COMMONWEALTHOFMASSACHUSETIS
SUFFOLKCOUNTYBOARDOFREGISTRATIONINNURSING
IntheMatterof
JohnHandren
RNLicenseNo.177486
RN License Exp.Date3/1/161
DocketNo.NUR-2011-0265
FINALDECISIONORDER
I.ProceduralBackground
Pursuantto801CMR1.01(11) (c),onMay12,2014,theBoardofRegistrationinNursing("Board")issuedaTentative Decision("Tentative")intheabovereferencedcomplaintagainstRespondent'slicensetopracticeasaRegisteredNurse(RN)intheCommonwealth. TheBoard'swrittennoticeofthe TentativeDecisionadvisedtheRespondentthathehadthirty(30)dayswithinwhichtofilewrittenobjectionswiththeBoard'sAdministrative HearingsCounsel(AHC)andthatanyobjectionsfiledmustincludewrittenargumentinsupportoftheobjections. Further,thenoticeadvisedRespondentthataresponsetoanyobjectionsmustbe filedwithintwenty(20)daysofthereceiptoftheobjections.
Respondentfailedtofilewrittenobjectionswiththe Boardonorbeforethedeadline date.Hesubmitted alettertotheAHCdatedafterthedeadlinelinedateanddeliveredonedaylater,therefore,theBoardneednotrespondtosaid
1
TheBoardtakesadministrativenoticeofRespondent'scurrentrecordofstanding,which
indicatesthatRespondenthasrenewedhislicenseanditnowexpiresonMarch1,2016.
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NUR-2011-0265
2
objections.
ProsecutingCounseldidnotfileobjections totheTentative
Decision.
Consequently, the Board adopts the Tentative Decision in its entirety including all finding of Fact, Ruling of Law and determinations of the Credibility of witnesses.
The evidence in this case supports the conclusion that Respondent’s documentation of the destruction of discontinued controlled substances fell below accepted standards of nursing practice. Additionally, in this role as a Nurse Manger Respondent was responsible for implementing necessary measures to promote and manage the delivery of safe nursing care to patients. Respondent failed to fulfill his responsibilities as a Nurse Manger when he failed to practice in accordance with accepted standards of nursing practice. Respondent’s conduct undermines public confidence in the nursing profession and warrants disciplinary action to G.L.c 112 61 and 244 CMR 9.03
Inkeepingwithitsdutytopromote thepublichealth,Welfare,andsafety, theBoardissuesthefollowingorderaftercarefulconsiderationofthefactsandinformationpresentedintherecord.
BasedonitsFinalDecision,theBoardordersRespondent'sLicensetopracticeasaRegisteredNurseinMassachusetts, RNlicenseNo.177486,tobeplacedonSUSPENSIONforone(1)year,commencingwiththe
2
SeePatriciaDugganv.BoardofRegistrationinNursing,Memorandum ofDecisionandOrder
SJ-2010-0338.
3
SeeIntheMatterofSylviaKyazze,DocketNo.NUR-2010-0206,(2012)(Respondentadmitted
toalteringanentryinapatientrecord);seealso,IntheMatterofCherylThevenin,DocketN.LN-08-138(2012)(Respondentfailedtodocumenttheadministrationorwastageofanarcotic medicationinapatient'srecord).
Handren,J.2
NUR-2011-0265
dateofthisOrder.The.Respondent alsounderstandsandagreesthattheBoardwillstaythelicenseSUSPENSIONupontheEffectiveDateofthisOrderandimmediatelythereafter,hislicensewillbeonPROBATIONforaminimumofone
(1)year(StayedSuspensionandProbationaryPeriod)or(ProbationaryPeriod),
providedthat,theRespondentcontinuouslycomplieswithalloftherequirementsthataresetforthinthisOrder
DuringtheStayedSuspensionandProbationaryPeriod,theRespondentfurtheragreesthatheshallcomplywithallofthefollowingrequirementstotheBoard's
satisfaction:
a.Complywithalllawsandregulationsgoverningthepracticeofnursing,andnotengageinanycontinuedorfurtherconductsuchas failingtomaintainthesecurityofcontrolledsubstances,failingtoproperlydestroyanddocumentthedestructionofcontrolled substances,andfailingtoperformallobligationsandresponsibilitiesofanurseinamanagementrole.
b.Notifythe Boardinwritingwithinten(10)daysofeachchangein hisnameand/oraddress.
c.Timelyrenewhislicensetopracticenursing.
d.Maintainactiveemploymentinapositionthatrequiresanursinglicense,inasettingwheretheRespondentreceivesconsistent, on-sitesupervisionbyaqualifiedlicensednurse4,foraminimumaverageoftwenty(20)hoursperweekthroughouttheProbationaryPeriod. TheRespondentmaynotacceptanyhome
care,travelortemporarystaffingassignmentorotherpractice assignmentwhereconsistent,on-site.supervisionisnotinplace.
4TheRespondentmustreceivedirectsupervisionfromalicensednursewhomusthaveatleastone(1)yearofclinicalnursingpracticeexperience,noopencomplaints,nopastdisciplineofthenurse'slicense,andwhoisphysicallylocatedatalltimesin eachfacilityinwhichtheRespondentpracticesnursing.
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NUR-2011-0265
i.Within 30daysofthe Effective Date,theRespondentshallnotifytheBoard'sProbationMonitor inwritingiftheRespondentisnotemployedinaccordancewithfootnote4
above.
e.ReviewthisOrderwitheachofhisnursingsupervisors,andarrangeforeachnursingsupervisortosubmitdirectlytotheBoard:
i.acompletedandsigned"SupervisorVerificationForm"(Form1),providedwiththisOrder,withinthirty(30)daysof
(1)theEffectiveDateand
(2)anysubsequentemploymentcommencedduringtheProbationaryPeriod
ii.quarterlywrittenreports5
Usingthe"SupervisionReport
Form"(Form2)providedwiththisOrderattestingtothequalityoftheRespondent'snursingpractice,reliabilityandattendanceandspecificallyaddressingRespondent'smedicationadministrationanddocumentationincluding
anyerrorsandincidents6•
f.NotifytheBoard'sProbationMonitorinwritingwithinten(10)daysofanychangeintheRespondent'semploymentstatus,includingeachchangeinEmployer,eachresignationortermination,andthename,addressandtelephonenumberofeachnewEmployer.
5
TheRespondentisresponsibleforensuringthatthesereportsontherequiredformarereceived
bytheBoardcommencingninety(90)daysaftertheEffectiveDateandonthefirstdayofevery thirdmonththereafter.
6
TheBoardmaytakeactionunderparagraph7intheeventthatthereportsrevealapracticeissuewhichtheBoarddeemssignificant.
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NUR-2011-0265
g.Submitdocumentationthathehassuccessfullycompletedthefollowingcontinuingeducation7withinsixty(60)daysaftertheEffectiveDate,
i.Three(3)contacthoursinLegalandEthicalAspectsofNursingPractice;
ii.Three(3)contacthoursinCriticalThinkingandNursingJudgment;and
iii.Six(6)contacthoursinMedicationAdministrationandDocumentation.
If the Respondents fails to comply with this Order, including each condition of license probation, then the Board shall lift the stay of suspension, and Respondent’sLicenseshallthenbesuspendedforone(1)year.Respondent
maypetitiontheBoardinwritingforterminationofhislicensesuspension
("suspensiontermination")afterone(1)yearandatsuchtimeasheisabletoprovidedocumentationsatisfactorytotheBoardthatdemonstrateshisabilitytopracticenursinginasafeandcompetentmanner.
TheBoard'sapprovalofRespondent'ssuspensionterminationmay beconditionedupon,andimmediatelyfollowedby,probationofRespondent'snursinglicenseforaperiodofone(1)year,aswellasotherrestrictionsandrequirementsthattheBoardmaythendeterminearereasonablynecessaryinthebestinterestsofthepublichealth,safety,andwelfare.
TheBoardmaychoosetoterminatethesuspensionofRespondent'slicenseatthetimeofhispetition forsuspensionterminationiftheBoarddeterminesthatsuchsuspensionterminationisinthebestinterestsofthepublicatlarge.
7
These continuingeducationcoursesmustbeinaddition toanycontact hoursrequiredfor
Licenserenewal.Theymaybetakenashomestudyorascorrespondencecourse,providedthat
theymeettherequirementsofBoardRegulationsat244CMR5.00,ContinuingEducation.
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NUR-2011-0265
TheBoardvotedtoacceptthewithinFinalDecisionatitsmeetingheldonJuly9,2014,bythefollowingvote:Infavor:M.Seal,RN/NM,P.Gales,RN,K.Gehly,RN,S.Kelly,RN/NP,J.Killion,LPN,A.Peckham,RN,MSN,E.RichardRothmund,C.Simonian,PharmD,R.Ph.,S.Taylor,MSN,RN,C.Tebaldi,RN,MSOpposed:NoneAbstained:NoneAbsent:B.Levin,RN
TheBoardvotedtoacceptthewithinOrder atitsmeetingheldonJuly9,2014,bythe followingvote:Infavor:M.Seal,RN/NM, P.Gales,RN,K.Gehly,RN,S.Kelly,RN/NP,J.Killion,LPN,A.Peckham,RN,MSN,E.Richard
Rothmund,C. Simonian; PharmD, R.Ph STaylorMSN,RN, Tebaldi, RNMSNOpposed: NoneAbstained: NoneAbsent: B.Levin, RN
EFFECTIVEDATEOFORDER
ThisFinalDecisionandOrderbecomeseffectiveuponthetenth(10th)dayfrom thedateitisissued(see"DateIssued"below).
RIGHTTOAPPEAL
Respondentishereby notifiedofhisrighttoappealthisFinalDecisionandOrdertotheSupremeJudicialCourtpursuanttoG.L.c.112,§64withinthirtydaysof receiptof noticeofthisFinalDecisionandOrder.
DateIssued:July11.2014
BoardofRegistrationinNursing
Caron Robertson
CaronRobertsonMSN,RN
DeputyExecutiveDirector
Handren,J.6
NUR-2011-0265
.·,
•.
Noticeto:
ViaFirstClassMailandCertifiedMail
No.70140510000103751148
JohnHandren
ViaHandDelivery
EugeneLangner,ProsecutingCounsel
Maimoona Ahmad Hearings Counsel
Handren,J.7
NUR-2011-0265
COMMONWEALTHOFMASSACHUSETTS
SUFFOLKCOUNTYBOARDOFREGISTRATIONINNURSING
IntheMatter of
JohnHandren
RNLicenseNo.177486
RNLicenseExp.Date3/1/161
DocketNo.NUR-2011-0265
TENATATIVE DECISION
I.ProceduralBackground
OnAugust29,2012,theBoard·ofRegistrationinNursing("Board")issued anOrdertoShowCause("ShowCauseOrder")totheRespondent,JohnHandren,aRegisteredNurse("RN")licensedbytheBoard,LicenseNo.177486.TheShowCauseOrderdirectedRespondenttoshowcausewhyhislicensetopracticenursingshouldnotbesuspended, revokedorotherwisedisciplinedpursuanttoMassachusettsGeneralLaws("G.L.")Chapter112,§61and244CMR9.03,baseduponallegationsthathepracticednursingwhileimpairedand
failedtoproperlydocumentthedestructionofdiscontinuedcontrolled
substances
3
.OnSeptember26,2012,RespondentfiledananswertotheShow
CauseOrder("Answer"),denyingtheallegationsagainsthim.
1
TheBoardtakesadministrativenoticeofRespondent'scurrentrecordofstanding,whichindicatesthat
RespondenthasrenewedhislicenseanditnowexpiresonMarchI,2016.
2
PursuanttoROICMRl.Ol (11) (c),theBoardissuesthisTentativeDecisioninthefirstinstance.
1
ProsecutingCounselfailedtoallegediversionofcontrolledsubstancesintheOrdertoShowCause. At
thehearinginthismatter,ProsecutingCounselorallymovedto addanallegationofdiversionandthemotionwasdeniedbytheAHC.
.·
AformaladjudicatoryhearingwasheldonMay17,2013andMay22.2013,beforeAdministrativeHearingsCounsel("AHC")MaimoonaS.AhmadpursuanttoG.L.c.30Aand801CMR1.01etseq.ProsecutingCounselEugene
Langner,Esq.,appearedonbehalfoftheBoard.Respondentwaspresentand
appearedprose.
Atotaloftwenty-two(22)exhibitswereenteredintoevidenceatthehearing.Atthe closeofthehearing,the recordremainedopenuntilJuly17,
2013, for the filling of post-Hearing Briefs-(‘”Briefs”)-An-audiorecording·was
madeofthehearing.
II.Witnesses
Thefollowingwitnessestestifiedattheformaladjudicatoryhearing:
A.ProsecutionWitnesses
1.BridgetLynch,LowellHealthCareCenter
2.MarkO’Flaherty,KindredTransitionalCareRehabilitation
3.KevinGrant,CedarHillHealthCareCenter
4.Sandra McMahon, Senior Inspector, Department of Public Health, Drug Control Program
B.RespondentWitnesses
1.JohnHandren,Respondent
Ill.DocumentaryEvidence
Thefollowingexhibitswereenteredintotherecordatthehearing:Exhibit1:OrdertoShowCause,datedAugust29,2012.
Exhibit2:Respondent'sAnswertoOrdertoShowCause,dated
September26,2012.
2
Exhibit3:·Reportof Sandra McMahon, Senior Inspector, Departmentof Public Health, DrugControl Program,dated October 13, 2011
Exhibit4:DepartmentofPublicHealthDrugIncidentReportdated June 13,2011.
Exhibit5:NarcoticBookRecordforPatientA,March14-June6,
2009.
Exhibit6:NarcoticBookRecordforPatientB, March14- June30,2009.
Exhibit7:NarcoticBookRecordforPatientC,November19,2010.
Exhibit8:NarcoticBookRecordforPatientD,February4,2010.
Exhibit9:NarcoticBookRecordforPatientE,April23,2010.
Exhibit10:NarcoticBookRecordforPatientF,May18,2010.
Exhibit11:NarcoticBookRecordforPatientG,January19-February
19,2010.
Exhibit12:ControlledSubstanceDisposalRecord,datedJune1,2009.
Exhibit13:ControlledSubstanceDisposalRecord,datedJune24,
2009.
Exhibit14:ControlledSubstanceDisposalRecord,datedFebruary22,2010.
Exhibit15:ControlledSubstanceDisposalRecord,datedMay1,2011.
Exhibit16:StatementofKevinGrant,datedMarch27,2012.
Exhibit17:Respondent'sCurriculumVitae,undated.
Exhibit18:Respondent'sPerformanceAppraisal,datedFebruary10,2011.
Exhibit19:LetterfromJonathanRoss,M.D.,toattorneyJanetE.
Michael,RN,MS,JD,datedMarch26,2012.
Exhibit20:SeparationAgreementandGeneralRelease, datedMay20,2011.
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Exhibit21:SummaryofContentsofNarcoticBookRecordsandControlledSubstanceDisposalRecords,undated.
Exhibit22:CurriculumVitaeofSandraMcMahon,undated.
IV.FindingsofFact
TheBoardfindsthefollowingfactsestablishedbyapreponderanceoftheevidence. Mattersnotspecificallyaddressedinthesefindingsdonotjustifya
changeinresult.
PreliminaryFinding
1.OnoraboutOctober1,1986,theBoardissuedtotheRespondentalicensetoengageinthepracticeofnursingasaRegisteredNurse("RN")intheCommonwealthofMassachusetts. TheRespondent'slicenseiscurrentandwillexpireonMarch1,2016,unlessrenewed. (Respondent'scurrentrecordof
standingofwhichtheBoardtakesadministrativenotice)
2.FromSeptember2008toMay2011,theRespondentwasemployedastheDirectorofNursingServicesatLowellHealthCareCenterinLowell, Massachusetts,initiallyasacontractemployeeandthenasapermanent employeeofthefacility. LowellHealthCareCenterisaspecializedlong-termcarefacility,focusingontraumaticbraininjuryandneurologicalbraindisorders.
(Exhibit3,TestimonyofLynch,Flaherty,Respondent)
3.AstheDirectorofNursingServices,RespondentwasresponsibleforthedaytodaycoordinationandoversightofallaspectsoftheNursingDepartment.His dutiesincludedmanagingandtrainingnursingstaff,resolvingidentifiedresidentcareandservicesconcerns,conductingrounds,ensuringadequate
Staffing,advisingonstrategyregardingtheoperationsoftheNursingDepartmentandgenerallyoverseeingtheNursingDepartmentasawhole.(Exhibit18,TestimonyofRespondent,Lynch,O'Flaherty)
4.BridgetLynch(Ms. Lynch)isthecurrentDirectorofNursingServicesatLowellHealthCareCenter.Shebecamethe DirectorofNursingServicesinJanuaryof2013.Atthetimeoftheincidentsthatarethesubjectofthisproceeding,shewastheAssistantDirectorofNursingServicesatLowellHealth
CareCenter.(Testimony-of-lynch)
5.MarkO'Flaherty("Mr.O'Flaherty")istheExecutiveDirectoratKindredTransitionalCareRehabilitation. Priortothat,fromNovember2002toNovember2012,hewastheAdministratoratLowellHealthCareCenterandRespondent'sdirectsupervisor. (TestimonyofO'Flaherty)
6.KevinGrant ("Mr.Grant") istheDirectorof FoodServicesatCedar HillHealthCareCenter. Priortothat,fromJune2006toOctober2011,hewastheDirectorofFoodServices atLowellHealthCareCenter. (TestimonyofGrant)
PracticingNursingWhileImpaired
7.DuringtheperiodbetweenJanuaryandMayof2011,Ms.LynchandMr.O'FlahertybothnoticedadeclineinRespondent'sworkperformance. (TestimonyofLynch,O'Flaherty)
8.Ms.Lynch testifiedthatsheandtheRespondentinitiallyhadaproductiveworkingrelationshipbutinJanuaryof2011shebegan tohaveconcernsaboutRespondent'sjudgmentandalertness. Onmorethanacoupleofoccasions,she
5
observedtheRespondentnoddingoffat hisdeskwithhiseyes closedandhisheadbobbingupanddown.(TestimonyofLynch)
9.Ms.LynchsharedanofficewiththeRespondentfromJanuaryof2011toAprilof2011whileherownofficewasbeingrenovated. ItwasduringthisperiodthatsheobservedtheRespondentnoddingoffathisdesk.(TestimonyofLynch)
10.Inaddition,Ms.LynchnoticedthattheRespondentwasunabletokeepup
withtheclinicaldemandsoftheNursingDepartment. Hewasunreliableandnot prepared for staff meeting. He did not have a good handle on what was goingon withtheresidentsorstaffintheNursingDepartmentandexhibitedageneralunawarenessofclinicalaffairs. Ms.LynchalsotestifiedthatshefeltshewasnotreceivingadequateguidanceinherroleasAssistant DirectorofNursing.
(TestimonyofLynch)
11.Mr.O'FlahertytestifiedthathebecameveryconcernedaboutRespondent'shealthandworkperformanceduringthetimeframeofJanuaryof2011toMayof2011.HenoticedagradualdeclineinRespondent'shealthevenpriortoJanuaryof2011buthereallybecameconcernedduringthattimeframe.TheRespondentappearedwornoutandsleepdeprived.Mr.O'FlahertytestifiedthattheRespondentwasnotfocusedatwork. Heexhibitedadecreasein productivity,poororganizationandtimemanagement,afailuretomeetdeadlines,andaninabilitytofollowdirections.(Exhibit18,Testimonyof
O'Flaherty)
6
12.OnMay20,2011,the Respondent's employmentatLowellHealthCareCenterwasterminatedforfailuretoperformthedutiesoftheDirectorof NursingServicessatisfactorily.(Exhibit20,TestimonyofLynch,O'Flaherty,Respondent)
13.TheRespondentdeniesthathe wasimpairedorunabletoperformhis
dutiesatanytimewhileworkingatLowellHealthCareCenter.(Exhibit 2,TestimonyofRespondent)
14.TheRespondenttestifiedthat hesufferedanonthejobinjurytohisback
In Decemberof2010 and-sufferedback pain dueto his in juryAsaresultofthebackpain,hehaddifficultysleepingandmayonoccasionhaveclosedhiseyesforamomentorappearedtiredatworkbuthewasalwaysinformedregardingclinicalaffairsandfulfilledhisdutiesatDirectorofNursingServicesdiligently.
(Exhibit2,TestimonyofRespondent)
15.TheRespondenttestifiedthathealsosufferedfromepisodicclusterheadaches,buthewasabletomanagethepainandtreattheheadacheswithsumatriptan,asubcutaneousmedicationprescribedbyhisphysicianDr.JonathanRoss. TheRespondentwasprescribeda6mgdosethatheselfadministeredwheneveraheadacheoccurred. (Exhibit19,Testimonyof
Respondent)
16.InaletterdatedMarch26,2012,Respondent'sphysicianDr.RossstatesthathehastreatedtheRespondentformanyyearsforsevereepisodicclusterheadacheswithsubcutaneoussumatriptan. Dr.RossstatesthatwhentheRespondentisinaheadachecycle,hemaygetmorethanoneheadacheper dayandmaythereforerequireuseofthemedicationmorethanonceaday. Dr.
7
Rossfurtherstates thatalthoughtheheadachesareintolerableandnotconducivetoworking,subcutaneoussumatriptaniseffectivewithinten(10)tofifteen(15)minutes,andallowsRespondenttocontinuehisworkingday.Dr.Rossconcludesbystating thatthesumatriptanisamedicalnecessityand
appropriatetousewhenevernecessary,accordingtodosingguidelines.(Exhibit19)
17,Mr.GranttestifiedaboutanincidentinvolvingRespondentthatoccurredsometime inNovemberorDecemberMr.Grant testified that he wenttousethemen'srestroomatLowellHealthCareCenterandwalkedinontheRespondent standingin frontofthebathroomsink,facingthemirrorwiththebottomofhisshirtunbuttonedandholdingtheshirtuparoundhischestwith hislefthand.Respondent'srighthandwasupnearhischestaswellbutobscured
byhisshirt. Mr.Grantimmediatelylefttherestroomandclosedthedoorbehind.TheRespondentfollowedhimoutandstatedthat"Nothingweirdwasgoingonthere,justsomethingmedical". (Exhibit16,TestimonyofGrant)
18.Mr.Grantdraftedawrittenstatementregardingtheincidentdescribedabovein¶17.(Exhibit16)
19.Inhiswrittenstatement,Mr.GrantspeculatesthatRespondentmayhavebeeninjectinghimselfwithsomeunknownsubstance,buthestatesthathedidnotseeasyringeoranysubstanceintheRespondent'shands. (Exhibit16)
20.TheRespondentcontendsthatallMr.Grant'stestimonyindicatesisthatheobservedtheRespondentwithhisshirtliftedinfrontofamirrorin the bathroomandisthereforeoflimited value. However,theRespondentadmitsthat
8
heself-injectssumatriptan totreathisepisodicclusterheadaches.(Exhibit2, Exhibit19,TestimonyofRespondent)
21.TheBoardagreeswithRespondentthatMr.Grant'sobservationofthe Respondentwith hisshirtliftedinthebathroomisoflimitedvalueindeterminingwhetherRespondentwasimpairedbysomesubstanceorconditionwhilepracticingnursingandtheBoarddeclinestorelyonitinmakingits
determinations.
22.TheBoardcreditsthetestimonyofMs. LynchandMr. O’FlahertyregardingtheirobservationsofRespondent'sworkperformance.Theytestifiedinaclear,candidandforthrightmanner.BothwitnessestestifiedthattheyhadaproductiveandcordialrelationshipwiththeRespondentpriortotheirobservationsofthedeclineinRespondent'sworkperformance.
23.TheBoardalsocreditsRespondent'sexplanationthathesufferedfromepisodicclusterheadachesbutwasprescribedsubcutaneoussumatriptanthatheself-administeredtotreathisepisodicclusterheadaches,andthatthesumatriptanallowedhimtocontinuetoperformhisdutiesasDirectorofNursing.TheBoardfurthercreditstheRespondent'stestimonythathesufferedanonthe jobinjuryandexperiencedsignificantbackpainasaresultoftheinjury.
24.BasedonthetestimonyofMs.LynchandMr.O'Flaherty,theBoardfindsthattheevidenceisinsufficienttosupportafindingthattheRespondentwasimpairedbysomesubstanceorconditionwhilepracticingnursing. Whilethe BoardacknowledgesthatthedeclineinRespondent'sworkperformance,consistingofnoddingoffathisdeskonacoupleofoccasions,decreased
9
productivity,lackoforganizationandtimemanagement,andafailuretokeepupwithclinicaldemands,isveryconcerninginanemployer-employeecontextandmaybeanappropriatebasisforterminationofemployment,theBoardfindsthat
itisnotthetypeofbehaviorthattheBoardhaspreviouslyreliedupontosupport
a findingofimpairment.
25.PursuanttoBoardregulationsat244CMR9.02,"impaired"is definedas"theinabilitytopracticenursingwithreasonablejudgment,skill,andsafetyby
reasonofalcoholordrugabuse,useofother substances, a physical or mental illnessorcondition,orbyanycombinationoftheforegoing".
26.TheBoardhasaddressedtheissueofnursesengagedinthepracticeoftheprofessionwhileimpairedandmadethefollowingdeterminationsinthefollowingdecisions:IntheMatterofDeborahA.Mercier,20080715-RN-006
(FinalDecisionandOrder,February9,2012)(AfindingofimpairmentwasbasedonobservationsofRespondent'shyperactivity,glassyandconstrictedeyes,ramblingspeechaswellasRespondent'sincorrectlylabeledbloodcultures) In theMatterofSharonJ.Mylott,RN-05-052(FinalDecisionandOrder,April 14,2008)(AfindingofimpairmentwasbasedonobservationsofRespondent's slurredandscrambledspeech;abnormalitiesinappearanceofRespondent's
eyesincludingenlargedpupilsandglasseyes;andanunsteadyandunbalancedgait);andIntheMatterofMichelleWalsh,LN-03-094(FinalDecisionandOrder,November2005)(AfindingofimpairmentwasbasedonobservationsofRespondentsleepingwhileonduty,failingtoadministermedicationtoher
10
assigned patients, aswellashavingdilatedpupils,speakingwith slurredspeech,andwalkingwith anunsteadygait).
27.TheRespondentinthiscasedidnotexhibitslurredspeech,glassyeyes, anunsteadygaitormostoftheotherbehavioroutlinedin¶26thattheBoardhaspreviouslyreliedupontosupportafindingofimpairment.
28.TheBoardfindsthatnoddingoffatthedeskonacoupleofoccasionscombinedwithdecreasedproductivity,lackoforganizationandtimemanagement,andageneral inabilitytokeep upwith clinicaldemandsdoesnotrisetothe levelofconductrequiredtosupportafindingthatanurseisunabletopracticenursingwithreasonablejudgment,skill,andsafety,whetherbyreason
ofsomesubstanceorcondition.
DocumentationandDestructionofDiscontinuedControlledSubstances
29.AfterRespondent'sterminationfromLowellHealthCareCenteronMay20,2011,Mr.O'FlahertyandMs.Lynchdiscovereddiscontinuedcontrolled substancesinRespondent'sofficethathadnotbeendestroyedandbegantheprocessofreconcilingthemedications. (TestimonyofLynch,O'Flaherty)
30.Mr.O'FlahertytestifiedthatthepolicyatLowellHealthCareCenterwasthatonlytheDirectorofNursing ServicesandtheAdministerjointlycouldwitness thedestructionofdiscontinuedcontrolledsubstances. Asaresult,the Respondentwouldcollectdiscontinuedcontrolledsubstancesandkeepthemin
asecure,doublelockednarcoticboxinhisoffice. Then,onaquarterlybasis,theRespondentandMr. O'Flahertywouldarrangeforatimetomeettowitnessthe
11
destructionofthediscontinued substancesandtheRespondentwouldcomplete theappropriatedocumentation. (TestimonyofO'Flaherty)
31.Mr.O'Flahertytestifiedthatacontrolledsubstance prescribedtoaparticularresidentmaybediscontinued for anynumberofreasons.Thediscontinuedcontrolledsubstancemustthenbedestroyed.Hetestifiedthatproperdocumentationanddestructionofdiscontinuedcontrolledsubstancesrequiredthatadiscontinuedcontrolledsubstancebemarkedassuchina
·patient'sMedicationAdministrationRecord ('MAR")andin-aNarcoticBook.ThecontrolledsubstancewouldthenbereleasedfromthepatientcareunittotheRespondentinhisroleasthe DirectorofNursingServices.ThereleaseofthecontrolledsubstancewouldbedocumentedintheNarcoticBookandrequired
theco-signatureofthestaffnurse whoreleasedthecontrolledsubstanceandthe Respondent. ThediscontinuedsubstancewouldthenbetransferredtoadoublelockednarcoticboxintheRespondent'soffice. TheRespondentandMr. O'FlahertywouldthenarrangetomeettowitnessthedestructionofthediscontinuedcontrolledsubstanceandthedestructionwouldbedocumentedinaControlledSubstanceDisposalRecord(alsoreferredtoasaControl
Log/NarcoticLog)alongwiththeco-signatureoftheRespondentandMr.O'Flahertyconfirmingthedestruction. (TestimonyofO'Flaherty)
32.Mr.O'FlahertytestifiedthatwhenheandMs.Lynch discovered discontinuedcontrolledsubstancesthathadnotbeendestroyedinRespondent's officeandattemptedtoreconciletherecords,theydiscoveredthatthereweremanycontrolledsubstancesthatdidnotcorrelatewiththeControlledSubstance
12
DisposalRecordand/orweremissing.Theythenconductedanauditasfarbackasreasonable andfoundnumerousdiscrepanciesinRespondent'sdocumentationofthedestructionofdiscontinuedcontrolledsubstances.
(TestimonyofLynch,O'Flaherty)
33.AreviewofthedocumentationdiscrepanciesrevealedthatRespondenthadfailedtoproperlydocumentthedestructionofdiscontinuedcontrolled
substances forPatientsA throughGoveraperiodoftwoyearsfromJuneof
2009toMayof2011. (Exhibits 5 through Exhibits 15Testimonyoflynch,O'Flaherty)
34.Thedocumentationdiscrepanciesincludedbutwerenotlimitedto(1)missingcontrolledsubstances(2)missingdocumentnumbers(3)missingitem numbers(4)lackofco-signaturesoranysignaturesatall,(5)missingquantitiesand(6)missingdates.(Exhibit 5throughExhibit15,TestimonyofLynch,
O'Flaherty).
35.OnJune23,2011Mr.O'Flaherty,asAdministratorofLowellHealthCareCenter,reportedalossofcontrolledsubstancestotheDepartmentofPublicHealth,DrugControlProgram. (Exhibit3,TestimonyofO'Flaherty)
36.SandraMcMahon("Ms.McMahon")isaSeniorInspectorfortheDepartmentofPublicHealth,DrugControlProgram. InresponsetoLowellHealthCareCenter'sreportedlossofcontrolledsubstances,Ms.McMahonwas assignedtoconduct,anddidconduct,aninvestigationatLowellHealthCare Center. (TestimonyofMcMahon,Exhibit3)
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37.Ms.McMahontestifiedasafactwitnessregardingtheinvestigationsheconductedwithregardtoRespondent'sdocumentationanddestruction ofdiscontinuedcontrolled substancesatLowellHealthCareCenter.Ms.McMahonwasalso qualifiedtotestifyasanexpertwitnessintheareasofacceptedstandardsofnursingpracticeregardingthedocumentationanddestructionof
discontinuedcontrolledsubstances.(TestimonyofMcMahon)
38.Ms.McMahonwaslicensedbytheBoardasanLPNin1979andworked in that capacityfor six (6) years. Formore thantwenty-eight(28)years,Ms.MahonhasworkedfortheMassachusettsDepartmentofPublicHealth,DrugControlProgram("DCP"). Asaseniorinvestigatorformanyyears,mostofMs.McMahon'sworkhasinvolvedinvestigatingcomplaintsofdruglossesand
tampering,suspecteddrugthefts,anddocumentation infractions. (TestimonyofMcMahon,Exhibit40)
39.Ms.McMahonhasparticipated in continuing job training.Shehasattended manycoursesandconferencesondrugloss,diversion,andrecordkeeping,includingtrainingconductedbytheNationalAssociationofDrugDiversionInvestigators("NADDI").Ms.McMahonisamemberofNADDIandregularlyattendsNADDIconferencesrelatedtocurrenttrendsinvolvingthedocumentationandpossiblediversionofcontrolledsubstances,primarilybyhealthcareprofessionals.Ms.McMahonalsoconductstrainingsonissuesrelatedtothesecurityofcontrolledsubstancesandrecordkeeping.(Testimony
ofMcMahon,Exhibit40)
14
40.AspartofherinvestigationatLowellHealthCareCenter,Ms.McMahoninterviewedLowellHealthCareCenter'sAdministrator, MarkO'Flaherty,theInterimDirectorofNursing,LaurindaDurie,andtheAssistantDirectorofNursing,BridgetLynch. Ms.McMahonreviewedtheNarcoticBookandControlledSubstanceDisposalRecordprovidedbyLowellHealthCareCenter. Ms.McMahonthenpreparedaninvestigativereportwithexhibitssummarizingthedocumentationdiscrepanciesshediscovered. Ms.McMahonstatedthatbased
on herreviewoftherecords shewasunableto determinewhendiscontinued
substancesweredestroyedorwhotheyweredestroyedbyforPatientsA
throughGandthesedocumentationdiscrepanciesspannedatimeperiodofovertwo(2)years. (TestimonyofMcMahon)
41.Ms.McMahontestifiedthatacceptedstandardsofnursingpracticerequirethatdiscontinuedcontrolledsubstancesberemovedfromthenursingunitassoonaspossible. ThediscontinuedcontrolledsubstancesmustbereleasedbythenurseontheunittotheDirectorofNursingServicesand/orhisdesigneeandthereleasemustbedocumentedintheNarcoticBookalongwiththesignatureofboththeunitnurseandtheDirectorofNursingServices. Oncethediscontinued
controlledsubstanceshavebeenreleasedtotheDirectorofNursingServices,heorsheisresponsiblefortheirsecurityandrecordkeeping. TheDirector of
NursingServicesmustthendestroythediscontinuedcontrolledsubstancesimmediatelyorkeeptheminasecured,doublelockedboxandmaintainan inventoryofthestoredsubstancesinaControlledSubstanceDisposalRecord.
(TestimonyofMcMahon)
15
42.Ms.McMahontestifiedthataccepted standardsofnursingpracticedonotrequirethatthediscontinuedcontrolledsubstancesbedestroyedwithinacertaintimeframebutsherecommendsthattheybedestroyedonamonthlybasis.
(TestimonyofMcMahon)
43.Ms.McMahontestifiedthataccordingtoacceptedstandardsofnursingpractice,onlyanAdministrator,DirectorofNursingServices,AssistantDirectorof
NursingServicesoraPharmacyConsultantmayserveaswitnessesforthe
destructionofdiscontinuedcontrolledsubstancesandaminimumoftwo
individualsfromthatgroupmustbepresenttowitnessthedestruction. ThedestructionmustthenbedocumentedintheControlledSubstanceDisposalRecordandmustbeaccompaniedbythesignatureofthetwowitnessesverifyingthedestruction. Ms.McMahonfurthertestifiedthatthedocumentationforthe transferofdiscontinuedcontrolledsubstancesintheNarcoticBookmust
correlatewiththeinventoryofdiscontinuedcontrolledsubstancesintheControlledSubstanceDisposalRecordatalltimes. (TestimonyofMcMahon)
44.Ms.McMahontestifiedthatnoneoftheentriesRespondentmadeintheNarcoticBookforpatientsAthroughGcorrespondwiththeentriesRespondent madeintheControlledSubstanceDisposalRecord. (TestimonyofMcMahon)
45.Ms.McMahonfurthertestifiedthatnoneoftheentriestheRespondentmadeintheNarcoticBookforPatients AthroughGcontaintheco-signaturesoftheunitnurses whoreleasedthediscontinuedcontrolledsubstancestotheRespondent. (Exhibits5through11,TestimonyofMcMahon)
16
•.
46.Ms.McMahonprovideddetailedtestimony,alongwithherwritteninvestigativereport,describingthediscrepanciesthatshefoundinRespondent'sdocumentationofthedestructionofdiscontinuedcontrolledsubstancesatLowellHealthCareCenter.Ms.McMahonconcludedthatRespondent'sdocumentationpracticesfellbelowtheacceptedstandardsofnursingpractice.Ms.McMahon'stestimonywasthoughtful,careful,andthorough.The BoardcreditsMs.
McMahon'stestimonyasreliableandcredible.(TestimonyofMcMahon,Exhibit
3)
47.TheRespondentdeniesthathisdocumentationanddestructionofdiscontinuedcontrolledsubstancesfellbelowtheacceptedstandardsofnursing
practice.(TestimonyofRespondent)
48.TheRespondentarguesthathewasnotgivenanadequateopportunitytoreconcile the records himself. He states that if he has been given the opportunity to reconcile the records for the discontinued controlled substances upon his termination, he would have been able to account for the documentation discrepancies. (Testimony of Respondent)
49. TheBoardfindsRespondent'sargumentunpersuasive. Mr.O'Flaherty testifiedthatRespondentneveraskedforanopportunitytoreconcilerecordspertainingtohisdocumentationofthedestructionofcontrolledsubstances.Furthermore,thepurposeofproperdocumentationpracticesistoensurethat anyonereviewingthedocumentationisabletodetermineexactlywhathappenedtothecontrolledsubstances. Inthiscase,Ms.McMahon,anacknowledged expertinthefieldofacceptedstandardsofnursingpracticeforthe
17
documentationanddestructionofdiscontinuedcontrolledsubstances,was unabletodeterminewhodestroyedthediscontinuedcontrolledsubstancesand
when theyweredestroyedfornumerouspatientsatLowellHealthCareCenter.
(TestimonyofO'Flaherty,McMahon)
50.TheRespondentcontendsthathecompletedallappropriatedocumentationforthedestructionofdiscontinuedcontrolledsubstancesbuthe
didsoinadocumenthereferstoastheDNSBook1insteadoftheControlled
Substance Disposal Record. TheRespondentstatesthathehadconcernsabout
thesecurityoftheControlledSubstanceDisposalRecordbecauseitwasaloose leafbinderofpaperandsohebegantodocumentthedestructionofthediscontinuedcontrolledsubstancesinaboundbookcalledtheDNSBook1andhedidsoforseveralmonthsuntilhewasinstructedbyseniormanagementtoreturntodocumentingthedestructionintheControlledSubstanceDisposalRecord. TheRespondentcontendsthatareviewoftheDNSBook1wouldshowthathisdocumentationpracticescompliedwithacceptedstandardsofnursing
practice.(TestimonyofRespondent)
51.TheBoarddoesnotcredittheRespondent'sexplanation. NooneatLowellHealthCareCenterwasabletolocateacopyofthedocumentRespondentreferstoas theDNSBook1.Furthermore,noneoftheentriestheRespondentmadeintheNarcoticBookfor·PatientsAthroughGmakeanyreferencetoaDNSBook1. Finally,neitherMs.LynchnorMr.O’Flaherty recalledusingaDNSBook1inlieuoftheControlledSubstanceDisposalRecordatLowellHealthCareCenter. (Exhibits4through15,TestimonyofRespondent)
18
52.EvenassumingtheRespondentdocumentedthedestructionofdiscontinuedcontrolledsubstanceintheDNSBook1insteadoftheControlledSubstanceDisposalRecordfor severalmonths,thiswouldfailtoaccountforallofthedocumentationdiscrepanciesforPatientsAthroughG,whichspanaperiodoftwoyearsfromJuneof2009throughMayof2011.(Exhibits4through
15,TestimonyofRespondent)
53.Finally,theRespondent arguesthatMs.LynchandMr.O'Flaherty,along
withselect upper management personnel,borepersonalanimositytowardhim
andconspiredtogethertoassignresponsibilityto himfortheirlackofabilitytoreconcilethediscontinuedcontrolledsubstancesbyeitherlosingcriticaldocumentationormanipulatingdocumentation.(TestimonyofRespondent)
54.TheBoard findsRespondent'sargumentin§53abovespeculativeand
withoutmerit:Furthermore,bothMs.LynchandMr.O'Flahertytestifiedthattheyhada productiveandcordialrelationshipwiththeRespondentpriortotheirobservationsofthedeclineinRespondent'sworkperformance.TheBoardcan discernnoreasonforeitherofthemtopurposefullymanipulateorlosecriticaldocumentationinorder toentrapRespondent.(TestimonyofLynch,O'Flaherty)
55.BasedonthetestimonyofMs.Lynch,Mr. O'Flaherty,andtheexperttestimonyofMs.McMahon,theBoardfindsthatRespondent'sdocumentationanddestructionofdiscontinuedcontrolledsubstancesatLowellHealthCare Centerfellbelowacceptedstandardsofnursingpractice.
V.RulingsofLaw
19
·.
1.BasedontheFindingsofFactin§§29-46,49,51-52, and54-55,above,theBoardfindsthatRespondentfailedtoengageinthepracticeofnursinginaccordancewithacceptedstandardsofpracticeinviolationofBoardregulations
at244CMR 9.03(5).
2.BasedontheFindingsofFactin§§29-46,49,51-52,and54-55,above,theBoardfindsthat RespondentviolatedBoardregulationsat244CMR9.03(35)
byfailingtomaintainthesecurityofcontrolledsubstancesthatwereunderhisresponsibility and control
3.BasedontheFindingsofFactin§§1-28,above,therecorddoesnotdemonstratethatRespondentviolatedBoardregulationsat244CMR9.03(36)bypracticingnursingwhileimpaired.
4.BasedontheFindingsofFactin§§ 9-46,49,51-52,and54-55,above, theBoardfindsthatRespondentviolatedBoardregulationsat244CMR9.03(39)byfailingtodocumentthehandling,administration,anddestructionofcontrolledsubstancesin accordancewithall federalandstatelawsandregulationsandin amannerconsistentwithacceptedstandardsofnursingpractice.
5.BasedontheFindingsofFactin§§29-46,49,51-52,and54-55,above, theBoardfindsthatRespondentviolatedBoardregulationsat244CMR9.03(44)byfailingtomakecomplete,accurate,andlegibleentriesinallrecordsrequiredbyfederalandstatelawsandregulationsandacceptedstandardsofnursingpractice.
6.BasedontheFindingsofFactin§§29-46,49,51-52,and54-55,above,theBoardfindsthatRespondentviolatedBoardregulationsat244CMR9.03(46)
20
byfailing,whileemployedinanursingmanagementrole,toadheretoacceptedstandardsofpracticeforthatrole.
7.BasedontheFindingsofFactin§§29-46,49,51-52,and54-55,above,theBoardfindsthatRespondentengagedinconductthatwaslikelytohavean
adverseeffectuponthehealth, safety,orwelfareofthe public inviolationof244CMR9.03(47).
8.BasedontheFindingsofFactin§§29-46,49,51-52,and54-55,above, theBoardfindsthatRespondent'sconductconstitutesgrossmisconductinthepracticeoftheprofessionofnursingandanoffenseagainstthelawsofthe
CommonwealthinviolationofG.L.c.112,§61.
9.BasedontheFindingsofFactin§§29-46,49,51-52,and54-55,above,Respondent'sconduct,asdescribed,constitutesunprofessionalconductandconductwhichunderminespublicconfidenceintheintegrityofthenursingprofession. Sugarmanv.BoardofRegistrationinMedicine,422Mass.338,342(1996);seealsoKvitkav.BoardofRegistrationinMedicine,407Mass.140, cert.denied,498U.S.823(1990);Raymondv.BoardofRegistrationinMedicine,387
Mass.708,713(1982).
VI.Discussion
MassachusettsGeneralLawsChapter112,§61authorizestheBoardtodisciplinethelicenseofaregisterednursefordeceitandforgrossmisconductinthepracticeoftheprofession. Section61readsinrelevantpart:
...[E]achboardofregistration...afterahearing,may...suspend,revokeorcancelanycertificate,registration,licenseorauthority
...Ifitappears...thattheholderofsuchcertificate,registration,license
orauthority ...isguiltyofdeceit,malpractice,grossmisconductinthe
21
practiceofhisprofession,orofanyoffenseagainstthelawsofthecommonwealthrelatingthereto...
G.L.c.112,§61
TheSupremeJudicialCourthasaffirmedthataBoard'sdisciplineoflicenseesforconductthatunderminespublicconfidencein theintegrityoftheprofessionisreasonablyrelatedtothepromotionofthepublichealth,welfare, andsafety. Raymondv.BoardofRegistrationinMedicine,387Mass.708,713
(1982).TheBoardhasauthorityto"protecttheimageoftheprofessionandis
Not limited to discipliningconductinvolvingdirectcare,criminalactivityordeceit".
Raymond,supraat713. Theboardsofregistrationhavebroadauthoritytoregulatetheconductofprofessionalsincludingtheabilitytosanctionprofessionalsforconductthatunderminespublicconfidenceintheintegrityoftheprofession.SeeKvitkav.BoardofRegistrationinMedicine,387Mass.708,713
(1982).
Inthiscase,ProsecutingCounselallegesthatRespondentpracticed nursingwhileimpairedandfailedtoproperlydocumentthedestructionofdiscontinued controlledsubstances.
TheBoardhaspreviouslyaddressedtheissueofnursesengagedinthepracticeoftheprofessionwhileimpairedandmadethefollowingdeterminationsinthefollowingdecisions:IntheMatterofDeborahA.Mercier,20080715-RN- 006(FinalDecisionandOrder,February9,2012)(Afindingofimpairmentwas basedonobservationsofRespondent'shyperactivity,glassyand constricted eyes,ramblingspeechaswellasRespondent'sincorrectlylabeledbloodcultures) IntheMatterofSharonJ.Mylott,RN-05-052(FinalDecisionand
22
Order, April 14,2008)(AfindingofimpairmentwasbasedonobservationsofRespondent'sslurredandscrambledspeech;abnormalities inappearanceofRespondent'seyesincludingenlargedpupilsandglasseyes;andanunsteadyand unbalancedgait);andIntheMatterofMichelleWalsh,LN-03-094(FinalDecisionandOrder,November2005)(Afindingofimpairmentwasbasedonobservationsof Respondentsleepingwhileonduty,failingtoadminister
medicationtoherassignedpatients,aswellashavingdilatedpupils,speaking
with slurred speech, and walking with an unsteady gait).
AsdiscussedintheFindingsofFact,theBoardfindsthatRespondent'sconduct,consistingofnoddingoffatthedeskonacoupleofoccasionscombinedwithdecreasedproductivity,lackoforganizationandtimemanagement,andageneralinabilitytokeepupwithclinicaldemands,doesnotrisetothelevelofconductrequiredtosupportafindingthatanurseisunabletopracticenursingwithreasonablejudgment, skill,andsafety,whetherbyreasonofsome
substanceorcondition. TheBoardherebydismissestheallegationthatRespondentpracticednursingwhileimpaired.
TherecordinthiscasedemonstratesthatRespondent,whileemployedatLowellHealthCareCenter,failedtodocumentthedestructionofdiscontinuedcontrolledsubstancesinamannerthatconformedtoacceptedstandardsofnursingpractice,Boardregulations,andthepoliciesandproceduresestablishedbyLowellHealthCareCenter. Respondent'sdocumentationdiscrepanciesincludedbutwerenotlimitedto(1)missingcontrolledsubstances(2)missingdocumentnumbers(3)missingitemnumbers(4)lackofco-signaturesorany
23
signaturesatall,(5)missingquantitiesand(6)missingdates. Asaresultof
·Respondent'simproperdocumentationpractices,itisimpossibletodeterminewhendiscontinuedsubstancesweredestroyedorwhotheyweredestroyedbyforPatientsAthroughG,andthesedocumentationdiscrepanciesspanneda
timeperiodofovertwo(2)years.
TheRespondentcontendsthathecompletedallappropriatedocumentationforthedestructionofdiscontinuedcontrolledsubstancesbuthe
didsoin a document he refers to as the DNS Book 1andthatareviewofthe
DNSBook1wouldshowthathisdocumentationpracticescompliedwithacceptedstandardsofnursingpractice. TheBoarddoesnotcreditthe Respondent’sexplanation. NooneatLowellHealthCareCenterwasabletolocateacopyofthedocumentRespondentrefers toastheDNSBook1.Furthermore,noneoftheentriestheRespondentmadein theNarcoticBookfor PatientsAthroughGmakeanyreferencetoaDNSBook1. Finally,neitherMs.LynchnorMr.O'FlahertyrecalledeverusingadocumentcalledDNSBook1at
LowellHealthCareCenter.
Theproperandlawfulhandlingofcontrolledsubstancesisafundamental tenetofnursingpractice. Narcoticsandothercontrolledsubstancesposepotentiallyseriousrisktothe-publichealth,safety,andwellbeing,andtherefore, arescrupulouslyregulated. Onboththefederalandstatelevels,strictproceduresandprotocolsexisttoinsurethatsuchdrugsareproperlysecuredandhandledatalltimes. Nurses,whoareentrustedwiththehandlingandadministrationofcontrolledsubstances,haveasolemnresponsibilitytodosoin
24
compliancewithfederalandstatelawandinamannerthatmaintainspublicconfidenceinthenursingprofession.TheRespondent,inhiscapacity astheDirectorofNursingServices,shouldhavebeenespeciallymindfulofthenecessityforaccurateandcompletedocumentation.
TheevidenceinthiscasesupportstheconclusionthatRespondent'sdocumentationofthedestructionofdiscontinuedcontrolledsubstancesfellbelow
acceptedstandardsofnursingpractice. Respondent'sconductundermines
publicconfidence in thenursing professionandwarrantsdisciplinaryactionpursuanttoG.L.·c.112 §61and244CMR9.03.
Accordingly,theBoard,inkeepingwithitsdutytopromotethepublichealth,safetyandwelfare,findsthatRespondentissubjecttodisciplineandappropriatesanctionsasdeterminedbytheBoard4.
BoardofRegistrationinNursing
Dated:May12,2014 Noticeto:JH,EL
ViaFirstClassMailandCertifiedMailNo.70123460000173312972
JohnHandren
C/0PatrickQuirke
By: Maimoona Sahi Ahmad
Maimoona SahiAhmad
Administrative Hearings Counsel
(617)973-0997
4 Pursuantto801CMR1.01(11) (c),partieshavethirty(30)daysfromtheissuanceofthisTentative Decisiontofilewrittenobjections. AnyobjectionsfiledmustalsoincludewrittenargumentsinsupportoftheobjectionsastheBoardwillnutholdoralargumentsontheobjections. Eachpartymayfilearesponsetoopposingcounsel'sobjectionswiththeAHCwithintwenty(20)daysofreceiptofa copyoftheobjections.
25
ViaHandDelivery
EugeneLangner,ProsecutingCounselDepartmentofPublicHealth
OfficeofGeneralCounsel239CausewayStreet
Boston,MA02114
26
COMMONWEALTHOFMASSACHUSETIS
SUFFOLKCOUNTYBOARDOFREGISTRATION
INNURSING
IntheMatterof
JohnHandren
RNLicenseNo.177486
License Expires 311/14
DocketNo.NUR-2011-0265
ORDERTOSHOWCAUSE
JohnHandren,youareherebyorderedtoappearandshowcausewhythe MassachusettsBoardofRegistrationin-Nursing-(''Board')-should-not-suspend, revokeor-otherwisetakeactionagainstyourlicensetopracticeasaRegisteredNurse("RN")inthe CommonwealthofMassachusetts,LicenseNo.177486,oryourrighttorenewsuchlicense,pursuanttoMassachusetts GeneralLaws(0.L.)Chapter112,§61andBoardregulation244CMR9.03,baseduponthefollowingfactsandallegations:
1.OnoraboutOctober1,1986,theBoardissuedtoyoualicensetoengageinthepracticeofnursingasaRegisteredNurseintheCommonwealthofMassachusetts, LicenseNo. 177486. Yourlicenseiscurrent,andexpiresonMarch1,2014.
2.OnnumerousoccasionsbetweenOctoberof2009andOctoberof2010,whileyouwereemployedasaRNandastheDirectorofNursingServices(DNS)atLowell HealthCareCenterinLowell,Massachusetts("LHCC"),youfailedproperlytodocumentthedestructionofdiscontinuedcontrolledsubstances.
3.OnnumerousoccasionsbetweenJanuaryandMayof2011,whileyouwereemployedasa RNandastheDNSatLHCC,youwereobservedto beimpairedwhileonduty,asevidencedbyyourheadbobbingupanddown,yourbeingunabletostayawakewhileonduty,speakingwithyoureyesclosed,and
forgettinginformationregardingyourpatients'clinicalconditions.
4.OnoneoccasioninNovemberof2010,whileyouwereemployedas aRNandastheDNSatLHCC,youwereobservedtobeadministeringyourselfmedication whileonduty.
5.YourconductasallegedwarrantsdisciplinaryactionbytheBoardagainstyour licensetopracticeasaRegisteredNursepursuanttoBoardregulation244CMR
9.03forviolationofStandardsofConductforNurses,namely:
(a)Yourconductasallegedviolates244CMR9.03(5)forfailingtoengageinthepracticeof nursinginaccordancewithacceptedstandardsofpractice.
(b)Yourconductasallegedviolates244CMR9.03(35)forfailingtomaintainthesecurityofcontrolledsubstancesthatwereunderyourresponsibilityandcontrol.
(c)Yourconductasallegedviolates244CMR9.03(36)forpracticingnursingwhileimpaired.
(d)Yourconductasallegedviolates244CMR9.03(39rforfailingtodocumentthehandling.administration, anddestructionofcontrolledsubstancesinaccordancewithallfederalandstate tawsandregulationsandinamannerconsistentwithacceptedstandardsofnursingpractice.
(e)Yourconductasallegedviolates244CMR9.03(44)forfailingtomake
complete, accurate, and legible entries in all records requiredby federal andstatelawsandregulationsandacceptedstandardsofnursingpractice.
(f)Yourconductasallegedviolates244CMR9.03(46)forfailing,whileemployedinanursingmanagementrole,toadheretoacceptedstandardsofpracticeforthatrole.
(g)Yourconductasallegedviolates244CMR9.03(47)forengaginginanyotherconductthatfailstoconformtoacceptedstandardsofnursingpracticeorinanybehaviorthatislikelytohaveanadverseeffectuponthehealth,safety,orwelfareofthepublic.
6.Yourconductas allegedwarrantsdisciplinaryactionbytheBoardagainstyourlicensetopracticeasaRegisteredNursepursuanttoG.L.c.112,§61fordeceit, malpractice,andgrossmisconductinthepracticeoftheprofessionorforanyoffenseagainstthelawsoftheCommonwealthrelatingthereto.
7.Yourconductasallegedreflectsa lackofthe"goodmoralcharacter"requiredforinitiallicensure asa RegisteredNurseandlicenserenewalunderG.L.c.112, §74.
8.Yourconductasallegedalsoconstitutesunprofessionalconductandconductwhichunderminespublicconfidenceintheintegrityoftheprofession. Sugarman
v.BoardofRegistrationinMedicine,422Mass.338,342(1996);seealso,Kvitka
v.BoardofRegistrationinMedicine,407Mass.140,cert.denied, 498U.S.823(1990);Raymondv.BoardofRegistrationinMedicine,387Mass.708,713
(1982).
*****
Youhavearighttoanadjudicatoryhearing("hearing")ontheallegations containedintheOrdertoShowCausebeforetheBoarddetermineswhethertosuspend,revoke,orimposeotherdisciplineagainstyourlicense. G.L.c.112,§61. Yourrightto
a hearingmay beclaimedbysubmittinga writtenrequestforahearingwithintwenty-one
(21)daysofreceiptofthisOrdertoShowCause.YoumustalsosubmitanAnswerto thisOrdertoShowCauseinaccordancewith801CMR1.01(6) (d)withintwenty-one(21)daysofreceiptof thisOrdertoShowCause.TheBoardwillgiveyoupriorwrittennoticeofthetimeandplaceofthehearingfollowingreceiptofawrittenrequestforahearing.
HearingsshallbeconductedinaccordancewiththeStateAdministrative ProcedureAct,G.L.c.30A,§§10and11,andtheStandardAdjudicatoryRulesofPracticeandProcedure,801CMR1.01and1.03,underwhichyouaregrantedcertain rightsincluding,butnotlimitedto,therights:toahearing,tosecurelegalcounseloranotherrepresentativetorepresentyourinterests,to allandexaminewitnesses,tocrossexaminewitnesseswhotestifyagainstyou,totestifyonyourownbehalf,tointroduceevidence,andtomakeargumentsinsupportofyourposition.
The Board will make an audio recording of any hearing conducted in the captioned matter. In the event that you wish to appeal a final decision of the Board, it is incumbent on you to supply a reviewing court with a "proper record" of the proceeding, which may include a written transcript. New Bedford Gas and Light Co. v. Board of Assessors of Dartmouth, 368 Mass. 745, 749-750 (1975). Upon request, the Board will make available a copy of the audio recording of the proceeding at your own expense. Pursuant to 801 CMR 1.01(10) (i) (1) upon motion, you "maybe allowed to provide a public stenographer to transcribe the proceeding [your] own expense upon terms ordered by the Presiding Officer by the stenographer or transcription service. The transcript will be made available to the Prosecutor representing the Board. Please note that the administrative record of the proceedings, including, but not limited to, the written transcript of the hearing, is a public record and subject to the provisions ofG.L. c. 4 § 7 and G.L. c. 66, §10.
Yourfailuretosubmitawrittenrequestforahearingwithintwenty-one(21)daysofreceiptofthisOrdertoShowCauseshallconstituteawaiveroftherighttoa/tearingontheallegationshereinandonanyBoarddisciplinaryaction. YourfailuretosubmitanAnswertotheOrdertoShowCausewithintwenty-one(21)daysofreceiptoftheOrdertoShowCauseshallresultintheentryofdefaultinthecaptionedmatter.
NotwithstandingtheearlierfilingofanAnswerand/orrequestforahearing,yourfailuretorespondtonoticesorcorrespondence,yourfailuretoappearfor anyscheduledstatusconference,pre-hearingconferenceorhearingdates,oryourfailuretootherwisedefendthisactionshallresultintheentryofdefault.
If youaredefaulted,theBoardmayenteraFinalDecisionandOrderthatassumesthetruthoftheallegationsinthisOrdertoShowCause,andmayrevoke,suspend,ortakeotherdisciplinary actionagainstyourlicensetopracticenursingiiitheCommonwealthofMassachusetts,includinganyrighttorenewyourlicense. .
Your AnswertotheOrdertoShowCauseandyourwrittenrequestforahearingmustbefiledwithEugeneLangner,ProsecutingCounsel,atthefollowingaddress:
EugeneLangner,Esq.Prosecuting CounselDepartmentofPublicHealth
OfficeoftheGeneralCounsel,5thFloor
239CausewayStreet. Boston,MA 02114
YouoryourrepresentativemayexamineBoardrecordsrelative tothiscasepriortothedateofthehearingduringregularbusinesshoursattheofficeoftheProsecutingCounsel. Ifyouelecttoundertakesuchanexamination,thenpleasecontactProsecuting
Counsel-inadvanceat-(617)973-0838 to schedule a timethat is mutuallyconvenient
BOARDOFREGISTRATION INNURSING,
RulaF.Harb,MSN,RN
ExecutiveDirector
By:
Date August 29, 2012
CERTIFICATEOFSERVICE
IherebycertifythatacopyoftheforegoingOrdertoShowCausewasservedupontheRespondent:
JohnHandren
byfirstclassmail,postageprepaid,andbyCertifiedMailNo.70111570000081802520andupontheattorneyfortheRespondent: ·
JanetE.Michael
LawOfficeofJanetE.Michael
P.O.Box10631
Portland,ME04104-6031
byfirstclassmail,postage prepaid.
This29th,dayofAugust,2012.