ALJDEC decisions subject to certification as final

13A-1202068-NUR · State Board of Nursing · 2013-04-16

IN THE OFFICE OF ADMINISTRATIVE HEARINGS

HEARING: March 27, 2013, at 8:00 a.m. APPEARANCES: The Arizona State Board of Nursing was represented by Elizabeth A. Campbell, Esq., Assistant Attorney General; Respondent Luann Marie Coogan did not appear. ADMINISTRATIVE LAW JUDGE: Diane Mihalsky _____________________________________________________________________

Background and Procedure 1. 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, 32-1663, and 32-1664. 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 32-1667. 2. Luann Marie Coogan (“Respondent”) holds Board-issued Registered Nurse License No. RN165063 in the State of Arizona. 3. On January 30, 2013, the Board summarily suspended Respondent’s registered nurse license and referred the matter to the Office of Administrative Hearings (“the OAH”), an independent agency, for an expedited evidentiary hearing. 4. On February 11, 2013, the Board issued a Complaint and Notice of Hearing, setting a hearing on March 27, 2013, at 8:00 a.m. The Complaint and Notice of Hearing also charged as a basis for discipline under A.R.S. §§ 32-1663(D) and 32-1664(N), that Respondent had committed unprofessional conduct as defined by A.R.S. § 32-1601(18)(d), including A.A.C. R4-19- 403(25)(a),[1] and A.R.S. §§ 32-1601(18)(e), 32-1601(18)(h), and 32-1601(18)(j).[2] The Board mailed a copy of the Complaint and Notice of Hearing via first-class mail and certified mail to Respondent at her address of record. 5. A hearing was held on March 27, 2013. The Board submitted two exhibits and presented the testimony of Tamara Greabell, RN, the nurse practice consultant assigned to investigate the complaint. 6. 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 duly noticed hearing was delayed fifteen minutes to allow Respondent additional travel time, she did not appear, personally or through an attorney, or contact the OAH to request that the start of the hearing be further delayed. Consequently, Respondent did not present any evidence to defend her license. Hearing Evidence 7. In April 2012, Ms. Greabell obtained through the Board’s subpoena four incident reports from the Surprise Police Department (“SPD”) of calls for service involving Respondent. 8. On October 28, 2011, at approximately 5:01 p.m., SPD officers responded to Respondent’s residence at 11656 West Pincushion Court in Surprise, Arizona for a welfare check. Officers observed Respondent picking up a plate and throwing it to the ground. Officers also noticed that Respondent had a small laceration above her right eye and possibly another laceration in the corner of her right eye. Respondent stated that the laceration had occurred when she threw down a plate and the breaking glass cut her.[3] 9. When SPD officers asked Respondent if she knew the date at the October 28, 2011 welfare check, she responded that the date was October 21, 2001. Because Respondent did not know the correct year, SPD officers called the fire department. While SPD officers waited for the fire department with Respondent, she “was bouncing from one topic to another while [the reporting officer] was talking to her.”[4] 10. On November 11, 2011, at approximately 4:40 p.m., SPD officers responded to Respondent’s neighbor’s house for a welfare check after Respondent had alleged that an unnamed person had threatened her. Respondent informed SPD officers that she was “scared for her life because a male subject was stalking her.”[5] Respondent refused to give officers the name of the male subject, but informed them that he had followed her from Illinois after she aborted his child and refused to have a relationship with him, that he had stolen three sets of keys to her house, and that he had been in her garage and had cut the wires to her motorcycle. The reporting SPD officer did not see any damage to the motorcycle. 11. During the November 11, 2011 incident, Respondent told SPD officers that “she was not crazy, and did not want to go back to the ‘psych ward.’”[6] The reporting officer noted that Respondent “has a history of hallucinations, and was committed a few weeks prior for similar circumstances.”[7] 12. Ms. Greabell testified that because she was unable to contact Respondent, she was unable to obtain Respondent’s medical records. 13. On January 8, 2012, at approximately 3:00 a.m., SPD officers responded to a domestic violence incident at Respondent’s residence involving a physical dispute between her and her boyfriend. The reporting officer noted that Respondent and her boyfriend both emanated a strong odor of an alcoholic beverage from their faces and bodies. SPD officers reported “an odor of fresh marijuana” upon entering Respondent’s residence, saw marijuana and pipes in plain view, and noted that Respondent possessed a valid Arizona medical marijuana card.[8] Respondent and her boyfriend admitted to smoking marijuana and consuming alcohol. 14. On January 20, 2012, at approximately 9:20 a.m., SPD officers responded to Respondent’s residence for a welfare check. Respondent informed the reporting officer that she “felt good and had taken her medication today.”[9] Although the reporting officer stated that Respondent was “rational and in a good state of mind” on January 20, 2012, he reported as follows: My history with [Respondent] is that when she is on her medication and not drinking, she is fine, but when she does not take her medication, she then starts drinking [and] she thinks that people are out to get her, that they are following her and spying on her. She thinks that this all stems from when she was living in Illinois, over 25 years ago, she supposedly shot and killed someone, and they are out to get her now. I spoke with her mother . . . several times over the past few months and she stated that this never happened.[10]

15. Ms. Graebell testified that she is qualified to make a nursing diagnosis, which was a standardized communication that nurses use based on actual or potential responses to an illness, although it is not a medical diagnosis. Ms. Greabell testified that asking a person to provide the date, time, and year is an accepted quick way to determine functioning. Ms. Greabell testified that the SPD police reports indicated that Respondent was suffering from an altered thought process: These reports showed several instances of either violent or volatile behavior, such as the Respondent throwing things. There [were] some descriptions of possible cognitive deficits, such as not knowing the correct year; instances of altered thought processes, as far as her speech, bouncing from one topic to another. There was a comment, a statement by the police officer that the Respondent had a history of hallucinations. And then there were descriptions where she is either hallucinating or demonstrating some paranoia of people out to get her, and also alcohol and possible substance abuse problems. . . . .

People with altered thought processes, some of the things you might observe are hypervigilance, paranoia, conspiracy theories, cognitive disassociation.[11]

16. Ms. Graebell testified that a nurse with an altered thought process and possible substance abuse was not safe to practice. 17. On April 3, 2012, the Board sent a letter to Respondent at her address of record, informing her that it had received a report of suspected alcohol and marijuana abuse. The Board enclosed an Investigative Questionnaire with the letter and instructed Respondent to return the completed questionnaire within two weeks.[12] 18. Ms. Greabell testified that the April 3, 2012 letter was returned to the Board as undeliverable. Ms. Greabell testified that Respondent never returned a completed Investigative Questionnaire or contacted the Board. CONCLUSIONS OF LAW 1. This matter lies within the Board’s jurisdiction under A.R.S. § 32-1606(B)(10). The Complaint and Notice of 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.[13] The Board bears the burden of proof to establish cause to penalize Respondent’s registered nurse’s license by a preponderance of the evidence.[14] “A preponderance of the evidence is such proof as convinces the trier of fact that the contention is more probably true than not.”[15]

The Board established that between October 28, 2011, and January 20, 2012, Respondent exhibited signs and symptoms of an altered thought process and the disruption of cognitive operations and activities as evidenced by hallucinations and paranoia, and that Respondent abused alcohol in combination with marijuana. The Board thereby established that Respondent committed unprofessional conduct as defined by A.R.S. § 32-1601(18)(d)[16] and (e).[17] The Board established that Respondent failed to complete the Investigative Questionnaire that it instructed her to complete and return to the Board. The Board thereby established that Respondent committed unprofessional conduct as defined by A.R.S. § 32-1601(18)(d) and (j),[18] specifically A.A.C. R4-19-403(25)(a).[19] The Board has established cause to discipline Respondent’s license under A.R.S. §§ 32-1663(D)[20] and 32-1664(N).[21] Respondent’s failure to appear for the duly noticed hearing or to submit any evidence to defend her license indicates that at this time, she cannot be regulated. RECOMMENDED ORDER Based on the foregoing, it is recommended that the Board affirm its order summarily suspending Respondent Luann Marie Coogan’s Registered Nurse License No. RN165063. It is further recommended that the Board revoke Respondent Luann Marie Coogan’s Registered Nurse License No. RN165063. 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, April 16, 2013.

/s/ Diane Mihalsky Administrative Law Judge

Transmitted electronically to:

Joey Ridenour, RN, MN, FAAN, Executive Director State Board of Nursing ----------------------- [1] Effective January 31, 2009. [2] Effective September 30, 2009. [3] See the Board’s Exhibit 1 at P3. [4] Id. [5] The Board’s Exhibit 1 at P8. [6] Id. [7] Id. [8] The Board’s Exhibit 1 at P13. [9] The Board’s Exhbit 1 at P.18. [10] The Board’s Exhibit 1 at P18-P19. [11] Court Reporter’s Hearing Transcript at 8-9, ll. 23 – 8, 22 – 24. [12] See the Board’s Exhibit 2. [13] See A.R.S. §§ 41-1092.04; 41-1092.05(D). [14] 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). [15] Morris K. Udall, Arizona Law of Evidence § 5 (1960). [16] A.R.S. § 32-1601(18)(d) (effective September 30, 2009) defines “unprofessional conduct” to include “[a]ny conduct or practice that is or might be harmful or dangerous to the health of a patient or the public.” [17] A.R.S. § 32-1601(18)(e) (effective September 30, 2009) defines “unprofessional conduct” to include “[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.” [18] A.R.S. § 32-1601(18)(j) (effective September 30, 2009) defines “unprofessional conduct to include “[v]iolating this chapter or a rule that is adopted by the board pursuant to this chapter.” [19] A.A.C. R4-19-403(25)(a) (effective January 31, 2009) further defines “any conduct or practice that is or might be harmful or dangerous to the health of a patient of the public” under A.R.S. § 32-1601(18)(d) as “failing to . . .[f]urnish in writing a full and complete explanation of a matter reported pursuant to A.R.S. § 32-1664 . . . .” [20] This statute 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. [21] This statute 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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Office of Administrative Hearings 1400 West Washington, Suite 101 Phoenix, Arizona 85007 (602) 542-9826