ALJDEC decisions subject to certification as final

18A-1402049-NUR · State Board of Nursing · 2018-10-30

IN THE OFFICE OF ADMINISTRATIVE HEARINGS

HEARING: September 20, 2018, with the record held open until October 10, 2018 to allow the court reporter’s transcript to be a part of the record. APPEARANCES: Respondent Deborah Lee Cruse appeared on behalf of herself. Assistant Attorney General Elizabeth Campbell appeared on behalf of the Arizona State Board of Nursing. ADMINISTRATIVE LAW JUDGE: Velva Moses-Thompson _____________________________________________________________________ FINDINGS OF FACT 1. The Arizona State Board of Nursing (“Board”) has the authority to regulate and control the practice of nursing in the State of Arizona pursuant to Ariz. Rev. Stat. sections 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, Ariz. Rev. Stat. sections 32-1601 through 32-1669. In addition, the Board has the authority to impose disciplinary sanctions against holders of the privilege to practice nursing in the State of Arizona pursuant to the Nurse Licensure Compact, Ariz. Rev. Stat. sections 32-1668 and 32-1669. 2. Respondent Deborah Lee Cruse held Board issued registered nurse license number RN136029, which expired in April 2010. 3. Ms. Cruse holds a registered nurse multistate licensure issued by the State of Texas. 4. In 2013 and 2014, Ms. Cruse worked in Arizona under the privilege to practice nursing in the State of Arizona under the multistate Compact. 5. On August 6, 2018, the Board issued a Complaint and Notice of Hearing setting the above-captioned matter for hearing at 1:00 p.m. on September 20, 2018 at the Office of Administrative Hearings in Phoenix, Arizona. 6. The Board presented the testimony of Brian Montgomery, Nurse Manager for Urgent Psychiatric Center (“Connections”), Tiana Juarez, Director of Nursing at Montana State Hospital, Ruth Kish, RN, Board Nurse Practice Consultant, and submitted exhibits 1 through 7. Ms. Cruse testified on her own behalf and presented the testimony of Devra Venecia. 7. In 2013 and 2014 Respondent worked for Professional Psychiatric Staffing Services (“Professional Psychiatric Staffing”) in Sun City West, Arizona. On February 25, 2014, Professional Psychiatric Staffing submitted a complaint to the Board reporting that Respondent had practice deficiencies and that on February 24, 2014, she had been involved in a controlled substance discrepancy while assigned to work at Connections in Phoenix, Arizona. Based on this information, the Board conducted an investigation. 8. In December 2013, Professional Psychiatric Staffing assigned Respondent to work at Southwest Behavioral Health in Phoenix, Arizona, Respondent made the concerning and irrational statement to other healthcare staff that not all of the psychotic patients were psychotic, but that some of them were possessed by demons. 9. On the night of February 21, 2014, from 7:00 p.m. to 7:00 a.m., Professional Psychiatric Staffing assigned Respondent to work at Connections AZ. During the morning of February 22, 2014, Ms. Cruse worked as a Registered Nurse for Urgent Psychiatric Center (“Connections”). Ms. Cruse was responsible for counting and listing the medication of incoming patients. Ms. Cruse refused to count the narcotics of an incoming patient.

10. At Connections, the medication was kept in a medication room and was under video surveillance. Ms. Cruse was observed on the surveillance video opening the medication cart and placing a bottle of pills in her pocket and closing the door. Ms. Cruse was observed taking the medication at a time when a medication pass was not scheduled. 11. At the request of Professional Psychiatric Staffing, Respondent submitted to a drug test on February 25, 2014. Respondent tested positive for Hydrocodone3 and Amphetamine.4 Respondent had a prescription for Hydrocodone, but did not have a current, valid prescription for Amphetamine. 12. In June of 2015, Ms. Cruse worked as a traveling nurse on a 13 week contract at the Montana State Hospital. The hospital provides a five day orientation for the traveling nurses. Ms. Cruse struggled after the initial orientation and was given a second orientation. Ms. Cruse expressed that she had only administered medication through Pyxis, but the hospital still believed that it would not prevent Ms. Cruse from performing her work. 13. Montana State Hospital terminated Ms. Cruse’s contract because she struggled with administering medication. Montana State Hospital is limited in the amount of orientation that it can provide to a traveling nurse. 14. The patients at the Montana State Hospital are admitted based upon a court order from a civil action or court ordered evaluation stemming from a criminal act. Montana State Hospital does not take voluntary patients. 15. Ms. Cruse expressed that she was not comfortable working with the forensic population. In addition, the patients were concerned about her using religious gestures. 16. During the Board’s investigation of the complaint against Ms. Cruse, it retrieved her Ms. Cruse’s prescription monitoring program report from January of 2009 to July of 2018. Since at least 2009, Respondent has been prescribed controlled substances in amounts and potentiating combinations that have the potential to impair cognitive function and judgment. 17. The report shows that Ms. Cruse was prescribed hydrocodone and Suboxone. The report shows that Ms. Cruse was prescribed 42 different prescriptions by 30 different pharmacies which was concerning to the Board.

18. At hearing, Ms. Cruse testified that she felt “picked on” by the Board and could not afford an attorney. Ms. Cruse testified that she never stole narcotics and that it was extremely busy on the morning of February 22, 2014. Ms. Cruse testified that she did not refuse to count narcotics and that she does not know what was meant by the term, “religious gesture.” Ms. Cruse also contended that the patients who alleged that she used religious gestures were psychiatric patients. 19. Ms. Cruse stated that most nurses make mistakes and she was overwhelmed during her orientation at Montana State Hospital. She stated that the trainer kept saying, “What’s wrong with you?” Ms. Cruse stated that she was put in a room by herself for two hours and admitted that she made more mistakes than she should have. 20. Ms. Cruse asserted that she was never terminated from Banner John Hopkins. 21. Ms. Cruse testified that she takes Suboxen for pain. Ms. Cruse admitted that she became addicted to painkillers because she previously had ovarian cancer. Ms. Cruse testified that she did not believe that the hearing was fair because she could afford a lawyer. She also testified that 98% of the people on the floor of the Montana State Hospital were sexual offenders. Ms. Cruse testified that she is an excellent nurse and should not have her license revoked. 22. Ms. Cruse provided a character witness in support of her case. Devra Venecia testified that she has been a friend of Ms. Cruse for fifteen years. Ms. Venecia testified that she worked at Scottsdale Shea with Ms. Cruse in 2005. Ms. Venecia testified that Ms. Cruse was a good nurse and a team player. CONCLUSIONS OF LAW 1. 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. Ariz. Rev. Stat. section 41-1092.04; Ariz. Rev. Stat. section 41- 1061(A). 2. The Board has jurisdiction to take action against Respondent’s privilege to practice nursing in Arizona pursuant to the Nurse Licensure Compact, Ariz. Rev. Stat. section 32-1668[1] and Ariz. Rev. Stat. section 32-1669.[2] However, only the Texas Board may discipline Respondent’s nursing license.[3] 3. The Board bears the burden of proof and must establish cause to penalize Respondent’s privilege to practice nursing in Arizona by a preponderance of the evidence. See Ariz. Rev. Stat. section 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). 4. A preponderance of the evidence is: The greater weight of the evidence, not necessarily established by the greater number of witnesses testifying to a fact but by evidence that has the most convincing force; superior evidentiary weight that, though not sufficient to free the mind wholly from all reasonable doubt, is still sufficient to incline a fair and impartial mind to one side of the issue rather than the other. Black’s Law Dictionary 1373 (10th ed. 2014).

5. The preponderance of the evidence shows that Respondent committed unprofessional conduct as defined by Ariz. Rev. Stat. section 32- 1601(22)(d), (e), and (j); A.A.C. R4-19-403(16), (17), (18), and (31). The testimony offered by Ms. Venecia provided in support of her competency as a nurse bears little weight as she has not worked with Respondent in over 10 years. Because Respondent has committed unprofessional conduct, the Board has authority to revoke her privilege to practice nursing in Arizona under the Nurse Licensure Compact. Ariz. Rev. Stat. sections 32-1663(A), (D); and section 32-1664(O). 6. Considering the facts and circumstances of this matter, it is recommended that Respondent Deborah Lee Cruse’s expired Arizona registered nurse license be revoked, and that Respondent Deborah Lee Cruse’s privilege to practice nursing in Arizona be revoked. RECOMMENDED ORDER Based on the foregoing, the Administrative Law Judge recommends that the Board revoke Deborah Lee Cruse’s privilege to practice nursing in Arizona under the Nurse Licensure Compact. It is further recommended that the Board revoke Deborah Lee Cruse’s expired Arizona registered nurse license. It is further recommended that the Board provide a copy of its final order to the Texas Board for its consideration under Ariz. Rev. Stat. section 32-1668, Article V (D). 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, October 30, 2018.

/s/ Velva Moses-Thompson Administrative Law Judge

Transmitted electronically to:

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

----------------------- [1] The Nurse Licensure Compact at Ariz. Rev. Stat. section 32-1668 also includes the following relevant provisions:

Article I Findings and Declaration of Purpose . . . . B. The general purposes of this compact are to: . . . . 5. Invest all party states with the authority to hold a nurse accountable for meeting all state practice laws in the state in which the patient is located at the time care is rendered through the mutual recognition of party state licenses. . . . . Article III General Provisions and Jurisdiction . . . . B. Party states may, in accordance with state due process laws, limit or revoke the multistate licensure privilege of any nurse to practice in their state and may take any other actions under their applicable state laws necessary to protect the health and safety of their citizens. . . . C. Every nurse practicing in a party state must comply with the state practice laws of the state in which the patient is located at the time care is rendered. . . . The practice of nursing will subject a nurse to the jurisdiction of the nurse licensing board and the courts, as well as the laws, in that party state. . . . . Article V Adverse Actions In addition to the general provisions described in article III, the following provisions apply: . . . . B. The licensing board of a party state shall have the authority to complete any pending investigations for a nurse who changes primary state of residence during the course of such investigations. . . .

[2] The Nurse Licensure Compact at Ariz. Rev. Stat. section 32-1669(A) provides that “[a] person who is extended the privilege to practice in this state pursuant to the compact adopted pursuant to section 32-1668 is subject to the same disciplinary requirements prescribed in this chapter, and the board's investigative and disciplinary powers and procedures apply to a person who practices in this state pursuant to this compact.” [3] See Ariz. Rev. Stat. section 32-1668, Nurse Licensure Compact at Article V, Adverse Actions, which provides in relevant part as follows:

C. A remote state may take adverse action affecting the multistate licensure privilege to practice within that party state. However, only the home state shall have the power to impose adverse action against the license issued by the home state. D. For purposes of imposing adverse action, the licensing board of the home state shall give the same priority and effect to reported conduct received from a remote state as it would if such conduct had occurred within the home state. In so doing, it shall apply its own state laws to determine appropriate action.

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Office of Administrative Hearings 1740 West Adams Street, Lower Level Phoenix, Arizona 85007 (602) 542-9826