ALJDEC decisions subject to certification as final

15A-1404120-NUR · State Board of Nursing · 2015-02-25

IN THE OFFICE OF ADMINISTRATIVE HEARINGS

HEARING: January 21, 2015, with the record held open until February 6, 2015 APPEARANCES: No one appeared for Respondent; Elizabeth A. Campbell, Esq. 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 Kriste Marie Onwiler holds registered nurse license number RN157061. 3. On December 16, 2014, the Board issued a Complaint and Notice of Hearing setting the above-captioned matter for hearing at 8:00 a.m. January 21, 2015, at the Office of Administrative Hearings in Phoenix, Arizona. 4. Ms. Onwiler did not appear at the scheduled hearing time and the matter was convened in her absence at about 8:15 a.m. 5. The Board presented the testimony of Yuma Police Department Detective Frederick Fell, Casey Butcher, RN, Donna Pettitt, RN, Cheryl Smith, RN, and Kristi Hunter, a nurse practitioner. 6. Ms. Pettitt, Ms. Butcher, and Ms. Smith are all employed by Amedisys Home Health, which also employed Ms. Onwiler during part of the time at issue in this matter. Amedisys provides therapy and nursing services to patients in their homes. 7. Ms. Hunter is a nurse practice consultant for the Board who investigated this matter. 8. In February 2014, Amedisys received a complaint from Wendi Harvey, in which Ms. Harvey stated that Ms. Onwiler had taken oxycodone pills from patient E.A. and told E.A. that the pills needed to be disposed of. 9. From Ms. Harvey, Ms. Hunter learned that it was about 120 oxycodone pills that Ms. Onwiler took from E.A. 10. During Amedisys’s investigation, Ms. Onwiler told Ms. Smith that E.A. had requested that Ms. Onwiler dispose of the oxycodone pills and that she had put the pills in her sharps container. When that sharps container was opened, it contained one hydrocodone pill and no oxycodone pills. E.A. was not being prescribed hydrocodone. 11. An Amedisys nurse is not to leave a patient’s home with that patient’s medication and placing narcotics in a sharps container is not a proper method of disposal. 12. Amedisys requested Ms. Onwiler to undergo a drug screen, but before a test could be successfully completed, Amedisys fired her for improper disposal of narcotics. When Ms. Onwiler brought her nursing bag to Amedisys, it contained a Norco[1] prescription for patient F.O. 13. On February 20, 2014, Ms. Onwiler had called in sick, but when Ms. Butcher and another nurse arrived at patient’s C.R.’s house, Ms. Onwiler was present. Amedisys’s policy was such that Ms. Onwiler should not have been at the patient’s home for other than a medical visit. Ms. Butcher was of the opinion that Ms. Onwiler had put C.R. at risk of infection. 14. On April 3, 2014, at which time Ms. Onwiler was no longer employed by Amedisys, Ms. Onwiler appeared at patient M.Y.’s house. At that time, Ms. Onwiler told Ms. Butcher that she was there to help M.Y. with her medications. Ms. Butcher was of the opinion that this was a conflict of interest and that Ms. Onwiler should not have been touching any of M.Y.’s medications. 15. On April 7, 2014, M.Y. went to Dr. Moore’s office with a caregiver, who turned out to be Ms. Onwiler. A nurse told Ms. Hunter that Ms. Onwiler had requested more pain medication for M.Y. 16. On April 10, 2014, M.Y. told Ms. Butcher that Ms. Onwiler had been at her home and had filled M.Y.’s medication boxes. Ms. Onwiler had included in those boxes narcotics that were to be used as needed, rather than on a set schedule. 17. Ms. Butcher became concerned about M.Y.’s use of pain pills and asked M.Y.’s caregiver to keep track of her intake. 18. Ms. Butcher determined that M.Y. was missing about forty-two Norco pills. Ms. Butcher also discovered that Norco had been replaced with Tylenol, which raised the additional concern that M.Y. was taking more Tylenol than she was ordered to. Excessive use of Tylenol can lead to liver damage. Ms. Butcher learned that Ms. Onwiler had been accessing M.Y.’s medication boxes shortly before these discrepancies were learned of. 19. On April 22, 2014, Ms. Butcher received a telephone call from M.Y.’s therapist who expressed the concern that based on the number of pills M.Y. had in comparison to her prescriptions, M.Y. was taking too much pain medication. 20. The therapist then informed Ms. Butcher that Ms. Onwiler had once insisted on counting the number of pills in one of M.Y.’s previously unopened prescriptions. Ms. Onwiler reported that the pills were not all there and went into a fit of hysterics. M.Y.’s caregiver confirmed this account. 21. In 2011 and again in 2012 and 2013, Ms. Onwiler provided in-home care to patient V.J. 22. In June 2014 when V.J. was no longer her patient, Ms. Onwiler contacted V.J. and later came to her home. At that time, Ms. Onwiler went through V.J.’s medications, including hydrocodone, and informed V.J. that some were out of date. Ms. Onwiler told V.J. that she had flushed these medications, but V.J. observed that Ms. Onwiler actually put them in her pocket. 23. During September 2014, Dr. Fayad’s office telephoned V.J. regarding a request from V.J.’s granddaughter to have V.J.’s prescription filled. Neither V.J. nor her granddaughter had made such a request. Soon after the call from Dr. Fayad, Ms. Onwiler contacted V.J. and told her that she would need to tell the police that V.J. had asked Ms. Onwiler to call in the request for a prescription refill and that if she did not, Ms. Onwiler could lose her nursing license and possibly go to jail. 24. V.J. also learned that her insurance premiums had been increased based on the amount of medication she was using and she learned that there had been six refills of hydrocodone that she had no recollection of receiving. 25. Det. Fell set up a “confrontation call” from V.J. to Ms. Onwiler, but Det. Fell testified that the call did not reveal any information that was “too incriminating.” 26. At the time of the confrontation call, other officers from the Yuma Police Department conducted a traffic stop of Ms. Onwiler’s vehicle. Det. Fell testified that based on his work and that of other police officers, they had probable cause to arrest Ms. Onwiler and that Ms. Onwiler had been the person requesting Dr. Fayad to refill V.J’s prescriptions. 27. Det. Fell obtained a video from Dr. Fayad’s office that shows Ms. Onwiler attempting to pick up medication for V.J. and pretending to be V.J.’s granddaughter. 28. Ms. Onwiler was arrested and at the time of her arrest she had an empty bottle of hydrocodone showing V.J. as the patient. Ms. Onwiler also had two prescriptions for hydrocodone in the name of patient F.O. 29. Ms. Onwiler admitted to Det. Fell that she had pretended to be V.J.’s granddaughter. Eventually, Ms. Onwiler told Det. Fell that she considered herself to be a junkie and was addicted to hydrocodone and that she had taken pills from V.J. and F.O. 30. Det. Fell subsequently discovered that F.O.’s medical records showed a much greater use of hydrocodone than F.O. was actually making. 31. Ms. Onwiler was assisting F.O. with his medications after Amedisys had fired her. 32. Ms. Onwiler was criminally charged with fraudulent schemes and artifices and taking the identity of another. Ms. Onwiler did not report to the Board that she had been charged with fraudulent schemes and artifices and taking the identity of another within ten days of those charges being filed. 33. On October 8, 2014, Ms. Onwiler signed a statement showing that she wanted help and was requesting “rehab.” 34. On October 24, 2014, Ms. Hunter interviewed Ms. Onwiler. During that interview, Ms. Onwiler initially denied that she had intentionally filled prescriptions for M.Y., but she later acknowledged that she had diverted medication (hydrocodone and oxycodone) from M.Y., V.J., and F.O. Ms. Onwiler also admitted that she falsely identified herself as V.J.’s granddaughter to Dr. Fayad’s office. 35. Ms. Onwiler acknowledged that she had provided services to C.R., including medication management and catheter care at a time when C.R. was not her patient, but was still a patient of Amedisys. Ms. Onwiler also acknowledged seeing other former patients in their homes and that she would help them keep their medications organized and assist with medication refills. 36. It is not standard of care for a nurse to continue to see patients to whom she is no longer assigned as nurse. To do so is a breach of ethics because the nurse and patient are not equals and is considered to be a boundary violation. 37. A nurse managing the medication of a person who is not her patient places that person at risk of not getting the correct dosages. 38. Medication management is a nursing service that should be documented in the patient’s chart. Because Ms. Onwiler was providing medication management for non-patients, she would not have had access to charts and could not have properly document this activity. This is also true for the catheter care Ms. Onwiler provided to C.R. 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 § R2-19-119. 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. The preponderance of the evidence shows that Ms. Onwiler engaged in conduct that is, or might be, harmful or dangerous to the health of a patient or the public, which constitutes unprofessional conduct under Ariz. Rev. Stat. section 32- 1601(22)(d).[2] 5. The preponderance of the evidence shows that Ms. Onwiler has repeatedly violated the Board’s statutes, which constitutes unprofessional conduct under Ariz. Rev. Stat. section 32- 1601(22)(g). 6. The preponderance of the evidence shows that Ms. Onwiler has committed an act that deceives, defrauds, or harms the public, which constitutes unprofessional conduct under Ariz. Rev. Stat. section 32-1601(22)(h). 7. The preponderance of the evidence shows that Ms. Onwiler has failed to maintain the minimum standards of acceptable nursing practice, which is a violation of Ariz. Admin. Code section 4-19- 403(1) and unprofessional conduct under Ariz. Rev. Stat. sections 32-1601(22)(d) and (j). 8. The preponderance of the evidence shows that Ms. Onwiler has failed to maintain professional boundaries, which is a violation of Ariz. Admin. Code section 4-19-403(3) and unprofessional conduct under Ariz. Rev. Stat. sections 32-1601(22)(d) and (j). 9. The preponderance of the evidence shows that Ms. Onwiler has failed to maintain a patient record that accurately reflects the nursing assessment, care, treatment, and other nursing services provided to the patient, which is a violation of Ariz. Admin. Code section 4-19-403(7) and unprofessional conduct under Ariz. Rev. Stat. sections 32-1601(22)(d) and (j). 10. The preponderance of the evidence shows that Ms. Onwiler has failed to take appropriate action to safeguard a patient’s welfare or follow policies and procedures of the nurse’s employer designed to safeguard the patient, which is a violation of Ariz. Admin. Code section 4-19-403(9) and unprofessional conduct under Ariz. Rev. Stat. sections 32-1601(22)(d) and (j). 11. The preponderance of the evidence shows that Ms. Onwiler has removed, without authorization, patients’ property or personal possessions, which is a violation of Ariz. Admin. Code section 4- 19-403(15) and unprofessional conduct under Ariz. Rev. Stat. sections 32-1601(22)(d) and (j). 12. The preponderance of the evidence shows that Ms. Onwiler removed narcotic drugs from a workplace location without permission, which is a violation of Ariz. Admin. Code section 4-19-403(16) and unprofessional conduct under Ariz. Rev. Stat. sections 32- 1601(22)(d) and (j). 13. The preponderance of the evidence shows that Ms. Onwiler obtained, possessed, used, or administered narcotic drugs in violation of her employer’s policy, which is a violation of Ariz. Admin. Code section 4-19-403(18) and unprofessional conduct under Ariz. Rev. Stat. sections 32-1601(22)(d) and (j). 14. The preponderance of the evidence shows that Ms. Onwiler made false or inaccurate statements to the Board or its designee during the investigation of this matter, which is a violation of Ariz. Admin. Code section 4-19-403(26) and unprofessional conduct under Ariz. Rev. Stat. sections 32-1601(22)(d) and (j). 15. The preponderance of the evidence shows that Ms. Onwiler did not timely report to the Board that she had been charged with a felony or a misdemeanor involving conduct that may affect patient safety, which is a violation of Ariz. Admin. Code section 4-19-403(28) and unprofessional conduct under Ariz. Rev. Stat. sections 32-1601(22)(d) and (j). 16. The Board has shown by a preponderance of the evidence that Ms. Onwiler has violated Ariz. Admin. Code section 4-19-403(31), which is unprofessional conduct under Ariz. Rev. Stat. sections 32-1601(22)(d) and (j) 17. The Board alleges that Ms. Onwiler committed a felony or a misdemeanor involving moral turpitude in violation of Ariz. Rev. Stat. section 32-1601(22)(b). Although, as of the hearing date, there were criminal charges pending against Ms. Onwiler, the Board has not shown by a preponderance of the evidence that she has been convicted of, or pleaded no contest to, any crimes. Consequently, the Board has not shown that Ms. Onwiler violated Ariz. Rev. Stat. section 32-1601(22)(b). 18. Because Ms. Onwiler has committed unprofessional conduct, the Board has authority to revoke her registered nurse license. See Ariz. Rev. Stat. § 32-1663. 19. Considering the facts and circumstances of this matter, it is recommended that Ms. Onwiler’s registered nurse license number RN157061 be revoked. RECOMMENDED ORDER IT IS ORDERED that Kriste Marie Onwiler’s registered nurse license number RN157061 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, February 25, 2015.

/s/ Thomas Shedden Thomas Shedden Administrative Law Judge

Transmitted electronically to:

Joey Ridenour, RN, MN, Executive Director State Board of Nursing ----------------------- [1] Hydrocodone-acetaminophen [2] The current versions of the applicable statutes are cited.

-----------------------

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