ 7D

58,90M19ERTHA LOVELA.CE, President Ohio Board of Nursing

glaLIIID
DATE

Case # 06-0523; 08-0779; 08-0920

Ohio Board of ursing

17 South High Street, Suite 400

wwwnursing.ohio_gov
ca

Columbus, Ohio 43215-7410 4 (614) 466-3947

CONSENT AGREEMENT BETWEEN LINDA MARIE REYNOLDS, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between LINDA MARIE REYNOLDS, R.N. (MS.. REYNOLDS) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. REYNOLDS voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by. legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement.

BA_SIS FOR ACTION

This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00). Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or .a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescripfton issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it.

Linda Marie Reynolds, R.N. Page 2 Specifically, Rule 4723-4-06(0), Ohio Administrative Code, states, that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. Rule 4723-4-06(E), OAC, states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client. Rule 4723-4-06(P), Ohio Administrative Code, states that a licensed nurse shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the board, to current employers, or to any future employers for positions requiring a, nursing license. B. C. MS. REYNOLDS has been licensed to practice nursing as a registered nurse in the State of Ohio, RN-240923, since September 1992. MS. REYNOLDS knowingly and voluntarily admits to the factual and legal allegations set forth in the Notice of Opportunity for Hearing dated March 20, 2009 (March 2009 Notice), a copy of which is attached hereto and incorporated herein. MS. REYNOLDS states that in 2005, she received inpatient treatment in Florida for 28 days for the overuse of Vicodin and Percocet. MS. REYNOLDS states that while working at Southpointe Hospital in December of 2005 through February of 2006, she withdrew two Percocets per the physician's order and retained those tablets for self-administration. Then, if the patient would complain about pain at a later time, MS. REYNOLDS would withdraw two additional Percocets and administered them to the patient. In this way, MS. REYNOLDS believed that the patient would not suffer from pain when she retained the patient's prescribed medication. MS. REYNOLDS admits that while working at Southpointe Hospital she was self-administering between 20 30 tablets a day. When questioned by Southpointe Hospital, MS. REYNOLDS stated that she had poor documentation skills. In 2007, MS. REYNOLDS admitted to the Board's agent that she was diverting from Southpointe Hospital. H. In 2007, while working at Northeast Ohio Pre-release Center, MS. REYNOLDS states she reinjured her back and obtained a prescription for Percocet, without disclosing her addiction to her physician.

D. E.

Linda Marie Reynolds, R.N. Page 3

1.

MS. REYNOLDS states in February 2008, her addiction to prescription pain medication became worse, and she began diverting Tylenol # 3 from Northeast Ohio Pre-release Center. MS. REYNOLDS would withdraw Tylenol #3 as prescribed for a patient, retain that dosage for selfadministration and wait for a patient to complain about pain. MS. REYNOLDS states some patients never complained to her so she was able to retain the entire prescription for herself until the prescription expired. When questioned by Northeast Ohio Pre-release Center, MS. REYNOLDS stated she had poor documentation practices and denied diversion_ MS. REYNOLDS states that on March 26, 2008, she entered inpatient treatment at Rosary Hall, Cleveland, Ohio for five days of detoxification. She started suboxone therapy at Rosary Hail under the supervision of Dr. Adelman. Upon release, she continued suboxone treatment under the supervision of Dr. Shein, Cleveland, Ohio and remains on suboxone therapy with the expectation that it will end after September 2009.

.1.

K.

M.

MS. REYNOLDS states that she attended the intensive Outpatient Program at Rosary Hall beginning April I, 2008, four days a week for five weeks, Then, MS. REYNOLDS states she attended Aftercare at Rosary Hall, once a week for eight weeks, with drug screens until August 2008. MS. REYNOLDS states that she has regularly attended AA meetings beginning April I, 2008. MS. REYNOLDS states she has a AA sponsor and a home group.

N.

P.

MS. REYNOLDS has not worked as a nurse since March 20, 2008 and placed her nursing license on inactive status effective April 2, 2008. AGREED CONDITIONS

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. REYNOLDS knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations:

Linda Marie Reynolds, R.N. Page 4 SUSPENSION OF LICENSE 1. MS. REYNOLDS's license to practice nursing as a registered nurse is hereby suspended for an indefinite period of time. MS. REYNOLDS may submit a written request for reinstatement after July 2010 if the conditions for reinstatement have been satisfied and MS. REYNOLDS is in full compliance of this Consent Agreement.

CONDITIONS FOR REINSTATEMENT 2. MS. REYNOLDS shall obey all federal, state, and local laws, and all laws and rules governing the 'ractice of nursing in Ohio and ee; MS. REYNOLDS shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. Within six (6) months prior to requesting reinstatement, MS. REYNOLDS agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCH) to conduct a criminal records check of MS. REYNOLDS, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. REYNOLDS's criminal records check reports to the Board. MS. REYNOLDS agrees that a request for reinstatement will not be considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board. Prior to reinstatement, MS. REYNOLDS shall enter into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of three (3) years following reinstatement.

3.

4.

5.

Addiction Psychiatric Evaluation 6. Within three (3) months prior to requesting reinstatement, MS. REYNOLDS shall, at her own expense, obtain a comprehensive evaluation by a psychiatrist who is certified by the American Board of Medical Specialties (ABMS) in Addiction Psychiatry and who is approved in advance by the Board. MS. REYNOLDS shall provide the Board with complete documentation of this evaluation, Prior to the evaluation, MS. REYNOLDS shall provide the evaluating psychiatrist with a copy of this Consent Agreement and the March 2009 Notice. Further, MS. REYNOLDS shall execute releases to permit the evaluating psychiatrist to obtain any information deemed appropriate and necessary for the evaluation, The psychiatrist shall submit a written opinion to the Board that includes diagnoses, and recommendations for treatment and monitoring, any additional restrictions to be placed on MS. REYNOLDS's license to practice, and stating whether MS. REYNOLDS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.

Linda Marie Reynolds, R.N. Page 5 7. MS. REYNOLDS shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the psychiatrist described above until released. Further, MS. REYNOLDS agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. REYNOLDS's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

Monitoring of Rehabilitation and Treatment 8. MS. REYNOLDS shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REYNOLDS's history of chemical dependency and recovery status. MS. REYNOLDS shall self-administer the prescribed drags only in the manner prescribed. MS. REYNOLDS shall abstain completely from the use of alcohol. For minimum twelve (12) continuous months immediately prior to requesting reinstatement, MS. REYNOLDS shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. REYNOLDS shall provide satisfactory documentation of such attendance to the Board prior to reinstatement. For minimum twelve (12) continuous months immediately prior to requesting reinstatement, MS. REYNOLDS shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. REYNOLDS's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. REYNOLDS shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. REYNOLDS's history of chemical dependency and recovery status. a. Within thirty (30) days prior to MS. REYNOLDS initiating drug screening, MS. REYNOLDS shall provide a copy of this Consent Agreement and the attached March 2009 Notice to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. REYNOLDS.

9. 10.

11.

' Linda Marie Reynolds, R.N. Page 6

b. After initiating drug screening, MS. REYNOLDS shall be under a continuing duty to provide a copy of this Consent Agreement and the attached March 2009 Notice, prior to initiating treatioent, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. REYNOLDS shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. Fitness for Duty Evaluation 12. Upon the request of the Board or its designee and with sixty (60) days of that request, MS. REYNOLDS shall, at her own expense, obtain a comprehensive physical examination by a Board approved physician for the purposes of evaluating MS. REYNOLDS's fitness for duty and safety to practice nursing as a registered nurse, This Board approved physician shall provide the Board with complete documentation of MS. REYNOLDS's comprehensive physical examination and with a comprehensive assessment regarding MS. REYNOLDS's fitness for duty and safety to practice nursing as a registered nurse. Prior to the examination, MS. REYNOLDS shall provide the Board approved physician with a copy of this Consent Agreement, the attached March 2009 Notice, Further, MS. REYNOLDS shall execute releases to permit the Board approved physician performing the comprehensive physical examination and assessment to obtain any information deemed appropriate and necessary for the assessment. The evaluating physician shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. REYNOLDS's license to practice, and stating whether MS. REYNOLDS is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS. REYNOLDS agrees that the Board may use the professional recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. REYNOLDS's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement,

13.

Reporting Requirements of Licensee 14. MS. REYNOLDS shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. M.S. REYNOLDS shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board.

15.

Linda Marie Reynolds, R.N. Page 7 16, MS. REYNOLDS shall submit any and all information that the. Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. REYNOLDS shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. REYNOLDS shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. REYNOLDS shall submit the reports and documentation required by this Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. REYNOLDS shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. REYNOLDS shall inform the Board within five (5) business days, in writing, of any change in address and/or telephone number.

17.

18.

19,

20.

21.

Nursing Refresher Course or Orientation Upon request of the Board or its designee, MS. REYNOLDS shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation approved in advance by the Board or its designee. Temporary Narcotic Restrictions, M.S. REYNOLDS shall not administer, have access to, or possess (except as prescribed for MS. REYNOLDS's use by another so authorized by law who has full knowledge of MS. REYNOLDS'S history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum period of SIX (6) MONTHS in which MS. REYNOLDS is working in a position that requires a nursing license. At any time after the six-month period previously described, MS. REYNOLDS may submit a written request to the Board to have this restriction re-evaluated, In addition, MS. REYNOLDS shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. REYNOLDS shall not call in or order prescriptions or prescription refills.

Linda Marie Reynolds, R.N. Page 8 Permanent Practice Restrictions MS. REYNOLDS further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: MS. REYNOLDS shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. REYNOLDS to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. REYNOLDS shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC, If, in the discretion of the Board, MS. REYNOLDS appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION / MODIFICATION OF TERMS The terms, limitations, and conditions of this Consent Agreement, other than the permanent licensure restriction(s), may be modified or terminated, in writing, at any time upon the agreement of both MS. REYNOLDS and the Board. The Board may only alter the indefinite suspension imposed if: (1) MS. REYNOLDS submits a written request for reinstatement; (2) the Board determines that MS. REYNOLDS has complied with all conditions of reinstatement; (3) the Board determines that MS. REYNOLDS is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. REYNOLDS and review of the documentation specified in this Consent Agreement; and (4) MS. REYNOLDS has entered into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of three (3) years following reinstatement.

Linda Marie Reynolds, R.N. Page 9

RECEIVFD

ACIC_NOWLEDcMENTS/LIA33ILITY RELRON 12 PH 2: 1 5

BOARD OF NURMG. lug the MS. REYNOLDS acknowledges that she has had an opportunity to ask questmcon terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner.
MS. REYNOLDS waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. REYNOLDS waives any and all claims or causes of action she may have against the Board, and its members, officers, employees anWor agents arising out of matters that are the subject of this Consent Agreement. This Consent Agreement is not an adjudication order as discussed in Chapter, 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. EFFECTWE DATE MS. REYNOLDS understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

/d7
LINDA MARIE REYNOLDS, R.N. DATE LISA KLENKE, President Ohio Board of Nursing DATE

Case #06-0523, 08-0779 & 08-0920

Ohio Board of Nursing

March 20, 2009

www.nursing.obio.gov

17 South High Street, Suite 400 a Columbus, Ohio 4321,5-7410 a (614) 466-3947

NOTICE'OF OPPORTUNITY FOR HEARING

Linda Marie Reynolds, R.N. 6720 Gertrude Avenue Cleveland, Ohio 44105 Dear Ms. Reynolds; In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1.

The acts underlying your II= occurred around February 2008 to March 2008 and consist of you, while working as a registered nurse at Southpointe Hospital (Northeast Ohio Pre-Release Center) in Warrensville, Ohio, falsifying, destroying, removing, concealing, altering, defacing or mutilating an inmate's medical records with the purpose to defraud or with knowledge that you were facilitating a fraud on the State of Ohio. Section 4723.28(8)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. 2. In or around March 2008, you admitted to a Board Compliance Agent that, while working at the Northeast Ohio Pre-Release Center, through Wexford Health Sources Inc., a staffing agency, you began diverting Tylenol #3 from an inmate in the beginning of February 2008. You explained that you signed out Tylenol #3 for an inmate that never takes it and self-administered the medications. In a written statement to the Board, dated April 3, 2008, you again admitted that you took Tylenol

Linda Marie Reynolds, R.N. Page 2

#3 while working as a nurse You further admitted that you have had a. "major drug addiction" since 2005 and that you went through a 28-day rehabilitation program in July to August 2005. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for selfadministering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it, Specifically, Rule 4723-4-06(G), Ohio Administrative Code, states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. 3. In or around March 2007, you admitted to a Board Compliance Agent that, while working as a nurse at Southpointe Hospital, you diverted and self-administered narcotics for several months before your employer confronted you in February 2006. You further admitted that you previously had prescriptions for Percocet and Vicodin but you took more than ordered, increased usage, and started buying them on the streets. You also explained that you previously went through a 28-day rehabilitation program in 2005.

Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for selfadministering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. 4. While working as a nurse at Southpointe Hospital, you acted in the following manner: a. Patient #1 had an order for one to two Percocet tablets every four hours as needed (PRN). All patients are identified on the Patient Key, which is confidential and to be withheld front public disclosure. You withdrew two tablets for Patient #1 on each of the following occasions but did not document administration or waste: January 30, 2006 at 10:12, 12:23, and 15:36; January 31, 2006 at 7:12 and 11:58; and February 5, 2006 at 7:23.

Linda Marie Reynolds, R.N. Page 3

b.

Patient #2 had an order for one to two Percocet tablets every four hours PM. You withdrew two tablets for Patient #2 on each of the following occasions but did not document administration or waste: January 26, 2006 at 6:55, 7:52, and 16:18; and January 31, 2006 at 9:19 and 13:17. Patient #3 had an order for one to two Percocet tablets every four hours PRN. You withdrew two tablets for Patient #3 on each of the following occasions but did not document administration or waste: January 11, 2006 at 9:26 and 14:22; and January 12, 2006 at 7:06, and 11:06. Patient #4 had an order for one to two Percocet tablets every four hours PRN. You withdrew two tablets for Patient #4 on each of the following occasions but did not document administration or waste: January 26, 2006 at 9:52; and January 27, 2006 at 9:29, 11:58, and 14:56. Patient #4 also had an order for one Ativan tablet every eight hours PRN. You withdrew one tablet on January 27, 2006 at 8:55 but did not document administration or waste.

c,

d.

e.

Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(E), OAC, states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 47234-06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410.

Linda Marie Reynolds, R.N. Page 4

If the Board fails to receive a request for a bearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Anne Barnett, RN, BSN, CWS Supervising Member Certified Mail Receipt No. 7008 3230 0003 2641 0492 Attorney Certified Mail Receipt No. 7008 3230 0003 2641 0508 cc: Leah O'Carroll, Assistant Attorney General Bret Jordan, Attorney for Ms. Reynolds 55 Public Square, Suite 1800 Cleveland, Ohio 44113

ATTACHMENT A

"SESlet10015011, .,. Ni
02)09/2012 Missed Call 02/10/2012 Missed Call 02/1512012 Missed Call 07/23/2012 Missed Call 11/13/2012 Missed Call 11/1412012Missed Call 11/1512012 Missed Call 11/16/2012 Missed Call 11/17/2012 Missed Calf 11/18/2012 Missed Call 11/19/2012 Missed Cali 11/20/2012 11121/2012 11/22/2012 11/23/2012 11/24/2012

Missed Cali Missed Call Missed Call Missed Call Missed Call 11125/2012 Missed Call 11/2712012 Missed Call 11/28/2012 Missed Call 1112912012 Missed Call 11/3012012 Missed Call 12/01/2012 Missed Calf 12/02/2012 'Missed Calf 12/0312012 MussedCall 12/04/2012 Missed Call 12/0612012 Missed Call 12/07/2012 Ivilssed Call 12/08/2012 -Missed Call 12/0912012 Weed Calf 12/10/2012 Missed Call

Case# 12-006209

Ohio Board of Nursing

17 South High Street, Suite 400

www.nursing,ohio.gov
(614) 466-3947

Columbus, Ohio 43215-7410

January 25, 2013

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Melissa Jane Rice, R.N. 142 Barry Drive Circleville, Ohio 43113 Dear Ms. Rice: You are hereby notified that, on or about March 16, 2012, you entered into a Consent Agreement (March 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of one (1) year. A. Item 3. of the March 2012 Consent Agreement states, "MS. RICE agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. RICE, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. RICE's criminal records check reports to the Board. MS. RICE's completed criminal records check, including the FBI check, must be received by the Board within six (6) months following the effective date of this Consent Agreement." Despite this provision, you have failed to submit to the Board a completed BCII/FBI criminal background check by its due date of September 16, 2012. 13. Item 4. of the March 2012 Consent Agreement states, "Within six (6) months of the effective date of this Consent Agreement, in addition to the requirements for licensure renewal, MS. RICE shall successfully complete and submit documentation of satisfactory completion of the following continuing nursing education or other comparable courses approved in advance by the. Board, taken subsequent to the effective date of <this Consent Agreement: ten (10) hours of Documentation; twenty (20) hours of Medication Administration; five (5) hours of Professional Accountability; and two (2) of Laws and Rules Scope of Practice." Despite this provision, you have failed to submit to the Board, by its due date of September 16, 2012, satisfactory documentation of successful, completion of the following continuing nursing education, or other comparable courses approved in advance by the Board: ten (10) hours of Documentation; twenty (20) hours of

Melissa Jane Rice, R.N. Page 2 Medication Administration; five (5) hours of Professional Accountability; and two (2) of Laws and Rules Scope of Practice. C. Item 8. of the March 2012 Consent Agreement states, "MS. RICE shall submit any and all information, which the Board or its designee may request, regarding her ability to practice nursing according to acceptable and prevailing standards of safe nursing care." Despite this provision, you have failed to submit, within thirty (30) days, a statement to the Board as requested by a Board Monitoring Agent. In a letter dated September 19, 2012, you were requested by a Board Monitoring Agent to submit a statement regarding your past due background check and your failure to submit satisfactory documentation of successful completion of continuing nursing education. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the March 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 3., 4. and 8. of the March 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-324180, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about March 16, 2012, you entered into a Consent Agreement (March 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of one (1) year. 2. Item 3. of the March 2012 Consent Agreement states, "MS. RICE agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. RICE, including a check of Federal Bureau of Investigation (FBI) records, and shall

Melissa Jane Rice, R.N. Page 3 cause BCIT to submit MS. RICE's criminal records check reports to the Board. MS. RICE's completed criminal records check, including the FBI check, must be received by the Board within six (6) months following the effective date of this Consent Agreement." Despite this provision, you have failed to submit to the Board a completed BCH/FBI criminal background check by its due date of September 16, 2012. 3. Item 4. of the March 2012 Consent Agreement states, "Within six (6) months of the effective date of this Consent Agreement, in addition to the requirements for licensure renewal, MS. RICE shall successfully complete and submit documentation of satisfactory completion of the following continuing nursing education or other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: ten (10) hours of Documentation; twenty (20) hours of Medication Administration; five (5) hours of Professional Accountability; and two (2) of Laws and Rules Scope of Practice." Despite this provision, you have failed to submit to the Board, by its due date of September 16, 2012, satisfactory documentation of successful completion of the following continuing nursing education, or other comparable courses approved in advance by the Board: ten (10) hours of Documentation; twenty (20) hours of Medication Administration; five (5) hours of Professional Accountability; and two (2) of Laws and Rules Scope of Practice. 4. Item 8. of the March 2012 Consent Agreement states, "MS. RICE shall submit any and all information, which the Board or its designee may request, regarding her ability to practice nursing according to acceptable and prevailing standards of safe nursing care." Despite this provision, you have failed to submit, within thirty (30) days, a statement to the Board as requested by a Board Monitoring Agent. In a letter dated September 19, 2012, you were requested by a Board Monitoring Agent to submit a statement regarding your past due background check and your failure to submit satisfactory documentation of successful completion of continuing nursing education. Section 4723 .28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice.

Melissa Jane Rice, R.N. Page 4

You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1076 cc: Henry G. Appel, Senior Assistant Attorney General

Case #10-0788 www.ifursing.ohio.gov 17 South High Street, Suite 400 4: Columbus, Ohio 4321.5-7410 (614) 466-3947

10 Board of ursi g

CONSENT AGREEMENT BETWEEN MELISSA JANE RICE, R,N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between MELISSA JANE RICE, R.N. (MS. RICE) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723,28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723 .28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of this chapter or any rules adopted under it. Specifically, Rule 47234-03(B), Ohio Administrative Code (OAC), states that a registered nurse shall maintain current knowledge of the duties, responsibilities, and accountabilities for safe nursing practice. Rule 4723-4-06(F), Ohio Administrative Code, states that a licensed nurse shall, in an accurate and timely manner, report to the appropriate practitioner errors in or deviations from the current valid order. MS. RICE has an active license to practice'nursing as a registered nurse, RN324180, in the State of Ohio. MS. RICE was- initially licensed as a registered nurse in April 2006. MS. RICE knowingly and voluntarily admits to the following: 1) On or about February 1, 2010, MS. RICE was terminated from nursing employment at Berger Health System in Circleville, Ohio, after it was discovered that MS. RICE documented over 300 times in a one-year

B.

C.

Melissa Jane Rice, R.N. Page 2 period (while peers averaged approximately 88 times) that patients refused their medications including: Insulin, Heparin and Lovenox and failed to notify the physician or take further action. 2) MS. RICE stated that she did not realize that asking her patients if they wanted to refuse the medication was a mistake. MS. RICE admits that if the patient refused, she would not administer the medication and did not always notify the physician of the refusal. MS. RICE is willing to cooperate with the Board in order to maintain her nursing license.

3)

AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS, RICE knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. RICE's license to practice nursing as a registered nurse shall be suspended indefinitely. Such suspension is hereby stayed, subject to the following probationary terms, conditions, and limitations for a minimum period of one (I) year: 1. MS. RICE shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. RICE shall appear in person for an interview before the full Board or its designated representative, as requested by the Board or its designee. MS. RICE agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. RICE, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. RICE's criminal records check reports to the Board. MS. RICE's completed criminal records check, including the FBI check, must be received by the Board within six (6) months following the effective date of this Consent Agreement. Continuing Nursing Education 4. Within six (6) months of the effective date of this Consent Agreement, in addition to the requirements for licensure renewal, MS. RICE shall successfully complete and submit documentation of satisfactory completion of the following continuing nursing education or other comparable courses approved in advance, by the Board, taken subsequent to the effective date of this Consent Agreement: ten (10) hours of Documentation; twenty (20) hours of Medication Administration; five (5) hours of Professional Accountability; and two (2) of Laws and Rules Scope of Practice.

Melissa Jane Rice, R.N. Page 3

Employment Conditions 5. If working in a position in which a nursing license is required, MS. RICE shall notify the Board, in writing, of the name and address of any current employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to accepting employment. MS. RICE, within fifteen (15) days of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS. RICE is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting employment in a position in which a nursing license is required. MS. RICE shall have her employer(s), if working in a position where a nursing license is required, submit written reports on a quarterly basis regarding job performance beginning within thirty (30) days of the effective date of the Consent Agreement or within thirty (30) days of accepting nursing employment. MS. RICE shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received.

6.

Reporting Requirements of Licensee 7. MS. RICE shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. RICE shall submit any and all information, which the Board or its designee may request, regarding her ability to practice nursing according to acceptable and prevailing standards of safe nursing care. MS. RICE shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. RICE shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. RICE shall submit all documentation required by this Consent Agreement or requested by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410, MS. RICE shall verify that the reports and documentation required by this Consent Agreement are received in the Board office.

8.

9.

10.

11.

12.

Melissa Jane Rice, R.N. Page 4

13.

MS. RICE shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

Temporary Practice Restrictions Unless otherwise approved in advanced, in writing, by the Board or its designee, MS. RICE shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. RICE to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advanced, in writing, by the Board or its designee, MS. RICE shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY MS. RICE agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. RICE has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. RICE via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. RICE may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. RICE appears to have violated or breached any terms or conditions of the Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/MODIFICATION OF TERMS The terms, limitations and conditions of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MS. RICE and the Board. The Board shall only alter the probationary period imposed by this Consent Agreement if: (1) MS. RICE has complied with all aspects of this Consent Agreement; and (2) the Board

Melissa Jane Rice, R.N. Page. 5 determines that MS. RICE is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring based upon an interview with MS. RICE and review of the reports required herein. Any period during which MS. RICE does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. RICE acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. RICE waives all of her rights under Chapter 119, ORC as they relate to matters that are the subject of this Consent Agreement. MS. RICE waives any and all claims or causes of action she may have against the Board, and members, officers, employees and/or agents of either, arising out of matters that are the subject of this Consent Agreement. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. However, any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. EFFECTIVE DATE, MS. RICE understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

(p)

MELISSA JANE RICE, R.N.

DATE

BERTHA LOVELACE, President Ohio Board of Nursing

Case #11-004198, 11-004855, & 12-005909

Ohio Board of Nursing

17 South High Street, Suite 400 January 25, 2013
e

www..nurs..ing.ohlogov
(614) 466-3947

Columbus, Ohio 43215-7410

NOTICE OF OPPORTUNITY FOR HEARING

Patrice Marie Ruckreigle 955 Findlay Street Perrysburg, Ohio 43551 Dear Ms. Ruckreigle: On or about December 13, 2012, the Ohio Board of Nursing (Board) issued to you a Notice of Immediate Suspension and Opportunity for Hearing, a copy of which is attached hereto and incorporated herein. You are notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28 of the Ohio Revised Code, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 27, 2012, in Lucas County Court of Common Pleas Case Number G-4801-CR-0201202057-000, you pled guilty to one (1) count of Theft of Drugs, a felony of the fourth degree, in violation of Section 2913.02(A)(2) & (B)(6), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about November 3, 2011, and involve you obtaining or exerting control over any dangerous drug beyond the scope of consent of the owner or person authorized to give consent. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. On or about November 14, 2011, you spoke with a Board Compliance Agent. You admitted to the Board Compliance Agent that in or about 2009 or after, you were prescribed to self-administer one (1) to two (2) tablets of Hydrocodone, but you self-administered four (4) tablets of

Patrice Marie Ruckreigle Page 2

Hydrocodone per day. You submitted a written statement to the Board, dated December 5, 2011, in which you indicate that you became addicted to narcotics at age 30, were in recovery for ten years, but began "[abusing] medication for approximately 6 months" and "diverted medication." Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. 3. On or about November 3, 2011, while working as a nurse at Arbors of Waterville, Waterville, Ohio, you were questioned about a tablet of Percocet that was missing from a resident's discharge medications. You admitted to taking the Percocet and voluntarily resigned from employment as a unit manager at Arbors of Waterville. On or about November 14, 2011, you spoke with a Board Compliance Agent. You admitted to the Board Compliance Agent that you took one (1) tablet of Percocet from a resident's discharge medications and placed that tablet in your pocket. You submitted a written statement to the Board, dated December 5, 2011, in which you admit to diverting a medication.

Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. 4. On or about November 30, 2011, you spoke with a Board Compliance Agent. You admitted that you allowed a former resident of Arbors at Waterville ("Resident") to reside with you. You stated that Resident's husband was ill so you invited Resident to live with you until her husband was well. You admitted that on the Wednesday before Thanksgiving, you allowed all of Resident's children to come to your house to celebrate Thanksgiving. You admitted that, over the years, you have remained in contact with one (1) or two (2) residents by calling them on the telephone or visiting on their birthdays.

Section 4723.28(B)(31), ORC, authorizes the Board to discipline a licensee for failure to establish and maintain professional boundaries with a patient, as specified in rules adopted under section 4723.07, ORC. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(1), Ohio Administrative Code (OAC), states that a licensed nurse shall delineate, establish, and maintain professional boundaries with each client. Rule 4723-4-06(L), OAC, states, in pertinent part, that a licensed nurse shall not: (3) Engage in behavior that constitutes inappropriate involvement in the client's personal relationships; or (4) Engage in behavior that may reasonably be interpreted as inappropriate involvement in the

Patrice Marie Ruckreigle Page 3

client's personal relationships. For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or informed consent to the behaviors by the nurse set forth in this paragraph. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearingAnursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No.7012 2210 0000 6272 1250 cc: Henry G. Appel, Senior Assistant Attorney General

Case #11-004198, 11-004855, & 12-005909

Ohio 3.0ard of Nursing

December 13, 2012

www.nursing.ohi.o.gov

17 South High Street, Suite 400 .* Columbus, Ohio 43215-7410 (614) 466-3947

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Patrice Marie Ruckreigle, R.N. 955 Findlay Street Perrysburg, Ohio 43551 Dear Ms. Ruckreigle: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about September 27, 2012, in LUcas County Court of Common Pleas Case Number G-4801-CR-0201202057-000, you pled guilty to one (1) count of Theft of Drugs, a felony of the fourth degree, in violation of Section 2913.02(A)(2) & (B)(6), ORC, and were found eligible for Intervention in Lieu of Conviction. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Theft of Drugs, a felony of the fourth degree, in violation of Section 2913 .02(A)(2) & (B)(6), ORC, constitutes a "felony drug abuse offense" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO. SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-340237, IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(A), ORC.

Patrice Marie Ruckreigle, R.N. Page 2 In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (3.0) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410, or to the e-mail address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, -", /gc_4.1/..0-, Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member A'. ,v /

Certified Mail Receipt No. 7012 2210 0000 6270 6301

cc:

Henry G. Appel, Senior Assistant Attorney General

Case #12-006206

Ohio Board of Nursing

17 South High Street, Suite 400 January 25, 2013

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 os, (614) 466-3947

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Shaunta Ruttencutter (a.k.a. "Shaunta Ruttencutter Reeves"), R.N. 284 University Drive Walton, Kentucky 41094 Dear Ms. Ruttencutter: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about October 23, 2012, in Hamilton County Court of Common Pleas Case Number B-1205194, you pled guilty to four (4) counts of Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(A), ORC; and four (4) counts of Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(2), ORC, and were found eligible for Intervention in Lieu of Conviction. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(A), ORC; and Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(2), ORC, constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-345456, IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(A), ORC.

Shaunta Ruttencutter (a.k.a. "Shaunta Ruttencutter Reeves"), R.N. Page 2

You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about October 23, 2012, in Hamilton County Court of Common Pleas Case Number B-1205194, you pled guilty to four (4) counts of Illegal Processing of Drug Documents, felonies of the fourth degree, in violation of Section 2925.23(A), ORC; and four (4) counts of Theft of Drugs, felonies of the fourth degree, in violation of Section 2913.02(A)(2), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about June 16 and 17, 2012, and involve you making a false statement in a prescription, order, report, or record involving Fentanyl. Further acts underlying this case involve you obtaining or exerting control over Fentanyl beyond the scope of consent of the owner to wit: Mercy Hospital-Mt. Airy. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. On or about July 25, 2012, you met with a Board Compliance Agent. You admitted to the Board Compliance Agent that while working as a nurse at Mercy Health Mount Airy Hospital, you diverted Fentanyl for self-administration. You submitted a written statement, dated July 25, 2012, in which you wrote: "So I took Fentanyl from syringe to give to myself intravenously in bathroom. I would document in computer discrepancy to reflect 45-50 ml were given to patient. ... I would selfadminister the fentanyl in my antecubital using tourniquet and syringe." You stated that you would remove "5 ml or so" of Fentanyl from 50 ml syringes that were to be put in patients' IV pumps and self-administer the drug while working. You indicated that you would remove approximately "15-20 ml" per day, and that you altered drug records to accomplish this.

Section 4723.28(B)(8), ORC, [as in effect prior to June 8, 2012] authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid

Shaunta Ruttencutter (a.k.a. "Shaunta Ruttencutter Reeves"), R.N. Page 3 prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(G), Ohio Administrative Code, states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0925 cc: Henry G. Appel, Senior Assistant Attorney General

Cases #10-5493 & 12-005948

Ohio Board of Nursing

January 25, 2013

www.mirsing.ohio.gov .17 South High Street, Suite 400 * Columbus, Ohio 43215-7410 6 (614) 466-3947

NOTICE OF IMMEDIATE SUSPENSION AND OPPORTUNITY FOR HEARING

Susan Leigh Schur, R.N. 5968 Emerald Street North Ridgeville, Ohio 44039 Dear Ms. Schur: In accordance with Sections 2929.42 and/or 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that, on or about October 17,.2012, in Cuyahoga County Court of Common Pleas Case Number CR-12-560407-A, you pled guilty to one (1) count of Theft; Aggravated Theft to wit: Dilaudid, a felony of the fourth degree, in violation of Section 2913.02(A)(2), ORC; one (1) count of Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of Section 2925.23(A), ORC; and one (1) count of Drug Possession, a felony of the fifth degree, in violation of Section 2925.11(A), ORC, and were found eligible for Intervention in Lieu of Conviction. Section 3719.121(C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929,42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to, a finding by a jury or court of the person's guilt of, or conviction of a felony drug abuse offense; a finding by a court of the person's eligibility for intervention in lieu of conviction; a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense; or a finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Theft; Aggravated Theft to wit: Dilaudid, a felony of the fourth degree, in violation of Section 2913.02(A)(2), ORC; Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of Section 2925.23(A), ORC; and Drug Possession, a felony of the fifth degree, in violation of Section 2925.11(A), ORC, constitute "felony drug abuse offenses" as defined in Section 2925.01, ORC. WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-323905, IS HEREBY SUSPENDED. Continued practice after receipt of this

Susan Leigh Schur, R.N. Page 2 notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(A), ORC. , You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about October 17, 2012, in Cuyahoga County Court of Common Pleas Case Number CR-12-560407-A, you pled guilty to one (1) count of Theft; Aggravated Theft to wit: Dilaudid, a felony of the fourth degree, in violation of Section 2913.02(A)(2), ORC; one (1) count of Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of Section 2925.23(A), ORC; and one (1) count of Drug Possession, a felony of the fifth degree, in violation of Section 2925.11(A), ORC, and were found eligible for Intervention in Lieu of Conviction. The acts underlying this case occurred on or about September 1, 2010, and involve you obtaining or exerting control over Diluadid without the consent of the owner to wit: Bedford Medical Center. Further acts underlying this case involve you making a false statement in any prescription, order, report, or record involving a Schedule 1 or II drug that is not Marihuana. Further acts underlying this case involve you obtaining, possessing, or using Dilaudid. Section 4723 .28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. 2. On or about January 26, 2011, you spoke with a Board Compliance Agent. You admitted to the Board Compliance Agent that you diverted Dilaudid from the pyxis machine at Bedford Medical Center where you worked as a nurse. You stated that your addiction started in or about March 2010 when you took a syringe home and injected it after a fight with your boyfriend. You admitted to diverting increasing amounts from the pyxis, to diverting wastes, to requesting orders increasing the dosage and frequency initially ordered for patients to cover your diversion, to self-administering while working to ease withdrawal symptoms, and to tampering with your urine specimen that you

Susan Leigh Schur, R.N. Page 3 submitted for drug testing. You stated that your addiction was "full blown" by the summer of 2010. Section 4723.28(B)(8), ORC, [as in effect prior to June 8, 2012] authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing@nursin' .ohio ov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Immediate Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0932 cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-002080

Ohio Board of Musing

January 25, 2013

www.nursing.ohio.gov
(614) 466-3947

17 South High Street, Suite 400 .4 Columbus, Ohio 43215-7410

NOTICE OF OPPORTUNITY FOR HEARING

Christine Frances Seek, L.P.N. PO Box 226 1282-A Possum Hollow Road Wheelersburg, Ohio 45694 Dear Ms. Seek: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28, ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about May 29, 2012, in Waverly Mayors Court Case Number 2012CRB00110, you were found guilty of four (4) counts of Receiving Stolen Property, misdemeanors of the first degree, in violation of Section 545.18-A, Codified Ordinances of Waverly, Ohio. The acts underlying your conviction occurred on or about April 2, 2012, while you were employed by an agency to provide nursing services at Scioto County Correctional Facility in Scioto County, Ohio (Scioto Correctional), and involve you receiving, retaining or disposing of medication that you had reasonable cause to believe had been obtained through a theft offense. According to the Waverly Police Department Report (Report), medication in prescription bottles was located in your vehicle, including: Ibuprofen, Hydrochlorot, Buspirone, Folic Acid, and Prenatal tablets. According to the Report, you admitted that you took these medications from Scioto Correctional. Section 4723.28(B)(3), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, of a misdemeanor committed in the course of practice. 2. On or about June 7, 2012, in an interview with a Board Compliance Agent, you admitted that while working as a nurse at Scioto Correctional, you diverted a variety of medications such as Prenatal Vitamins, Folic Acid, and Anti-Depressants and self-administered these medications. You further stated

Christine Frances Seek, L.P.N. Page 2 that you gave other medications taken from Scioto Correctional to your husband for his use. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for selling, giving away, or administering drugs or therapeutic devices for other than legal and legitimate therapeutic purposes. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Off 432157410, or to the email address, hearing(iOursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, E4/ Ad, ..&, ,,e,c:-,,,,4,) A7 /V e>\/./.

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0697 cc: Henry G. Appel, Senior Assistant Attorney General

Cases# 12-3477, 12-4147

Ohio J3oard of Nursing

January 25, 2013

www.nursing.ohio.gov

17 South High Street, Suite 400 o Columbus, Ohio 43215-7410 (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Virginia Sue Stewart (aka "Susie Stewart"), R.N. 3982 Wyndham Ridge Drive # 103 Stow, Ohio 44224 Dear Ms. Stewart: You are hereby notified that, on or about September 23, 2011, you entered into a Consent Agreement (September 2011 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that, upon meeting all of the requirements for licensure, your license to practice nursing as a registered nurse in the State of Ohio would be granted and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years following the effective (issuance) date of your license. Attached to and incorporated within the September 2011 Consent Agreement, pursuant to Paragraph D. of the 2011 Consent Agreement, are letters received by the Board in your support. A. You were issued a license to practice nursing as a registered nurse in the State of Ohio on March 9, 2012. B. Item 6. of the September 2011 Consent Agreement states, "MS. STEWART shall abstain completely from the use of alcohol or any substances that contain alcohol." Item 7. of the September 2011 Consent Agreement states, "For a minimum, continuous period of one (1) year immediately prior to requesting to work as a nurse, and continuing throughout the probationary period, MS. STEWART shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. STEWART's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license(s) for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. STEWART shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. STEWART's history of chemical dependency and recovery status."

Virginia Sue Stewart (aka "Susie Stewart"), R.N. Page 2

Despite these provisions, on the following dates, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol): July 31, 2012; August 14, 2012; September 13, 2012; and October 11, 2012. On or about August 10, 2012, in a telephone interview with your Monitoring Agent, you were asked if you had consumed Alcohol prior to providing a specimen for analysis to Firstlab on July 31, 2012, and you reported that you had consumed Alcohol. On or about October 24, 2012, in a telephone interview with your Monitoring Agent, you were asked when you last consumed Alcohol and you reported that you had consumed Alcohol on October 10, 2012. Furthermore, on the following dates, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis: December 20, 2011; March 24, 2012; May 25-26, 2012; June 28, 2012; September 20, 2012; September 29, 2012; October 7, 2012; and October 14, 2012; November 16-18, 2012; November 29, 2012; December 1, 2012; December 4, 2012; and December 6-7, 2012. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: June 28, 2012, and November 14, 2012. On or about December 9, 2012, in a written communication to your Monitoring Agent regarding your failure to provide a specimen as scheduled on November 14, 2012, you stated, "I was notified that I was chosen to screen on that date. I struggled a few days earlier, and I was afraid that I was going to test positive." C. Item 11. of the September 2011 Consent Agreement states, "Upon request of the Board or its designee, MS. STEWART shall, at her expense and within ninety (90) days of said request, obtain a psychiatric evaluation from a Board approved psychiatrist and shall provide the Board with complete documentation of such evaluation. Prior to the evaluation,. MS. STEWART shall provide the psychiatrist with a copy of this Consent Agreement and shall execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. STEWART's license, and a statement as to whether MS. STEWART is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care." You were sent a letter dated July 19, 2012, from your Board Monitoring Agent requesting that you obtain a Psychiatric Evaluation and submit documentation of the completed evaluation to the Board within ninety (90) days of receipt of the. letter. Despite this provision, as of January 10, 2013, you have failed to submit documentation of a completed Psychiatric Evaluation to the Board.

Virginia Sue Stewart (aka "Susie Stewart"), R.N. Page 3 Section 4723 .28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the September 2011 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 6., 7. and 11. of the September 2011 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-378994, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about On or about September 23, 2011, you entered into a Consent Agreement (September 2011 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that, upon meeting all of the requirements for licensure, your license to practice nursing as a registered nurse in the State of Ohio would be granted and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of three (3) years following the effective (issuance) date of your license. Attached to and incorporated within the September 2011 Consent Agreement, pursuant to Paragraph D. of the 2011 Consent Agreement, are letters received by the Board in your support. 2. You were issued a license to practice nursing as a registered nurse in the State of Ohio on March 9, 2012. 3. Item 6. of the September 2011 Consent Agreement states, "MS. STEWART shall abstain completely from the use of alcohol or any substances that contain alcohol." Item 7. of the September 2011 Consent Agreement states, "For a minimum, continuous period of one (1) year immediately prior to requesting to work as a nurse, and continuing throughout the probationary period, MS. STEWART shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. STEWART's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license(s) for purposes of

Virginia Sue Stewart (aka "Susie Stewart"), R.N. Page 4 Section 472328(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. STEWART shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. STEWART's history of chemical dependency and recovery status." Despite these provisions, on the following dates, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol): July 31, 2012; August 14, 2012; September 13, 2012; and October 11, 2012. On or about August 10, 2012,in a telephone interview with your Monitoring Agent, you were asked if you had consumed Alcohol prior to providing a specimen for analysis to Firstlab on July 31, 2012, and you reported that you had consumed Alcohol. On or about October 24, 2012, in a telephone interview with your Monitoring Agent, you were asked when you last consumed Alcohol and you reported that you had consumed Alcohol on October 10, 2012. Furthermore, on the following dates, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis: December 20, 2011; March 24, 2012; May 25-26, 2012; June 28, 2012; September 20, 2012; September 29, 2012; October 7, 2012; and October 14, 2012; November 16-18, 2012; November 29, 2012; December 1, 2012; December 4, 2012; and December 6-7, 2012. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: June 28, 2012, and November 14, 2012. On or about December 9, 2012, in a written communication to your Monitoring Agent regarding your failure to provide a specimen as scheduled on November 14, 2012, you stated, "I was notified that I was chosen to screen on that date. I struggled a few days earlier, and I was afraid that I was going to test positive." 4. Item 11. of the September 2011 Consent Agreement states, "Upon request of the Board or its designee, MS. STEWART shall, at her expense and within ninety (90) days of said request, obtain a psychiatric evaluation from a Board approved psychiatrist and shall provide the Board with complete documentation of such evaluation. Prior to the evaluation, MS. STEWART shall provide the psychiatrist with a copy of this Consent Agreement and shall execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. STEWART's license, and a statement as to whether MS. STEWART is capable of practicing nursing according to acceptable and prevailing standards of safe nursing, care." You were sent a letter dated July 19, 2012, from your Board Monitoring Agent requesting that you obtain a Psychiatric Evaluation and submit documentation of

Virginia Sue Stewart (aka "Susie Stewart"), R.N. Page 5 the completed evaluation to the Board within ninety (90) days of receipt of the letter. Despite this provision, as of January 10, 2013; you have failed to submit documentation of a completed Psychiatric Evaluation to the Board. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723 .28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address,hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1113 cc: Henry G. Appel, Senior Assistant Attorney General

Case #2011A02732

Ohio Board of Nursing

www.nursing.ohig.gov

17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947

CONSENT AGREEMENT BETWEEN VIRGINIA SUE (SUSIE) STEWART, R.N. APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between VIRGINIA SUE (SUSIE) STEWART, R.N. APPLICANT (MS. STEWART) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. STEWART voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. IIASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings:

A.

The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Section 4723.28(B)(10), ORC, authorizes the Board to deny a license for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of habitual or excessive use of drugs, alcohol, or other chemical substances that impair the ability to practice. MS. STEWART submitted an application to practice nursing as a registered nurse in June 2011, On her application, MS. STEWART answered "yes" to the question whether she had been convicted of, found guilty of, pled guilty to, pled

B.

Virginia Sue (Susie) Stewart, R.N. Applicant Page 2

no contest to, pled not guilty by reason of insanity to, entered an Alford plea, received treatment or intervention in lieu of conviction, or received diversion for a misdemeanor offense, Additionally, MS. STEWART attached documentation of the following alcohol-related misdemeanor convictions in Miami County (Ohio) Municipal Court: i, Theft (Petty Theft) in Case No. 2005 CR B 05023; ii . Disorderly Conduct in Case No. 2006 CR B 00613; iii. Disorderly Conduct in Case No. 2007 CR B 01030; iv. Disorderly Conduct in Case No. 2007 CR B 01190; v. OVI in Case No, 2007 CR .B 13564; vi . Disorderly Conduct in Case No. 2007 CR B 05345; vii. OVI in Case No. 2010 TR C 03316 and three (3) counts of Endangering Children-Operating Vehicle in Case No. 2010 CR B 01460 (one incident). C. In personal statements submitted to the Board, MS. STEWART described herself as a "perfect case" of a female alcoholic and reported that she began to use alcohol to "cope" in 2003, when her (then) husband first announced that he wanted a divorce, and that she began her recovery after her 2007 OVI charge/conviction. Additionally, MS. STEWART reported that her 2010 convictions noted above occurred after having two (2) years of sobriety. The Board received letters in support of MS. STEWART from Jill C. White, MS, LSW, her counselor at New Creation Counseling Center, and the Honorable Elizabeth Gutmann, Miami County Municipal Court. These letters are attached hereto and incorporated herein. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promise's hereinafter set forth, and in lieu of any formal proceedings at this time, MS. STEWART shall be granted authorization to take the NCLEX examination. Upon meeting all of the requirements for licensure, including passing the NCLEX, MS. STEWART shall be granted a license to practice nursing as a registered nurse and said license shall be suspended indefinitely. Such suspension is hereby stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum period of three (3) years following the effective (issuance) date of MS. STEWART's license to practice as a registered nurse: 1. MS. STEWART shall not work in a position that requires a nursing license until she submits a written request to work as a nurse and obtains approval from the Board or its designee. MS. STEWART must be in full compliance with this Consent Agreement in order to work as a nurse.

D.

Virginia'Sue (Susie) Stewart, R.N. Applicant Page 3

2.

MS. STEWART shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. STEWART shall appear in person for interviews before the full Board or its designee as requested by the Board or its designee.

3.

Monitoring of Alcohol/Chemical Use 5. MS. STEWART shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. STEWART's history of chemical dependency and recovery status. MS. STEWART shall self-administer prescribed drugs only in the manner prescribed. MS. STEWART shall abstain completely from the use of alcohol or any substances that contain alcohol. For a minimum, continuous period of 'one (1) year immediately prior to requesting to work as a nurse, and continuing throughout the probationary period, MS. STEWART shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. STEWART's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license(s) for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. STEWART shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. STEWART's history of chemical dependency and recovery status. a. Within thirty (30) days prior to initiating drug screening, MS. STEWART shall provide a copy of this Consent Agreement and the attached letters to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS, STEWART. b, After initiating drug screening, MS. STEWART shall be under a continuing duty to provide a copy of this Consent Agreement and the attached letters, prior to initiating treatment,

6.

7.

Virginia Sue (Susie) Stewart, R.N. Applicant Page 4

to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. STEWART shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization 8. For a minimum, continuous period of one (1) year immediately prior to requesting to work as a nurse, MS. STEWART shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. STEWART shall provide satisfactory documentation of such attendance to the Board prior to requesting to work as a nurse and every six (6) months thereafter.

Chemical Dependency Evaluation 9. Within three (3) months immediately prior to requesting to work as a nurse, MS. STEWART shall, at her expense, obtain a chemical dependency evaluation from chemical dependency professional approved in advance by the Board. MS. STEWART shall provide the Board with complete documentation of the evaluation. Prior to the evaluation, MS. STEWART shall provide the professional with a copy of this Consent Agreement and the attached letters as well as her treatment records from New Creation Counseling Center. MS. STEWART shall execute releases to permit the professional to obtain any information deemed appropriate and necessary for the evaluations. The evaluating professional shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. STEWART's license to practice, including narcotic restrictions, and statements as to whether MS. STEWART is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS. STEWART shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the professionals described above until released. Further, MS. STEWART agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. STEWART's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement.

10.

Psychiatric Evaluation & Treatment 11. Upon request of the Board or its designee, MS. STEWART shall, at her expense and within ninety (90) days of said request, obtain a psychiatric evaluation from a Board approved psychiatrist and shall provide the Board with

Virginia Sue (Susie) Stewart, R.N. Applicant Page 5

complete documentation of such evaluation. Prior to the evaluation, MS. STEWART shall provide the psychiatrist with a copy of this Consent Agreement and shall execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. STEWART's license, and a statement as to whether MS. STEWART is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. Reporting Requirements of Licensee 12. MS. STEWART shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. STEWART shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. STEWART shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. STEWART shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers, MS. STEWART shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. STEWART shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410.

13.

14.

15.

16,

17

18.
19.

MS. STEWART shall verify that the reports and documentation required by this Consent Agreement are received in the Board office.
MS. STEWART shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

Virginia Sue (Susie) Stewart, R.N. Applicant Page 6

Permanent Practice Restrictions MS. STEWART further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: Unless otherwise approved in advance, in writing, by the Board or its designee, MS. STEWART shall not practice nursing as a registered nurse: (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (4) for an individual or group of individuals who directly engage MS. STEWART to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance, in writing, by the Board or its designee, MS. STEWART shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include but are not limited to the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723,28(B), ORC. if, in the discretion of the Board, MS. STEWART appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations and conditions of this Consent Agreement, other than the permanent restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. STEWART and the Board. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. STEWART acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. STEWART waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement.

Virginia Sue (Susie) Stewart, R.N. Applicant Page 7 sTEWART waives any and all Claims or causes of action she may have against the Board, and its members, officers, employees andior agents arising out of matters that arc the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is Used in Section 149.43, ORC, The information contained herein may be reported to appropriate organizations, data banks and governmental bodies, This Consent Agreement is not en adjudication order within the meaning of Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall cornply with the Administrative Procedures Act, Chapter 119, ORC. BEEF unry_pATz L _ MS. STEWART understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

tc) Aq4" 9f/ VIR INIA. SUE (SUSIE) STEIVAR , It.N. E plicant

6' (i 1 1

betitbiti 8001-#
BERTHA LOVELACE, President Ohio J3oard of Nursing

nI 1 taB itlfm
DATE

MIAMI COUNTY MUNICIPAL COURT Court House - 201 West Main Street TROY, OHIO 45373-$263 TELEPHONE (937) 440-3910/ FAX (937) 440-391
ELIZABETH S. GUTMANN Judge GARY E. Z-UHL Magistrate May 6, eoli MEL K Judge

COMPUANCE
RECEIVP,D JUN 0 3 2011

RICHARD NICODE.MUS

Clerk of Courts

Ms Jarnie Lang Ohio Board of Nursing Attention: License Unit 17 South High Street, Suite 4,00 Columbus, OH 45215-7410 Dear Ms, Lang: First of all, let me introduce myself For the last twelve years I have been a municipal judge in Miami County, Ohio. Through my role as a Drug Court Judge, which is a recovery program run by our court, I have come to know Susie Stewart very well Susie is a graduate of our program; which takes about 18 months to complete During that time, Susie worked through many difficult issues including her divorce and the loss of custody of her children. She learned to accept herself, and put her recovery first. Another thing I that I came to know about Susie during her time in Drug Court is that she has a great passion for nursing. No matter what obstacle would get in her way, she always remained f'ocused on her goal of one day becoming a nurse. Knowing her as I do, I have little doubt that she would be a very good nurse That's the easy part of this letter to write, the hard truth is that Susie is an alcoholic The good news is that Susie works an excellent recovery program, and is not ashamed of her journey. I believe over the last several years she made peace with many of the issues standing in her way, including the end of her marriage and the custody of her children

Ms. Jamie Lang Ohio Board of Nursing Page - 2

It is my hope that Susie's hard work and dedication will be recognized, and that she will be given 6 chance to take the nursing boards A Judge knows better than anybody that there are rules in life, but there also needs to be exceptions to those rules. The nursing profession should not be denied the chance to have a person of Susie's intelligence, work ethic and passion She would be a credit to the profession. If you would like to speak with me personally, I would be happy to do so and you can contact me at 93'7-440-8936. Thank you for the good work that you do on behalf of the nursing profession. Very orally yours,

,: lli;r3126/4 -jisz,tizcejna.9.41u
.Judge Elizabeth S. Gutmann Miami County Municipal Court ESGiss

Counseling Center

rattion

7695 South County Road 25A, Tipp City Ohio 45371 (9.37) 667-4678 Fax (937) 667-4963

Dear Ms. Lang, It is my privilege to write a letter of support for Susie (Virginia) Stewart. Susie has been my client since May 2003. She initially came to rue for support when her exhusband first brought up divorce. I-have seen her through every up and down since. It is my personal opinion that through the difficulties and consequences she has truly come to understand herself, and the progression of addiction. She has also come to understand the importance of forgiveness, not only towards others but also forgiving herself. The shame and guilt kept Susie in the addiction cycle for a long time. Allowing the past to be her greatest ally has been instrumental in her recovery. She has turned her trials into important life lessons, and has displayed much growth. Also, as my client, she has displayed dedication and commitment. She has remained consistent with her appointments and is committed to complete honesty. We have worked through what I understand as anxiety driven, stress-induced alcoholism. She has learned how to cope with new tools, sponsor, family and friends instead of using alcohol to numb her pain or deal with life stressors. Unfortunately, relapses are not an =Common occurrence before complete recovery occurs. As such, Susie is very regretful of the last relapse, which resulted in significant legal consequences. However, she was determined not to let it derail her. She did not lose hope. She has worked hard with one and with her sponsor to tear apart this relapse and has a good handle on it. She has worked through the 12 steps with her sponsor and displays the positive, grateful attitude necessary for success with recovery. She continues to work bard and focus on these issues to ensure continued sobriety. She celebrated her on&year sobriety date on Easter Sunday, and is looking forward to the future. Susie has faced this year with complete abstinence from alcohol, and this has been in the face of serious psychosocial stressors. . Susie's goals are to remain sober, be a-great mom and be a great nurse. I have watched as Susie has worked very hard to obtain her RN-BSN. I understand that part of the process is a review of her criminal background. While Susie is not opposed to having restrictions put on her,1 understand that this may make it difficult for the hiring process. As Social Worker, I wholeheartedly support Susie as she pursues her dream of beeoming a nurse, without work restrictions. It is my professional opinion Susie will make an excellent nurse and an exceptional employee.

MEMBER AGENCY TROY & TIPP CITY

UNITED WAY

Case # 12-6367

Ohio Board of Nursing

17 South High Street, Suite 400 January 25, 2013

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 0 (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Kathryn M. Struna, R.N. 10203 Chippewa Road Brecksville, Ohio 44141 Dear Ms. Struna: You are hereby notified that, on or about September 24, 2010, you entered into a Reinstatement Consent Agreement (September 2010 Reinstatement Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations until at least September 2013. Attached to and incorporated within the September 2010 Reinstatement Consent Agreement is a May, 15, 2009 Consent Agreement. Redactions are made according to Section 2953.32, ORC. A. Item 1, of the September 2010 Reinstatement Consent Agreement states, "MS. STRUNA shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 4. of the September 2010 Reinstatement Consent Agreement states, "MS. STRUNA shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. STRUNA's history of chemical dependency and recovery status. MS. STRUNA shall selfadminister the prescribed drugs only in the manner prescribed." Item 6. of the September 2010 Reinstatement Consent Agreement states, "MS. STRUNA shall continue submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC.. This screening shall require a daily call-in process. The specimens submitted by MS. STRUNA shall be negative, except for substances prescribed,

Kathryn M. Struna, R.N. Page 2 administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. STRUNA." Despite these provisions, on August 24, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Cannabinoid. Furthermore, on or about the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: September 4, 2012, October 4, 2012, and December 12, 2012. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the September 2010 Reinstatement Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 4. and 6. of the September 2010 Reinstatement Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-240855, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about on or about September 24, 2010, you entered into a Reinstatement Consent Agreement (September 2010 Reinstatement Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a registered nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations until at least September 2013. Attached to and incorporated within the September 2010

Kathryn M. Struna, R.N. Page 3 Reinstatement Consent Agreement is a May, 15, 2009 Consent Agreement. Redactions are made according to Section 2953.32, ORC. 2. Item 1. of the September 2010 Item 1. of the September 2010 Reinstatement Consent Agreement states, "MS. STRUNA shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 4. of the September 2010 Reinstatement Consent Agreement states, "MS. STRUNA shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. STRUNA's history of chemical dependency and recovery status. MS. STRUNA shall selfadminister the prescribed drugs only in the manner prescribed." Item 6. of the September 2010 Reinstatement Consent Agreement states, "MS. STRUNA shall continue submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. STRUNA shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. STRUNA." Despite these provisions, on August 24, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Cannabinoid. Furthermore, on or about the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: September 4, 2012, October 4, 2012, and December 12, 2012. Section 4723 .28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions, placed on a nursing license by the Board.

Kathryn M. Struna, R.N. Page 4

Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 472328, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing@nursing,phip.gpv. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1151 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 1168 cc: Henry G. Appel, Senior Assistant Attorney General Barry T. Doyle, Esq.

( :.;Ohio Board of Nursing i 4'1_. c): 0 ,,,,

1

WWw.titirsing.ohio.gov

17 South High Siveet. Suite AD 0 Columbus. Ohio 413215-7410 t, (614) 466-3947

`'-'.`.)"Ir o so,

To Whom It May Concern:

You recently requested records regarding Kathryn M. Struna, RN. Enclosed are records in response to your request. Information has been redacted, per Section 2953.32 of the Ohio Revised Code. If you have any further questions or concerns, please contact the Compliance Unit Manager or a Supervising Attorney.

Thank you. Compliance Unit Ohio Board of Nursing

Case #08-2937 & //10-3756

Ohio b. card of Nursing

www.nursing.ohio.gov
(614) 466-3947

17 South ihigh Street. Suite 400 =, Columbus. Ohio 432i5-7410

REINSTATEMENT CONSENT AGREEMENT BETWEEN KATHRYN M. STRUNA, R.N. AND OHIO BOARD OF NURSING

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vc

, This Consent Agreement is entered into by and between KATHRYN M: Slial A.0? ....,..,, R.N. (MS. STRUNA) and the Ohio Board of Nursing (Board), the state agency char ed' iri with enforcing Chapter 4723, of the OhioRevised Code (ORC), and all administr ve 1:.:3 ro G) IN) rules promulgated thereunder. MS, STRUNA voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions On any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a One of five hundred dollars ($500.00) or less per violation. MS. STRUNA admits to violating Section 4723 28, ORC, as set Nth in her May 15, 2009 Consent Agreement (May 2009 Consent Agreement). A copy of the May 2009 Consent Agreement is attached hereto and incorporated herein. MS. STRUNA has complied with the terms of her May 2009 Consent Agreement. MS. STRUNA is now eligible to request reinstatement of her license and has submitted such a request in writing.

B.

C.

Kathryn M Sauna, R.N. Page 2

D.

On June 2, 2010, MS. STRUNA obtained a chemical dependency evaluation and a psychiatric evaluation from the Cleveland Clinic Fdt.urdation (CCF), MS. STRUNA was diagnosed with Opioid Dependency, in Remission and Depression. MS. STRUNA attends 2-3 recovery meetings per week and is receiving treatment from Dr. David Streem, a psychiatrist, addictionologist. MS. STRUNA is also undergoing counseling, on a weekly basis from Blaine DiFranko, 1_,PPC. MS, STRUNA is currently prescribed antidepressants and predication for her chemical dependence. It was opined that MS. STRUNA appears stable and her treatment recommendations include continuing with the Suboxone program, aftercare group and therapy. MS. STRUNA deeply regrets her prior actions. MS. STRUNA also understands that violations of the terms, conditions and limitations of this Consent Agreement may result in further suspension and possible permanent revocation of her license to practice nursing as a registered nurse in Ohio. CREED tit DITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. STRUNA knowingly and voluntarily agices with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for renewal, MS. STRUNA's license to practice nursing as a registered nurse shall be reinstated and suspended indefinitely. Such suspension. shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations until at least September 2013: MS. STRUNA shall obey all federal, state, and local laws, and all laws and rules governing the practice of mush g in Ohio.

MS. STRUNA shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. 3.

Kathryn M Stoma, R.N. Page 3

Monitoring of Rehabilitation and Treatment 4. MS. STRUNA shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. STRUNA's history of chemical dependency and recovery status. MS. STRUNA shall self-administer prescribed drugs only in the manner prescribed. MS. STRUNA shall abstain completely from the use of. alcohol_ MS. STRUNA shall continue submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 472328(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS, STRUNA shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. STRUNA's history of chemical dependency and recover y status. MS. STRUNA shall- continue attending a minimum of two (2) meetings per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program. Further, MS. STRUNA shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning November 1, 2010. Within thirty (30) days following the effective date of this Consent Agreement, MS. STRUNA shall participate in continuing counseling at intervals deemed appropriate by Susan M. Daum, CS, LICDC, Sr. Counselor at CCF or another chemical dependency .professional approved in advance by the Board or its designee until released. MS. STRUNA shall have the chemical dependency professional submit written reports regarding MS. STRUNA's progress, status, and compliance with her treatment plant o the Board on a quarterly basis beginning November 1, 2010. MS. STRUNA shall provide the chemical dependency professional with a copy of this Consent Agreement and the attached May 2009 Consent Agreement prior to

5 6.

8.

Kathryn M. Struna, R.N. Page 4 October 22, 2010. MS. STRUNG shall inform the Board, in writing, within five (5) business days of discontinuing participation in counseling, and prior to said discontinuation, shall inform the Board, in writing, of the name(s) of another chemical dependency professional(s) and intervals of treatment for approval by the Board or its designee. Psychiatric Evaluation and Monitoring 9, Upon request by the Board or its designee and within sixty (60) days of such a request, MS, STRUNA shall, at her expense,_ obtain a comprehensive evaluation by a psychiatrist who is certified by the American Board of Medical Specialties (ABMS) in Addiction Psychiatry and who is approved in advance by the Board. Prior to the evaluation, MS. STRUNA shall provide the evaluating psychiatrist with a copy of this Consent Agreement, the attached May 2009 Consent Agreement. Further, MS. STRUNA shall execute releases to permit the evaluating psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations For treatment and monitoring, any additional restrictions that .should be placed on MS. STRUNA's license, and whether MS. STRUNA is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If a psychiatric evaluation is requested, MS. STRUNA shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the psychiatrist described above until released_ Further, MS. STEMMA agrees that the Board may utilize the professional's recommendations and conclusions fror the evaluation as a basis for additional terms, conditions, and limitations on MS. STRUNA's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement, Within sixty (60) days following the effective date of this Consent Agreement, MS. STRUNA shall continue to participate in continuing individual counseling at intervals deemed appropriate by Dr. Streem, another addiction psychiatrist approved in advance by the Board or its designee until released. MS. STRUNA shall have the psychiatrist submit written reports regarding MS. STRUNA's progress, status, and compliance with her treatment plan to the Board on a quarterly basis beginning November 1, 2010. MS. STRUNA shall provide the psychiatrist with a copy of this Consent Agreement and the attached May 2009 Consent Agreement prior to October 22, 2010. MS. STRUNA shall inform the Board, in writing, within five (5) business

1 O.

11.

Kathryn M. Strum., R.N. Page 5 days of discontinuing participation in individual counseling, and prior to said discontinuation, shall inform the Board, in writing, of the name(s) of another psychiatrist(s) and intervals of treatment for. approval by the Board or its designee. 12. Within sixty (60) days following the effective date of this Consent Agreement, MS. STRUNA shall participate in continuing counseling . at intervals deemed appropriate by Ms DiFrank or another mental health professional approved in advance by the Board or its designee until released. MS, STRUNA shall have the mental health professional submit written reports regarding MS. STRUNA's progress, status, and compliance with her treatment plan to the Board on a quarterly basis beginning November 1, 2010. MS. STRUNA shall provide the mental health professional with a copy of this Consent Agreement and the attached May 2009 Consent Agreement prior to October 22, 2010 MS. STRUNA shall inform the Board, in writing, within five (5) business days of discontinuing participation in counseling, and prior to said discontinuation, shall inform the Board, in writing, of the name(s) of another mental health treating professional(s) and. intervals of treatment for approval by the Board or its designee.

Treating Practitioners and Reporting 13. Within sixty (60) days of the effective date of this Consent Agreement, MS. STRUNA shall provide a copy of this Consent Agreement and the attached May 2009 Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS, STRUNA shall be under a continuig.duty to provide a copy of this Consent Agreement and the attachment, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. MS. STRUNA shall cause all treating practitioners to complete a medication- prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to he completed for any and all substances prescribed, administered, or dispensed to MS. STRUNA throughout the duration of this Consent Agreement. Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. STRUNA shall notify the Board of any and all medication(s) or prescription(s) received.

14.

15,

Kathryn M. Stoma, R.N. Page 6

Employment Conditions 16. Prior to accepting employment as a nurse, each time with every employer, MS. STRUNA shall notify the Board in writing. MS. STRUNA is under a continuing duty to provide a copy of this Consent Agreement and the attached May 2009 Consent Agreement to any new employer prior to accepting employment as a nurse. MS. STRUNA shall, have her employeqs) submit written reports regarding job performance on a quarterly basis beginning November 1, 2010 or within thirty (30) days of accepting nursing employment, Further, MS. STRUNA shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement and the attachment, including the dale they were received.

17.

Reporting Requirements of Licensee 1g. MS. STRUNA shall repot t to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the ocean once of the violation. MS. STRUNA shall sign release of information forms allowing health "professionals and other organizations to submit the requested documentation directly to the Board. MS. STRUNA shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. STRUNA shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. STRUNA shall submit the reports and documentation required by this Consent Agreement on roans specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit.of the Board. MS. STRUNA shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410,

19.

20.

21.

22.

23.

Kathryn M. Struna, R.N. Page 7

MS. STRUNA shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. STRUNA shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number, Nursing Refresher Course or Orientation Upon request by the Board or its designee, MS. STRUNA shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation approved in advance by the Board or its designee. Temporary Narcotic Restriction MS. STRUNA shall not administer, have access to, or possess (except as prescribed for MS. STRUNA's use by another so authorized by law who has full knowledge of MS. STRUNA's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum of one (I) year in which MS. STRUNA is working in a position that requires a nursing license. At any time after the one (1) year period of time previously described, MS. STRUNA may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. STRUNA shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. Permanent Practice Restrictions MS, STRUNA further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: Unless otherivise approved in advance by the Board or its designee, MS. STRUNA shall not practice nursing as a registered nurse (I) for agencies-providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for' an individual or group of individuals who directly engage MS. STRUNA to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance by the Board or its designee, MS. STRUNA shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice-President of Nursing.

Kathryn lvi. Struna, Page 8

FAILURE TO CQMPLY MS. STRUNA agrees that her license to practice nursing as a registered nurse. will be automatically suspended if it appears to the Board that. MS. STRUNA has violated or breached any terms or conditions of the Consent. Agreement. Following the automatic suspension, the Board shall notify MS. STRUNA via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. STRUNA may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 41723,28(B), ORC. If, in the discretion of the Board, MS. STRUNA appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the- effective date of this Consent Agreement, DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement, other than the permanent licensure restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. STRUNA and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (I) the Board determines that MS. STRUNA has complied with all aspects of this Consent Agreement; and (2) the Board determines that. MS. STRUNA is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. STRUNA and review of the reports us required herein. Any period during which MS. STRUNA does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. STRUNA acknowledges that she has had an opportunity to ask questions concerning the terms of this -Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. STRUNA waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. STRUNA waives any and all claims or causes of action she may have against. the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement.

la

Kathryn 14 Struna, Page 9 This Consent Agreement shall be considered a public record as that term is used in Section 149,43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC,

EFFECTINE DATE
tvlS. STRUNA understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon, the last date of signature below.

k()
TIMM , ST NA, R.N. DATE

/7- /O
BARRY YLE, Esq, Attorn y for Ms. Struna DATE

4cdt4 AkdoeivG Tetiau

BERTHA. LOVELACE, President Ohio Board of Nursing

RAi

laLI I ID
DA'T'E

Case #.05-3062; 08-2937

Ohio oard of Nursing

7 grant) High Street., Sulte,4(10, . Columbus, Ohio 43215-74 i0 o' (644) 466-31)47

CONSENT AGREEMENT DETWEEN KATHRYN M, STRUNA, R.N. . AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between KATHRYN STRUNA, R,N, {MS, STRUNA) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4721 of the Ohio Revised Code (ORC), and all adtninistratiVe rules promulgated thereunder, MS. Sil-CONA voluntarily enters, into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agrecinent contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement_ BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A, The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, snspencl, or place restrictions on any license issued by the Board, reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00). Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in Lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Section 4723.25(13)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729,01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual Section 4723,25(13)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723 or any rules adopted under it. Specifically, Rule 4723-4-06(P), OAC, states a licensed nurse shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the board, to current

Kathryn M. Strata, R.N. Page 2 employers, or to any future employers for positions requiring a nursing license, B. MS. STRUNIA's lieense to practice nursing as a registered nurse in the State of Ohio, RN 240855, is currently inactive, as of October 2008, MS. STRUNA was initially licensed as a registered nurse in September 1992. MS. STRUNA knowingly and voluntarily admits to the following: 1. MS. STRUNA first entered treatment for alcohol abuse in 1994 at Gienheigh Hospital, Cleveland, Ohio. MS. STRUNA attended and completed a peer program between 1994 and 1997 and remained sober until 2005_ 2. To 2005, MS. MINA_ began using Vicodin, as prescribed, after an injury. Then in 2006, MS, STRUNA used Vicodin that was prescribed to her husband without his knowledge. Beginning January 2008, MS. STRINA started taking Dilaudid from waste containers at her work as a clinical instructor in nursing at Case Western while she continued her use of Vicodin. MS. STRUNA did not truthfully respond to Case Western's investigation regarding the missing waste containers, 3. In January 2008, MS. STRUNA. entered Glenbeigh Hospital's twentyone day inpatient program and then attended two Intensive Outpatient sessions. In late March 2008, MS. STRUNA relapsed using cough medicine containing codeine. Between April 2008 and May 2008, MS. STRUM obtained Vicoriln and was using between four and twenty Vicodin tablets per day. 4. On May 5, 2008, MS.STRUNA entered a third treatment program at the Cleveland Clinic Foundation's Alcohol and Drug Recovery Center (CCF) and successfully completed all phases of treatment, specifically inpatient hospitalisation from May 5, 2008 through May 7, 2008 for withdrawal; partial hospitalization from May 8, 2008 through May 26, 2008; Unit Based Intensive Outpatient Program from May 27, 2008 through :tune 27, 2008; and Weekly AftetCare Sessions from July 1, 2008 through August 19, 2008, 5. KS. STRUNA was diagnosed on May 5, 2008 by the Dependence and Depression not otherwise specified.

C.

cp., with Opioid

6. MS. STRUNA began suboxone therapy under the supervision of Dr. David Stieem, an addietionologist associated with CCF. M.S. KRIM& currendy attends a biweekly professional, women's group and AA meetings daily. MS. STRUNA has a sponsor and states her sobriety dace is May 5, 2008.

Knthiyn M. Struna, Page 3

7 MS. STRUNA, states that she has submitted random weekly negative drug screens to CCF since May 2008.

AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. STRUNA knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations; SUSPENSION OF LICENSE MS, STRUNA's license to practice nursing as a registered nurse is hereby suspended for an indefinite period of time. MS. STRUNA may submit a written request for reinstatement if the conditions for reinstatement have been satisfied and MS. STRUNA is in full compliance with this Consent Agreement. CONDITIONS FOR REINSTATEMENT , ) MS. STRUNA shall obey all federal, state, and local laws, and all laws and rules practice of nursing in Ohio. oovernin

-7
3.

WitaW:Mll

MS. STRUNA shall appear in person f6r interviews before the full Board or its designated representative as requested by the Board or its designee. Within six (6) months prior to requesting reinstatement, MS. STRUNA agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (13CII) to conduct a criminal records check of MS. STIWNA, including a check of Federal Bureau of Investigation (FBI) records, and request BCII to submit MS. STRUNA's criminal records check reports to the Board. MS. STRUNA agrees

Kathryn M. Struna, R,N. Page 4 that the Board will not consider a ugliest for reinstatement until the Board has .0.... ,ed the completed crirninai records check, including the FBI cheek. ,ceiN, 5 Prior to reforesting reinstatement, MS. STRUNA shalt enter into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of three (3) years following reinstatement,

Psychiatric Evaluation 6. Within three (3) months prior to requesting reinstatement, MS. STRUNA shall, at her own expense, obtain a psychiatric evaluation from a Board approved addiction psychiatry specialist and shah provide the Board with complete documentation, of such evaluation, Prior to the. evaluation, MS. STRUNA. shall provide' the addiction psychiatry specialist with a copy of this Consent Agreement and records From her previous treatment at the Cleveland Clinic Foundation Alcohol and Drug Recovery Center. MS. STR.ONA shall execute releases to permit the addiction psychiatry specialist to obtain any information deemed appropriate and necessary for the evaluation. The addiction psychiatry specialist shalt submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. STRUNA's license, and a statement, as to whether la. STRUNA. is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care, MS, STRUNA. shall provide the Board with satisfactory documentation of compliance with an aspects of the treatment plan developed by the addiction psychiatry specialist until released. Purther, MS. STRUNA agrees that the. Board may use the addiction psychiatry specialist recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. STRUNA's license and that the terms, conditions, and limitations may be Incorporated in an addendum to this Consent Agreement.

7.

Monitoring of Rehabilitatiori and Treatment 8. MS. STRUNA shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has fall knowledge of MS, STRUNA's history of chemical dependency and recovery status. MS. STRUNA shall self-administer the prescribed drugs only in the manner prescribed. MS. STRUNA. shalt abstain completely from the use of alcohol, For a, minimum, continuous period of six (6) mouths immediately prior to requesting reinstatement, MS. STRUNA shall attend a minimum of one (1) meeting per week of a support or peer group meeting, approved in advance by the Board, or a

9. 10..

Kathryn M. Struna, R.N. Page 5 Twelve Step program, and MS. STRONA shall provide satisfactory documentation of such attendance to the Board prior to reinstatement. 11. For a mmum, continuous six (6) months prior to requesting restatement, MS. STRUNA shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection she specified by the Board at such times as the Board may request. Upon and after MS. STRUNA's initiation of drug screening, refusal to submit such speciaten, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 472328(B), ORC. This screening shall require a daily call-in process. lie specimens submitted by MS. STRUNA shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. STRUNA's history of chemical dependency and recovery status. R UA. a. Within .thirty (30) days prior to MS. STN initiating drug screening, MS. STRUNA shall provide a copy of this Consent Agreement to ail treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone ournbe...rs and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. STRTINA. b. After initiating drug screening, MS. STRUNA shall be under a continuing duty to provide a copy of this Content Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. STRUNTA shall notify the Board of any and all medication(s) or preseription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. Reporting Requirements 12. MS, STRUNA shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS, STRUNA shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board, MS, STRUNA shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice.

13,

14.

Kathryn M. Struna, R.N. Page 6 15. MS. STRUNA, shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the .Hoard or to employers or potential employers. MS. STRDNA shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shaft. be made to the Compliance Unit of the Board. MS. STRUNA shall submit the reports and documentation required by this Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, MS. STRUN..4. shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. STRUNA shall inform the Board within five (5) business days, in writing, of any change in address and/or telephone number,

16.

17.

1E. 19.

Nursing Refreslter CourEe or Orieiltatinn Upon request of the Board or its designee, MS: STRUNA shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation approved in advance by the Board or its designee, Temporary Narootic Restriction MS. SMINA shall not administer, have access to, of possess (except as prescribed for MS. SCI UNAIS USG by another so authorized by law who has full knowledge of MS. STRUNA's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum of one (1) year in whichMS. STRUNA. it working in a position that requires a nursing license. At any time- after the one (1) year period previously described, MS. STRUM. may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. SitleUNA. shall not possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS, Sre'RUNA shall nut count narcotics. MS. FMB-NA shall not call in or Order prescriptions or prescription refills for narcotics, other controlled substances, or mood altering drugs Permanent Practice Restrictions MS, STRUM further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS! unless otherwise approved in advance by the Board or its designee, MS. STRUNA shall not practice nursing as a registered nurse (1) for agencies providing

Kathryn Mn. Strum., R.N. Page -) home care in the patient's residence; (2) for hospice nate programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides miming care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS, STRONA to provide nursing services for fees, compensation, or other consideration or as a volunteer. Unless otherwise approved in advance by the Board or its designee, MS. STRUNA shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positioas include., but are not limited to, the following; Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice. President of Nursing.

FAIT

TOSSOPIX

The above described terms and conditions shall constitute "restrictions placed on a }iDenge," for H, in the discretion of the Board, M. STRUNA- appears put-poses of Section 4723.28(B), to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplintu-y proceedings for any and all possible violations or breaches, including, bin not limited to, alleged violations of the laws of Ohio OcctirrirEg before the effective date of this Consent. Agreement, ciP TER The terms, limitations, and conditions of this Consent Agreement, other than the permanent licensure restrietion(s), may be modified or terminated, in writing, at any time upon the agreement of both MS. STRUNA and the 13oard. The Board may only alter the indefinite suspension imposed if: (1) MS. STRUNA submits a written request for reinstatement; (2) the Board determines that M.S. STRUNA has complied with all conditions of reinstatement; (3) the Board determines that MS. STRUNA is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. STRUNA and review of the documentation specified in this Consent Agreement; and (4) MS. STRUNA has entered into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of three (3) years following reinstatement,

A CKNOWLEDfWEINTSAJAigkr

MS. STRUNA acknowledges that she has had au opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. STRUNA waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement

Kathryn M. Strum., R.N. Page 8 This Consent Agreement is not an adjudication order as discussed in Chapter, 119, MC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. This Consent Agreement shall be considered a public record as that term is used in Section 149.43 ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. EFFECTIVE DATE MS. STRUNA understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

DATE

BARRY ifriYLE, tg. Attorney for Kathryn M. Struna, RN.

ma, Ro
LISA ICLENKB, President Ohio Board of Nursing

ATTACHMENT A
09124/2010 - 12/07/2012

Missed Call History: , ,,

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4.1i,7 -. etailii
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12/25/2011 033/02/2012 04/0612012 04/28/2012 05/03/2012 05/05/201.2 05/07/2012 05/19/2012 05/21/2012 05/22/2012 05/23/2012 05/24/2012

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

05/25/2012 05126/2012 05/27/2012 05/2812012 06/30/2012 07/01/2012 07/08/2012 07/15/2012 07/18/2012 07/22/2012

Missed Call Missed Call Missed Cal! Missed Cali Missed Call Missed Cali Missed Call Missed Cali Missed Call Missed Call

07/28/2012 Missed Cali 07/29/2012 Missed Call 07/3012012 08/06/2012 08/09/2012 08/11/2012 08/16/2012 08/18/2012 08/19/2012 08125/2012 09/01/2012 09/03/2012 09/04/2012 09/06/2012 09/07/2012 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call 08/05/2012. Missed Call

09/08/2012

Missed Call

09110/2012 Missed Call 09/19/2012 Missed Call 09/23/2012 10104/2012 10/20/2012 10/31/2012 Missed Call Missed Call Missed Call Missed Call 09129/2012 Missed Call

11/12/2012 ' Missed Call 11/13/2012, Missed Call 11/15/2012 Missed Calf 11/2212012 Missed Call 11123/2012 11/24/2012 Missed Call Missed Call

12/10/2012 Missed Call 12/1 2/2012 Missed Call 12/1 4/2012 Missed Call 12/23 - 12/25/2012 Missed Calls 12/27 - 12/31/2012 Missed Calls 1/14/2013 Missed Call

Case # 11-003069

Ohio Board of Nursing

17 South fiigh Street, Suite 400

www.nursing.ohio.gov
(614) 466-3947

Columbus, Ohio 43215-7410

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Jean I. Taubennestler, R.N. 4803 Wellington Ave. Parma, Ohio 44134 Dear Ms. Taubennestler: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars (S500.00) per violation for the following reasons: 1. On or about May 25, 2011, while working as a nurse at the Cleveland Clinic, you submitted a drug screen specimen that was positive for Marijuana Metabolite (THC) and Methadone. On or about December 5, 2011, you told a Board Compliance Agent that you were smoking Marijuana beginning in or about April 2011. You also told the Board Compliance Agent that prior to working on May 25, 2011, you ingested Methadone, which you purchased from a friend believing it to be Xanax. Section 4723.28(B)(8), ORC [as in effect prior to June 8, 2012], authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. 2. On or about May 25, 2011 between 7:00 AM and 12:30 PM, while working as a nurse the Cleveland Clinic, your practice deficiencies included the following: a. You failed to timely assess Patient #1's [See attached Patient Key to remain confidential and not subject to public disclosure] condition. b. You falsely charted the administration of medications to Patient #1 at 9:00 AM, when you had not withdrawn any medications from the Pyxis prior to 12:00 PM. c. At approximately 11:00 AM you falsely told another nurse that you had already administered the 9:00 AM medications to Patient #1.

Jean I. Taubennestler, R.N. Page 2 d. You failed to timely assess Patient #2's condition. e. You failed to timely administer medications prescribed to Patient #2 at 9:00 AM. f. You failed to timely assess Patient#3's condition. As a result, Patient #3 did not timely receive prescribed Morphine resulting in a failure to address Patient#3's pain. Section 4723.28(8)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(C), Ohio Administrative Code (OAC), states that a registerednurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged which includes, but is not limited to, the following: (1) Consistent performance of all aspects of nursing care. Rule 4723-4-06(E), OAC, states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 47234-06(G), OAC, states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. Rule 47234-06(P), OAC, states that a licensed nurse shall not make any false, misleading, or deceptive statements, or submit or cause to be submitted any false, misleading or deceptive information, or documentation to: (2) Current employers; (5) Other members of the client's health care team. 3. Paragraphs 1. and 2., including all subparts, are hereby incorporated as if fully rewritten herein. You told a Board Compliance Agent that on May 25, 2011 you went into work and completely blacked out. You further stated that you received inpatient care for substance abuse from on or about May 25, 2011 until May 27, 2011. You reported using drugs on the same day of your discharge and then again on May 29, 2011. Section 4723.28(B)( I 0), ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of habitual or excessive use of drugs, alcohol, or other chemical substances that impair the ability to practice. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice.

Jean 1. Taubennestler, R.N. Page 3 You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearin @nursina.ohio ov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.
.

Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0796

cc: Henry G. Appel, Senior Assistant Attorney General

Cases # 12-005699

0410 Board .of Nursing

17 South High Street, Suite 400 January 25, 2013

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Stacy Ann Toth, L.P.N. 607 Dennison Avenue Cadiz, Ohio 43907 Dear Ms. Toth: You are hereby notified that, on or about September 21, 2012, you entered into a Consent Agreement (September 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum of two (2) years. A. Item 1. of the September 2012 Consent Agreement states, "MS. TOTH shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(16), Ohio Revised Code (ORC), authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(P), Ohio Administrative Code (OAC), states, in pertinent part, that a licensed nurse shall not make any false, misleading, or deceptive statement, or submit or cause to be submitted any false, misleading or deceptive information, or documentation to: (2) Current employers; (3) Prospective employers when applying for positions requiring a nursing license. Item 13. of the September 2012 Consent Agreement states, "MS. TOTH shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers." Despite this provision, on or about October 3, 2012, after accepting employment as a nurse with Bowerston Hills Nursing and Rehabilitation Center (Bowerston Hills), you provided your employer a copy of the September 2012 Consent Agreement without the signature page. During your orientation at Bowerston Hills on or about October 1, 2012, you informed administrators that you had no knowledge what your restrictions were. The signature page, being page 7 of September 2012 Consent Agreement, reveals that you signed the document on August 21, 2012. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(P), OAC, states, in pertinent part, that a licensed nurse shall not make any false, misleading, or deceptive statement, or submit or cause to be submitted any false, misleading or deceptive information, or

Stacy Ann Toth, L.P.N. Page 2 documentation to: (2) Current employers; (3) Prospective employers when applying for positions requiring a nursing license. Section 472328(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. B. Item 7. of the September 2012 Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. TOTH shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. TOTH's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. TOTH shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. TOTH." Despite this provision, as of December 18, 2012, you have failed to register with Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen. C. Item 8. of the September 2012 Consent Agreement states, "MS. TOTH shall notify the Board, in writing, of .the name and address of any current nursing employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to accepting nursing employment." Item 9. of the September 2012 Consent Agreement states, "MS. TOTH, within fifteen (15) days of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS. TOTH is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting nursing employment. MS. TOTH shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of the effective date of this Consent Agreement or beginning within thirty (30) days of working in a nursing position. MS. TOTH shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date Consent Agreement was received." Despite these provisions, you failed to notify the Board of your new employer, Bowerston Hills, prior to accepting nursing employment on or about October 1, 2012. Furthermore, you failed to provide Bowerston Hills a copy of the September 2012 Consent Agreement prior to accepting nursing employment.

Stacy Ann Toth, L.P.N. Page 3 Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the September 2012 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 7., 8., 9. and 13. of the September 2012 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-101646, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a licensed practical nurse without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on yotfr license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about September 21, 2012, you entered into a Consent Agreement (September 2012 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that your license to practice nursing as a licensed practical nurse in the State of Ohio would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum of two (2) years. 2. Item 1. of the September 2012 Consent Agreement states, "MS. TOTH shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(16), Ohio Revised Code (ORC), authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(P), Ohio Administrative Code (OAC), states, in pertinent part, that a licensed nurse shall not make any false, misleading, or deceptive statement, or submit or cause to be submitted any false, misleading or deceptive information, or documentation to: (2) Current employers; (3) Prospective employers when applying for positions requiring a nursing license. Item 13. of the September 2012 Consent Agreement states, "MS. TOTH shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers." Despite this provision, on or about October 3, 2012, after accepting employment as a nurse with Bowerston Hills Nursing and Rehabilitation Center (Bowerston Hills), you provided your employer a copy of the September 2012 Consent Agreement without the signature page. During your orientation at Bowerston Hills on or about October 1, 2012, you informed administrators that you had no knowledge what your

Stacy Ann Toth, L.P.N. Page 4 restrictions were. The signature page, being page 7 of the document, reveals that you signed the agreement on August 21, 2012. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(P), OAC, states, in pertinent part, that a licensed nurse shall not make any false, misleading, or deceptive statement, or submit or cause to be submitted any false, misleading or deceptive information, or documentation to: (2) Current employers; (3) Prospective employers when applying for positions requiring a nursing license. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 3. Item 7. of the September 2012 Agreement states, "Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. TOTH shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. TOTH's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. TOTH shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. TOTH." Despite this provision, as of December 18, 2012, you have failed to register with Firstlab, the Board's random drug/alcohol screen program administrator, to determine if you had been selected to provide a urine specimen. 4. Item 8. of the September 2012 Consent Agreement states, "MS. TOTH shall notify the Board, in writing, of the name and address of any current nursing employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to accepting nursing employment." Item 9. of the September 2012 Consent Agreement states, "MS. TOTH, within fifteen (15) days of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS. TOTH is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting nursing employment. MS. TOTH shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of the effective date of this Consent Agreement or beginning within thirty (30) days of working in a nursing position. MS. TOTH shall have her employer(s) send documentation to the

Stacy Ann Toth, L.P.N. Page 5 Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date Consent Agreement was received." Despite these provisions, you failed to notify the Board of your new employer, Bowerston Hills, prior to accepting nursing employment on or about October 1, 2012. Furthermore, you failed to provide Bowerston Hills a copy of the September 2012 Consent Agreement prior to accepting nursing employment. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410, or to the e-mail address, hearin&mursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0987 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 11-001477

Ohio Board of Nursing

www.nursing.ohio.gpv 17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947

CONSENT AGREEMENT BETWEEN STACY ANN TOTH, L.P.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between STACY ANN TOTH, LPN. (MS. TOTH) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement, BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation, Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(21), ORC, authorizes the Board to discipline a licensee for, in the case of a licensed practical nurse, engaging in activities that exceed the practice of nursing as a licensed practical nurse. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(E), Ohio Administrative Code (OAC), states that a licensed nurse shall, in a complete, accurate, and timely mariner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-4-06(G), OAC, states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in. the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services.

Stacy Ann Toth, L.P.N. Page 2

B. MS. TOTH was initially licensed to practice nursing as a licensed practical nurse in the State of Ohio, PN#101646, in October 1997. MS. TOTH's license is currently active. C. MS. TOTH knowingly and voluntarily admits to the following: 1. On or about February 4, 2011, MS. TOTH gave Prevacid to a patient without a physician order. 2. On or about February 4, 2011, MS. TOTH administered medications to a patient prior to the scheduled time, and documented as if MS. TOTH had given them at the correct time. 3. MS. TOTH acknowledges that there have been times when MS. TOTH signed for the performance of treatments and dressing changes that she did not perform. 4, Between on or about January 31, 2011 and February 11, 2011, MS. TOTH removed four (4) Percocet doses for a patient who states she did not receive them. D. MS. TOTH states the following: 1. MS. TOTH states that she was unable to perform some treatments because of the demands of her workload. MS. TOTH acknowledges she should have consulted with a physician prior to giving a patient an extra dose of Prevacid. MS. TOTH regrets these practice errors. 2, MS. TOTH denies diverting any medications and denies any misuse of prescription drugs. MS. TOTH is willing to submit to drug screens in order demonstrate she is safe to practice. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. TOTH knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: MS. TOTH's license to practice nursing as a licensed practical nurse shall be suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum period of two (2) years: 1. MS. TOTH shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio.

Stacy Ann Toth, L.P.N. Page 3 2. 3. MS. TOTH shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. MS. TOTH agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. TOTH, including a check of Federal Bureau of Investigation (1-13I) records, and shall request BCII to submit MS. TOTH's criminal records check reports to the Board. MS. TOTH's completed criminal records check, including the FBI check, must be received by the Board prior to release from these probationary terms.

Educational Requirement 4. Within six (6) months of the effective date of this Consent Agreement, MS. TOTH, shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education, or another comparable course approved in advance by the Board or its designee, taken subsequent to the effective date of this Consent Agreement: five (5) hours on Medication Administration, five (5) hours on Documentation, one (I) hour on Time Management, one (1) hour on Ohio Law and Rules.

Monitoring 5. MS. TOTH shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. TOTH. MS. TOTH shall self-administer the prescribed drugs only in the manner prescribed. MS. TOTH shall abstain completely from the use of alcohol or products containing alcohol. Within forty-five (45) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. TOTH shall submit, at her expense and on the day selected, blood, breath, hair, or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. TOTH's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. TOTH shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has received a complete copy of this Consent Agreement prior to prescribing for MS. TOTH.

6. 7.

Stacy Ann Toth, L.P.N. Page 4

a. Prior to MS. TOTH initiating drug screening, MS. TOTH shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. TOTH. b. After initiating drug screening, MS. TOTH shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. TOTH shall notify the Board of any and all medication(s) or preseription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. Employment Conditions 8. MS. TOTH shall notify the Board, in writing, of the name and address of any current nursing employer within thirty (30) days following the effective date of this Consent Agreement, or any new employer prior to accepting nursing employment. MS. TOTH, within fifteen (15) days of the effective date of the Consent Agreement, if working in a position in which a nursing license is required, shall provide her employer(s) with a copy of this Consent Agreement. Further, MS. TOTH is under a continuing duty to provide a copy of this Consent Agreement to any new employer prior to accepting nursing employment. MS. TOTH shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of the effective date of this Consent Agreement or beginning within thirty (30) days of working in a nursing position. MS. TOTH shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date Consent Agreement was received.

9.

Reporting Requirements 10. MS. TOTH shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. TOTH shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. TOTH shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice.

11.

12.

Stacy Ann Toth, L.P.N. Page 5

13.

MS. TOTH shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. TOTH shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. TOTH shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. TOTH shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. TOTH shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

14.

15.

16.

17.

Temporary Practice Restrictions Unless otherwise approved in advance, in writing, by the Board or its designee, MS. TOTH shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. TOTH to provide nursing services for fees, compensation, or other consideration or who engage MS. TOTH as a volunteer. Unless otherwise approved in advance, in writing, by the Board or its designee, M.S. TOTH shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY M.S. TOTH agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. TOTH has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. TOTH via certified mail of the specific nature of the charges and automatic suspension of her license. MS. TOTH may request a hearing regarding the charges.

Stacy Ann Toth, L.P.N. Page 6

The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC, If, in the discretion of the Board, MS. TOTH appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION,/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement may be modified or terminated, in writing, at any time upon the agreement of both MS. TOTH and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. TOTH has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. TOTH is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. TOTH and review of the reports as required herein. Any period during which MS. TOTH does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. TOTH acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. TOTH waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. TOTH waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC.

Stacy Ann Toth,L.P.N. Page 7

EFFECTIVE DATE
MS. TOTH understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

\41,cca,),: Iyult Ath VPIJ

STACY ANN TOTH, L.P.N.

q)alia(ild\
DATE

9 k I to II_
BERTHA LOVELACE, president Ohio Board of Nursing DATE

m rn

Case # 12-002209

Ohio Board of Nursing

17 South High Street, Suite 400 January 25 , 2013

www.nursing.ohio.gov

Columbus, Ohio 43215-7410 i$ (61,4) 466-3947

NOTICE OF AUTOMATIC SUSPENSION. AND OPPORTUNITY FOR HEARING

Dawn M. Turshon, R.N. 6871 Ames Road #816 Parmatown Apartments Parma, Ohio 44129 Dear Ms. Turshon: You are hereby notified that, on or about January 22, 2010, you entered into a Consent Agreement (January 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that upon meeting the requirements for renewal, your license to practice nursing as a registered nurse would be reinstated and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions and limitations until at least January 2015. Attached to and incorporated within the January 2010 Consent Agreement is a March 18, 2005 Consent Agreement, an August 25, 2004 Order of Summary Suspension, and an August 2004 Notice of Opportunity for Hearing. A. Item 4. of the January 2010 Consent Agreement states, "MS. TURSHON shall abstain completely from the use of alcohol and/or substances containing alcohol." Item 5. of the January 2010 Consent Agreement states, "Continuing throughout the probationary period, MS. TURSHON shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. TURSHON shall be negative, except for substances prescribed, administered; or dispensed to her by another so authorized by law who has full knowledge of MS. TURSHON's history of chemical dependency and recovery status." Despite these provisions, on the following date, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol): August 2, 2012.

Dawn M. Turshon, R.N. Page 2 Furthermore, on or about the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: May 31, 2012; June 19, 2012; August 13, 2012; September 6, 2012; October 25, 2012; November 8, 2012; December 20, 2012; December 27, 2012; January 9, 2013; and January 14, 2013. On August 14, 2012, you submitted a written statement to your Board, Monitoring Agent that you "have made a desicion not to continue compliance with my contract" and that you would no longer call the lab on a daily basis. You also stated "I am aware that my licnese will be revoked, which at this point I am comfortable with [sic]." Section 4723.28(B)(17), ORC, authorizes the Bodrd to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the January 2010 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 4. and 5. of the January 2010 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-216875, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine ofnot more than five hundred dollars ($500.00) per violation for the following reasons:

1. On or about January 22, 2010, you entered into a Consent Agreement (January 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which yo-u agreed with the Board that upon meeting the requirements for renewal, your license to practice nursing as a registered nurse would be reinstated and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions and limitations until at least January 2015. Attached to and incorporated within the January 2010 Consent Agreement is a March 18, 2005 Consent Agreement, an August 25, 2004 Order of Summary Suspension, and an August 2004 Notice of Opportunity for Hearing.

Dawn M. Turshon, R.N. Page 3 2. Item 4. of the January 2010 Consent Agreement states, "MS. TURSHON shall abstain completely from the use of alcohol and/or substances containing alcohol." Item 5. of the January 2010 Consent Agreement states, "Continuing throughout the probationary period, MS. TURSHON shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. TURSHON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. TURSHON's history of chemical dependency and recovery status." Despite these provisions, on the following date, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol): August 2, 2012. Furthermore, on or about the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: May 31, 2012; June 19, 2012; August 13, 2012; September 6, 2012; October 25, 2012; November 8, 2012; December 20, 2012; December 27, 2012; January 9, 2013; and January 14, 2013. On August 14, 2012, you submitted a written statement to your Board Monitoring Agent that you "have made a desicion not to continue compliance with my contract" and that you would no longer call the lab on a daily basis. You also stated "I am aware that my licnese will be revoked, which at this point I am comfortable with [sic]." Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to

Dawn M. Turshon, R.N. Page 4 practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing@pursing.ohio.uov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and.Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1205 cc: Henry G. Appel, Senior Assistant Attorney General

Case #04-1284, #04-1942 & #09-5347

Ohio Board of Nursing

17 South High Street, Suite 400

wwwstursing.ohio.gov

Columbus, Ohio 43215-7410 e (614) 466-3947

CONSENT AGREEMENT BETWEEN DAWN M. TURSHON, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between DAWN M. TURSHON, R.N. (MS. TURSHON) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723, of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. TURSHON voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. MS. TURSHON admits to violating Section 472128, ORC, as set forth in the August 2004 Order of Summary Suspension, the August 2004 Notice of Opportunity for Hearing, and the March 2005 Consent Agreement, On or about September 8, 1988, MS. TURSHON was initially issued a license to practice nursing in Ohio as a registered nurse RN-216875. On August 25, 2004, the Board issued an Order of Summary Suspension (August 2004 Order) and a Notice of Opportunity for Hearing (August 2004 Notice) in which MS. TURSHON's license was immediately suspended. Further, on March 18, 2005, MS. TURSHON and the Board entered into a Consent Agreement in which her license was indefinitely

B.

DaWn M. Turshon, R.N. Page 2

suspended (March 2005 Consent Agreement). Copies of the August 2004 Order, the August 2004 Notice and the March 2005 Consent Agreement are attached hereto and incorporated herein.. C. MS. TURSHON has a long history of chemical dependency and relapse issues. In 1997, MS. TURSHON entered into an Alternative Program Participant Agreement with the Board's Alternative Program for Chemical Dependency (AP Program), MS. TURSHON successfully completed the AP Program in 2000, Pursuant to the March 2005 Consent Agreement and at MS. TURSHON's request, the Board resumed actively monitoring MS. TURSHON in April 2008.. Throughout this period, MS. TURSHON submitted documentation to the Board in which she reported taking multiple prescribed narcotic and/or mood-altering medication for shingles and other ailments from at least five (5) different treating physicians. Under the terms of the March 2005 Consent Agreement, MS. TURSHON is now eligible to request reinstatement of her license and she has submitted such a request in writing. MS. TURSHON submitted to the Board a July 7, 2008 chemical dependency evaluation that was performed at Windsor Laurelwood Center for Behavioral Medicine (Laurelwood) by Mary Crenshaw, L1SW, LICDC. MS. TURSHON was diagnosed with Alcohol Dependence in Full Sustained Remission and Opiate Dependence in Partial Remission; MS. TURSHON reported to Ms, Crenshaw that, at that time, she was prescribed antidepressants and narcotics.. MS. TURSHON also reported that since 1994, she had undergone chemical dependency treatment from at least three (3) different facilities. MS. TURSHON also reported that in 1996, she was convicted of Driving While Intoxicated and that afterwards, she stopped drinking alcohol, Ms. Crenshaw recoinmended that MS. TURSHON continue attending 12 step recovery meetings. Ms.. Crenshaw did not make any further treatment recommendations. MS. TURSHON submitted a August 24, 2009 chemical dependency evaluation to the Board that was performed at Laurelwood by Elizabeth Adams, LCDC 111.. MS. TURSHON was diagnosed with Opiate Dependence in Full Sustained Remission, Alcohol Dependence in Full Sustained Remission and Cannabis Dependence in Full Sustained Remission and no treatment recommendations were made.

D,

E.

F.

G.

Dawn M, Turshon, RN. Page 3

H.

On May 28, 2009, MS. TURSHON submitted a drug specimen that was positive for Ethyl Glucuronide.. During a medical review of her May 28, 2009 positive drug screen, MS. TURSHON reported incidental exposure to alcohol- through consumption of Scope mouthWash and hand sanitizers. MS. TURSHON understands that any violations of this Consent Agreement and/or any further violations of the laws and rules governing the practice of nursing may result in further disciplinary action, up to and including permanent revocation of her Ohio license. AGREED CONDITIONS

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. TURSHON knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for renewal, MS. TURSHON's license to practice nursing as a registered nurse shall be reinstated and suspended indefinitely, Such suspension shall be stayed, subject to the.following PROBATIONARY 'terms, conditions, and limitations until at least January 2015: 1. MS. TURSHON shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. TURSHON shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.

2.

Monitoring of Rehabilitation and Treatment 3 MS. TURSHON shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. TURSHON's history of chemical dependency and recovery status. MS. TURSHON shall self-administer prescribed drugs only in the manner prescribed. MS. TURSHON shall abstain completely from the use of alcohol and/or substances containing alcohol. Continuing throughout the probationary period, MS. TURSHON shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to

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Dawn M. Turshon, R.N. Page 4

submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC, This screening shall require a daily call-in process. The specimens submitted by MS. TURSHON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. TURSHON's history of chemical dependency and recovery status. 6. Continuing throughout the probationary period, MS. TURSHON shall attend a minimum of one (I) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. TURSHON shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning March. 1, 2010. Within thirty (30) days of the effective date of this Consent Agreement and continuing throughout the probationary period, unless immediate, exigent, and necessary care is temporarily required due to urgent circumstances, MS. TURSHON shall only obtain prescribed medication of controlled-substances from her primary treating physician Mark Roth, M.D.,' or another primary treating physician approved in advance by the Board or its designee until released. Prior to the initiation of treatment, MS. TURSHON provide the physician with a copy of this Consent Agreement, the attached August 2004 Order, the attached August 2004 Notice and the attached March 2005 Consent Agreement.. Further, MS. TURSHON shall have the primary treating physician submit written reports regarding MS. TURSHON's progress, status, and compliance with her treatment plan to the Board on a quarterly basis beginning March 1, 2010. MS. TURSHON shall provide the primary treating physician with a copy of this Consent Agreement, the attached August 2004 Order, the attached August 2004 Notice and the attached March 2005 Consent Agreement prior to February 19, 2010. MS. TURSHON shall inform the Board, in writing, within five (5) business days of discontinuing participation in treatment, and prior to said discontinuation, shall inform the Board, in writing, of the name(s) of another primary treating physician(s) and intervals of treatment for approval by the Board or its designee.. For the purposes of this Consent Agreement, the Board or its designee shall determine on a case-by-case basis, if the "urgent circumstances" exception. applies, The Board or its designee shall consider various factors, including but not limited to whether serious bodily harm and/or a life threatening injury and/or life threatening illness has occurred and/or may occur, unless immediate, exigent, and necessary care is temporarily required and provided to MS. TURSHON by

7.

Dawn M. Turshon, RN. Page 5 another prescribing physician who is not her primary treating physician. 8. Upon request by the Board or its designee and within sixty (60) days of such a request, MS. TURSHON shall, at her own expense, obtain a comprehensive evaluation by a psychiatrist who is certified by the American Board of Medical Specialties (ABMS) in Addiction Psychiatry and who is approved in advance by the Board,. MS. TURSHON shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. TURSHON shall provide the evaluating psychiatrist with a copy of this Consent Agreement attached August 2004 Order, the attached August 2004 Notice and the attached March 2005 Consent Agreement and summaries from her treating physicians for the past five years, including the types and frequency of drugs she has been prescribed in that period. Further, MS. TURSHON shall execute releases to permit the evaluating psychiatrist to obtain any information deemed appropriate and necessary for the evaluation, The psychiatrist shall submit a written opinion to the Board that includes diagnoses and recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. TURSHON's license, and a statement as to whether MS. TURSHON is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. If an addiction psychiatric evaluation is requested, MS. TURSHON shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the psychiatrist described above until released. Further., MS. TURSHON agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. TURSHON's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement, Within ninety (90) days of the effective date of this Consent Agreement, MS. TURSHON shall, at her own expense, seek a comprehensive evaluation by a physician who is certified by the American Board of Medical Specialties (ABMS) in Pain Medicine and who is approved in advance by the Board, Prior to the evaluation, MS. TURSHON shall provide the evaluating physician with a copy of this Consent Agreement, the attached August 2004 Order, the attached August 2004 Notice and the attached March 2005 Consent Agreement, and summaries from her treating physicians for the past five years, including the types and frequency of antidepressants and narcotics she has been prescribed in that period. Further, MS. TURSHON shall

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Dawn M,. Turshon, R.N. Page 6

execute releases to permit the physician to obtain any information deemed appropriate and necessary for the evaluation. The physician shall submit a written opinion to the Board that includes diagnoses, and recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. TURSHON's license, and a statement as to whether MS. TURSHON is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 11 If a pain management evaluation is requested, MS. TURSHON shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the physician described above until released.. Further, MS. TURSHON agrees that the Board may use the above-described physician's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. TURSHON's license and that the terms, conditions, and limitations may be incorporated by an addendum to this Consent Agreement.

Treating Practitioners and Reporting 12. Within sixty (60) days of the effective date of this Consent Agreement, MS. TURSHON shall provide a copy of this Consent Agreement, the attached August 2004 Order, the attached August 2004 Notice and the attached March 2005 Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. TURSHON shall be under a continuing duty to provide a copy of this Consent Agreement and the attachments, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner.. MS. TURSHON shall cause all treating practitioners to complete a . medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. TURSHON throughout the duration of this Consent Agreement, Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. TURSHON shall notify the Board of any and ,all medication(s) or prescription(s) received.

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Dawn M. Tusher), R.N. Page 7

Employment Conditions 15. Prior to accepting employment as a nurse, each time with every employer, MS. TURSHON shall notify the Board in writing, MS. TURSHON shall, prior to accepting employment, if working in a position in which a nursing license is required, provide her employer(s) with a copy of this Consent Agreement, the attached August 2004 Order, the attached August 2004 Notice, and the attached March 2005 Consent Agreement. Further, MS. TURSHON is under a continuing duty to provide a copy of this Consent Agreement and the attachments to any new employer prior to accepting employment to work as a nurse. MS. TURSHON shall, have her employer(s) submit written reports regarding job performance on a quarterly basis within thirty (30) days of accepting nursing employment. Further, MS. TURSHON shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement and the attachments, including the date they were received.

16.

Reporting Requirements of Licensee 17. MS. TURSHON shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation, MS. TURSHON shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. TURSHON shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. TURSHON shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS, TURSHON shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board_ All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board, MS. TURSHON shall submit the reports and documentation required by this Consent Agreement or any, other documents required by the

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Dawn M. Turshon, R.N. Page 8

Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410, 23, MS. TURSHON shall verify that the reports and documentation required by this Consent Agreement are received in the Board office, MS. TURSHON shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

24.

Nursing Refresher Course or Orientation Prior to working in a position where a nursing license is required, MS. TURSHON shall complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation to be approved in advance by the Board or its designee. Permanent Narcotic Restriction MS. TURSHON further knowingly rind voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: MS. TURSHON shall not administer, have access to, or possess (except as prescribed for MS. TURSHON's use by another so authorized by law who has full knowledge of MS. TURSHON's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs. In addition, MS. TURSHON shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. Permanent Practice Restrictions MS. TURSHON further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: MS. TURSHON shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) as a nurse for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. TURSHON to provide nursing services for fees, compensation, or other consideration Or as a volunteer. MS. TURSHON shall not function as a supervisor while working in a position for which a nursing license is required. FAILURE TO COMPLY MS. TURSHON agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. TURSHON has violated or

Dawn M. Turshon, R.N. Page 9

breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. TURSHON via certified Mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. TURSHON may request a hearing regarding the charges.. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. TURSHON appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement, other than the permanent practice restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. TURSHON and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. TURSHON has complied with ail aspects of this Consent Agreement; and (2) the Board determines that MS. TURSHON is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. TURSHON and review of the reports as required herein. Any period during which MS. TURSHON does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY' RELEASE MS. TURSHON acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner. MS. TURSHON waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. TURSHON waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement.. This Consent Agreement shall be considered a public record as that term is used in Section 149,43, ORC, The information contained herein may be reported to appropriate organizations, data banks and governmental bodies.

IiiDawn M. Turshon, Page 10

J1

ilthis Consent Agreement is not an adjudication order as discussed in Chaptek 119, RC, Cr Any action initiated by the Board based on alleged violations of this Consenk Agreement !; shall comply with the Administrative Procedures Act, Chapter 119, ORC.
1!

EFFECTIVE DATE

1:

TURSHON understands that this Consent Agreement is subject to raigioation by the Board prior to signature by the Board President and shall become affective upon the 1}last date of signature below,

111DAWN Mr TURSHON,
IP

DATE

I ?; w,; , 'resident A0 Ohio Board of Nursing 11

RA)

d0.n.3i2tab10
DATE

C'aSe # 04-42g3

Ohio Board of Nursing

CONSENT AGREEMENT BETWEEN DAWN M. TURSHON, AND OHIO BOARD OF NURSING

vrw-w.nursing.ohio.gov

17 South High Street, Suite 400.* Columbus, Ohio 43215-7410 * (614) 466-3947

This Consent Agreement is entered into by and between DAWN M. TURSHON, R.N., F.K.A. DAWN HICKS, (MS. TURSHON) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. TURSHON voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 472328, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(8),, ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in. Section 4729,01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(9), ORC, authorizes the Board to discipline a licensee for habitual indulgence in the use of controlled substances, other habit-forming drugs, or alcohol or other chemical substances to an extent that impairs ability to practice. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 472.3, ORC, or any rules adopted under it. Specifically, Rule 4723-4-03(E)(1), Ohio Administrative Code (OAC), states that a registered nurse shall, in a timely manner,

Dawn M. Turshon, R.N.. Page 2 implement any order for a client. Rule 472.3-4-06(E), OAC, states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-406(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client.. Rule 4723-4-06(L), OAC, states that a licensed nurse shall not misappropriate a client's property or: (1) engage in behavior to seek or obtain personal gain at the client's expense or (2) engage in behavior that may reasonably be interpreted as behavior to seek or obtain personal gain at the client's expense, Rule 4723-4-06(P), OAC, states that a licensed nurse shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board, to current employers, or to any future employers for positions requiring a pursing license. B. MS. TURSHON's license to practice nursing as a registered nurse in the State of Ohio, RN-216875, was summarily suspended on August 25, 2004 MS. TURSHON knowingly and voluntarily admits to the factual and legal allegations set forth in the Notice of Opportunity for Hearing issued by the Board on August 25, 2004, a copy of which is attached hereto and incorporated herein.. AGREED CONDITION Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. TURSHON knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: SUSPENSION OF LICENSE 1. MS. TURSHON's license to practice nursing as a registered nurse is hereby suspended for an'indefinite period of time, but not less than two (2) years, retroactive to March 2004.. MS. TURSHON may submit a written request for reinstatement anytime after March 2006.

C.

CONDITIONS FOR REINSTATEMENT 2. MS. TURSHON shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. TURSHON shall appear in person for interviews before the full Board or its designated representative as requested by the Board and prior to reinstatement. MS. TURSHON shall submit a satisfactory personal statement regarding compliance with the terms of this Consent Agreement and progress within one month prior to reinstatement.

3,

4.

Dawn M.. Turshon, R.N. Page 3

5.

Prior to reinstatement, MS. TURSHON shall enter into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of five (5) years following reinstatement. MS. TURSHON shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing education: two (2) hours of Ohio nursing law and rules; and eight (8) hours of chemical dependency.

6.

Monitoring of Rehabilitation and Treatment 7. MS. TURSHON shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. TURSHON's history of chemical dependency. MS. TURSHON shall self-administer the prescribed drugs only in the manner prescribed. MS. TURSHON shall abstain completely from the use of alcohol. Not less than one (1) year prior to seeking reinstatement by the Board, MS. TURSHON shall, at her own expense, seek a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. TURSHON shall provide the chemical dependency professional with a copy of this Consent Agreement. Further, MS. TURSHON shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation_ The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses and recommendations for treatment and monitoring. MS. TURSHON shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. TURSHON agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. TURSHON's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement. Within three (3) months prior to seeking reinstatement by the Board, MS TURSHON shall, at her own expense, seek a second chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. TURSHON shall provide the chemical dependency professional with a copy of this Consent Agreement.. Further, MS. TURSHON shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a

8. 9.

10

11.

Dawn M. Turshon, RN. Page 4 written opinion to the Board that includes any additional restrictions to be placed on MS. TURSHON's license to practice, and stating whether MS. TURSHON is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 12.. For a minimum, continuous period of one (1) year immediately prior to requesting reinstatement, MS. TURSHON shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. TURSHON's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(8), ORC This screening shall require a daily call-in process. The specimens submitted by MS. TURSHON shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. TURSHON's history of chemical dependency. a. Within thirty (30) days prior to MS. TURSHON initiating drug screening, MS. TURSHON shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. TURSHON. b. After initiating drug screening, MS. TURSHON shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Further, MS. TURSHON shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. 13. For a minimum, continuous period of one (1) year immediately prior to requesting reinstatement, MS. TURSHON shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and licensee shall provide satisfactory documentation of such attendance to the Board on a quarterly basis.

Reporting Requirements of Licensee 14. MS. TURSHON shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board.

Dawn M. Turshon, RN, Page 5 15. MS. TURSHON shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. TURSHON shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. TURSHON shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Monitoring Unit of the Board. MS. TURSHON shall submit the reports and documentation required by this Consent Agreement to the attention of the Monitoring Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-3413. MS. TURSHON shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. TURSHON shall inform the Board within three (3) business days, in writing, of any change in address and/or telephone number,

16.

17.

18.

19.

20.

Criminal Records Check MS. TURSHON further knowingly and voluntarily agrees with the Board to the following: 21. Within six (6) months of requesting reinstatement, MS. TURSHON agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. TURSHON, including a check of Federal Bureau of Investigation records, and request. BCII to submit M S TURSHON's criminal records check reports to the Board.

Permanent Narcotic Restrictions MS. TURSHON further knowingly and voluntarily agrees with the Board to the following permanent licensure restrictions: 22. MS. TURSHON shall not administer, have access to, or possess (except as prescribed for MS. TURSHON's use by another so authorized by law who has full knowledge of MS. TURSHON's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs. In addition, MS. TURSHON shall not possess or carry any work keys for locked medication carts, cabinets, drawers, or containers, MS. TURSHON shall not count narcotics.

Dawn M. Turshon, Page 6 Permanent Practice Restrictions MS. TURSHON further knowingly and voluntarily agrees with the Board to the following permanent licensure restrictions: 23. MS. TURSHON shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) as a nurse for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. TURSHON to provide nursing services for fees, compensation, or other consideration or as a volunteer, MS. TURSHON shall not function as a supervisor while working in a position for which a nursing license is required. FAILURE TQ COMPLY The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 472318(B), ORC. lf, in the discretion of the Board, MS. TURSHON appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement DURATION/MODIFICATION OF TERMS The terms, limitations, and conditions of this Consent Agreement, other than the permanent licensure restrictions, may be modified or terminated in writing at any time upon the agreement of both MS. TURSHON and the Board. The Board may only alter the indefinite suspension imposed if: (1) MS. TURSHON submits a written request for reinstatement; (2) the Board determines that MS. TURSHON has complied with all conditions of reinstatement; (3) the Board determines that MS. TURSHON is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. TURSHON and review of the documentation specified in this Consent Agreement; and (4) MS. TURSHON has entered into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of five (5) years following reinstatement. ACICN 4'LEDGMENTSILIABILITY RELEASE MS. TURSHON acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner.

24_

Dawn M. Turshon, Page 7 MS. TURSHON waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement.. MS. TURSHON waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Agreement. This Consent Agreement is not an adjudication order within the meaning of Section 119,01(D), ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC The information contained herein may be reported to appropriate organizations, data banks and governmental bodies.. EFFECTIVE DATE MS. TURSHON understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below..

ck.AJT\

but&41,1 `--DATE

3 -. 0

DAWN M. TURSHON, R.N.

"i(VONNE SMITH, President Ohio Board of Nursing

DATE

a. lg. DS

C,

Case # 044283

Ohio Board of1Nursing

www,nursing.ohio gov

17 South High Street, Suite 400 Columbus, Ohio 43215-7410 e (614) 466-3947

August 25, 2004

Dawn M. Turshon, R.N. (FKA Dawn Hicks) 19701 Libby Rd. Maple Heights, Ohio 4413'7 Dear Ms, Turshon: Pursuant to Section 4723.281(B) of the Ohio Revised Code ("ORC"), the Ohio Board of Nursing ("Board"), has imposed a summary suspension of your Ohio nursing license, RN-216875, to practice nursing as a registered nurse effective immediately. Continued practice after receipt of this letter shall be considered practicing nursing without holding a current, valid license as a registered nurse that is a violation of Section 4723.03(A), ORC. Enclosed are copies of the Order of Summary Suspension and the Notice of Opportunity for Hearing. Section 119.12, ORC, may authorize an appeal from this Order of Summary Suspension. Such an appeal, setting forth the Order appealed from and the grounds of the appeal, must be commenced by the filing of a Notice of Appeal with the Board and the Franklin County Court of Common Pleas within fifteen (15) days after the mailing of this letter and in accordance with requirements of Section 119.12, ORC. Additionally, pursuant to Chapter 119, ORC, you are hereby notified that you are entitled to a hearing on the allegations set forth in the Notice of Opportunity for Hearing. if you wish to request such hearing, that request must be received in the office of the Board within thirty (30) days of the time of mailing of the Notice, Further information concerning such hearing is contained within the Notice of Opportunity for Hearing. If you have any questions regarding this issue, please contact Lisa Ferguson-Ramos, Compliance Manager, at (614) 995-3635. Sincerely,

try 't 11 n, Executive Director

Case # 04-1283

Before the Ohio Board of Nursing in the Matter Of Dawn M. Turshon, R.N.

ORDER OF SUMMARY SUSPENSION

This matter came for consideration before the Ohio Board of Nursing the 25th day of August 2004. Pursuant to Section 4723.28I(B), Ohio Revised Code and upon the evidence presented to Yvonne Smith, RN., lvt&N., CN.S., President and John M. Brion, R.N., M.S., Executive Director: The Ohio Board of Nursing, through its President and Executive Director, determined there is evidence that Dawn M. Turshon, R.N., has violated Sections 4723.28(B)(8), (13)(9), (B)(13), (B)(19) and (B)(16), Ohio Revised Code, as alleged in the Notice of Opportunity for Hearing which is attached hereto and fully incorporated herein. The Board, through its President and Executive Director, also determined that there is clear and convincing evidence that continued practice of nursing by Dawn M. Turshon, , presents a danger of immediate and serious harm to the public. THEREFORE, IT IS HEREBY ORDERED THAT THE LICENSE OF DAWN M. TURSHON, RN-216875, TO PRACTICE NURSING AS A REGISTERED NURSE IN THE STATE OF OHIO IS SUSPENDED.. DAWN M. TURSHON IS HEREBY ORDERED TO SURRENDER TO THE BOARD HER LICENSE TO PRAel ICE NURSING AS A REGISTERED NURSE, RN-216875, WITHIN TEN (10) DAYS OF RECEIPT OF THIS ORDER. This Order will be entered in the Journal of the Ohio Board of Nursing for the 25th day of August 2004. This Order shall become effective immediately.

*-04edil ,doxr/v,er/
Yvaine Smith, President

cla:) jog
Date

Case # 04-1283
N

,$ Ohio Board www, , 17 South High Street, Suiteof *Nursing 43215-7410 *rsing ohio .gov 400 Columbus, Ohio (614) 466-3947

A, F

August 25, 2004

NOTICE OF OPPORTUNITY FOR HEARING

Dawn M. Turshon, R.N. (FKA Dawn Hicks) 19701 Libby Rd. Maple Heights, Ohio 44137 Dear Ms. Turshon: In accordance with Chapter 119, Ohio Revised Code (ORC"), you are hereby notified that the Ohio Board of Nursing ("Board") proposes under authority of Section 4723.28, ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500..00) per violation for the following reasons: 1. While working as a registered nurse at St. Vincent Charity Hospital in Cleveland, Ohio, in or about April, May and June 2004, you cared for Patients #1 through #12 as identified on the attached Patient Key [Patient Key is confidential--to be withheld from public disclosure). As indicated on Exhibit #1, which is attached hereto and incorporated herein, you failed to appropriately document administration of medications and/or wasting medications with a witness; failed to administer or sign out doses as ordered by the physician; documented administration of medication prior to or significantly later than the time you signed it out; and signed out medications with no appropriately documented order for such medication. In an interview with a Board Compliance Agent on June 27, 2004, you admitted that while employed as a registered nurse on or about May 27, 2004, at St. Vincent Charity Hospital in Cleveland, Ohio, you stole a prescription for Vicodin belonging to Patient #4, as identified on the attached patient key, and that posing as the patient's sister, you took the prescription to a pharmacy in an attempt to have it filled. You indicated that you stole the patient's prescription because you were using more of your own prescription medication (Percocet) than you were supposed to. 3. On or about June 27, 2004, immediately following your shift at St. Vincent Charity Hospital and an interview with a Board Compliance Agent, you

Dawn M. Turshon, R.N. Page 2 underwent a urine drug screen and tested positive for Meperidine (Demerol). You failed to provide documentation to the Board of a valid prescription for Demerol and you indicated to a medical review officer that you took your daughter's Demerol. 4. Further, in your interview with the Board Compliance Agent on June 27, 2004, you indicated that you received prescription medications from two physicians, your treating practitioner and surgeon, and that you filled your prescriptions for pain management at the Cleveland Clinic. Pharmacy records indicate that since January 2003, you had prescriptions for pain medications from approximately 31 physicians filled at several pharmacies and that in June 2004 alone, you obtained approximately 495 tablets of Oxycodone and Hydrococone by filling prescriptions from five different physicians at four different pharmacies,

Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for selfadministration or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordancei with a legal, valid prescription issued for that individual. Section 4723.28(B)(9), ORC, authorizes the Board to discipline a licensee for habitual indulgence in the use of controlled substances, other habit-forming drugs, or alcohol or other chemical substances to an extent that impairs ability to practice. Section 4723,28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.2.(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723 or any rules adopted under it. Specifically, Rule 4723-4-03(E)(1), Ohio Administrative Code (hereinafter "OAC"), states that a registered nurse shall, in a timely manner, implement any order for a client. Rule 4723-4-06(E), OAC, states that a licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client's response to that care. Rule 4723-4-06(H), OAC, states that a licensed nurse shall implement measures to promote a safe environment for each client. Rule 4723-4-06(L), OAC, states that a licensed nurse shall not misappropriate a client's property or; (1) engage in behavior to seek or obtain personal gain at the client's expense or (2) engage in behavior that may reasonably be interpreted as behavior to seek or obtain personal gain at the client's expense.. Rule 4723-4-06(P), OAC, states that a licensed nurse shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board, to current employers, or to any future employers for positions requiring a nursing license. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. if you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice.

Dawn M. Turshon, Page 3

You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-3413. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

if:g4rAG/ace
Bertha Lovelace, R.N., B.A., C.R.N.A. Supervising Member

certified Mail Receipt No. 7003 3110 0005 0231 9306 cc: Katherine Bockbrader, Assistant Attorney General Holly Fischer, Assistant Attorney General

Exhibit #1 Case # 04-1283

Date Sign Out Time Physicians order CDAR Chart on MAR Waste Miscellaneous Notes

Patient

/Li

Ultram Taper Tylenol #3 1-2 Q4hrs PRN 5/18 Valium 2.5mg IV Q 6 PRN 5/19 Valium 5mg PO Q6 PRN 5/18/04 2230 5/19/04 - 0015 Ultram to have been given 0100 0400 0700 / Ultram to have been given 2200 2330 5/20/04 0230 0300 10mg Valium 2 Tylenol /13 No 2. tylenol 1/3 No i Ultram 2 tylenol #3 2 tylenol #3 2 tylenol #3 No No No @0530 No @1900 No Yes @0700 No No No No No No No No No

Missed dosage failed to administer. Missed dosage failed to administer.

-_

Documented as signed out 30 minutes after previous dose si2rted out.

#2

5/18 4mg morphine X1 stat 5/18 5mg ambien Qhs PRN 5/18 --- pereoeet 1-2 Q4hrs PRN
5118/04

2200 2315 0715 Morphine 2mg IV Q2hrs PRN

5/19104 _ ., #3 6/9/04 5/20/04

4mg morphine 2mg morphine 2 percocet

..

No Na No

No No No No order for this.

0025 0235 0630

4mg morphine 4mg morphine 10mg Morphine

No No No

Yes (2 mg) Yes (2 mg) Signed out 10 mg. Morphine after 0700 shift count_ Signed out Yes (5 mg) , more for administration to patient than ordered.

Exhibit #1 Case # 04-1283

/14

5/27/04 Entry by Turshon:Morphine D/C (allergy), Demerol 75mg 1M Q4hrs.prn 5127104 1930 1930 2320 0430 6/22 Pereocet 1 PO Q4hrs PRN 6/23/04 0000 0500 Morphine 4mg IV Q2hrs PRN 6/8/04 2000 2215 6/9104 0030 2230 6110/04 0305 0520 4mg morphine 4mg morphine 4mg morphine 4mg morphine 4m g morphine 4mg morphine Morphine 2mg IV Q2hrs. Morphine 2mg IV xi now (6/170530) 6/17/04 0000 2rng morphine No No 2 percocet 2 percocet Yes Yes . No
No

5/28/04 /15

4mg. morphine 75 demerol ambien 75 demerol

No Yes No No

No No No No

Order to D/C morphine.

No No

Order for 1 tablet only. Order for I table( only.

//6

No No No No No No

No No No No

I/7

Exhibit #1 Case # 04-1283

118 Meperidine (Demerol) 25-75mg Q4hrs PRN (D/C'd 5117/04) 518 Arnbien PD QHS PRN . 5118/04 order written by Turshon for ambien contains no physician name 5117104 order to continue ICU med.'s written on transfer; order for Demerol not properly rewritten per policy after expiration on 5117/04. 75 demerol I ambien 75 demerol 75 demerol 75 demerol 75 demerol 1 ambien ' 75 demerol 75 demerol No Yes No @0400 No Yes Yes No No No No No No

5/18/04

5/19/04

5/20/04

2030 2330 2330 0200 0600 1930 2300 2330 0500

-,

No No

/19 4/9104 0100 0500 0500

Demerol 75mg Q41irs prrt, 4/5/04 to 4/8/04 75 demerol 75 demerol 75 demerol Percocet 1-2 Q4hrs PRN 6/27104 0230 0645 Demerol 100mg IM Q4hrs. 6/26/04 2000 2330 Percoect 2 Q6hrs. PRN 6/9104 0030 0430 2 percocet 2 percocet Yes No No Percocet signed out too soon per order. 100 demerol 100 demerol Yes No No No 2 percocet .' 2 percocet No No No No No No No No Yes No Medication order had expired not a valid order. No witness to waste. Medication order had expired not a va]id order.

k. 1/10

#11

1/12

ATTACH M ENT A
02/06/2010 - 01/17/2013

Missed Call History: eg-A5-Datoon4wmp.folvveppv 02/06/2010 06/12/2010 07/11/2010 08/29/2010 02/20/2011 05/07/2011 06/02/2011 06/2512011 09/08/2011 11/13/2011 11/14/2011 11/15/2011 Missed Call Missed Call Missed Call Missed Call MiSsed Call Missed Call Miised Call Missed Call Missed Call Missed Call Missed Call Missed Call

ftwitstkoompatP wrivoo.-gd-oxtwx,kaibmw,,,....wmtwic4v.,aftmA*<.:A

11/16/2011 12/27/2011 01/14/2012 01/26/2012 03/10/2012

Missed Call Missed Call Missed Call Missed Call Missed Call

03/17/2012 Missed Call 03/29/2012 04/16/2012 04/28/2012 05/12/2012 06/19/2012 07/13/2012 07/28/2012 08/10/2012 08114/2012 08/15/2012 08/16/2012 08117/2012 08/19/2012 08/20/2012 08/21/2012 08/22/2012 08/23/2012 08/24/2012 08/25/2012 08/26/2012 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cali Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

08127/2012 08/28/2012 08/29/2012 08/30/2012 08/31/2012 09/01/2012 09/02/2012 09/03/2012 09/04/2012 09/05/2012 09/06/2012 09/07/2012 09/08/2012 09/09/2012 09/10/2012 1/2012 09/1 09112/2012 09/13/2012 09114/2012 09/1 5/2012 09/16/2012 09/17/2012 09/18/2012 09/19/2012 09/2012012 09/21/2012

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cali Missed Cali Missed Cali Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cali Missed Call Missed Cali Missed Cali Missed Call Missed Call

09/23/2012 09/24/2012 09/25/2012 09/26/2012

Missed Call Missed Call Missed Call Missed Call

09/27/2012 Missed Call 09/28/2012 09/3012012 Missed Call Missed Call

09/29/2012 Missed Call 10/0112012 Missed Call 10/02/2012 Missed Call

10/03/2012 Missed Call 10/04/2012 Missed Call 10/05/2012 10/06/2012 10107/2012 10/08/2012 10/09/2012 10/10/2012 10/11/2012 10112/2012 10/13/2012 10/14/2012 10/15/2012 10/16/2012 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

10/17/2012 Missed Call 10/18/2012 Missed Call

10/19/2012 10/20/2012 10/21/2012 10122/2012 10/23/2012 10/24/2012 10/25/2012 10/26/2012 10/27/2012 10/28/2012 10/29/2012 10/30/2012 10/31/2012 11/01/2012 11/02/2012 11/03/2012 11/04/2012 11/05/2012 11/06/2012 11/07/2012 11/08/2012 11/09/2012 11/10/2012 11/11/2012 _ k__

Missed Call Missed Call Missed Calf Missed Call Missed Call Missed Call Missed Cafl Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

11/14/2012 11/15/2012 11/16/2012 11/17/2012 11/18/2012 11/19/2012 11/20/2012 11/21/2012 11/22/2012 11/23/2012 11/24/2012 11/25/2012 11/26/2012 11/27/2012 11/28/2012 11/29/2012 11/30/2012 12/01/2012 12/02/2012 12/03/2012 12/04/2012 12/0512012 12/06/2012 12/07/2012 12/08/2012 12109/2012

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

12/10/2012 12/11/2012

Missed Call Missed Call

12J12/2012 Missed Call 12/13/2012 12/14/2012 12/15/2012 12/16/2012 12/17/2012 Missed Call Missed Call Missed Call Missed Call Missed Call

12/18/2012 Missed Call 12/19/2012 12/20/2012 12/2112012 12/22/2012 Missed Call Missed Call Missed Call Missed Call

12/23/2012 Missed Call 12/24/2012 12/25/2012 12/26/2012 Missed Call Missed Call Missed Call

12/27/2012 Missed Call 12/2812012 12/29/2012 12/30/2012 12/31/2012 01/01/2013 01/02/2013 01/03/2013 01/04/2013 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Gail Missed Call Missed Call

01/05/2013 01/06/2013 01/07/2013 01/08/2013 01/09/2013 01/10/2013

Missed Call Missed Call Missed Call Missed Cali Missed Call Missed Call

01/11/2013 Missed Cali 01/12/2013 Missed Call 01/13/2013 01/14/2013 01 /15/2013 01/16/2013 01/1712013 Missed Call Missed Call Missed Call Missed Call Missed Call

Cases# 11-003258 & 12-007263

Ohio Board .of Nursing

17 South High Street, Suite 400 January 25, 2013

www.nurs.ingoh.io.gov

Columbus, Ohio 43215-7410 4, (614) 466-3947

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Alexandra Marie Veddern, 6863 Socialville Foster Road Mason, Ohio 45040 Dear Ms. Veddern: You are hereby notified that, on or about November 19, 2010, you entered into a Consent Agreement (November 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that upon meeting the requirements for licensure, you would be granted a license to practice nursing as a licensed practical nurse in the State of Ohio and your license to practice nursing as a licensed practical nurse would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions and limitations until at least November 2011. A. Item 6. of the November 2010 Consent Agreement states, "Beginning within 60 (sixty) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. VEDDERN shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. VEDDERN shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VEDDERN's history of chemical use," On or about the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: June 3, 2011, September 6, 2011, October 1, 2012, November 1, 2012, November 30, 2012, December 27, 2012 arid January 7, 2013. Section 4723 .28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board.

Alexandra Marie Veddern, L.P.N. Page 2 B. Item 4. of the November 2010 Consent Agreement states, "MS. VEDDERN shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VEDDERN's history of chemical use. MS. VEDDERN shall self-administer prescribed drugs only in the manner prescribed." Item 9. of the November 2010 Consent Agreement states, "Within sixty (60) days of the effective date of this Consent Agreement, MS. VEDDERN shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. VEDDERN shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner." Despite these provisions, you initiated treatment with an additional practitioner, Dr. Greg Duma, M.D., Riverfront Diet Clinic, Covington, Kenturcky, on or about October 12, 2011, November 10, 2011, and January 20, 2012, and you failed to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by an additional practitioner and failed to notify the Board of medical treatment and receipt of a prescription within twenty-four hours of those events. Further, despite these provisions, you failed to provide a copy of the November 2010 Consent Agreement to Dr. Duma. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the November 2010 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 4., 6, and 9. of the November 2010 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A LICENSED PRACTICAL NURSE, PN-142879, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a licensed practical nurse without a current, valid license, which is a violation of Section 4723.03(B), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about November 19, 2010, you entered into a Consent Agreement (November 2010 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which

Alexandra Marie Veddern, L.P.N. Page 3 you agreed with the Board that upon meeting the requirements for licensure, you would be granted a. license to practice nursing as a licensed practical nurse in the State of Ohio and your license to practice nursing as a licensed practical nurse would be suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions and limitations until at least November 2011. 2. Item 6. of the November 2010 Consent Agreement states, "Beginning within 60 (sixty) days of the effective date of this Consent Agreement and continuing throughout the probationary period, MS. VEDDERN shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. VEDDERN shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VEDDERN's history of chemical use." On or about the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: June 3, 2011, September 6, 2011, October 1, 2012, November 1, 2012, November 30, 2012, December 27, 2012 and January 7, 2013. Section 4723.28(B)(17), Ohio Revised Code, ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. 3. Item 4. of the November 2010 Consent Agreement states, "MS. VEDDERN shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VEDDERN's history of chemical use. MS. VEDDERN shall self-administer prescribed drugs only in the manner prescribed." Item 9. of the November 2010 Consent Agreement states, "Within sixty (60) days of the effective date of this Consent Agreement, MS. VEDDERN shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. VEDDERN shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner."

Alexandra Marie V eddern, L.P.N. Page 4 Despite these provisions, you initiated treatment with an additional practitioner, Dr. Greg Duma, M.D., Riverfront Diet Clinic, Covington, Kentucky, on or about October 12, 2011, November 10, 2011, and January 20, 2012, and you failed to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by an additional practitioner and failed to notify the Board of medical treatment and receipt of a prescription within twenty-four hours of those events. Further, despite these provisions, you failed to provide a copy of the November 2010 Consent Agreement to Dr. Duma. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC . In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing nursin .ohio. ov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1199 cc: Henry G. Appel, Senior Assistant Attorney General

Case #10-4108

Ohio Board of Nursing

www.nursing.ohio.gov

17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947

CONSENT AGREEMENT BETWEEN ALEXANDRA M. VEDDERN, L.P.N. APPLICANT AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between ALEXANDRA M. VEDDERN, L,P.N.;, APPLICANT (MS. VEDDERN) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. VEDDERN voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. Section 4723.28(B)(4), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for a conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Section 4723.28(B)(9), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for habitual indulgence in the use of controlled substances, other habit-forming drugs, or alcohol or other chemical substances to an extent that impairs ability to practice.

Alexandra M. Veddern, L.P.N. Applicant Page 2

B.

On or about August 9, 2010, MS. VEDDERN submitted to the Board an Application for Licensure by Examination to Practice in Ohio as a Licensed Practical Nurse, MS. VEDDERN knowingly and voluntarily admits that, in Butler County, Ohio, she has three misdemeanor convictions. Specifically, MS. VEDDERN has a misdemeanor Theft conviction in 2004 related to shoplifting and two drunk driving convictions. MS. VEDDERN's most recent drunk driving conviction occurred in 2009 and she was successfully released early from her court-ordered probation in March 2010. In her statement to the Board, MS. VEDDERN's expressed remorse for her earlier actions. MS. VEDDERN was permitted to take the NCLEX-PN, and on or about October 27, 2010, MS. VEDDERN passed the NCLEX-PN. AGREED CONDITIONS

C.

D.

E.

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any' formal proceedings at this time, MS. VEDDERN knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for licensure, MS. VEDDERN shall be granted a license to practice nursing as a licensed practical nurse in the State of Ohio. MS. VEDDERN's license to practice nursing as a licensed practical nurse shall be suspended indefinitely. Such suspension shall be - stayed, subject to the following PROBATIONARY terms, conditions, and limitations until at least November 2011: MS. VEDDERN shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. 2. MS. VEDDERN shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.

Continuing Education Hours 3. By March 1, 2011, MS. VEDDERN shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing education taken subsequent to the effective date of this Consent Agreement: six (6) hours of professionalism and/or ethics and ten (10) hours of ehemical,dependency.

Alexandra M, Veddern, L.P,N. Applicant Page 3

Monitoring of Rehabilitation and Treatment 4, MS. VEDDERN shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VEDDERN's history of chemical use. MS. VEDDERN shall self-administer prescribed drugs only in the manner prescribed. MS. VEDDERN shall abstain completely from the use of alcohol, if recommended by a chemical dependency professional in Paragraph 7. below. Beginning within sixty (60) days of the effective date of this Consent Agreement and continuing throughout the probationary period;. MS. VEDDERN shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(8), ORC, This screening shall require a daily call-in process, The specimens submitted by MS. VEDDERN shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VEDDERN's history of chemical use. Within sixty (60) days following the effective date of this Consent Agreement, MS, VEDDERN shall, at her own expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. VEDDERN shall provide the chemical dependency professional with a .copy of this Consent Agreement. Further, MS, VEDDERN shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The evaluating professional shall submit a written opinion to the. Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. VEDDERN's license to practice, and a statement as to whether MS. VEDDERN is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care.

5.

6.

7.

Alexandra M. Veddern, L.P.N. Applicant Page 4 8. MS. VEDDERN shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released, Further, MS. VEDDERN agrees that the Board may utilize the chemical dependency professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. VEDDERN's license and that the terms, conditions, and limitations shall be incorporated in an addendum to this Consent Agreement.

Treating Practitioners and Reporting 9, Within sixty (60) days of the effective date of this Consent Agreement, MS. VEDDERN shall provide a copy of this Consent Agreement to all treating practitioners and shall provide- to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. VEDDERN shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. Within sixty (60) days of the effective date of this Consent Agreement, MS. VEDDERN shall provide a copy of this Consent Agreement to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. VEDDERN shall be under a continuing duty to provide a copy of this Consent Agreement, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner. MS. VEDDERN shall cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. VEDDERN throughout the duration of this Consent Agreement. Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. VEDDERN shall notify the Board of any and all . medication(s) or prescription(s) received.

10.

11.

12.

Employment Conditions 13. Prior to accepting employment as a nurse, each time with every employer, MS. VEDDERN shall notify the Board.

Alexandra M. Veddern, L.P.N. Applicant Page 5

14.

MS. VEDDERN is under a continuing duty to provide a copy of this . Consent Agreement to any new employer prior to accepting employment in &position in which a nursing license is required. MS. VEDDERN shall have her employer(s), if working in a position where a nursing license is required, submit written reports regarding job performance on a quarterly basis beginning January 1, 2011 or within thirty (30) days of accepting nursing employment. MS. VEDDERN shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement, including the date the Consent Agreement was received.

Reporting Requirements of Licensee 15. MS. VEDDERN shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. VEDDERN shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board. MS. VEDDERN shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. VEDDERN shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. VEDDERN shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. VEDDERN shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. VEDDERN shall verify that the reports and documentation required by this Consent Agreement are .received in the Board office. MS. VEDDERN shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

16.

17.

18.

19.

20.

21.

22.

Alexandra M. Veddern, L.P.N. Applicant Page 6

Temporary Practice Restrictions MS. VEDDERN shall not practice nursing as a licensed practical nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. VEDDERN to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. VEDDERN shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. yAILTIRE TO COMPLY MS. VEDDERN agrees that her license to practice nursing as a licensed practical nurse will be automatically suspended if it appears to the Board that MS. VEDDERN has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. VEDDERN via certified mail of the specific nature of the charges and automatic suspension of her license, Upon receipt of this notice, MS. VEDDERN may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC. If, in the discretion of the Board, MS. VEDDERN appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations, -and conditions, of this Consent Agreement, may be modified or terminated, in writing, at any time upon the agreement of both MS. VEDDERN and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS: VEDDERN has complied with all aspects of this Consent - Agreement; and (2) the Board determines that MS. VEDDERN is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with. MS. VEDDERN and review of the reports as required herein. Any period during which MS. VEDDERN does not work in a

2010-11-09 14:32 MCCS Credit Granting Alexandra.M. Veddern,L.P.N. Applicant Page 7

614. 995 3686 P 2/2

position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement. ACKNOWLEDGMENTS/LIABILITY RELEASE MS. VEDDIMN acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and :that all questions asked have been answered in a satisfactory manner, MS. VEDDERN waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. VEDDERN waives any and all claims or causes of action she may have against the Board, arid its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that terra is used in Section. 149A3 .ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent. Agreement is not an adjudication order as discussed in Chapter 119, ORC, Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Adrriinistrative Procedures A. Chapter 119, ORC CITVE BA LE, MS. VEX:0ERN understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature. below,

/&,0J
BERTHA LovELAm president Ohio Board (4 Nursing

11.11 1. DATE

11108/2010 T

16:03 [TX,/R){ NO 5180

002

ATTACHMENT A
01/10/2011 - 01/11/2013

Missed Call History: Date 01/16/2011 01/29/2011 02/19/2011 02/25/2011 03/13/2011 03/17/2011 03/19/2011 04/04/2011 04/30/2011 05/07/2011 05/11/2011 05/15/2011 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Details.

05/21/2011 05/28/2011 05/29/2011 05/3112011 06/02/2011 06/03/2011 06/08/2011 06/15/2011 07/02/2011 07/03/2011 07/04/2011 07/10/2011 07/23/2011 07/3112011 08/14/2011 08/19/2011 08/27/2011 09/06/2011 09/16/2011 10/05/2011 10/16/2011 10/21/2011 10/30/2011 10/31/2011 11/12/2011 11/13/2011

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

11/17/2011 11/18/2011 11/20/2011 11/21/2011 11/24/2011 12/04/2011 12/05/2011 12/11/2011 12117/2011 12/18/2011 12/19/2011 12/24/2011 12/25/2011 12/26/2011 12/31/2011 01/01/2012 01/04/2012 01/08/2012 01/12/2012 01/13/2012 01114/2012 01/16/2012 01/18/2012 01/21/2012 01/22/2012 01/24/2012

Missed Call Missed Call Missed Call Missed Call Missed Call, Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Calf Missed Call Missed Call Missed Call Missed Call Missed Call

01126/2012 01/28/2012 01/31/2012 02/04/2012 02/05/2012 02/08/2012 02/11/2012 02/12/2012 02/15/2012 02/17/2012 02/18/2012 02/19/2012 02/23/2012 02/26/2012 03/03/2012 03/10/2012 03/11/2012 03/17/2012 03/18/2012 03/22/2012 03/23/2012 03/24/2012 03/25/2012 03/31/2012 04/01/2012 04/05/2012

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

04/06/2012 04/07/2012 04/08/2012 04/13/2012 04/14/2012 04/15/2012 04/18/2012 04/21/2012 04/22/2012 04/29/2012 05/05/2012 05/06/2012 05/10/2012 05/11/2012 05/12/2012 05/13/2012 05/15/2012 05/16/2012 05/19/2012 05/20/2012 05/26/2012 05/27/2012 05/28/2012 06/02/2012 06/03/2012 06/09/2012

Missed Call' Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call , Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

06/10/2012 06/16/2012 06/17/2012 06/19/2012 06/22/2012 06/23/2012 06/24/2012 06/30/2012 07/01/2042 07/07/2012 07/08/2012 07/13/2012 07/14/2012 07/15/2012 07/16/2012 07/20/2012 07/21/2012 07/22/2012 07/23/2012 07/24/2012 07/25/2012 07/26/2012 07/27/2012 07/28/2012 08/04/2012 08/05/2012

Missed Call Missed Call Missed Cali Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Calf Missed Call Missed Call Missed Call Missed Call

08/09/2012 08/10/2012 08/11/2012 08/12/2012 08/16/2012 08/17/2012 08/18/2012 08/19/2012 08/23/2012 08/24/2012 08/25/2012 08/26/2012 08/31/2012 09/01/2012 09/02/2012 09/06/2012 09/07/2012 09/08/2012 09/09/2012 09/15/2012 09/16/2012 09/21/2012 09/22/2012 09/23/2012 09/24/2012 09/29/2012

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

09/30/2012 10105/2012 10/00/2012 10/07/2012 10/11/2012 10/13/2012 10/14/2012 10/19/2012 10/20/2012 10/21/2012 10/25/2012 10/27/2012 10/28/2012 11/01/2012 11/03/2012 11/04/2012 11/10/2012 11/11/2012 11/17/2012 11/18/2012 11/22/2012 11/24/2012 11/25/2012 11/29/2012 11/30/2012 12/01/2012

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed. Call Missed Call Missed Call Missed Call

12/02/2012 12/03/2012 12/08/2012 12/09/2012 12/11/2012 12/14/2012 12/15/2012 12/16/2012 12/18/2012 12/19/2012 12/20/2012 12/22/2012 12/23/2012 12/24/2012 12/25/2012 12/26/2012 12/28/2012 12/29/2012 12/30/2012 12/31/2012 01/01/2013 01/02/2013 01/03/2013 01/04/2013 01/05/2013 01/06/2013

Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call

01/07/2013 01/08/2013 01/09/2013 01/10/2013 01/11/2013

Missed Call Missed Call Missed Call Missed Call Missed Call

Row Count: 225

Cases # 12-001324; and 12-004089

Ohio Board of Nursing

January 25, 2013

www.nursing.ohi.o.gov
(614) 466-3947

17 South High Street, Suite 400 a Columbus, Ohio 43215-7410

NOTICE OF AUTOMATIC SUSPENSION AND OPPORTUNITY FOR HEARING

Veronica Susan Vigorito, R.N. 435 Isaac Avenue Niles, Ohio 4/11146 Dear Ms. Vigorito: You are hereby notified that, on or about September 23, 2011, you entered into a Consent Agreement (September 2011 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that upon meeting the requirements for renewal, your license to practice nursing as a registered nurse in the State of Ohio would be reinstated and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations for a minimum period of at least three (3) years. Attached to and incorporated within the September 2011 Consent Agreement is a July 24, 2009 Consent Agreement, a May 16, 2008 Notice of Opportunity For Hearing and an April 28, 2008 Notice of Immediate Suspension. A. Item 1. of the September 2011 Consent Agreement states, "MS. VIGORITO shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 7. of the September 2011 Consent Agreement states, "MS. VIGORITO shall continue submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. VIGORITO shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VIGORITO's history of chemical dependency and recovery status."

Veronica Susan Vigorito, R.N. Page 2 On August 1, 2012, you provided a specimen for analysis to Firstlab that tested positive-for Oxazepam, without a legal valid prescription. During a telephone interview on October 18, 2012, you informed your Board Monitoring Agent that you had relapsed. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dthigerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723 .28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. B. Item 2. of the September 2011 Agreement states, "MS. VIGORITO shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee." Despite this provision, you failed to appear at your scheduled personal interview with your Board Monitoring Agent at the Board's office on September 28, 2012 at 2:00 p.m. C. Item 6. of the September 2011 Consent Agreement states, "MS. VIGORITO shall abstain completely from the use of alcohol." Item 7. of the September 2011 Consent Agreement states, "MS. VIGORITO shall continue submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. VIGORITO shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VIGORITO's history of chemical dependency and recovery status." Despite these provisions, on March 23, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol): Furthermore, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide a specimen for analysis and failed to do so: August 27, 2012; September 20, 2012; October 22, 2012; November 7, 2012; November 15, 2012; and December 3, 2012.

Veronica Susan Vigorito, R.N. Page 3 D. Item 9. of the September 2011 Consent Agreement states, "If the Board or its designee requests an addiction psychiatric evaluation, and, MS. VIGORITO shall, within ninety (90) days of such a request, and at her expense, obtain a comprehensive evaluation by a psychiatrist who is certified by the American Board of Medical Specialties (ABMS) in Addiction Psychiatry and who is approved in advance by the Board. Prior to the evaluation, MS. VIGORITO shall provide the evaluating psychiatrist with a copy of this Consent Agreement, the attached July 2009 Consent Agreement, the attached May 2008 Notice, and the attached April 2008 Notice, and summaries from her treating physicians for the past five years, including the types and frequency of drugs she has been prescribed in that period. Further, MS. VIGORITO shall execute releases to permit the evaluating psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. VIGORITO's license, and a statement as to whether MS. VIGORITO is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care." You were sent a letter dated July 9, 2012, from your Board Monitoring Agent requesting that you obtain an Addiction Psychiatric Evaluation and submit documentation of the completed evaluation to the Board. Despite the above provision, as of January 7, 2013, you have failed to submit documentation of a completed Addiction Psychiatric Evaluation to the Board. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. In accordance with the paragraph under "FAILURE TO COMPLY" of the September 2011 Consent Agreement, you are hereby notified that it appears to the Board that you have violated Items 1., 2., 6., 7. and 9. of the September 2011 Consent Agreement. YOU ARE FURTHER NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE, RN-286613, IS HEREBY AUTOMATICALLY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing as a registered nurse without a current, valid license, which is a violation of Section 4723.03(A), ORC. You are further notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons:

Veronica Susan Vigorito, R.N. Page 4 1. On or about September 23, 2011, you entered into a Consent Agreement (September 2011 Consent Agreement) with the Ohio Board of Nursing (Board), a copy of which is attached hereto and incorporated herein, in which you agreed with the Board that upon meeting the requirements for renewal, your license to practice nursing as a registered nurse in the State of Ohio, would be reinstated and suspended indefinitely and that such suspension would be stayed subject to probationary terms, conditions, and limitations,for a minimum period of at least three (3) years. Attached to and incorporated within the September 2011 Consent Agreement is a July 24, 2009 Consent Agreement, a May 16, 2008 Notice of Opportunity For Hearing and an April 28, 2008 Notice of Immediate Suspension, 2. Item 1. of the September 2011 Consent Agreement states, "MS. VIGORITO shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio." Section 4723.28(8)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Item 7. of the September 2011 Consent Agreement states, "MS. VIGORITO shall continue submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(3), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. VIGORITO shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VIGORITO's history of chemical dependency and recovery status." On August 1, 2012, you provided a specimen for analysis to Firstlab that tested positive for Oxazepam, without a legal valid prescription. During a telephone interview on October 18, 2012, you informed your Board Monitoring Agent that you had relapsed. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board.

Veronica Susan Vigorito, R.N. Page 5 3. Item 2. of the September 2011 Agreement states, "MS. VIGORITO shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee." Despite this provision, you failed to appear at your scheduled personal interview with your Board Monitoring Agent at the Board's office on September 28, 2012 at 2:00 p.m. 4. Item 6. of the September 2011 Consent Agreement states, "MS. VIGORITO shall abstain completely from the use, of alcohol." Item 7. of the September 2011 Consent Agreement states, "MS. VIGORITO shall continue submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis afa collection site specified by the Board at such times as the Board may request_ Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner .as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. VIGORITO shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VIGORITO's history of chemical dependency and recovery status. Despite these provisions, on March 23, 2012, you provided a specimen for analysis to Firstlab, the Board's random drug/alcohol screen program administrator, that tested positive for Ethyl Glucuronide (Alcohol). Furthermore, on the dates set forth in Attachment A, attached hereto and incorporated herein, you failed to call Firstlab to determine if you had been selected to provide a specimen for analysis. In addition, on the following dates, you were selected to provide, a specimen for analysis and failed to do,so: August 27, 2012; September 20, 2012; October 22, 2012; November 7, 2012; November 15, 2012; and December 3, 2012 5. Item 9. of the September 2011 Consent Agreement states, "If the Board or its designee requests an addiction psychiatric evaluation, and, MS. VIGORITO shall, within ninety (90) days of such a request, and at her expense, obtain a comprehensive evaluation by a psychiatrist who is certified by the American Board of Medical Specialties (ABMS) in Addiction Psychiatry and who is approved in advance by the Board. Prior to the evaluation, MS. VIGORITO shall provide the evaluating psychiatrist with a copy of this Consent Agreement, the attached July 2009 Consent Agreement, the attached May 2008 Notice, and the attached April 2008 Notice, and summaries from her treating physicians for the past five years, including the types and frequency of drugs she has been prescribed in that period. Further, MS. VIGORITO shall execute releases to permit the evaluating, psychiatrist to obtain any information deemed appropriate and necessary for the

Veronica Susan Vigorito, R.N. Page 6 evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. VIGORITO's license, and a statement as to whether MS. VIGORITO is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care." You were sent a letter dated July 9, 2012, from your Board Monitoring Agent requesting that you obtain an Addiction Psychiatric Evaluation and submit documentation of the completed evaluation to the Board. Despite the above provision, as of January 7, 2013, you have failed to submit documentation of a completed Addiction Psychiatric Evaluation to the Board. Section 4723.28(B)(17), ORC, authorizes the Board to discipline a licensee for violation of any restrictions placed on a nursing license by the Board. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410, or to the e-mail address, hearing@nursing,ohio.goy. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Automatic Suspension and Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Veronica Susan Vigorito, R.N. Page 7 Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 1052 cc: Henry G. Appel, Senior Assistant Attorney General

Case #11-3152

Ohio Board of Nursing

WWW. nursing.ohiagov

17 South High Street, Suite 400 Columbus, Ohio 43215-7410 (614) 466-3947

REINSTATEMENT CONSENT AGREEMENT BETWEEN VERONICA S.. VIGORITO, R.N. AND OHIO BOARD OF NURSING
This Consent Agreement is entered into by and between VERONICA S. VIGORITO, R.N. (MS. ,VIGORITO) and the Ohio Board of Nursing (Board), the state agency charged with enforcing Chapter 4723, of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. VIGORITO voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. BASIS FOR ACTION This Consent Agreement is, entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00) or less per violation. MS. VIGORITO admits to violating Section 4723.28, ORC, as set forth in her July 24, 2009 Consent Agreement (July 2009 Consent Agreement), in her April 28, 2008 Notice of Immediate Suspension (April 2008 Notice) and her May 16, 2008 Notice of Opportunity for Hearing (May 2008 Notice). In August 1999, MS. VIGORITO was initially issued a license to practice nursing in Ohio as a registered nurse, M-286613. MS. VIGORITO's license was immediately suspended by her April 2008 Notice. MS. VIGORITO's July 2009 Consent Agreement resolved her April 2008 Notice and her May 2008 Notice and MS. VIGORITO's nursing license was indefinitely suspended. A copy of the July 2009 Consent Agreement, the May 2008 Notice, and the April 2008 Notice are attached hereto and incorporated herein.

B.

Veronica S. Vigorito, R.N. Page 2

C.

MS. VIGORITO is now eligible to request reinstatement of her license and has submitted such a request in writing. MS. VIGORITO is prescribed antidepressant medication by her primary treating physician Dr. Brahmaiah Tandra and has been diagnosed with Depressive Disorder. MS. VIGORITO submitted her May 2011 chemical dependency evaluation to the Board that was performed by Kofee L. Lilly, MACM, LCDCIII. MS. VIGORITO was diagnosed with Opiate Dependence in Sustained Full Remission and with Sedative Dependence in Sustained Full Remission. No treatment recommendations were made. MS. VIGORITO submitted a statement to the Board and reported that she has maintained her sobriety since April 19, 2008. AGREED CONDITIONS

D.

B.

F.

Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. VIGORITO knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations: Upon meeting the requirements for renewal, MS. VIGORITO's license to practice nursing as a registered nurse shall be reinstated and suspended indefinitely. Such suspension shall be stayed, subject to the following PROBATIONARY terms, conditions, and limitations for a minimum period of at least three (3) years: 1. MS. VIGORITO shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. VIGORITO shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee.

2,

Continuing Education Hours 3. Within ninety (90) days from the effective date of this Consent Agreement, MS. VIGORITO shall, in addition to the requirements of licensure renewal, successfully complete and submit satisfactory documentation of successful completion of the following continuing nursing education, or other comparable courses approved in advance by the Board, taken subsequent to the effective date of this Consent Agreement: five (5) hours of professionalism/ethics.

Veronica S. Vigorito, R.N. Page 3 Criminal Records Check 4. Within ninety (90) days prior to submitting a request for release from the probationary terms, conditions and limitations of this Consent Agreement, MS. VIGORITO agrees that she will submit a request to the Bureau of Criminal identification and Investigation (BCII) to conduct a criminal records check of MS. VIGORITO, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCII to submit MS. VIGORITO's criminal records check reports to the Board. MS . VJGORJTO agrees that a request for release from the probationary terms of this Consent Agreement will not be considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board.

Monitoring of Rehabilitation and Treatment 5. MS. VIGORITO shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VIGORITO's history of chemical dependency and recovery status. MS. VIGORITO shall self-administer prescribed drugs only in the manner prescribed. MS. VIGORITO shall abstain completely from the use of alcohol. MS. VIGORITO shall continue submitting, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. VIGORITO shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VIGORITO's history of chemical dependency and recovery status. MS. VIGORITO shall continue attending a minimum of one (I) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. VIGORITO shall provide satisfactory documentation of such attendance to the Board every six (6) months beginning November 1, 2011.

6. 7.

8.

Veronica S. Vigorito, R.N. Page 4

Evaluation 9. If the Board or its designee requests an addiction psychiatric evaluation, and, MS. VIGORITO shall, within ninety (90) days of such a request, and at her expense, obtain a comprehensive evaluation by a psychiatrist who is certified by the American Board of Medical Specialties (ABMS) in Addiction Psychiatry and who is approved in advance by the Board. Prior to the evaluation, MS. VIGORITO shall provide the evaluating psychiatrist with a copy of this Consent Agreement, the attached July 2009 Consent Agreement, the attached May 2008 Notice, and the attached April 2008 Notice, and summaries from her treating physicians for the past five years, including the types and frequency of drugs she has been prescribed in that period. Further, MS. VIGORITO shall execute releases to permit the evaluating psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. VIGORITO's license, and a statement as to whether MS. VIGORITO is capable of practicing nursing according to .acceptable and prevailing standards of safe nursing care. If an evaluation is requested, MS. VIGORITO shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the psychiatrist described above until released. Further, MS. VIGORITO agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. VIGORITO's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

10.

Treating Practitioners and Reporting 11. Within sixty (60) days of the effective date of this Consent Agreement, MS. VIGORITO shall provide a copy of this Consent Agreement, the attached July 2009 Consent Agreement, the attached May 2008 Notice, and the attached April 2008 Notice to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers. Further, MS. VIGORITO shall be under a continuing duty to provide a copy of this Consent Agreement and the attachment, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner.

Veronica S. Vigorito, R.N. Page 5

12.

Ms. VIGORITO shall cause all treating practitioners to complete a

medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. VIGORITO throughout the duration of this Consent Agreement.

13.

Within twenty-four (24) hours of release from hospitalization or medical treatment, MS. VIGORITO shall notify the Board of any and all medication(s) or prescription(s) received.

Employment Conditions 14. Prior to accepting employment as a nurse, each time with every employer, MS. VIGORITO shall notify the Board in writing. MS. MOM() is under a continuing duty to provide a copy of this Consent Agreement, the attached July 2009 Consent Agreement, the attached May 2008 Notice, and the attached April 2008 Notice to any new employer prior to accepting employment as a nurse. M.S. VIGORITO shall have her employer(s) submit written reports regarding job performance on a quarterly basis beginning within thirty (30) days of accepting nursing employment. Further, MS. VIGORITO shall have her employer(s) send documentation to the Board, along with the first employer report, of receipt of a copy of this Consent Agreement and the attachments, including the date they were received.

15.

Reporting Requirements of Licensee

16.

MS. VIGORITO shall report to the Board, in writing, any violation of

this Consent Agreement within thirty (30) days of the occurrence of the violation.

17,

MS. VIGORITO shall sign release of information forms allowing health professionals and other organizations to submit the requested documentation directly to the Board.

18.

MS. VIGORITO shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice.
MS. VIGORITO shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers.

19.

Veronica S. Vigorito, R.N. Page 6

20,

MS. VIGORITO shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. All reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. MS. VIGORITO shall submit the reports and documentation required by this Consent Agreement or any other documents required by the Board to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. VIGORITO shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS, VIGORITO shall inform the Board within five (5) business days, in writing, of any change in employment status or of any change in residential or home address or telephone number.

21.

22.

23.

Nursing Refresher Course or Orientation Prior to working in a position where a nursing license is required, MS. VIGORITO shall complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation to be approved in advance by the Board or its designee. Temporary Narcotic Restriction MS. VIGORITO shall not administer, have access to, or possess (except as prescribed for MS. VIGORITO's use by another so authorized by law who has full knowledge of MS. VIGORITO's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum of ONE (I) YEAR in which MS. VIGORITO is working in a position that requires a nursing license. At any time after the one-year period previously described, MS. VIGORITO may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. VIGORITO shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. VIGORITO shall not call in or order prescriptions or prescription refills. Permanent Practice Restrictions MS. VIGORITO further knowingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: MS. VIGORITO shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an

Veronica S. Vigorito, R.N. Page 7

individual or group of individuals who directly engage MS. VIGORITO to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. VIGORITO shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, VicePresident of Nursing. FAILURE TO COMPLY MS. VIGORITO agrees that her license to practice nursing as a registered nurse will be automatically suspended if it appears to the Board that MS. VIGORITO has violated or breached any terms or conditions of the Consent Agreement. Following the automatic suspension, the Board shall notify MS. VIGORITO via certified mail of the specific nature of the charges and automatic suspension of her license. Upon receipt of this notice, MS. VIGORITO may request a hearing regarding the charges. The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723,28(B), ORC. If, in the discretion of the Board, MS. VIGORITO appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute faunal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. DURATION/ MODIFICATION OF TERMS The terms, limitations, and conditions, of this Consent Agreement, other than the permanent practice restrictions, may be modified or terminated, in writing, at any time upon the agreement of both MS. VIGORITO and the Board. The Board may only alter the probationary period imposed by this Consent Agreement if: (1) the Board determines that MS. VIGORITO has complied with all aspects of this Consent Agreement; and (2) the Board determines that MS. VIGORITO is able to practice according to acceptable and prevailing standards of safe nursing care without Board monitoring, based upon an interview with MS. VIGORITO and review of the reports as required herein. Any period during which MS. VIGORITO does not work in a position for which a nursing license is required shall not count toward fulfilling the probationary period imposed by this Consent Agreement.

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Veronica S. Vigorito, RN. Page 8 .CENOWLEDGMEMS/LIABILM7 RELEASE MS. VIGORITO acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that at questions asked have been answered in a satisfactory manner.

MS. viGoRrro

waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement.

MS. VIGORITO waives any and all chirns or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters, which are the subject of this Consent Agreement. This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies. This Consent Agreement is not an adjudication order as discussed in Chapter 119, ORC. Any action initiated by the Beard based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC. EFFECITU DATE MS. VIGORITO understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

VERONICAS. VIGORITO, g.N.

DATE

gogitio, mautlyw
BERTHA LOVELACE, President Ohio Board of Nursing

DATE

g iglawf

Case #07-3194 & 07-3616

Ohio. Board of Nursing

CONSENT AGREEMENT BETWEEN VERONICA S. VIGORITO, R.N. AND OHIO BOARD OF NURSING

www.nursing.ohio.go-v

17 South High Street, Suite 400 0: Columbus, Ohio. 43215-7410 0 (614) 466-3947

This Consent Agreement is entered into by and between VERONICA S. VIGORITSE Rg. (MS. VIGORITO) and the Ohio Board of Nursing (Board), the state agency charge with enforcing Chapter 4723. of the Ohio Revised Code (ORC), and all administrative rules promulgated thereunder. MS. VIGORITO voluntarily enters into this Consent Agreement being fully informed of her rights under Chapter 119, ORC, including the right to representation by legal counsel and the right to a formal adjudicative hearing on the issues considered herein. This Consent Agreement contains the entire agreement between the parties, there being no other agreement of any kind, verbal or otherwise, which varies the terms of this Consent Agreement. SA.SIS FOR ACTION This Consent Agreement is entered into on the basis of the following stipulations, admissions and understandings: A. The Board is empowered by Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend, or place restrictions on any license issued by the Board; reprimand or otherwise discipline a licensee; or impose a fine of five hundred dollars ($500.00). Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Section 4723.28(13)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for selfadministering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(8)(10), ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe

Veronica S. Vigorito, R.N. Page 2 nursing care because of habitual or excessive use of drugs, alcohol, or other chemical substances that impair the ability to practice. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(P), Ohio Administrative Code, states that a licensed nurse shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the board, to current employers, or to any future employers for positions requiring a nursing license. B. C. MS. VIGORITO has been licensed to practice nursing as a registered nurse in the State of Ohio, RN-286613, since August 1999. MS. VIGORITO knowingly and voluntarily admits to the factual and legal allegations set forth in the Notice of Immediate Suspension dated April 28, 2008 (April 2008 Notice) and Notice of Opportunity for Hearing issued to her by the Board on May 16, 2008 (May 2008 Notice), copies of which are attached hereto and incorporated herein. MS. VIGORITO states that she was sentenced by the Mahoning County Common Pleas, Case No. 07 CR 1570, to one year of supervision by the Mahoning County Drug Court. The terms of her supervision included random drug screens that required a daily telephone call to determine selection, weekly meetings before the Drug Court, and attendance at three AA meetings each week. MS. VIGORITO states that she relapsed in April 2008 and was sentenced to two days in jail and one week of inpatient treatment at Neil Kennedy Treatment Center, Youngstown, Ohio. MS. VIGORITO reports that she has not had any additional relapses. MS. VIGORITO also states she attended twenty days of inpatient treatment at Glenbeigh, Cleveland, Ohio in 2006 for chemical dependency treatment. MS. VIGORITO states that she successfully completed the Mahoning County Common Pleas Court drug program on April 8, 2009. AGREED CONDITIONS Wherefore, in consideration of the foregoing and mutual promises hereinafter set forth, and in lieu of any formal proceedings at this time, MS. VIGORITO knowingly and voluntarily agrees with the Board to the following terms, conditions, and limitations:

D.

E.

F.

G.

Veronica S. Vigorito, Page 3

SUSPENSION OF LICENSE 1. MS. VIGORITO's license to practice nursing as a registered nurse is hereby suspended for an indefinite period of time, but not less two (2) years from the date of the April 2008 Notice. MS. VIGORITO may submit a written request for reinstatement after April 2010 if the conditions for reinstatement have been satisfied.

CONDITIONS FOR REINSTATEMENT 2. MS. VIGORITO shall obey all federal, state, and local laws, and all laws and rules governing the practice of nursing in Ohio. MS. VIGORITO shall comply with all terms and conditions imposed upon her by the Mahoning County Common Pleas Court, Case Number Case No. 07 CR 1570, until released. MS. VIGORITO shall appear in person for interviews before the full Board or its designated representative as requested by the Board or its designee. Within six (6) months prior to requesting reinstatement, MS. VIGORITO agrees that she will submit a request to the Bureau of Criminal Identification and Investigation (BCII) to conduct a criminal records check of MS. VIGORITO, including a check of Federal Bureau of Investigation (FBI) records, and shall cause BCI1 to submit MS. VIGORITO's criminal records check reports to the Board. MS. VIGORITO agrees that a request for reinstatement will not be considered by the Board until the completed criminal records check, including the FBI check, has been received by the Board. Prior to requesting reinstatement, MS. VIGORITO shall enter into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of three (3) years following reinstatement.

3. 4.

5.

Psychiatric Evaluation 6. Upon the request of the Board or its designee and within sixty (60) days of that request, MS. VIGORITO shall, at her own expense, seek a psychiatric evaluation from a Board approved psychiatrist and shall provide the Board with complete documentation of such evaluation. Prior to the evaluation, MS. VIGORITO shall provide the psychiatist with a copy of this Consent Agreement, the April 2008, and May 2008 Notice. MS. VIGORITO shall execute releases to permit the psychiatrist to obtain any information deemed appropriate and necessary for the evaluation. The psychiatrist shall submit a written opinion to the Board that includes diagnoses, recommendations for treatment and monitoring, any additional restrictions that should be placed on MS. VIGORTIO's license, and a statement as to whether MS.

Veronica S. Vigorito, R.N. Page 4 VIGORITO is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. 7. MS. VIGORITO shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the professional until released. Further, MS. VIGORITO agrees that the Board may use the professional recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. VIGORITO's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

Monitoring of Rehabilitation and Treatment 8. MS. VIGORITO shall abstain completely from the personal use or possession of drugs, except those prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VIGORITO's history of chemical dependency and recovery status. MS. VIGORITO shall self-administer the prescribed drugs only in the manner prescribed. MS. VIGORITO shall abstain completely from the use of alcohol. Within three (3) months prior to requesting reinstatement, MS. VIGORITO shall, at her own expense, obtain a chemical dependency evaluation by a Board approved chemical dependency professional and shall provide the Board with complete documentation of this evaluation. Prior to the evaluation, MS. VIGORITO shall provide the chemical dependency professional with a copy of this Consent Agreement and the April 2008 Notice and the May 2008 Notice. Further, MS. VIGORITO shall execute releases to permit the chemical dependency professional to obtain any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes diagnoses, recommendations, for treatment and monitoring, and any information deemed appropriate and necessary for the evaluation. The chemical dependency professional shall submit a written opinion to the Board that includes any additional restrictions to be placed on MS. VIGORITO's license to practice, and stating whether MS. VIGORITO is capable of practicing nursing according to acceptable and prevailing standards of safe nursing care. MS. VIGORITO shall provide the Board with satisfactory documentation of compliance with all aspects of the treatment plan developed by the chemical dependency professional described above until released. Further, MS. VIGORITO agrees that the Board may utilize the professional's recommendations and conclusions from the evaluation as a basis for additional terms, conditions, and limitations on MS. VIGORITO's license and that the terms, conditions, and limitations may be incorporated in an addendum to this Consent Agreement.

9. 10.

11.

Veronica S. Vigorito, R.N. Page 5 12. For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement, MS. VIGORITO shall attend a minimum of one (1) meeting per week of a support or peer group meeting approved in advance by the Board, or a Twelve Step program, and MS. VIGORITO shall provide satisfactory documentation of such attendance to the Board prior to reinstatement. For a minimum, continuous period of six (6) months immediately prior to requesting reinstatement, MS. VIGORITO shall submit, at her expense and on the day selected, blood or urine specimens for drug and/or alcohol analysis at a collection site specified by the Board at such times as the Board may request. Upon and after MS. VIGORITO's initiation of drug screening, refusal to submit such specimen, or failure to submit such specimen on the day she is selected, or in such a manner as the Board may request, shall constitute a violation of a restriction placed on a license for purposes of Section 4723.28(B), ORC. This screening shall require a daily call-in process. The specimens submitted by MS. VIGORITO shall be negative, except for substances prescribed, administered, or dispensed to her by another so authorized by law who has full knowledge of MS. VIGORITO's history of chemical dependency and recovery status. a. Within thirty (30) days prior to MS. VIGORITO initiating drug screening, MS. VIGORITO shall provide a copy of this Consent Agreement and the attached April 2008 Notice and May 2008 Notice to all treating practitioners and shall provide to the Board a list of all treating practitioners, including addresses and telephone numbers and cause all treating practitioners to complete a medication prescription report that is to be mailed by the practitioner directly to the Board. The medication report is to be completed for any and all substances prescribed, administered, or dispensed to MS. VIGORITO. b. After initiating drug screening, MS. MOM() shall be under a continuing duty to provide a copy of this Consent Agreement and the attached. April 2008 Notice and May 2008 Notice, prior to initiating treatment, to additional treating practitioners, and to update the list of treating practitioners with the Board within forty-eight (48) hours of being treated by another practitioner, Further, MS. VIGORITO shall notify the Board of any and all medication(s) or prescription(s) received within twenty-four (24) hours of release from hospitalization or medical treatment. Reporting Requirements of Licensee 14. 15. MS. 'MOM() shall report to the Board, in writing, any violation of this Consent Agreement within thirty (30) days of the occurrence of the violation. MS. VIGORITO shall sign release of information forms allowing health professionals and other organizations to submit requested documentation or information directly to the Board,

13.

Veronica S. Vigorito, Page 6 16. MS. VIGORITO shall submit any and all information that the Board may request regarding her ability to practice according to acceptable and prevailing standards of safe nursing practice. MS. VIGORITO shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the Board or to employers or potential employers. MS. VIGORITO shall submit the reports and documentation required by this Consent Agreement on forms specified by the Board. MI reporting and communications required by this Consent Agreement shall be made to the Compliance Unit of the Board. M.S. VIGORITO shall submit the reports and documentation required by this Consent Agreement to the attention of the Compliance Unit, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 43215-7410. MS. VIGORITO shall verify that the reports and documentation required by this Consent Agreement are received in the Board office. MS. VIGORITO shall inform the Board within five (5) business days, in writing, of any change in address and/or telephone number.

17.

18.

19.

20. 21.

Nursing Refresher Course or Orientation Upon request of the Board or its designee, MS. VIGORITO shall, prior to working in a position where a nursing license is required, complete and submit satisfactory documentation of completion of a nursing refresher course or an extensive orientation approved in advance by the Board or its designee. Temporary Narcotic Restrictions MS. VIGORITO shall not administer, have access to, or possess (except as prescribed for MS. VIGORITO's use by another so authorized by law who has full knowledge of MS. VIGORITO's history of chemical dependency and recovery status) any narcotics, other controlled substances, or mood altering drugs for a minimum period of ONE (1) YEAR in which MS. VIGORITO is working in a position that requires a nursing license. At any time after the one year period previously described, MS. VIGORITO may submit a written request to the Board to have this restriction re-evaluated. In addition, MS. VIGORITO shall not count narcotics or possess or carry any work keys for locked medication carts, cabinets, drawers, or containers. MS. VIGORITO shall not call in or order prescriptions or prescription refills.

Veronica S. Vigorito, Page 7 Permanent Practice Restrictions MS. VIGORITO further knovvingly and voluntarily agrees with the Board to the following PERMANENT LICENSURE RESTRICTIONS: MS. VIGORITO shall not practice nursing as a registered nurse (1) for agencies providing home care in the patient's residence; (2) for hospice care programs providing hospice care in the patient's residence; (3) for staffing agencies or pools; (4) as an independent provider where the nurse provides nursing care and is reimbursed for services by the State of Ohio through State agencies or agents of the State; or (5) for an individual or group of individuals who directly engage MS. VIGORITO to provide nursing services for fees, compensation, or other consideration or as a volunteer. MS. VIGORITO shall not function in a position or employment where the job duties or requirements involve management of nursing and nursing responsibilities, or supervising and evaluating nursing practice. Such positions include, but are not limited to, the following: Director of Nursing, Assistant Director of Nursing, Nurse Manager, Vice President of Nursing. FAILURE TO COMPLY The above described terms and conditions shall constitute "restrictions placed on a license" for purposes of Section 4723.28(B), ORC, If, in the discretion of the Board, MS. VIGORITO appears to have violated or breached any terms or conditions of this Consent Agreement, the Board reserves the right to institute formal disciplinary proceedings for any and all possible violations or breaches, including, but not limited to, alleged violations of the laws of Ohio occurring before the effective date of this Consent Agreement. RURATION .:t MODIFICATION OF TERMS The terms, limitations, and conditions of this Consent Agreement, other than the permanent licensure restriction(s), may be modified or terminated, in writing, at any time upon the agreement of both MS. VIGORITO and the Board. The Board may only alter the indefinite suspension imposed if: (1) MS. VIGORITO submits a written request for reinstatement; (2) the Board determines that MS. VIGORITO has complied with all conditions of reinstatement; (3) the Board determines that MS. VIGORITO is able to practice according to acceptable and prevailing standards of safe nursing care based upon an interview with MS. VIGORITO and review of the documentation specified in this Consent Agreement; and (4) MS. VIGORITO has entered into a Consent Agreement with the Board for probationary terms, conditions, and limitations determined by the Board for a minimum period of three (3) years following reinstatement.

Veronica S. Vigorito, R.N. Page 8

ACKNOWLEDGMENTS/LIABILITY RELEASE
MS. VIGORITO acknowledges that she has had an opportunity to ask questions concerning the terms of this Consent Agreement and that all questions asked have been answered in a satisfactory manner, MS. VIGORITO waives all of her rights under Chapter 119, ORC, as they relate to matters that are the subject of this Consent Agreement. MS. VIGORITO waives any and all claims or causes of action she may have against the Board, and its members, officers, employees and/or agents arising out of matters that are the subject of this Consent Agreement. This Consent Agreement is not an adjudication order as discussed in Chapter, 119, ORC. Any action initiated by the Board based on alleged violations of this Consent Agreement shall comply with the Administrative Procedures Act, Chapter 119, ORC, This Consent Agreement shall be considered a public record as that term is used in Section 149.43, ORC. The information contained herein may be reported to appropriate organizations, data banks and governmental bodies.

EF7ECTIVE DATE
MS. VIGORITO understands that this Consent Agreement is subject to ratification by the Board prior to signature by the Board President and shall become effective upon the last date of signature below.

aq 9-46
VERONICA S. VIGORITO, R.N. DAe /d9

LISA KLENKE, President Ohio Board of Nursing

7.aq .D9
DATE

Case #07-3194 & 07-3616

Ohio Board of Nursing

vAvw.nursing.ohio.gov

17 South High Street, Suite 400 t Columbus, Ohio 43215-7410 4; (614) 466-3947

May 16, 2008

NOTICE OF OPPORTUNITY FOR HEARING

Veronica Vigorito, 435 Isaac Avenue Niles, Ohio 44446 Dear Ms. Vigorito: On or about April 28, 2008, the Ohio Board of Nursing issued to you a Notice of Immediate Suspension, a copy of which is attached hereto and incorporated herein. In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Board proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: A. On or about March 5, 2008, in Mahoning County Court of Common Pleas Case No, 07 CR 1570, you pled guilty to one (1) count of Theft of Drugs, a fourth-degree felony in violation of Section 2913,02(A)(1)(B)(1)(6), and subsequently, sentencing was held in abeyance pending completion of your treatment in Drug Court. The acts underlying your guilty plea involve you diverting liquid Lorazepam from the supply of a home health care patient on or about October 12, 2007. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony or of any crime involving gross immorality or moral turpitude. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law. B. On October 12, 2007, you were admitted to the Emergency Department of St. Elizabeth Health Center at the Austintown Campus for drug ingestion. A bottle of Ativan (Lorazepam) was found on your person, and you

Veronica Vigorito, R.N. Page 2 admitted to hospital personnel that you consumed a patient's liquid Ativan. C. In an interview with a Board Investigator, on November 6, 2007, you stated that you could not remember consuming the patient's Lorazepam, and you denied having any chemical dependency issues or treatment. Subsequently, on or about December 17, 2007, you contacted the Board Investigator and admitted that you stole the liquid Lorazeparn from the patient. You also admitted that you had a previous chemical dependency evaluation and treatment in or around May 2007 because you would selfadminister more medication than what was prescribed for you.

Section 4723.28(B)(8), ORC, authorizes the Board to discipline a licensee for self-administering or otherwise taking into the body any dangerous drug, as defined in Section 4729.01, ORC, in any way not in accordance with a legal, valid prescription issued for that individual. Section 4723.28(B)(10), ORC, authorizes the Board to discipline a licensee for impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of habitual or excessive use of drugs, alcohol, or other chemical substances that impair the ability to practice. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723 4 06(P), Ohio Administrative Code, states that a licensed nurse shall not submit or cause to be submitted any false, misleading, or deceptive statements, information, or documentation to the board, to current employers, or to any future employers for positions requiring a nursing license. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a bearing in this matter. If you with to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you axe entitled to appear at such bearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 43215-7410. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal

Veronica Vigorito, R.N. Page 3 allegations set forth in this Notice of Opportunity for Hearing, deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per, violation. Sincerely,

46u.
cc:

444ege

Debra A. Broadnax, M.S.N., R.N., C.N.S. Supervising Board Member Certified Mail Receipt No. 7006 0810 0004 4840 8361 Leah O'Carroll, Assistant Attorney General

Case #07-3194 & 07-3616

of rsin
April 28, 2008

www.nursing.ohio.gov

17 South High Street, Suite 400 i Columbus, Ohio 43215-7410 4 (614) 466-3947

NOTICE OF IMMEDIATE SUSPENSION

Veronica Vigorito, 435 Isaac Avenue Niles, Ohio 44446 Dear Ms. Vigorito: In accordance with Section 2929.42 andfor 3719.12 of the Ohio Revised Code (ORC), the Ohio Board of Nursing (Board) has been notified that on or about March 5, 2008, in Mahoning County Court of Common Pleas Case No. 07 CR 1570, you pled guilty to one (1) count of Theft of Drugs, a fourth-degree felony in violation of Section 2913.02(A)(1)(B)(1)(6), and subsequently, sentencing was held in abeyance pending completion of your treatment in Drug Court. Section 3719.121 (C), ORC, states in pertinent part as follows: On receiving notification pursuant to Section 2929.42 or 3719.12 of the Revised Code, the board under which a person has been issued a license, certificate or evidence of registration immediately shall suspend the license, certificate, or registration of that person on a plea of guilty to a finding by a jury or court of the person's guilt of, or conviction of, a felony drug abuse offense, a finding by a court of the person's eligibility for intervention in lieu of conviction, a plea of guilty to, or a finding by a jury or court of the person's guilt of, or the person's conviction of an offense in another jurisdiction that is essentially the same as a felony drug abuse offense, or finding by a court of the person's eligibility for treatment or intervention in lieu of conviction in another jurisdiction. Section 2913.02(A)(1)(B)(1)(6), Theft of Drugs, constitutes a felony drug abuse offense as defined in Section 2925.01 ORC, WHEREFORE, PURSUANT TO SECTION 3719.121(C), ORC, YOU ARE HEREBY NOTIFIED THAT YOUR LICENSE TO PRACTICE NURSING AS A REGISTERED NURSE IS HEREBY SUSPENDED. Continued practice after receipt of this notice of suspension shall be considered engaging in the practice of nursing without a current, valid license, which is a violation of Section 4723.03(A), ORC, You are hereby ordered to surrender your Ohio license to practice nursing as a registered nurse, RN-286613, to the Board within ten (10) clays of receipt of this notice.

Veronica Vigorito, R.N. Page 2 In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing on this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing this notice. As required by Section 3719.121(C), ORC, the suspension ordered herein shall remain in effect until this hearing is held. You are hereby further informed that if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, argument, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit Manager, 17 South High Street, Suite 400, Columbus, OH 4321.5.7410. You are also advised that at the next scheduled Board meeting, the Board will, upon consideration of the factual and legal allegations set forth iii the Notice of Immediate Suspension and Opportunity for Hearing, propose to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation.

Sincerely,

44. 4.
cc:

deptoadve414,

Debra A. Broadnax, RN, MSN, CNS Supervising Board Member Certified Mail Receipt No. 7007 3020 0000 7377 6168 Leah 0' Carroll, Assistant Attorney General

ATTACHMENT A
09/2412011 - 12/21/2012 Veronica Vigorito 435 Isaac Ave, Niles, OH, 44446 Status: Active Frequency Code:

Missed Call History: _ Missed Call Scheduled For Testing-Opt # 1 Missed Call Missed Call petails. ... ..

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11/26/2012 'Missed Call 11/27/2012 11/28/2012 11/29/2012 11/3012012 12/01/2012 12/03/2012 12/04/2012 12/05/2012 12/06/2012 12/07/2012 12/08/2012 12/09/2012 12/10/2012 12/11/2012 12/12/2012 12/13/2012 12/14/2012 12/15/2012 12/16/2012 12/17/2012 12/18/2012 12/20/2012 12/21/2012 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Scheduled For Testing-Opt # 1 Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Call Missed Cali Missed Call Missed Call Missed Call Missed Call Missed Call

12/02/2012 ,Missed Call

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Case #12-005358

bio Board of Nursing

17 South High Street, Suite 400 January 25, 2013

www.nu sing.ohio.gov

Columbus, Ohio 43215-7410 6 (614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Sheema T. Vincent, R.N. 23 B Johnson Road Latham, NY 12110 Dear Ms. Vincent: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about May 21, 2012, the Arizona State Board of Nursing issued a Findings of Fact, Conclusions of Law and Order No. (Arizona Board 2012 Order) in which your license to practice nursing as a registered nurse in Arizona was revoked. A copy of the Arizona Board 2012 Order is attached hereto and incorporated herein.

Section 4723.28(B)(1), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 432157410, or to the email address, hearin @nursin' .ohio ov.

Sheema T. Vincent, R.N. Page 2

If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0680 cc: Henry G. Appel, Senior Assistant Attorney General

Janice K. Brewer
Governor

. Joey Ridenour
Executive Director

Arizona State Board of Nursing

4747 North 7th Street, Suite 200 Phoenix AZ 85014-3655 Phone (602) 771-7800 Fax (602) 771-788S E-Mail: arizonagazbn.gov Home Page: http://www.azbn.gov

AFFIDAVIT OF CUSTODIAN OF RECORDS STA:I E; OF ARIZONA COUNTY OF MARICOPA I, key Ridenour, Executive Director for the 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 of the records on SHEEMA T VINCENT. Personnel of the Arizona State Board of Nursing prepared the records during the ordinary course of business. Witness my hand and the seal of the Arizona State Board of Nursing at 4747 N. 7th Street, Suite 200, Phoenix, Arizona 85014-3655 on October 2, 2012.

SEAL

44-ci

16-1:44t41.4,0

'Irk. a,etk,

Joey Ridenour, RN., M.N., F.A.A.N. Executive Director

1 2

ARIZONA STATE BOARD OF NURSING 4747 North 7th Street, Ste 200 Phoenix, Arizona 85014-3655 602-771-7800 IN THE MATTER OF REGISTERED NURSE LICENSE NO RN160863 ISSUED TO FINDINGS OF FACT, CONCLUSIONS OF LAW AND ORDER NO.

7 8 9 10 11 12 13 14 15 16 17

SJJEEMA T. VINCENT, RESPONDENT.

On May 21, 2012, the Arizona State Board of Nursing ("Board") considered the State's Motion to Deem Allegations Admitted and Recommended Discipline and Respondent's Response to the Motion, if any, at the Arizona Board of Nursing, 4747 North 7th Street, Suite 200, Phoenix Arizona 85014-3655. Kim Zack, Assistant Attorney General, appeared on behalf of the State. Respondent was not present and was not represented by counsel. On May 21, 2012, the Board granted the State's Motion to Deem Allegations Admitted. Based upon A.R.S. 32-I663(F) and Notice of Charges No. 1012076 issued in this matter, the Board adopts

18 19 20 21 22 23 24 25 26 27 28 29

the following Findings of Fact, Conclusions of Law, and REVOKES Respondent's certified nursing assistant certificate. FINDINGS OF FACT 1. SHEEMA T. VINCENT ("Respondent") holds Board issued registered nurse license

no. RN160863, originally issued on or about December 10, 2009. 2. The Board has authority pursuant to A.R.S. 32-1606, 32-1663, and 32-1664 to

impose disciplinary sanctions against the holders of nursing licenses for violations of the Nurse Practice Act, A.R.S. 32-1601 - 1669.

3.

On or about December 27, 2010, Respondent self reported to the Board that she had

been convicted of charges related to an altercation with her daughter. Respondent provided a copy of a court document, specifically, a Certificate of Disposition from Colonie Town Court (NY) that indicated that she was fined on a Harassment 2nd charge. No disposition date was listed on this document. Based upon this disclosure, the Board initiated an investigation. 4. On or about June 7, 2010, according to court documents received from Colonie Town

Court (NY) for ease number 10060758, Respondent struck her 15 year old daughter numerous times about the hands, arms, body and legs with a plastic broom handle. The record further documented that the victim's injuries required medical treatment and were described as a fractured right hand/wrist, pain swelling and bruising to the left shoulder, left elbow, and both legs. 5. On or about June 8, 2010, in. Colonie Town Court (NY), case number 10060758, an

Information/Complaint was sworn to in support of charges against Respondent, specifically, misdemeanor Endangering the Welfare of a Child, felony Assault in the Second Degree, and misdemeanor Criminal Possession of a Weapon in the Fourth Degree. Respondent failed to report her charges to the Board within ten days. 6. On or about December 8, 2010, in Colonie Town Court (NY), case number 10060758,

Respondent entered into a Negotiated Plea and Allocation agreement to the charge of Harassment 2nd degree and or about January 24, 2011, as documented on a Certificate of Disposition, Respondent's case was disposed of showing that she was fined $125.00. 7. On or about February 16, 2011, Board Staff mailed Respondent a Board questionnaire

with instructions to provide a written explanation and specific court and police records regarding each of her arrests, citations or charges, by March 2, 2011. She failed to respond.

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8.
2

On or about October 13, 2011, Board Staff mailed Respondent a second Board

questionnaire with instructions to provide a written explanation and specific court and police records regarding each of her arrests, citations or charges, by October 27, 2011. Respondent was informed in

3 5

the letter that failure to cooperate with the Board during an investigation could be considered a violation of the Nurse Practice Act and it could lead to a disciplinary action. She failed to respond.

6 8

9.

On or about November 7, 2011, Board staff unsuccessfully attempted to contact

Respondent at her telephone number of record. The call could not be completed.
9 1,0 11 12 13 14 15 16 17 18 19

10.

On or about November 7, 2011, Board staff mailed Respondent a written request for her

to contact Board staff. She failed to respond. CONCLUSIONS OF LAW 1. The conduct and circumstances alleged in the Findings of Fact constitute

violations of A.R.S. 32-1663(D), as defined in A.R.S. 32-1601(18) (d), (h) and (j) (effective September 30, 2009) 18. "Unprofessional conduct' includes the following whether occurring in this state or elsewhere: (d) Any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public. (h) a) Committing an act that deceives, defrauds or harms the public. Violating a rule that is adopted by the Board pursuant to this chapter.

20 21

22
23 24 25

Specifically: A.A.C. R4-19-403 (2), (25)(a), (28)(a), (28)(b) and (28)(c) (effective January 31, 2009). For purposes of A.R.S. 32-1601(16)(d), any conduct or practice that is or might be hau 'dui or dangerous to the health of a patient or the public includes one or more of the following:

26
27 25 29

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2. 25.

Intentionally or negligently causing physical or emotional injury. Failing to: a. Furnish in writing a full and complete explanation of a matter reported

pursuant to A.R.S. 32-1664. 28. if a licensee or applicant is charged with a felony or a misdemeanor involving conduct that may affect patient safety, failing to notify the Board in writing, as required under A.R.S. 32-3208, within 10 days of being charged. The licensee or applicant shall include the following in the notification: a. Name, address, telephone number, social security number, and license

number, if applicable; b. c. Date of the charge; and Nature of the offense,

The conduct and circumstances alleged in the Findings of Fact constitute violations of A.R.S. 32r3208 (A) and (D) Criminal Charges; mandatory reporting requirements; civil penalty (adopted effective 09/18/03): A. A health professional who has been charged with a misdemeanor involving conduct that may affect patient safety or a felony after receiving or renewing a license or certificate must notify the health professional's regulatory board in writing within ten working days after the charge is filed. D. A health professional who does not comply with the notification requirements of this section commits an act of unprofessional conduct. The health professional's regulatory board may impose a civil penalty of not more than one thousand dollars in addition to other disciplinary action it takes.

2.

The conduct and circumstances described in the Findings of Fact constitute sufficient

2 3

cause pursuant to A.R.S. 324664 (N) to suspend or revoke the license of Sheema T. Vincent to practice as a registered nurse in the State of Arizona.

ORDER
6 7 8

In view of the above Findings of Fact and Conclusions of Law, the Board issues the following Order: Pursuant to A.R.S. 32-1664(N), the Board hereby REVOKES registered nurse license

9
10 11 12 13 14

number RN160863 issued to Sheema T. Vincent. RIGHT TO PETITION FOR REHEARING OR REVIEW Pursuant to A.R.S. 414092.09, Respondent may file, in writing, a motion for rehearing or review within thirty (30) days after service of this decision with the Arizona State Board of Nursing. The motion for rehearing or review shall be made to the attention of Vicky Driver,

15 16 17 18 19

Arizona State Board of Nursing, 4747 North 7th Street Ste 200, Phoenix AZ 85014-3655, and must set forth legally sufficient reasons for granting a rehearing. A.A.C. R4-19-608. For answers to questions regarding a rehearing, contact Vicky Driver at (602) 771-7852. Pursuant to A.R.S. 414092.09(B), if Respondent fails to file a motion for rehearing or review

20 21 22 23 24 25 26 27 - 28 29

within thirty (30) days after service of this decision, Respondent shall be prohibited from seeking judicial review of this decision. This decision is effective upon expiration of the time for filing a request for rehearing or review, or upon denial of such request, whichever is later, as mandated in A.A.C. R4-19-609. Respondent may apply for reinstatement of the said, license pursuant to A.A.C. R4-19-404 after a period of five years.

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1 2 3 4

DATED this 21't day of May, 2012. ARIZONA STATE BOARD OF NURSING SEAL.

iti46.4;-"wo 16/L.0A_ 4aitiL

Joey Ridenour, R.N., M.N., F.A.A Executive Director

COPIES mailed this 31s day of May, 2012, by Certified Mail No. 7011 3500 0001 5221 0976 and First Class Mail to: Sheema T. Vincent 23 B Johnson Rd Latham NY 12110 COPIES mailed this 315t day of May, 2012, by Certified Mail No. 7011 3500 0001 5221 0983 and First Class Mail to: Sheema T. Vincent 813 Beryl Way. Watervliet NY 12189-2966 COPIES mailed this 31st day of May, 2012, by First Class Mail to: Kim Zack Assistant Attorney General 1275 W Nashington Phoenix AZ 85007

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

By: Vicky Driver

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Case #12-005998

Ohio Board of Nursing www.nursing.ohio.gov

17 South High Street, Suite 400 4 Columbus, Ohio 43215-7410 January 25, 2013 (614) 466-3947

NOTICE OF OPPORTUNITY FOR HEARING

Melanie Anne Walter, R.N. 1066 Old Farm Trail Medina, Ohio /1/1256 Dear Ms. Walter: Your license to practice as a registered nurse was suspended on May 18, 2012, under the terms and conditions of a Consent Agreement that you entered into with the Board, effective May 18,'2012. You are notified that in accordance with Chapter 119, ORC, the Board proposes under authority of Section 4723.28 of the Ohio Revised Code, ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about October 11, 2012, in Cuyahoga County Court of Common Pleas Case Number CR-12-561836-A, you pled guilty to one (1) count of Theft; Aggravated Theft to wit: Dilaudid, a felony of the fourth degree, in violation of Section 2913.02(A)(2), ORC; one (1) count of Drug Possession, a felony of the fifth degree, in violation of Section 2925.11(A), ORC; and one (1) count of Illegal Processing of Drug Documents, a felony of the fourth degree, in violation of Section 2925 .23(A), ORC. The acts underlying this case occurred on or about January 1, 2011, and involve you obtaining or exerting control over Dilaudid beyond the scope of consent of the owner or person authorized to give consent. Further acts involve you obtaining, possessing, or using Dilaudid. Further acts involve you making a false statement in any prescription, order, report, or record involving a Schedule I or II drug that is not Marihuana. Section 4723.28(B)(4), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, any felony. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for conviction of, a plea of guilty to, a judicial finding of guilt of, a judicial finding of guilt resulting from a plea of no contest to, or a judicial finding of eligibility for intervention in lieu of conviction for, violating any municipal, state, county, or federal drug law.

Melanie Anne Walter Page 2

Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus OH 43215-7410, or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, /c2.t/1-2-6z--',.,7_,0 A7 A/ dA/./57 Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0345 cc: Henry G. Appel, Senior Assistant Attorney General

Case #12-001864 & 12-005021

Ohio Board of Nursing

17 South High Street, Suite 400
'4

www.nursing.ohio.gov
(614) 466-3947

Columbus, Ohio 43215-741.0

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Faith Brooke Wendell, R.N. 3594 Village Dr. #B Franklin, Ohio 45005 Dear Ms. Wendell: In accordance with Chapter 119 Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4'723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions a license granted to you to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: On or about May 25, 2012, you submitted a statement to the Board, in which you admitted that, in or around April 2012, you submitted documentation of a physical examination or evaluation that had been altered in regard to date and time to Medical Solutions, a potential employer, in an attempt to obtain RN employment. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(P)(2), Ohio Administrative Code states that a licensed nurse shall not make any false, misleading, or deceptive statements, or submit or cause to be submitted any false, misleading or deceptive information, or documentation to prospective employers when applying for positions requiring a nursing license. 2. On or about September 11, 2012, as a result of your actions noted above in Paragraph 1, you entered into an Agreed Order (Texas Agreed Order) with the Texas Board of Nursing, in which you received a Warning With Stipulations and Fine. A copy of the Texas Agreed Order is attached hereto and incorporated herein. According to the Texas Agreed Order, you cannot work outside of Texas pursuant to a licensure compact without the written permission of both the Texas Board of Nursing and the compact state where you wish to work.

Section 4723.28(B)(1), ORC, authorizes the Board to discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction.

Faith Brooke Wendell, R.N. Page 2

Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing on this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing this notice. You are hereby further informed that if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present you position, argument, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter to: Lisa Ferguson-Ramos, Compliance Unit Manager, 17 South High Street, Suite 400, Columbus, OH 43215-7410, or to the email address, hearing@nursin .ohio. ov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in the Notice of Opportunity for Hearing, to deny; permanently revoke, revoke, suspend or place restrictions a license granted to you to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0512

cc: Henry G. Appel, Senior Assistant Attorney General

BEFORE THE TEXAS BOARD OF NURSING

In the Matter of Registered Nurse License Number 817656 issued to FAITH BROOKE WENDELL

AGREED ORDER -

On this day the Texas Board of Nursing, hereinafter referred to as the Board, considered the matter of FAITH BROOKE WENDELL, Registered Nurse License Number 817656, hereinafter referred to as Respondent. Information received by the Board produced evidence that Respondent may have violated Section 301.452(6)(10), Texas Occupations Code. Respondent waived informal proceedings, notice and hearing, and agreed to the entry of this Order offered on June 15, 2012, by Katherine A. Thomas, MN, RN, FAAN, Executive Director, subject to ratification by the Board.

FINDINGS OF FACT -------------1,-----Priorto-theinstitutionof-AgeneyproceedinWriOtiaathTifiaftiliabilow 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(s). 2, Respondent waived informal proceedings, notice and hearing, and agreed to the entry of this Order. Respondent is currently licensed to practice professional nursing in the State of Texas, Respondent received an Associate Degree in Nursing from Tompkins Cortland Community College, Dryden, New York, on May 9, 2007. Respondent was licensed to practice professional nursing in the State of Texas on May 10, 2012. Respondent's professional nursing employment history is unknown.

3. 4.

5.

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6.

On or about April 27, 2012, while employed with Medical Solutions, Omaha, Nebraska, Respondent produced a falsified physical evaluation document from a clinic to indicate she had completed a physical when, in fact, she had not. Respondent then provided this falsified document to Medical Solutions and represented it as a current physical evaluation. Respondent's conduct was likely to deceive her employer and may have affected their decision to continue employment. Regarding the conduct outlined in Finding of Fact Number Seven (7), Respondent provided a response on June 14, 2012, in which she admits to the above allegation. Respondent states that she was desperate for work and "made a very poor decision." Respondent states that she "accepts responsibility" and would like to resolve this matter as quickly as possible.

7.

CONCLUSIONS OF LAW 1. Pursuant to Texas Occupations Code, Sections 301.451-301.555, the Board has jurisdiction over this matter. Notice was served in accordance with law. The evidence received is sufficient to prove violation of Section 301.452(b)(10), Texas Occupations Code, and 22 TEX. ADMIN. CODE 217.12(6)(A)8(6)(I). The evidence received is sufficient cause pursuant to Section 301.452(b), Texas Occupations Code, to take disciplinary action against Registered Nurse License Number 817656, ----heretofore-issued -to TAITH_BROOKE_WENDELL,_ineluding.revocationofRespondents___. licenSe(s) to practice nursing in the State of Texas,

2. 3.

4.

ORDER IT IS THEREFORE AGREED and ORDERED, subject to ratification by the Texas Board of Nursing, that RESPONDENT SHALL receive the sanction of a WARNING WITH STIPULATIONS AND FINE, and RESPONDENT SHALL comply in all respects with the Nursing Practice Act, Texas Occupations Code, 301.001 et seq., the Rules and Regulations Relating to Nurse Education, Licensure and Practice, 22 Tax. AmtiN, CODE 211.1 et seq. and this Order. IT IS FURTHER AGREED and ORDERED that, while under the terms of this Order, this Order SHALL apply to any and all future licenses issued to Respondent to practice nursing in
817656:171

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the State of Texas. IT IS FURTHER AGREED and ORDERED that this Order SHALL be applicable to Respondent's nurse licensure compact privileges, if any, to practice nursing in the State of Texas, IT IS FURTHER AGREED and ORDERED that while Respondents license(s) is/are encumbered by this Order, Respondent may not work outside the State of Texas pursuant to a nurse licensure compact privilege without the written permission of the Texas Board of Nursing and the Board of Nursing in the party state where Respondent wishes to work. IT IS FURTHER AGREED that: (1) RESPONDENT SHALL, within one (1) year of entry of this Order, successfully complete a course in Texas nursing jurisprudence and ethics. RESPONDENT SHALL obtain Board approval of the course prior to enrollment only if the course is pot 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) 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

517656:177

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has for relicensure. Board-approved courses may be found at the following Board website address: htt ://www.bon.texas ov/disci linar action/sti,scourses.html. (2) RESPONDENT SHALL, within one (1) year of entry this, successfully complete the course "Sharpening Critical Thinking Skills," a 3.6 contact hour online program provided by the National Council of State Boards ofNursing (NCSBN) Learning Extension. In order to receive credit for completion of this program, RESPONDENT SHALL SUBMIT the continuing education certificate of completion for this program to the Board's office, to the attention of Monitoring, This course is to be taken in addition to any continuing education requirements the Board may have for relicensure. Board-approved courses may be found at the following Board website address: http://www.bontexas.govIdisciplinaryaction/stipscourses.hind. (3) RESPONDENT SHALL pay a monetary fine in the amount of five hundred dollars ($500,00) RESPONDENT SHALL pay this fine within forty-five (45) days of entry of this Order, Payment is to be made directly to the Texas Board of Nursing in the form of cashier's check or U.S. money order. Partial payments will not ($500.00) be accepted. IT IS FURTHER AGREED, SHOULD RESPONDENT PRACTICE AS A NURSE IN THE STATE OF TEXAS, RESPONDENT WILL PROVIDE DIRECT PATIENT CARE AND PRAC'T'ICE 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 STIPULATIONS FOR ONE (I) YEAR(S) OF EMPLOYMENT. THE LENGTH OF THE STIPULATION PERIOD WILL BE EXTENDED UNTIL SUCH TWELVE (12) MONTHS HAVE ELAPSED. PERIODS OF UNEMPLOYMENT OR OF EMPLOYMENT THAT DO NOT REQUIRE THE USE OF A

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REGISTERED NURSE (RN) OR A VOCATIONAL NURSE (LVN) LICENSE, AS APPROPRIATE, WILL NOT APPLY TO THIS STIPULATION PERIOD: (4) RESPONDENT SHALL notify each present employer in nursing of this Order of the Board and the stipulations on RESPONDENT'S license(s). 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 of this Order of the Board and the stipulations on RESPONDENT'S license(s), 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, (5) 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. (6) RESPONDENT SHALL be supervised by a Registered Nurse, if licensed as a Registered Nurse, or by a Licensed Vocational Nurse or a Registered Nurse, if licensed as a Licensed Vocational 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 predetermined

S17656:171

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unit(s). RESPONDENT SHALL NOT be employed by a nurse registry, temporary nurse employment agency, hospice, or home health agency. RESPONDENT SHALL NOT be selfemployed or contract for services. Multiple employers are prohibited. (7) 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) month period for one (1) year of employment as a nurse. IT IS FURTHER AGREED, that upon full compliance with the terms of this Order, all encumbrances will be removed from RESPONDENTS license(s) to practice nursing in the State of Texas and RESPONDENT shall be eligible for nurse licensure compact privileges, if any.

BALANCE OF THIS PAGE INTENTIONALLY LEFT BLANK, CONTINUED ON NEXT PAGE.

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RESPONDENTS 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 violation 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 of this Order become effective, and a copy will be mailed to me. I understand that if I fail to comply with all terms and conditions of this Order, I will be subject to investigation and disciplinary sanction, including revocation of my lieense(s) to practice nursing in the State of Texas, as a consequence of my noncompliance. Signed this day of 20

FAITH BROOKE WENDELL, Respondent

Sworn to and subscribed before me this

day of

20

SEAL Notaty Public in and for the State of

Approved as to form and substance.

John Rivas, Attorney for Respondent Signed this day of , 20

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Aug 09 12 11:50a Taralynn Mackay 5123856878 0810/2812 LI: se

tiro.

(512)-281-9559

p.2

RESPONDENTS CERTIF1CATMN
understand that I have the right to tegai counsel prior to .5igning, this A gredd Order. oei-3.4-004.14441. I bavereviccved this Order. 1 neither admit not deny the violation alleged herein. 8y my signature On this Otdcr, I agree to the Findings of Fact, Conclusions of Law, Otder,. acid any conditions of said Order, to avoid further disciplinary actin in this matter. 1 waive judiciat review of this Order. f understand that.this Order is subiect to ratification by the. Board. - When this Order is ratified, the tetn-ls of This Order hecomy ertwtive, and a copy will be mailed to
me. T understand that if I Fail to comply with all terms and conditions of this Order, I will be subject

to investigation and disciplinary sanction, including revocation of my 1icense(0 to practice nursing. in the State of Texas, as a consequence of my norionrnpliapce.
Sighed

ftd ay of 5.

, 20

Iv04_1`
FAITH BROOK WENTN,T, Respondent

swartts-S56-gutwettbarbefore-mz- tbist

all.oarofL-2-41--

wittary PARA etato tri sWi t 'aft l Ousffied ttsmAYIsIt z 'btrOszzsico 0,4st Enkapo;

Notary Public in and for the State of

t )01,077

-7-

Aug 09 12 11:59a e8/05/2e12

Tatelynn Mackay
50 512385070
81 2E ,

(512)-281-9659

0.3 1. "1-ikat flat L

Pr,..VONDENT'S CETerificATION
I understand that t have the right to legal counsel prior to signing this Agreed Order. have reviewed this Order. I neither admit nor deny the violation 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 tnattec. I waivt judicial review of this Order, I understand that this Order is sub*t to ratification by the Board. When this Order is ratified, the terms of this Order become effeettve;and a copy will be mailed to me, I understand that if I fail to comply with ail tents and conditions of this Order, I will be subject to investigation and disciplinary sanction, including. revocation of my licen.se(s) to practice nursink in the State of Texas, as a consequence of my noncompliance,

Signed this

day of

, 20,

FA

-t BROOKE WEI4DELL Respondent

Sworn to and subscribed before me this

day of

Notary Public in and for the State of

Approve

s. to form and substance.

Tatalyrut Ma' ay, Attorney for Responde Siped this 1 day of

M456:177

ale

WHEREFORE, PREMISES CONSIDERED, the Texas Board of Nursing does hereby ratify and adopt the Agreed Order that was signed on the 6'h day of July, 2012, by FAITH BROOKE WENDELL, Registered Nurse License Number 817656, and said Order is final. Effective this 11th day of September, 2012.

C: 1 1,17'72

Katherine A. Thomas, MN, RN, FAAN Executive Director on behalf of said Board

817656177

I co

Cases 11-002204 & 12-000746

Ohio Boarcl -of Norsing

17 South High Street, Suite 400 January 25, 2013

wTvvw.nursing.obio,gov (614) 466-3947 Columbus, Ohio 43215-7410

NOTICE OF OPPORTUNITY FOR HEARING

Kennis William Wilson (aka "Kelly Wilson"), L.P.N. 9589 Tucker Road. Mount Vernon, Ohio 43050 Dear Mr. Wilson: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanenfly revoke, suspend or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. While working as a nurse at Concepts in Community Living (CCL), Mount Vernon, Ohio, you provided care to Patients #1 and #2, and acted in the manner described below [See Attached Patient Key to Remain Confidential and Not Subject to Public Disclosure]: a. On or about April 24, 2011, you received information that Patient #1 was not eating or drinking well, appeared to have phlegm and was having trouble clearing the phlegm. Upon receipt of this information, you failed to consult with Patient. #1's physician, or seek further medical attention for Patient #1 at a medical facility. Instead, despite physician orders and an Individual Service Plan to the contrary, you instructed staff at CCL to elevate Patient#2's head of bed to 90 degrees if needed and to check vital signs every thirty (30) minutes. Patient #1 died from acute bilateral Pneumonia in the early hours of the following day. On or about August 16, 2011, you admitted to a Board Compliance Agent that you acted outside the scope of your nursing practice when you instructed staff to elevate Patient #1's head of bed to 90 degrees. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-04(A), Ohio Administrative Code, (OAC) states that a licensed practical nurse shall function within the scope of practice of nursing for a licensed practical nurse as

Kennis William Wilson (aka "Kelly Wilson"), L.P.N. Page 2 set forth in Division (F) of Section 4723.01, ORC, and the rules of the Board. Rule 4723-4-04(C), OAC, states that a licensed practical nurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged which includes, but is not limited to, the following: (1) Consistent performance of all aspects of nursing care; and (2) Appropriate recognition, referral or consultation, and intervention, when a complication arises Section 4723.28(B)(21), ORC, authorizes the Board to discipline a licensee for, in the case of a licensed practical nurse, engaging in activities that exceed the practice of nursing as a licensed practical nurse. b. On or about August 16, 2011, you admitted to a Board Compliance Agent that you "re-created" the April 2011 Medication Administration Report (MAR) for Patient #1 after it was unable to be found following an office move. You further admitted that you prompted staff to initial the boxes on the re-created MAR as they would have on the original. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(G), OAC, states that a licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. c. In or about March 2011 through May 2011, you failed to perform a monthly Suprapubic Catheter change on Patient #2 as required by physician order. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-04(E), OAC, states, in pertinent part, that a licensed practical nurse shall, in a timely manner: (1) Implement any order or direction for a client unless the licensed practical nurse believes or should have reason to believe the order or direction is: (a) Inaccurate; (b) Not properly authorized; (c) Not current or valid; (d) Harmful, or potentially harmful to a client; or (e) Contraindicated by other documented infoiniation. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723.28, ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice.

Kearns William Wilson (aka "Kelly Wilson"), L.P.N. Page 3 You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, hearing@nursing.ohio.gov. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a licensed practical nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely, Al / Rhonda S. Barkheimer, C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0802 cc: Henry G. Appel, Senior Assistant Attorney General

Case # 11-004630

Oldo

www.nursing.ohlo.gov (614) 466-3947 17 South High Street, Suite 400 # Columbus, Ohio 43215,7410

Board or Nursing

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Anne Marie York, R.N. 4973 Abberton Court Hilliard, Ohio 43026 Dear Ms. York: In accordance with Chapter 119, Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under authority of Section 4723.28 ORC, to deny, revoke, permanently revoke, suspend or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about November 10, 2011, you admitted in a written statement to you employer that, while working as a nurse at Doctor's Hospital in Columbus, Ohio you stole Dilaudid and "maybe some Percocet" on numerous occasions and gave the medication to your husband. Section 4723.28(B)(5), ORC, authorizes the Board to discipline a licensee for selling, giving away, or administering drugs or therapeutic devices for other than legal and legitimate therapeutic purposes. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. 2. On or about November 10, 2011, you admitted in a written statement to you employer that, while working as a nurse at Doctor's Hospital in Columbus, Ohio, Patient #1 [see attached Patient Key to remain confidential and not subject to public disclosure] "did not receive IV Dilaudid 2 mg for a total of 6 mg" as you documented on October 26, 2011 at 2003 hours, October 26,2011 at 2305 hours, and October 27, 2011 at 0357 hours. Instead, you admitted that you stole the Dilaudid and took it home. Section 4723.28(B)(13), ORC, authorizes the Board to discipline a licensee for obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice. Section 4723.28(B)(19), ORC, authorizes the Board to discipline a licensee for failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Section 4723.28(B)(16), ORC, authorizes the Board to discipline a licensee for violation of Chapter 4723, ORC, or any rules adopted under it. Specifically, Rule 4723-4-06(G), Ohio Administrative Code (OAC), states that a licensed nurse shall not falsify any

Anne Marie York, R.N. Page 2 client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services. Rule 4723-406(H), OAC, states that a licensed nurse shall implement measures to promote a safe enviromnent for each client. Accordingly, the Board is authorized to impose one or more of the sanctions cited in Section 4723 28 , ORC. In accordance with Chapter 119, ORC, you are hereby informed that you are entitled to a hearing in this matter. If you wish to request such hearing, the request must be made in writing and must be received in the Board office within thirty (30) days of the time of mailing of this notice. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in Writing. At the hearing, you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, Ohio 432157410 or to the email address, YegingRpprsittg,pllig.,2oy. If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, deny, revoke, permanently revoke, suspend, or place restrictions on your license to practice nursing as a registered nurse; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

c 7Y/c-pc...lea-,
Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0581 Attorney Certified Mail Receipt No. 7012 2210 0000 6272 0598 cc: Henry G. Appel, Senior Assistant Attorney General James M. McGovern, Esq.

Case #12-006084

Ohio Board ...of IS titsing

www.nursing.ohio.gov
(614) 466-3947

17 South High Street, Suite 400 - 0 Columbus, Ohio 43215-7410

January 25, 2013

NOTICE OF OPPORTUNITY FOR HEARING

Rachel Elizabeth Zucco, R.N. 1387 1/2 Sunset Avenue Arcata, California 95521 Dear Ms. Zucco: In accordance with Chapter 119. of the Ohio Revised Code (ORC), you are hereby notified that the Ohio Board of Nursing (Board) proposes under the authority of Section 4723.28, ORC, to deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse in Ohio; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation for the following reasons: 1. On or about October 24, 2012, in Case No 2012-549, the Board of Registered Nursing, Department of Consumer Affairs, State of California adopted a Decision and Order (California Board 2012 Order) in which your license to practice nursing as a registered nurse in California was placed on probation for a three (3) year-period. A certified copy of the California Board 2012 Order, along with Attachments are attached hereto and incorporated herein.

Section 4723.28(B)(1), ORC, authorizes the Board to deny a license or otherwise discipline a licensee for denial, revocation, suspension, or restriction of authority to practice a health care occupation, including nursing, for any reason other than a failure to renew, in Ohio or another state or jurisdiction. Accordingly, the Board is authorized to impose one or more of the sanctions as cited in Section 4723.28 ORC. You are hereby further informed that, if you timely request a hearing, you are entitled to appear at such hearing in person, by your attorney, or by such other representative as is permitted to practice before the Board, or you may present your position, arguments, or contentions in writing. At the hearing you may also present evidence and examine witnesses appearing for and against you. Should you choose to request a hearing, please mail or deliver the request, in addition to any other correspondence regarding this matter, to: Lisa Ferguson-Ramos, Compliance Unit Manager, Ohio Board of Nursing, 17 South High Street, Suite 400, Columbus, OH 432157410, or to the email address, hearing@nursing.ohio.gov.

Rachel Elizabeth Zucco, R.N. Page 2

If the Board fails to receive a request for a hearing within thirty (30) days of the time of mailing of this notice, the Board may, in your absence and upon consideration of the factual and legal allegations set forth in this Notice of Opportunity for Hearing, to deny, permanently deny, permanently revoke, revoke, suspend or place restrictions on your license to practice nursing as a registered nurse in Ohio; reprimand or otherwise discipline you; or impose a fine of not more than five hundred dollars ($500.00) per violation. Sincerely,

Rhonda S. Barkheimer, R.N., C.N.P. Supervising Board Member Certified Mail Receipt No. 7012 2210 0000 6272 0727 cc: Henry G. Appel, Senior Assistant Attorney General

BEFORE THEBOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: RA.CEIEL ELIZABETH ZUCCO 1387 % Sunset Avenue Arcata, CA 95521 Registered Nu e License No. 785263 Respondent Case No. 2012-549 OAH No. 2012040117

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 October 24., 2012.. IT IS SO ORDERED September 24, 2012. hereby certify We, copy fcregoirib lb be a, dine:documents ort fife in our effice..1.4, BONiti.'0F.REGISTEREDAAASINQ
O'L' Louiiieftgeby,, Xcutivi dffi*

7 Raymond. MaEel, President Board of Registered Nursing Department of Consumer Affairs State of California

KAMALA D. Flinn Attorney General of California 2 FRANK. H. PACCIE Supervising Deputy Attorney General 3' CHAR SACHSON Deputy Attorney General 4 State Bar No, 161032 455 Golden Gate Avenue, Suite 11000 5 'San Francisco, CA 94102-7004 Telephone: (415) 703-5558 Facsimile: (415) 703-5480 6 ttorneys for Complainant 7 1 8 9 10 11 12 13 14' 15 16' 17 18 19 In the interest of a prompt and speedy settiexuent of thismatter, consistent with the public interest and the responsibility of the Board of Registered Nursing of the Depaninent of Consumer Affairs, the parties hereby agree to the following Stipulated Settlement and Disciplinary Order which Will.be submitted to the Board for apppval and adoption as the final disposition of the
21

BEFORE THE BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFMRS STATE'OF CALIFORNIA In the Matter of the Accusation Against: RACHEL ELIZABETH ZUCCO 1387 112 Sunset Ave. Arcata, CA 95521 Registered' Nursing License No. 785263 Respondent. Case No. 2012-549 OAB: No. 2012040117 STIPULATED SETTLEMENT AND DISCIPLINARY ORDER

Accusation. PARTIES 1. Louise R. Bailey, M.Ed., RN (Complainant) is the Interim Executive Officer of the

22 23 24 25 26 27 '28

Board of Registered Nursing She brought this action solely in her official capacity and is represented in this matter by Karnala b. Harris, Attorney General of the State of California, by Char Sachsen, Deputy Attorney General. -

1 STIPULATED SEITLE1VIENT (2012-549)

2. 2 3 4 5 6 7 8 9 10. 11 '12 13 14 15 16 17 18 19 20
21

Respondent Rachel Elizabeth Zucco (Respondent) is represented in this proceeding

by attorney Adam G. Mote, whose address is: 255 California Street, Suite 1300, San Francisco, CA 94111. 3. On or about October 11, 2010, the Board of Registered Nursing issued Registered

Nursing License No. 785263 to Rachel Elizabeth Zucco (Respondent). The Registered Nursing License was in full force and effect at all times relevant to the charges brought in Accusation No. 2012549 and will expire on July 31, 2014, unless renewed. JURISDICTION 4. AccusationNo. 2012.549 was Bled 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 March 15, .2012. Respondent timely Bled her Notibe of Defense contesting the Accusation. 5. A copy of Accusation No. 2012-549 is attached as exhibit A and incorporated herein

by reference. ADVISEMENT AND WArVERS 6. Respondent has carefully read, fully discussed with counsel, and understands the

charges and allegations in Accusation No. 2012-549. Respondent has also carefully read, fully discussed with counsel, and understands the effects of this Stipulated Settlement and Disciplinary Order. 7. Respondent is fully aware of her legal rights in this matter, including the right to a

hearing cai the charges andallegations iia the Acousation; the right to be represented by coiMiel 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 decisien.;..and all other rights accorded by the California

22 23 24 25

26 : Administrative Procedure Act and other applicable laws. 27 28 8. Respondent voluntarily, knowingly, arid intelligently waives and gives up each and

every right set forth above: 2

KTPTILATED SETTLEMENT (2012-549)

1 2 3 4 5 6 7 8 9 10 11 12 13 9.

CULPABILITY Respondent admits the truth of each and every charge and allegation in Accusation .

No, 2012-549. 10. Respondent agrees that her Registered Nursing License is subject to discipline and she agrees to be bound by the Board's probationary terms as set forth in the Disciplinary Order below. CIRCUMSTANCES IN MITIGATION 11. Respondent Rachel Elizabeth Zucco has never been the subject of any disciplinary action.' She is admitting responsibility at an early stage in the proceedings. CONTINGENCY 12. This stiptilation 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

. 14 settlement, without notice to or participation by Respondent or her counsel. By signing the 15 16 17 18 19 20 21 22 23 24 25 26 27 28

STIP A.T1 SETTLEMENT (2012-549).

stipulation, Respondent understands and agrees that she may not withdraw her agreement or seek torescincl 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 considered this matter, 11 The parties understand and agree thaffacsinii16 coPies of this Stipulated Settlement and Disciplinary Order, including facsimile signatures thereto, shall have the same force and effect as the originals, 14, This Stipulated Settlement and Disciplinary Order is intended by the parties to be an

integrated writing representing the complete, final, and exclusive embodiment of their agreement. It supersedes any and all prior or contemporaneous agreements, understandings, discussions, negotiations, and commitments (written or oral). This Stipulated Settlement and Disciplinary

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
20

Order may not be altered, amended, modified, supplemented, or otherwise changed except by a writing executed by an authorized representative of each of the parties. 15. In consideration of the foregoing admissions and stipulations, the parties agree that

the Board may, without further notice or formal proceeding, issue and enter the following Disciplinary Order DISCIPLINARY ORDER IT IS HEREBY 'ORDERED that Registered Nursing License No. 785263 issued to Respondent Rachel Elizabeth Zucco(Respondent) is revoked. However, the revocation is stayed and. Respondent is 'placed on probation for three (3) years on the following terms and conditions-. Severability Clause. Each condition of probation contained herein is a separate and distinct condition. If any condition of this Order, or any application thereof, is declared unenforceable in whole, in part, or to any extent, the remainder of this Order, and all other applications thereof, shall not be affected. Each condition of this Order shall separately be valid and enforceable to the fullest extent permitted by law. 1. Obey An Laws. Respondent shall obey all federal, state and local laws. A full and

detailed account of any and all violations of law shall be reported by Respondent to the Board in writing within seventy-two (72) hours of occurrence. To permit monitoring of compliance with this condition, Respondent shall submit completed fingerprint fauns and fingerprint fees within 45 days of the effective date of the decision, unless previously submitted as part of the licensure application process.
Yv

21 22 23 24 25
26

Criminal Cotirt OiderS: if Respondent is iindei crinainat Court orders, including probation or parole, and the order is 'violated, this shall be deemed a violation of these probation conditions, and may result in the filing of an accusation and/or petition to revoke 'probation. 2. ' Comply with the Board's Probation Program. RespOndent shall fully comply with the conditions of the ProbatiorrProgram established by the Board and cooperate with repreSentatives of the Board in its monitoring and investigation of the Respondent's compliance with the Board's Probation Program. ReSpondent shall inform. the Board in writing within no more than 15 days of any address change and shall at all times maintain an active, current license 4
STIPULATED SEE. MEMENT (2012-549)

27 28

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

status with the Board, including during any period of suspension. Upon successful completion of probation, Respondent's license shall be fully restored. 3. Report in Person. Respondent, during the period of probation, shall appear in

person at interviews/meetings as directed by the Board or its designated representatives, 4. Residency, Practice, or Licensure Outside of State. Periods of residency or

practice as a registered nurse outside of California shall not apply toward a reduction of this probation time period. Respondent's probation is tolled, if and when she resides outside of California. Respondent must provide written notice to the Board within 15 days of any change of residency or practice outside the state, and within 30 days prior to re-establishing residency or returning to practice in this state. Respondent shall provide a list of all states and territories where she has ever been licensed as a registered nurse, vocational nurse, or practical nurse. Respondent shall further provide information regarding the status of each license and any changes in such license status during the term of probation. Respondent shall inform the Board if she applies for or obtain a new nursing license during the term of probation. 5. Submit Written Reports. Respondent, during the period of probation, shall submit

or cause to be submitted such written reports/declarations and verification of actions under penalty of perjury, as required by the Board. These reports/declarations shall contain statements relative to Respondent's compliance with all the conditions of the Board's Probation Program. Respondent shall immediately execute all release of information forms as may be required by the Board or its representatives. Respondent shall provide a copy of this Decision to the nursing regulatory agency in: every state and territory in which she has a registered nurse license. 6. Function as a Registered Nurse. Respondent, during the period of probation, shall

engage in the practice of registered.nursing in California for a minimum of 24 hours per week for 6 consecutive months 'or as determined by the Board. . For purposes of compliance with the section, "engage in the practice of registered nursing" may include, when approved by the Board, volunteer work as a registered nurse, or work in any 5
STIPULATED SETILE1sONT (2012-549)

non-direct patient care position that requires licensure as a registered nurse. 2 The Board may require that advanced practice nurses engage.in advanced practice nursing for a minimum of 24 hours per week for 6 consecutive months or as determined by the Board. 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 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 shall apply. 7. Employment Approval and Reporting Requirements. Respondent shall obtain

prior approval from the Board before commencing or continuing airy employment, paid or voluntary, as a registered nurse, Respondent shall cause to be submitted to the Board all performance evaluations and other employment related reports as a registered nurse upon request of the Board. Respondent shall provide a copy of this Decision to her employer and immediate

supervisors prior to commencement of any nursing or other health care related employment. In addition to the 'above, Respondent shall notify the Board in writing within seventy-two (72) hours after she obtains any nursing or other health care related employment. Respondent shall notify the Board in writing within seventy-two (72) hours after she is terminated or separated, regardless of cause, from any nursing, or other health ca.r.e.related employmenteccdtbea__ . . . . full explanation of the circumstances surrounding the termination or separation, 8. Supervision. Respondent shall obtain prior approval from the Board regarding

21 22 23 24 25 26 27 28

Respondent's level of supervision and/or collaboration before commencing or continuing any employment as a registered nurse, or education and train g that includes'patient care. Respondent shall practice only under the direct supervision of a registered nurse in good standing (no current discipline) with the Board of Registered Nursing, unless alternative methods of supervision and/or collaboration (e.g., with an advanced practice nurse or physician) are approved. 6
STIPULATED SETtLEMENT (2012-549)

Respondent's level of supervision and/or collaboration may include, but is not limited to the

2 following: 3 4 5 6 7 g 9 10 11 12 13 14 is 16 17 18 19 (a) Maximum - The individual providing supervision and/or collaboration is present in the patient care area or in any other work setting at all times. (b) .Moderate - The individual providing supervision and/or collaboration is in the patient care unit or in any other work setting at least half the hours Respondent works. (c) Minimum - The individual providing supervision and/or collaboration has person-toperson communication with Respondent at least twice during each shift worked. (d) Home Health Care - If Respondent is approved to work in the home health care setting, the individual providing supervision and/or collaboration shall have person-to-person communication with Respondent as required by the Board each work day. Respondent shall maintain telephone or other telecommunication contact with the individual providing supervision and/or collaboration as required by the Board during each work day. The individual providing supervision and/or collaboration shall conduct, as required by the Board, periodic, on-site visits to patients' homes visited by Respondent with or without Respondent present. 9.. Employment Limitations. Respondent shall not work for a nurse's registry, in any private duty position as a registered nurse, atemporary nurse placement agency, a traVeling nurse, or for an it-house nursing pool. Respondent shall not work for a licensed home health agency as a visiting nurse unless the registered nursing supervision. and other protections.for home visits,have heemapproy,ed.by_the____ 21 22 23 24 25 26 27 28 Board. Respondent shall not work in any other registered nursing occupation where home visits are required. Respondent shall not work in any health care setting as a supervisor of registered nurses. The Board may additionally restrict Respondent from supervising licensed vocational nurses . and/or unlicensed assistive personnel on a case-by-case basis. Respondent shall not work as a facility rrieinber in an approved school of nursing or as an instructor in a Board approved continuing education program, Respondent shall work only on. a regularly assigned, identified and predetermined 7
STIPULATED SETTLEMENT (2012-549)

worksite(s) and shill not Work in a float capacity. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 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 fox its records. 11. 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 $1,572.50 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 couiply 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 heating in order to comply withthis condition. During the one year extension, all original. conditions. of probation-21 22 23 24 25 26 27 28 will apply, 12, Violation of Probation. If Respondent violates the conditions of her piobation, the

Board after giving Respondent notice and an opportunity to be heard, may set aside the stay order and impose the stayed discipline (revocation/suspension) of Respondent's license. If during the period of probation, an accusation or petition to revoke probation has' been filed against Respondent's license or the Attorney General's Office has been requested to prepare an accusation or petition to revoke probation against Respondent's license, the probationary period shall automatically be extended and shall not expire until the accusation or petition has 8
STIPULATED SETTLEMENT (2012-549)

1 2 3 4 5 6 7 g 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

been acted upon by the Board. 13. License Surrender. During Respondent's term of probation, if she ceases practicing due to retirement, health reasons or is otherwise unable to satisfy the conditions of probation, Respondent may surrender her license to the Board. The Board reserves the right to evaluate Respondent's request and to exercise its discretion whether to grant the request, or to take any other action deemed appropriate and reasonable under the circumstances, without further hearing. Upon formal acceptance of the tendered license and wall certificate, Respondent will no longer be subject to the conditions of probation. Surrender of Respondent's license shall be considered a disciplinary action and shall become a part of Respondent's license history with the Board. A registered nurse whose license has been surrendered may petition the Board for reinstatement no sooner than the following minimum periods from the effective date of the disciplinary decision: (1) Two years for reinstatement of a license that was surrendered for any reason other

than a mental. or physical illness; or (2) One year for a license surrendered for a mental or physical illness.

14, Physical Examination. Within 45 days of the effective date of this Decision, Respondent, at her'expense, shall have a licensed physician, nurse practitioner, or physician assistant, who is approved by the Board before the assessment is performed, submit an assessment of the Respondent's physical condition.and capability to perform the duties of a. registered nurse. Such an assessment shall be submitted in a formal; aceptaale to tho.Bmd,...IL____ . medically determined, a recommended treatment program will be instituted and followed by the Respondent with the physician, nurse practitioner, or physician assistant providing written reports to the Board on forms provided by the Board. If Respondent is determined to be unable to practice safely as a registered nurse, the licensed physician, nurse practitioner, or physician assistant making this determination shall immediately notify the Board and Respondent by telephone, and the Board shall requeSt that the Attorney General's office prepare an accusation or petition to revoke probation. Respondent shall immediately cease practice and shall not resume practice until notified by the Board. During this

STWOLATED SE MEMENT (2012-549)

period of suspension, Respondent shall not engage in any practice for which a license issued by 2 3 4 .5 6 7 8 9
. 10

the Board is required until the Board has notified Respondent that a medical determination permits Respondent to resume practice. This period of suspension will not apply to the reduction of this probationary time period. If Respondent fails to have the above assessment submitted to the Board within the 45-day requirement; Respondent Shall immediately cease practice and shall not resume practice until notified by the Board'. This period of suspension will not apply to the reduction of this probationary time period. The Board may waive or postpone this suspension only if significant, , documented evidence of mitigation is provided: Such evidence must establish good faith efforts by Respondent to obtain the assessment, and a specific date for compliance must be provided. Only one such waiver or extension may be permitted. 15. Participate in Treatment/Rehabilitation Program for Chemical Dependence.

11 12 13 14 15 16 17 18 19

Respondent, at her expense, shall sticeessfully complete during the probationary period or shall .have successfully completed prior to commencement of probation a Board-approved treatment/rehabilitation program of at least six months duration. As required, reports shall be submitted by the program on forms provided by the Board. If Respondent has not completed a Board-approved treatment/rehabilitation program prior to commencement of probation, Respondent, within 45 days from the effective date of thedecision, shall be enrolled in a.program. If a program is not successitily completed within the first nine months of probation, the Board shall consider Respondent in. violation of probation. ..

21 22 23 24 25
26

Based on Board recommendation, each week Respondent shall be required to attend at least one, but no more than five 12-step recovery meetings or equivalent (e:g., Narcotics Anonymous, Alcoholics Anonymous, etc.) and a nurse support group as approved and directed by the Board. If a nurse support group is not available, an additional 12-step meeting or equivalent shall be added.. Respondent shall submit dated and signed documentation confirming such attendance to the Board during the entire period of probation. Respondent shall continue with the recovery plan recommended by the treatment/rehabilitation program or a licensed mental' health examiner and/or other ongoing recovery groups. 10
STIPULATED SETTLEMENT (2012-549)

27 28

1.

16. Abstain from Use of Psychottopie (Mood-Altering) Drugs. Respondent shall completely abstain from the possession, injection or consumption by any route of all controlled substances and all psychotropic (mood altering) drugs, including alcohol, except when the same are ordered by a healt,h care professional legally authorized to do so as part of documented ' medical treatment. Respondent shall have sent-to the Board, in writing and within fourteen (14) days, by the prescribing health professional, a report identifying the medication, dosage, the date the medication was prescribed, the Respondent's prognosis, the date the medication will no longer be required, and the effect on the recovery plan, if appropriate. Respondent shall identify for the Board a single physician, nurse practitioner or physician assistant who shall be aware of Respondent's history of substance abuse and will coordinate and monitor any prescriptions for Respondent for dangerous drugs, controlled substances or moodaltering drugs. The coordinating physician, nurse practitioner, or physician assistant shall report to the Board,on a quarterly basis Respondent's compliance with this condition. If any substances considered addictive have been prescribed, the report shall identify a program for the time limited use of any such substances. The Board may require the single coordinating physician, nurse practitioner, or physician assistant to be a specialist in addictive medicine, or to consult with a specialist in addictive. medicine, 17. Submit to Tests and Samples. Respondent, at her expense, shall participate in a random, biological fluid testing ota drug screening program. whicbetbe_aeard appeoye,,s,.:The

2 3 4 5 6 7 S 9. 10 11 12 13 14 15 16
, 17

18 19

21 22 23 24 25 26 27 28

length of time and frequency will be subject to approval by the Board. Respondent is responsible for keeping the Board informed of Respondent's current telephone number at all times. Respondent shall also ensure that messages may be left at the telephone number when she is not 'available and ensure that repOrts are submitted directly by the testing agency to the-Board, as directed. Any confirmed positive finding shall be reported immediately to the Board by the program and Respondent shall be considered in violation of probation. In addition, Respondent, at-any time during the period of probation, shall fully cooperate with the Board or any of its representatives, and shall, when requested, submit to such tests and 11
STWtJLATED SE i LENIENT (2012-549)

1 2 3 4
5 6

samples as the Board or its representatives may require for the detection of alcohol, narcotics, hypnotics, dangerous drugs, or other controlled substances. If Respondent has a positive drug screen for any substance not legally authorized and not reported to the coordinating physician, nurse practitioner, or physician assistant, and the Board files a petition to revoke probation or an accusation, the Board may suspend Respondent from practice pending the final decision on the petition to revoke probation or the accusation. This period of suspension will not apply to the reduction of this probationary time period. If Respondent fails to participate in a random, biological fluid testing or drug screepirtg 'program within the specified time frame, Respondent shall innriediately cease practice and shall not resume practice until notified by the Board. After taking into account documented evidence of mitigation, if the Board files a petition to revoke probation or an accusation, the Board may suspend Respondent from practice pending the final decision on the petition to revoke probation or the accusation. This period of suspension will not apply to the reduction. of this probationary time period.. 18. Mental Health Examination. Respondent shall, within 45 days of the effective date

7 8 9 10 11 '12 13 14 15 16

of this Decision, have a mental health' examination including pSychological testing as appropriate to determine her capability to perform the duties of a registered nurse. The examination will be

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performed by a psychiatrist, psychologist or other licensed mental health practitioner approved by the Board. The examining mental health practitioner will submit a written report of that assessment and recommendations to the Board... All costs' are the responsibility.ofRespondent Recommendations for treatment, therapy or counseling made as a result of the mental health examination will be instituted and followed by Respondent. If Respondent is determined to be unable to practice safely as a registered nurse, the licensed mental health care practitioner making this determination shall immediately notify the I3oard and Respondent by telephone, and the Board,shall request that the Attorney General's office prepare an accusation or petition to revoke probation. Respondent shall immediately Cease practice and may not resume practice until notified by the Board. During this period of suspension, Respondent shall not engage in any practice for which a license issued by the Board 12
STIPULATED SETTLEMENT (2012-549)

1* /27/ 2012 15:53

707E227727

ARCATA rizotv OFFICE

1$ required, until the Board has notified Respondent that a mental health det.ertnination permits

2 3 4 5 6 7 8 9

Respondent to resume practice. This period of suspension will not apply to the Tedu4tion of ithi$ probationary time period. If Respondent fails to have the above assessment submitted to the Board within The 45-day requirement, Respondent shall immediately cease practice and AO not resume practice until notified by the Board. This period of suspension will not apply to the reduction of this probationary time period. The Board may waive or postpone this suspensioz onIrif significant, documented evidence of mitigation is provided. Such evidence must establish-good faith efforts by Respondent to obtain the assessment, end a specific date for eomplianoc must bo provided.

1,0 Only one such waiver otextension may be permitted. I 12 13 14 15 16 1,7 1.8 19 20 19. Therapy or Counseling Program. Respondent, at he expense, shall participate in an on-going counseling program until such time as the Board releases her h'om this requirement and only upon the mcommondation of the counselor. Written progress reports from tire counselor will be requited at various intervals. ACPEPTA.iile!
I have carefully read the above Stipulated. Settlement and Disciplinary Order and have fully

discussed it with my attorney, Adam G. SIoto. I understand the stipulation and the effect it will have on my Registered Nursing License. I enter into this Stipulated Settlement and Disciplinary . Order voluntarily, knowingly, and intelligently, and agree to be bound by the Decision and Order of the Board of Registered Nursing,

s_zsa, 22 DATa): Lazar:

23 24 25 RAcatb, 4tAzoEla Respondent I have readand fully discussed with Respondent Rachel Elizabeth Zucoo the terms and conditions and other matters contaiacd.in the above Stipulated Settlement and Disciplinary Order. I approve its form and contaystn.,dbymor:"G:slo?'. ' 2 DAM:, 25
OF cnnAnnm G.Siom tn,Siate Links, au. efripa.adarn@Siote$15W.scaro:45;',...,,, 'n.14',WIZO:MM Ik3447'05 G_WOW Ai

Morney for Respondent.

3

smuLATSD SE'rrLEIvIENT (2012449)

1 2 3 4 5 6 7 8 9 10 11 12 HAR SACF1SON Deputy Attorney General Attorneys for Complainant Dated: 7,9(ttRespectfully submitted, KAK4ALA D. HARius Attorney General of California FRANK H. PACOE Supervising Deputy Attorney General ENDORSEMENT The foregoing Stipulated Settlement and Disciplinary Order is hereby respectfully submitted for consideration by the Board of Registered Nursing of the Department of Consumer Affairs.

14 15 16 17 18 19 -20 21 22 23 24 25 26 27 28 14 STIPULATED SETTLEMENT (2012449) SF2012401499 40560969.doe.

Exhibit A
Accusation No: '2012,649

1 2 3 4 5 6

KAMALA D. HARRIS

Attorney General of California FRANK H. PACOE Supervising Deputy Attorney General ' CITAR SA.CHSON Deputy Attorney. General State Bar No. 161032 455 Golden Gate Avenue, Suite 11000 San Francisco, CA 94102-7004 Telephone: (415) 703-5558 Facsimile: (415) 703-5480 Attorneys for Complainant BEFORE THE BOARD OF REGISTERED NURSING DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA

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In the Matter of the Accusation Against: RACHEL ELIZABETH ZUCCO 1387 1/2 Sunset Ave. Arcata, CA 95521 Registered Nursing License No. 785263 Respondent.

Case No. 9o1.2. 5Cfci ACCUSATION

Complainant alleges: PARTIES 1. Louise R. Bailey, M.Ed., RN (Complainant) brings this Accusation solely in her

official capacity as the Interim Executive Officer of the Board of Registered Nursing, Department of ConsumerAffairs: 2. On or about October 11, 2010, the Board of Registered Nursing issued Registered.

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Nursing License Number 785263 to Rachel Elizabeth Zucco (Respondent). The Registered Nursing License was in full force and effect at all times relevant to the charges brought herein and will expire on July 31, 2012, unless renewed. JURISDICTION 3. This Accusation is brought before the Board of Registered Nursing (Board),

Department of Consumer Affairs, under the authority of the following laws. All section 1 Accusation

1 2 3 4

references are to the Business and Professions Code unless otherwise indicated. 4. Section 2750 of the Business and Professions Code ("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 7

5.

Section 2761 of the Code states:

'The board may take disciplinary action against a certified or licensed nurse or deny an

8, application for acertificate or license for any of the following: 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Section 2762 of the Code states: "in addition to other acts constituting unprofessional conduct within the meaning of this chapter [the Nursing Practide ActJ, it is unprofessional conduct for a person licensed under this chapter to do any of the following: "(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 himself or herself, or furnish or administerto. another, any controlled: substance as defined in Division 10 (comroeneingwith Section 11000) of the Health and Safety Code or any dangerous drug or.dangerous device as defined in Section 4022. "(b) Use any controlled substance as defined hi Division 10 (commencing with Section 11,000) of the Health and. Safety Cede, or any dangerous drug or dangerous device as defined in Section 4022, or alcoholic beverages, to an extent or 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 the public the practice authorized by his or her license. 2
Accusation

"(a) Unprofessional conduct, which includes, but is not limited to, the following: ,. "(1) Conviction of a felony or of any offense substantially related to the qualifications,

functions, and duties of a registered nurse, in which event the record of the conviction shall be conclusive evidence thereof.
I'

1 2 3 4 5 6
7

"(c) Be convicted of a criminal offense involving the prescription, consumption, or self-administration of any of the substances described in subdivisions (a) and (b) of this section, or the possession of; or falsification of a record pertaining to, the' substances' described in subdivision (a) of this section, in which. event the record of the conviction is concluSive evidence thereof "(d) Be committed or 'confined by a court of competent jurisdiction for intemperate use of or addiction to the use of any of the substances described in subdivisions (a) and (b) of this section, in which event the court order of commitment or confinement is prima facie evidence of such commitment or confinement. "(e) Falsify, or make grossly incorrect, grossly inconsistent, or unintelligible entries in any hodpital, patient, or other record pertaining to the substances described in subdivision (a) of this section." 7. Section 490 of the Code,provides, in pertinent part, that a board may suspend or

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15

revoke a license on the ground that the licensee has been convicted of a crime substantially related to the qualifications, functions, or duties of the business or profession for which the license was issued. 8. Section 2764 of the Code provides, in pertinent part, that the expiration of a license

16 17 18 19 20 21 22 23 24 .25 26 27 `28

shall not deprive the Board of jurisdiction to proceed with a disciplinary proceeding against the licensee or to render a decision imposing discipline on the license. 9: Section 118, subdivision (b), of the Code provides that the expiration of a license

shall not deprive-the Board of jurisdiction. to proceed with a disciplinary action during the period within which the license may be renewed, restored, reissued or reinstated. COST RECOVERY 10, Section 125.3 of the Code provides, in pertinent part, that the Board may request the

administrative law judge to direct a licentiate found to have committed a violation or violations of the licensing act to pay a sum not to exceed the reasonable costs of the investigation and enforcement of the case:

3
Acckisation

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FIRST CAUSE FOR DISCIPLINE (CRIIVIENAL CONVICTION) 11. Respondent is subject to disciplinary action under sections 2761(a), 2761(f), 2.762(c), and/or 490 in that on or about August 23, 2011, in a criminal proceeding entitled The People of the State of California 1). Rachel Elizabeth ace. in Humboldt County Superior Court, Case Number CR1101797, Respondent was convicted by her plea of no contest of violating Vehicle Code section 23152(a) (driving while under the influence of alcohol). Respondent was sentenced to probation for three years, seven days jail time, ordered to complete a First Offender Program, and ordered to pay fines in the amount of $1,911.00. The circumstances of the conviction are that on or about March 25, 2011 on Highway 101 in Eureka, California, Respondent ran off the road and crashed her vehicle into a sign post.. She had a strong smell of alcohol about her person, had difficulty walking, failed field sobriety tests and refused blood'alcohol testing. Respondent did not have a California driver's license. SECOND CAUSE FOR DISCIPLINE (USING ALCOHOL IN A MANNER DANGEROUS TO SELF OR OTHERS) 12. Respondent is subject to disciplinary action under section 2762(b) in that on or about March 25, 2011 on Highway 101 in Eureka, California, Respondent ran off the road and crashed her vehicle into a sign post. She had a strong smell of alcohol about her person, had difficulty walking, failed field sobriety tests and refused blood alcohol testing. Respondent did not have a California driver's license. -- 13: Respondent is further subject to disciplinary'action under section2762(b), in that on or about January 9, 2011, she was found passed out in her vehicle on Old Arcata Road in Eureka, California. A Good Samaritan called 911 when he was unable to rouse her. Police' arrived, roused her, and noted that Respondent had a strong odor of alcohol about her. The vehicle's engine was running and the windshield wipers were on. Respondent failed field sobriety tests. Her blood alcohol level was .25%. 11/ /// 4
Accusation

PRAYER 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
52012441499 40540572,doo

WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged, and that following the hearing, the Board of Registered Nursing'issue a decision: 1. Revoking or suspending Regiitered Nursing License Number 785263, issued to Rachel Elizabeth Zucco; 2. Ordering Rachel Elizabeth. Zucco to pay the Board of Registered Nursing the reasonable costs of the investigation and enforcement of this case, pursuant to Business and Professions Code section 125.3; 3. Taking such other and further action as deemed necessary and proper.

DATED:

...kk0.1.41.-iA,-

LOUISE R. BAILEY, M.ED., RN Interim Executive Officer Board of Registered Nursing Department of Consumer Affairs State of California Complainant

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Accusation