ALJDEC decisions subject to certification as final

14A-1309019-NUR · State Board of Nursing · 2014-08-01

IN THE OFFICE OF ADMINISTRATIVE HEARINGS

HEARING: July 8, 2014, with the record held open until July 24, 2014 APPEARANCES: No one appeared for Respondent; Elizabeth Campbell, Esq. appeared for the State Board of Nursing ADMINISTRATIVE LAW JUDGE: Thomas Shedden _____________________________________________________________________ FINDINGS OF FACT 1. The Arizona State Board of Nursing (“Board”) is the authority for licensing and regulating the practice of nursing in the State of Arizona. 2. Respondent Sheila C. Bean holds registered nurse license number RN180883. 3. On May 16, 2014, the Board summarily suspended Ms. Bean’s license. 4. On June 3, 2014, the Board issued a Complaint and Notice of Hearing (Summary Suspension, Expedited Hearing) setting the above-captioned matter for hearing at 8:00 a.m. July 8, 2014 at the Office of Administrative Hearings in Phoenix, Arizona. 5. Ms. Bean did not appear at the scheduled time and the matter was convened in her absence at about 8:25 a.m. 6. The Board presented the testimony of Elaine Wade, RN, a charge nurse at Mountain Vista Medical Center in Mesa, Arizona (“Mountain Vista”) during the time Ms. Bean worked there; Matthew Wekell, RN, manager of Mountain Vista’s telemetry unit during part of the time Ms. Bean worked there; and Jessica Hood, RN, who worked at Mountain Vista during the time Ms. Bean worked there. 7. The Board also presented the testimony of its Nurse Practice Consultants Tamara Greabell, RN, and Kristen Wilson, RN, a psychiatric nurse practitioner. 8. From December 2012 until July 2013, Ms. Bean worked as a registered nurse at Mountain Vista. Ms. Bean’s employment was terminated on July 19. 2013, based upon performance issues. 9. On March 19, 2013, Ms. Bean was caring for patient SW at Mountain Vista. When SW suffered a change in condition, Ms. Bean reported that change to SW’s physician, but provided the physician medication information from a different patient’s chart. 10. Ms. Bean received a medication order from the physician, but did not immediately document that information in SW’s chart as required. 11. Under Mountain Vista’s policies, Ms. Bean should have informed Ms. Wade, the charge nurse, of the change in SW’s condition but failed to do so. 12. Ms. Wade provided credible testimony that Ms. Bean was difficult to supervise because Ms. Bean would not communicate with Ms. Wade and would not keep Ms. Wade informed of changes in patients’ condition. When Ms. Wade raised her concerns with Ms. Bean, Ms. Bean would become defensive and would not stay focused on the issues at hand. 13. Ms. Wade also testified that Ms. Bean was not an effective communicator and that she would go off on tangents that were not related to nursing. 14. Ms. Wade assigned Ms. Bean the least complicated patients to avoid problems. 15. On March 23, 2013, a CNA called Ms. Wade and informed her that one of Ms. Bean’s patients (EG) was very angry and trying to leave his room. Ms. Wade arrived and learned that Ms. Bean had failed to provide EG his medication because Ms. Bean had been trying to resolve a computer issue. Ms. Wade’s opinion was that Ms. Bean should have provided the medication when required and that there was no valid reason for her failure to provide that medication. 16. Ms. Bean then explained to the patient why she had failed to provide the required medication which caused EG to get further agitated. Ms. Wade was of the opinion that it was not proper for Ms. Bean to give excuses to EG. 17. On June 2, 2013, Ms. Wade received a call in which she was informed that Ms. Bean was refusing to give a patient medication because Ms. Bean thought that she would be encouraging the patient’s addictions. Ms. Wade testified that there was no basis for Ms. Bean to ignore the doctor’s order to give the medication. 18. It was Ms. Wade’s opinion that Ms. Bean had been arguing with the patient and that one should never argue with a psychiatric patient. The evidence shows that the patient was on suicide watch and that Ms. Bean’s behavior was causing the patient’s anger to escalate. Ms. Wade found it appropriate to take Ms. Bean off that case. 19. Given the issues related to Ms. Bean’s job performance, Mr. Wekell prepared an Action Plan dated March 23, 2013. The Action Plan provided that Ms. Bean’s goals should include better communication with the charge nurse and her coworkers. 20. Mr. Wekell discussed the Action Plan with Ms. Bean, but that discussion did not go well. In general, Mr. Wekell found that when Ms. Bean was being given constructive criticism, she would focus on a single word rather than on the overall concepts. 21. Mr. Wekell testified about an incident that occurred on May 1, 2013. At that time, Ms. Bean failed to give patient WM a second unit of blood as ordered. Although Mr. Wekell did not understand why Ms. Bean would not give the second unit, it appeared she had failed to do so because there had been a paperwork deficiency with the first unit. Mr. Wekell’s testimony made it clear that this paperwork deficiency was not a valid basis for Ms. Bean’s failure to follow the order and provide the second unit of blood. 22. Mr. Wekell prepared a June 2, 2013 “Performance Plan” that Mr. Wekell considered to be a last chance for Ms. Bean. Mr. Wekell explained that between March and June 2013, there had been other discussions with Ms. Bean regarding her job performance. Among the issues noted in the Performance Plan was the need for Ms. Bean to communicate effectively and to respect personal boundaries. 23. As an example of Ms. Bean’s poor communication skills, Mr. Wekell testified that Ms. Bean’s “handoff” reports were long and unfocused. 24. Mr. Wekell also testified about information in the Performance Plan showing that Ms. Bean was spending more time than typically required to close out her shifts, which indicated a time management problem or a need for more help. 25. Mr. Wekell did not believe that he and Ms. Bean went over the entire Performance Plan, because although he thought the Performance Plan was relatively short, given Ms. Bean’s communication issues, it would have taken hours to go through it all. 26. Mountain Vista also issued a “Notice of Corrective Action Plan” that was signed by Ms. Bean on July 3, 2013. 27. On July 13, 2013, while working at Mountain Vista, Ms. Bean left her post and her patient assignment in the telemetry unit without notice and without reporting to the charge nurse that she was leaving. 28. After leaving her patient assignment on July 13, 2013, Ms. Bean went to the medical center staffing office and spoke to Ms. Hood who was the acting House Supervisor. 29. According to Ms. Hood, Ms. Bean was delusional and paranoid. Ms. Bean was not making any sense and Ms. Hood described Ms. Bean as having a psychotic episode. 30. Given Ms. Bean’s condition, Ms. Hood placed her on administrative leave. Ms. Bean would not leave the premises and Ms. Hood had to call security to have Ms. Bean escorted off the premises. 31. Ms. Hood’s opinion was that Ms. Bean was not mentally or physically able to care for patients and that she was not safe to practice on July 13, 2013. 32. Mountain Vista terminated Ms. Bean’s employment effective on July 19, 2013, with a recommendation that she not be rehired. 33. On September 3, 2013, Ms. Bean was interviewed for a Nurse Practice Consultant position at the Board. 34. Ms. Greabell testified that Ms. Bean’s behavior disintegrated during the interview and that she became increasingly difficult to follow. In addition, Ms. Bean engaged in inappropriate humor, made references that were not relevant to the questions being asked (including references to her “sphincter”), and she was unable to describe some of her previous employment. 35. On September 4, 2013, Ms. Bean sent the Board an email that included inappropriate comments and emoticons of piles of feces.

36. On March 20, 2014, Ms. Bean appeared at the Board’s office unannounced and requested to see associate director Nikki Austin. According to Ms. Greabell, Ms. Bean was very agitated and reported that she had been cyber-hacked and that she was under surveillance. Ms. Greabell testified that Ms. Bean’s speech was very rapid and that her thought process was disjointed and that some of what she said made no sense. 37. Ms. Wilson is the Board’s Nurse Practice Consultant assigned to Ms. Bean’s case. 38. On October 1, 2013, Ms. Wilson sent to Ms. Bean an Investigative Questionnaire that Ms. Bean never returned to the Board. 39. Ms. Wilson made attempts to contact Ms. Bean, but Ms. Bean did not respond to Ms. Wilson’s messages. 40. Ms. Wilson did have one telephone conversation with Ms. Bean, which occurred in June 2014. During the telephone conversation Ms. Wilson had to redirect Ms. Bean in an effort to keep her on topic. 41. Based on that conversation, her review of emails and other correspondence written by Ms. Bean, and based on information provided by Mountain Vista, Ms. Wilson’s opinion was that Ms. Bean’s thought process was disorganized, that her thoughts were often not related to the topic at hand, that she suffered from delusional ideation, and that she displayed a lack of insight at times. 42. Ms. Wilson’s opinion was that Ms. Bean was mentally incompetent to a degree that is or might be harmful or dangerous to the health of a patient or the public and that she was not safe to practice. CONCLUSIONS OF LAW 1. The Board bears the burden of persuasion. Ariz. Rev. Stat. § 41- 1092.07(G)(2). 2. The standard of proof on all issues is that of a preponderance of the evidence. Ariz. Admin. Code § 2-19-119. 3. A preponderance of the evidence is “[e]vidence which is of greater weight or more convincing than the 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 1182 (6th ed. 1990). 4. If the Board determines that a licensee has committed an act of unprofessional conduct, it may take disciplinary action. Ariz. Rev. Stat. §§ 32-1663(D) and 32-1664(N). 5. The preponderance of the evidence shows that Ms. Bean has engaged in conduct that might be harmful or dangerous to the health of a patient or the public, which is a violation of Ariz. Rev. Stat. section 32-1601(22)(d). 6. The preponderance of the evidence shows that Ms. Bean is mentally incompetent or physically unsafe to a degree that might be harmful or dangerous to the health of a patient or the public, which is a violation of Ariz. Rev. Stat. section 32- 1601(22)(e). 7. The preponderance of the evidence shows that Ms. Bean left her duty station without making arrangements to have another nurse cover her patients, which is a violation of Ariz. Admin. Code section 4-19-403(5) and Ariz. Rev. Stat. section 32-1601(22)(d). 8. The preponderance of the evidence shows that Ms. Bean failed to take appropriate action to safeguard at least two patients’ welfare and that she failed to follow Mountain Vista’s policies and procedures, which are violations of Ariz. Admin. Code section 4-19-403(9) and Ariz. Rev. Stat. section 32-1601(22)(d). 9. The preponderance of the evidence shows that Ms. Bean failed to answer the Board’s questionnaire, which is a violation of Ariz. Admin. Code section 4-19-403(25)(a) and Ariz. Rev. Stat. section 32-1601(22)(d). 10. The preponderance of the evidence shows that Ms. Bean’s conduct was such that the Board had reasonable cause to believe that the health of a patient or the public might be harmed, which is a violation of Ariz. Admin. Code section 4-19-403(31) and Ariz. Rev. Stat. section 32-1601(22)(d). 11. The preponderance of the evidence shows that Ms. Bean has repeatedly violated the Board’s statutes or rules, which is a violation of Ariz. Rev. Stat. section 32-1601(22)(g). 12. Considering the facts and circumstances of this matter, it is recommended that Ms. Bean’s license be revoked. RECOMMENDED ORDER IT IS ORDERED that Sheila C. Bean’s registered nurse license number RN180883 is revoked. 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, August 1, 2014.

/s/ Thomas Shedden Thomas Shedden Administrative Law Judge

Transmitted electronically to:

Joey Ridenour, RN, MN, Executive Director State Board of Nursing -----------------------

Office of Administrative Hearings 1400 West Washington, Suite 101 Phoenix, Arizona 85007 (602) 542-9826