ALJDEC decisions subject to certification as final

12A-1207130-NUR · State Board of Nursing · 2013-03-18

IN THE OFFICE OF ADMINISTRATIVE HEARINGS

HEARING: February 12, 2013, with the record held open until February 26, 2013. APPEARANCES: The Arizona State Board of Nursing was represented by Assistant Attorney General Elizabeth Campbell. Respondent Pamela Marie Kause did not appear. ADMINISTRATIVE LAW JUDGE: Tammy L. Eigenheer _____________________________________________________________________ FINDINGS OF FACT Background and Procedure The Arizona State Board of Nursing (the Board) has the authority to regulate and control the practice of nursing in the State of Arizona pursuant to A.R.S. §§ 32-1606, 1663, and 1664. The Board also has the authority to impose disciplinary sanctions against the holders of nursing licenses for violations of the Nurse Practice Act, A.R.S. §§ 32-1601 through 1667. In 2005, the Board issued Registered Nurse License No. RN130944 to Respondent Pamela Marie Kause to allow her to practice nursing in the State of Arizona. The Board was notified of a July 10, 2012, email sent by Respondent to multiple recipients including President Barack Obama, the United States Department of Justice, and the Federal Bureau of Investigations. The email was a rambling and largely incoherent account of wrongs Respondent alleged had been perpetrated against her by Canadian terrorists, the military, and the government. The Board assigned the matter to its Nurse Practice Consultant, Tamara Greabell. Ms. Greabell interviewed witnesses, reviewed additional emails from Respondent, sent Respondent an Investigative Questionnaire, and presented an Investigative Report to the Board. The Board referred the matter to the Office of Administrative Hearings, an independent agency, for an evidentiary hearing. On January 8, 2013, the Board issued an Amended Complaint and Notice of Hearing, alleging that cause existed to discipline Respondent’s registered nurse license under A.R.S. § 32-1601(18)(d) and (e) (2009), A.R.S. § 32- 1601(22)(d) and (e) (2012), and A.A.C. R4-19-403(25)(a) (2009). The Complaint and Notice of Hearing was sent via certified mail to Respondent at her address of record. A hearing was held on February 12, 2013. The Board submitted two exhibits and presented the testimony of two witnesses: (1) Tracy Sutherland, Critical Educator at Eastern Maine Medical Center in Bangor, Maine, and (2) Ms. Greabell. Respondent did not request to appear telephonically at the duly noticed hearing and did not request that the hearing be continued. Although the start of the hearing was delayed 25 minutes to allow Respondent additional travel time, she did not appear, personally or through an attorney, and did not contact the OAH to request that the start of the hearing be further delayed. Consequently, Respondent did not present any evidence to defend her Registered Nurse license. Hearing Evidence Between July 10, 2012, and July 12, 2012, and between August 28, 2012, and November 19, 2012, Respondent sent a number of “bizarre and rambling emails to various government organizations and the Board of Nursing in which Respondent exhibited paranoia and delusional thought processes indicative of a psychiatric disorder.” Exhibit 1. On or about September 17, 2012, Board staff mailed an Investigative Questionnaire to Respondent’s address of record. On or about October 24, 2012, the United States Postal Service returned the Investigative Questionnaire to the Board marked “Not known. Unable to forward.” On or about November 20, 2012, Ms. Greabell attempted to contact Respondent at her telephone number of record. The number had been disconnected. On December 13, 2012, Ms. Greabell interviewed Lisa St. Pierre, Nurse Recruiter at Eastern Maine Medical Center. Ms. St. Pierre stated that on December 5, 2012, she conducted a job interview with Respondent. According to Ms. St. Pierre, during the interview Respondent had difficulty focusing and was fixated on her hair and asked Ms. St. Pierre if she should have put her hair in a French braid. Ms. Sutherland testified Respondent was approximately two hours late for her second interview because she walked four miles from the first interview to the second interview. Ms. Sutherland also indicated Respondent was fixated on her hair and asked if she should have put her hair in a French braid. When asked about her varied work history, Respondent indicated she was currently assigned as a marshal tasked with finding missing children. When asked how she handled difficult situations, Respondent answered, “Smile, smile, and smile.” At one point in the interview, Ms. Sutherland directed her attention to someone else for a moment and when she turned back around, Respondent was gone. Respondent was found wandering around in a patient’s room. Respondent had a plastic bag with her that appeared to have personal belongings including underwear and pantyhose. Ms. Sutherland testified Respondent would rummage through the bag at various times during the interview. During an elevator ride, Respondent repeatedly asked Ms. Sutherland where the restroom was despite Ms. Sutherland’s assurances she would show Respondent the restroom when they arrived on the fifth floor. According to Ms. Sutherland, Respondent did not appear mentally stable. Ms. Sutherland testified her interaction with Respondent was the “most bizarre interview” she had ever done. Ms. Sutherland left Respondent in a waiting area for Angela Wheldon to meet her for another interview. When Ms. Wheldon arrived, she observed Respondent rummaging through an infection control cart in the area. Respondent again appeared fixated on her hair and Ms. Wheldon’s hair. Respondent touched Ms. Wheldon’s hair and asked where she got her hair done. At some point, Respondent realized she had misplaced her plastic bag and was insistent it needed to be found right away. Between November 28, 2012, and January 22, 2013, Respondent sent more emails similar to those previously described. CONCLUSIONS OF LAW The Complaint and Notice of Public Hearing that the Board mailed to Respondent at her address of record was reasonable, and Respondent is deemed to have received notice of the hearing. See A.R.S. § 41-1092.04; A.R.S. § 41-1061(A). This matter lies within the Board’s jurisdiction under A.R.S. § 32- 1606(A)(8). The Board bears the burden of proof and must establish cause to penalize Respondent’s registered nurse’s license by a preponderance of the evidence. See A.R.S. § 41-1092.07(G)(2); A.A.C. R2-19-119(A) and (B)(1); see also Vazanno v. Superior Court, 74 Ariz. 369, 372, 249 P.2d 837 (1952). “A preponderance of the evidence is such proof as convinces the trier of fact that the contention is more probably true than not.” Morris K. Udall, Arizona Law of Evidence § 5 (1960). A preponderance of the evidence is “evidence which is of greater weight or more convincing than evidence which is offered in opposition to it; that is, evidence which as a whole shows that the fact sought to be proved is more probable than not.” Black’s Law Dictionary 1120 (8th ed. 2004). The Board established that Respondent committed unprofessional conduct as defined by A.R.S. § 32-1601(18)(d) and (e) (2009), A.R.S. § 32-1601(22)(d) and (e) (2012),[1] and A.A.C. R4-19-403(25)(a) (2009).[2] Given Respondent’s failure to respond to the requests of the Board and her apparent unstable mental health, Respondent cannot be regulated at this time. In light of the risk of potential harm to patients, the Board established cause to revoke, suspend, or otherwise discipline Respondent’s license under A.R.S. § 32-1663(D)[3] and A.R.S. § 32-1664(N).[4] RECOMMENDED ORDER Based on the foregoing, the Administrative Law Judge recommends that the Board revoke License No. RN130944 previously issued to Respondent Pamela Marie Kause. In the event of certification of the Administrative Law Judge Decision by the Director of the Office of Administrative Hearings, the effective date of the Order will be five days from the date of that certification. Done this day, March 18, 2013.

/s/ Tammy L. Eigenheer Administrative Law Judge

Transmitted electronically to:

Joey Ridenour, RN, MN, Executive Director State Board of Nursing ----------------------- [1] A.R.S. § 32-1601(22)(d) and (e) (2009) and A.R.S. § 32-1601(22)(d) and (e) (2012) define “unprofessional conduct” to include, respectively, “[a]ny conduct or practice that is or might be harmful or dangerous to the health of a patient or the public,” and “[b]eing mentally incompetent or physically unsafe to a degree that is or might be harmful or dangerous to the health of a patient or the public.” [2] This rule further defines “unprofessional conduct” to include failing to “[f]urnish in writing a full and complete explanation of a matter reported pursuant to A.R.S. § 32-1664.” [3] A.R.S. § 32-1663(D) provides that if the Board determines a licensee has committed an act of unprofessional conduct, the Board may revoke or suspend the license, impose a civil penalty, censure the license, place the licensee on probation, or accept the voluntary surrender of the license. [4] A.R.S. § 32-1664(N) provides that if the Board finds that the licensee has committed an act of unprofessional conduct, the Board may revoke or suspend the license.

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