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

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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.

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TheRespondentisresponsibleforensuringthatthesereportsontherequiredformarereceived

bytheBoardcommencingninety(90)daysaftertheEffectiveDateandonthefirstdayofevery thirdmonththereafter.

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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.

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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

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.OnSeptember26,2012,RespondentfiledananswertotheShow

CauseOrder("Answer"),denyingtheallegationsagainsthim.

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TheBoardtakesadministrativenoticeofRespondent'scurrentrecordofstanding,whichindicatesthat

RespondenthasrenewedhislicenseanditnowexpiresonMarchI,2016.

2

PursuanttoROICMRl.Ol (11) (c),theBoardissuesthisTentativeDecisioninthefirstinstance.

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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.

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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

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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)

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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.

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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

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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

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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

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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

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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

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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.