Before the

Administrative Hearing Commission

State of Missouri

STATE BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) No. 10-2101 BN

)

STEPHANIE BURCHFIELD, )

)

Respondent. )

DECISION

We find cause to discipline Stephanie Burchfield for misappropriating a controlled substance from the medical facility where she worked in Florida and because the Florida State Board of Nursing (“the Florida Board”) reprimanded her registered professional nurse license for this conduct.

Procedure

On November 5, 2010, the State Board of Nursing (“the Board”) filed a complaint. After numerous attempts to obtain service of our notice of complaint/notice of hearing, service by publication was authorized and completed on December 25, 2011. We held the hearing on

May 4, 2012, as scheduled in the notice of hearing. Angela S. Marmion represented the Board. Neither Burchfield nor anyone representing her appeared.

The Board relies on uncertified copies of documents relating to the Florida Board’s disciplinary proceedings against Burchfield. These are hearsay, and lack even the imprimatur of reliability conferred by a state agency’s certification. Nevertheless, where no objection is made, hearsay evidence in the records can and must be considered in administrative hearings.[1] Burchfield did not appear at the hearing and accordingly made no objection to the documents. Therefore, we have relied on their contents to make our findings of fact, which are undisputed.

Findings of Fact

  1. The Board licensed Burchfield as a registered professional nurse (“RN”). Burchfield’s license was current and active at all times relevant to this case, but lapsed on April 30, 2011. Burchfield also held a license as an RN in the state of Florida.
  2. While in Florida, Burchfield was employed by Supplemental Health Care, a staffing agency that assigns nurses to work at health care facilities. On August 28, 2008,[2] Burchfield was assigned to work at Capital Regional Medical Center (“Capital”) in Tallahassee, Florida. On that day, the following occurred:
  3. G.G. was a patient at Capital. She did not have a physician’s order for Demerol. G.G. was discharged from Capital at 10:00 a.m.
  4. At 10:13 a.m. Burchfield removed four vials of 50 mg Demerol, ostensibly for G.G.
  5. At 11:24 a.m. Burchfield removed four vials of 50 mg Demerol, ostensibly for G.G.
  6. At 1:37 p.m. Burchfield removed two vials of 75 mg Demerol, ostensibly for G.G.
  7. Burchfield failed to document the administration or wasting of all of the above amounts of Demerol.
  1. C.Y.M. was a patient at Capital. She did not have a physician’s order for Demerol. C.Y.M. was discharged from Capital at 3:05 p.m.
  2. At 3:21 p.m. Burchfield removed four vials of 50 mg Demerol, ostensibly for C.Y.M.
  3. At 5:21 p.m., Burchfield removed four vials of 50 mg Demerol, ostensibly for C.Y.M.
  4. At 5:55 p.m., Burchfield removed one vial of 75 mg Demerol, ostensibly for C.Y.M.
  5. Burchfield failed to document the administration or wasting of all of the above amounts of Demerol.
  6. T.G. was a patient at Capital. She did not have a physician’s order for Demerol. T.G. was discharged from Capital at 9:15 a.m.
  7. At 9:55 a.m., Burchfield removed one vial of 75 mg Demerol, ostensibly for T.G.
  8. Burchfield failed to document the administration or wasting of the Demerol.
  9. R.P. was a patient at Capital. He did not have a physician’s order for Demerol. R.P. was discharged from Capital at 4:00 p.m.
  10. At 5:54 p.m., Burchfield removed two vials of 75 mg Demerol, ostensibly for R.P.
  11. Burchfield failed to document the administration or wasting of the Demerol.

4. On January 11, 2010, the Florida Board entered a final order in which it reprimanded Burchfield’s nursing license.[3] The Florida Board’s disciplinary action was based on Burchfield’s conduct at Capital on August 28, 2008.

5. Demerol is the brand name for meperidine.[4] It is a controlled substance in Missouri[5] and in Florida.[6]

Conclusions of Law

We have jurisdiction to hear the case.[7] The Board has the burden of proving that Burchfield has committed an act for which the law allows discipline.[8] The Board alleges that there is cause for discipline under § 335.066:

2. The board may cause a complaint to be filed with the administrative hearing commission as provided by chapter 621 against any holder 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 of 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, 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 335.096;

* * *

(8) Disciplinary action against the holder of a license or other right to practice any profession regulated by sections 335.011 to 335.096 granted by another state, territory, federal agency or country upon grounds for which revocation or suspension is authorized in this state;

* * *

(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[.]

Controlled Substances – Subdivisions (1) and (14)

Burchfield withdrew Demerol, a controlled substance, without administering it to patients or wasting it. Section 195.202 states:

Except as authorized by sections 195.005 to 195.425, it is unlawful for any person to possess or have under his control a controlled substance.

We infer that Burchfield unlawfully possessed the Demerol in violation of § 195.202. Such unlawful possession is cause to discipline her license pursuant to § 335.066.2(1) and (14).

Professional Standards – Subdivision (5)

The Board’s complaint alleges that there is cause to discipline Burchfield pursuant to

§ 335.066.2(5). The Board made no mention of this cause for discipline at the hearing, however, and made no argument for it.

Nonetheless, it is clear that Burchfield misappropriated controlled substances while she was employed as a nurse at Capital. Such conduct was willful, wrong, and inextricably bound up with her performance of her nursing duties. It is a manifest violation of professional standards that we would be remiss to ignore.

Misconduct means “the willful doing of an act with a wrongful intention[;] intentional wrongdoing.”[9] Misrepresentation is a falsehood or untruth made with the intent and purpose of deceit.[10] Dishonesty is a lack of integrity or a disposition to defraud or deceive.[11] Burchfield’s conduct at Capital – diverting Demerol by ostensibly withdrawing it for patients who would not receive it – evidenced all of the above. She is subject to discipline under § 335.066.2(5).

Professional Trust or Confidence – Subdivision (12)

Professional trust is the reliance on the special knowledge and skills that professional licensure evidences.[12] It may exist not only between the professional and his clients, but also between the professional and his employer and colleagues.[13] Patients and medical professionals who work with nurses must trust them to handle and administer controlled substances in a safe, lawful, and appropriate manner. Burchfield failed to do so. She is subject to discipline under

§ 335.066.2(12).

Other Disciplinary Action -- Subdivision (8)

Burchfield’s license was reprimanded by the Florida Board for her misappropriation of Demerol at Capital. We have already determined that such misappropriation is grounds for discipline in Missouri, and a reprimand is a “disciplinary action.”[14] We conclude that her license is subject to discipline under § 335.066.2(8).

Summary

We find cause to discipline Burchfield under § 335.066.2(1), (5), (8), (12), and (14).

SO ORDERED on June 8, 2012.

______

KAREN A. WINN

Commissioner

2

[1]Clark v. FAG Bearings Corp., 134 S.W.3d 730, 736 (Mo. App., S.D. 2004) (citing Dorman v. State Bd. of Regis’n for the Healing Arts, 62 S.W.3d 446 (Mo. App., W.D. 2001)).

[2] All subsequent events in this finding of fact took place on August 28, 2008.

[3] The Board’s complaint alleges that the Florida Board suspended Burchfield’s Florida license. The Florida disciplinary documents submitted by the Board indicate that the Florida Board reprimanded rather than suspended Burchfield’s license. Nonetheless, the complaint was adequate to put Burchfield on notice that the Florida Board’s action against her Florida license is the gravamen of the Board’s complaint against her Missouri license.

[4] PHYSICIANS’ DESK REFERENCE 2740 (ed. 2000); § 536.070(6). Statutory citations are to RSMo Supp. 2011, unless otherwise noted.

[5] Section 195.017.4(2)(p).

[6] Section 893.03(2), Florida Statutes.

[7]Section 621.045.

[8]Missouri Real Estate Comm’n v. Berger, 764 S.W.2d 706, 711 (Mo. App., E.D. 1989).

[9]Missouri Bd. for Arch’ts, Prof’l Eng’rs & Land Surv’rs v. Duncan, No. AR-84-0239 (Mo. Admin. Hearing Comm’n Nov. 15, 1985) at 125, aff’d, 744 S.W.2d 524 (Mo. App., E.D. 1988).

[10]MERRIAM-WEBSTER’S COLLEGIATE DICTIONARY 794 (11th ed. 2004).

[11]Id. at 359.

[12] Trieseler v. Helmbacher, 168 S.W.2d 1030, 1036 (Mo. 1943).

[13] Cooper v. Missouri Bd. of Pharmacy, 774 S.W.2d 501, 504(Mo. App., E.D. 1989).

[14] The term ‘disciplinary action’ . . . contemplates any censure, reprimand, suspension, denial, revocation, restriction or other limitation placed upon the license of a person[.]” Bhuket v. State ex rel. Missouri Bd. of Regis’n for the Healing Arts, 787 S.W.2d 882, 885 (Mo. App., W.D. 1990) (interpreting “disciplinary action” in

§ 334.100.2(8), RSMo Supp. 1984).