FINACT15A-1510008-NUR.pdf

18A-1510008-NUR · State Board of Nursing · 2018-03-27

Doug Ducey Joey Ridenour Governor Executive Director

Arizona State Board of Nursing 1740 West Adams Street, Suite 2000 Phoenix. AZ 85007 Phone (602) 771-7800 Fax (602) 771-7888 E-Mail: [email redacted] Home Page: http://www.azbn.gov

TO: Case Management Office of Administrative Hearings

FROM: Trina Smith Legal Assistant Hearing Department

DATE: March 27, 2018

RE: Jarrid Ruben Ortiz Docket No. 15A-1510008-NUR ______________________________________________________________________________

On March 23, 2018, the Board considered the Administrative Law Judge Decision (“ALJ Decision”), which recommended that the Board Revoke Registered Nurse License Number RN177628 issued to Jarrid Ruben Ortiz.

The Board adopted the Findings of Fact, Conclusions of Law and Recommended Order in its entirety with minor clerical corrections as follows:

• Correction to spelling of Witness name Ms. Midkiff where misspelled.

• Correction to last sentence of Finding of Fact #26 to read; “Ms. Midkiff also testified that the standard of care requires that an assessment must be completed before administering Lorazepam”. Lorazepam is not a pain medication ARIZONA STATE BOARD OF NURSING 1740 West Adams Street, Suite 2000 Phoenix AZ 85007 602-771-7800

IN THE MATTER OF THE REGISTERED NURSE LICENSE NO.RN177628 FINDINGS OF FACT, ISSUED TO: CONCLUSIONS OF LAW AND ORDER NO. 18A-1510008-NUR JARRID RUBEN ORTIZ RESPONDENT.

A hearing was held before Velva Moses-Thompson, Administrative Law Judge (“ALJ”), at 1400

West Washington Suite 101, Phoenix Arizona, on January 26, 2018. Elizabeth Campbell, Assistant Attorney General, appeared on behalf of the State. Jarrid Ruben Ortiz (“Respondent”) was not present and was not represented by counsel.

On February 15, 2018, the ALJ issued Findings of Fact, Conclusions of Law and

recommendations. On March 23, 2018, the Arizona State Board of Nursing met to consider the ALJ’s recommendations. Based upon the ALJ’s recommendations and the administrative record in this matter, the Board makes the following Findings of Fact and Conclusions of Law.

FINDINGS OF FACT

1. On November 27, 2017, the Arizona State Board of Nursing ("Board") issued a Notice of Hearing setting the above-captioned matter for hearing on January 4, 2018 at 9:00 a.m. 2. The Notice of Hearing provides that the issue is "whether grounds exist to take disciplinary action, including suspension or revocation against Respondent Jarrid Ruben Ortiz ("Mr.

Ortiz") who holds registered nurse license number RN177628 to perform as a registered nurse in the

State of Arizona." 3. Mr. Ortiz did not appear at the scheduled hearing time and the matter was convened in his absence at about 9:20 a.m.

4. The Board presented the testimony of Patricia Jo Midkiff, RN and submitted exhibits 1 through 12. 5. On or about September 29, 2015, the Board received a complaint from Banner Boswell

Medical Center in Sun City, AZ ("BBMC") alleging that Mr. Ortiz practiced outside the scope of his

license while working as a nurse at BBMC. See Exhibit 1. The complaint was submitted by Susan Hopf, RN, BSN, MN, Chief Nursing Officer at BBMC. See id. As a result of this complaint, the Board opened an investigation that was assigned to Ms. Midkiff, a nurse practice consultant for the board.

6. On or about January 27, 2017, Ms. Midkiff issued notification to Mr. Ortiz that the

Board had received complaints against his license. Ms. Midkiff provided Board Investigative Questionnaires ("questionnaires") with the notification and requested that Mr. Ortiz complete and return questionnaires. See Exhibit 12, Bates p. 114. Mr. Ortiz did not return the questionnaires. 7. Ms. Midkiff called Mr. Ortiz and sent him e-mail regarding the Board's investigation.

See Exhibit 12, Bates p. 136. However, Mr. Ortiz never responded.

8. In July and August of 2014, Mr. Ortiz was employed by BBMC as a registered nurse. 9. On July 25, 2014, Patient EWD was admitted to BBMC for a fractured right hip. Patient EWD was 93 years old and suffered from heart problems. Patient EWD had a history of kidney failure.

10. Mr. Ortiz worked the July 29, 2014 to July 30, 2014 night shift. During his shift, Mr.

Ortiz documented over-medicating Patient EWD by administering 4mg of Morphine IV and two tablets of Percocet (Oxycodone/APAP) within one minute of each other. See Exhibit 2, Bates p. 8. According to Patient EWD's order for morphine, Patient EWD was to be given Morphine every four hours. See

Exhibit 2, Bates p. 7. Mr. Ortiz also administered 2mg of Ativan (Lorazepam) and 4mg of Morphine

within 10 minutes of each other and less than 3 hours after the previous doses of Percocet and Morphine.

11. On the morning of July 30, 2014, Patient EWD's attending physician documented that Patient EWD was very drowsy and was unable to participate in physical therapy. See Exhibit 2, Bates p. 13. The physician also noted that Patient EWD was given "2 Percocet, 0.5 mg Ativan, and 8 mg of

Morphine since midnight by night shift." See id.

12. During the July 29, 2014 to July 30, 2014 night shift at BBMC, Mr. Ortiz discontinued Cardizem infusions on Patients PP and WW without physician orders, and failed to record the discontinuance in each patient's record.

13. During August 21, 2015 to August 25, 2015, Mr. Ortiz removed several doses of

Dilaudid (Hydromorphone) and Fentanyl for various patients in the Emergency Department without a provider order. 14. On September 11, 2015, Mr. Ortiz was terminated from BBMC due to narcotic discrepancies.

15. On or about August 3, 2016, Mr. Ortiz submitted an employment application to Honor

Health - Deer Valley. Mr. Ortiz reported "educational/more money/better schedule" as his reason for leaving BBMC under the "Reason for Leaving" section. 16. Mr. Ortiz worked as a registered nurse for Honor Health in Deer Valley ("Honor

Health") In November of 2016. While working on November 7, 2016, Mr. Ortiz exceeded the scope of

his practice by placing a verbal order for Fentanyl 50 mcg/ml injection for Patient JC without the provider's knowledge and approval. See Exhibit 6, Bates pp. 48 and 51. In addition, Mr. Ortiz documented withdrawing and administering Fentanyl 50mcg/ml intravenously to Patient JC after the

patient's intravenous access device had already been removed and the patient had been discharged from

the facility. See Exhibit 6, Bates pp. 48. Mr. Ortiz falsely documented that Dr. Faye P. Provenza placed a verbal order for Fentanyl 50 mcg/ml. See Exhibit 6, Bates pp. 51.

17. On November 7, 2016, Patient AO had a provider order for Fentanyl 50 mcg/ml every minutes as needed for pain. See Exhibit 8, Bates pp. 57. Patient AO's Clinical Orders and Medical Administration Report show:

• At 2015, Mr. Ortiz withdrew 100 mcg from the MedDispense.

• At 2017, Mr. Ortiz documented 50 mcg as given. • At 2024, Mr. Ortiz documented 50 mcg as wasted. • At 2035, Mr. Ortiz withdrew 100 mcg from the Med Dispense.

• At 2037, Mr. Ortiz documented 50 mcg as given.

• At 2101, Mr. Ortiz documented 50 mcg as given. • At 2103, Mr. Ortiz withdrew 100 mcg from the MedDispense. • At 2106, Mr. Ortiz received a one-time provider order for Fentanyl 25 mcg • At 2106, Mr. Ortiz withdrew 100 mcg from the Med Dispense

• At 2109, Mr. Ortiz documented 25 mcg as given.

• At 0149 on 11/08/16, Mr. Ortiz documented 50 mcg as wasted. • At 0150 on 11 /08/16, Mr. Ortiz documented 50 mcg as wasted. • At 0151on11/08/16, Mr. Ortiz documented 25 mcg as wasted.

18. Mr. Ortiz failed to account 50 mcg of Fentanyl. Mr. Ortiz failed to promptly administer

or waste medication. Mr. Ortiz failed to promptly document medication as given or wasted. Mr. Ortiz failed to comply with the provider's order regarding the timing of the administration of the Fentanyl by giving the Fentanyl 50 mcg does less than 30 minutes apart.

19. On November 11, 2016, at 21:00, a one-time provider order for Patient TL for Fentanyl mcg was entered as a verbal order with readback. See Exhibit 9. Patient Tl's Clinical Orders and Medical Administration Report show: 1

• At 2055, Respondent withdrew 100 mcg from the Med Dispense via override.

• At 2100, Respondent documented 50 mcg as given. • At 2108, Respondent withdrew 100 mcg from the MedDispense. • At 2118, Respondent documented 50 mcg as given.

• At 2321, Respondent documented 50 mcg as wasted.

• At 2321, Respondent again documented 50 mcg as wasted. • At 2339, Respondent withdrew 100 mcg from the Med Dispense (this withdrawal was in

• Patient was discharged at 0207 • At 0701on11/07/16, Respondent documented 100 mcg was wasted. 20. Mr. Ortiz did not document pain assessments for Fentanyl administrations. Mr. Ortiz

did not promptly administer or waste medication and promptly document medication as given or

wasted. Mr. Ortiz practiced beyond the scope of his registered nurse license by removing medication in excess of an order or without an order. 21. On November 6, 2016, at 18:39, a one-time provider order for Patient TL for Morphine was entered. See Exhibit 9, Bates p. 69. Mr. Ortiz did not document the administration of Morphine

to the patient until 20:13 (military time, hours: minutes). See id. Mr. Ortiz did not document pain

assessments for Morphine administration. 22. On November 6, 2016 at 4:04, Mr. Ortiz entered a one-time order for Patient TL Lorazepam 1 mg, listing himself as the ordering provider and stating that order was "per protocol" and

See id.

that the provider was not required to co-sign. The hospital policy required verbal and telephone orders for lorazepam to be cosigned for Lorazepam. Mr. Ortiz did not document assessment for Lorazepam documented as administered at 03:08 and 04:04 as is required by the standard of care.

23. On November 17, 2016, Mr. Ortiz was terminated from Honor Health.

24. Honor Health conducted its own investigation into Mr. Ortiz's conducted before Mr. Ortiz was terminated. During that investigation, Honor Health attempted to contact Mr. Ortiz by phone and email. However, Honor Health did not receive a response from Mr. Ortiz. See Exhibit 11, Bates pp.

110-111.

25. Ms. Midkiff testified that the standard of care for nurses requires that especially for an elderly patient, the nurse must evaluate the effects of a narcotic before administering another narcotic. Ms. Midkiff stated that there is a great potential for narcotic pain medications to depress central nervous system function and respiration.

26. Ms. Midkiff stated that the standard of care requires that a pain assessment be

completing before administering Morphine. Ms. Midkiff also testified that the standard of care requires that an assessment must be completed before administering Lorazepam. 27. Ms. Midkiff opined that while working for Honor Health, Mr. Ortiz failed to comply

with the standard of care when that requires that an RM promptly administer or waste medication.

28. Ms. Midkiff testified that MR. Ortiz's Before Mr. Ortiz was terminated from Honor Health Deer Valley attempted to contact Mr. Ortiz by phone and by e-mail during its internal investigation of Mr. Ortiz's conduct. Mr. Ortiz did not respond to board letters, electronic mail and

phone calls placed to Mr. Ortiz's contact number and addresses of record.

29. I find Ms. Midkiff's testimony to be credible.

CONCLUSIONS OF LAW 1. This matter lies within the Board's jurisdiction under ARIZ. REV. STAT. § 32- 1606(A)(8).

2. The Board bears the burden of persuasion to establish cause to penalize Mr. Ortiz's

registered nurse license. ARIZ. REV. STAT. § 41-1092.07(G)(2); 3. The Board's burden is a preponderance of the evidence. ARIZ. ADMIN. CODE § R2- 19-119.

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 facts, as set forth previously, establish that Mr. Ortiz committed unprofessional

conduct as defined by ARIZ. REV. STAT. section 32-1601(24)(d) 2,(g) 3(j) 4;ARIZ. REV. STAT. section 32-1601 (22)(h) 5, A.A.C. R4-19-403(1)(7)(9)(12)(27)(31), (8)(a-b), and (25) (a). 6. Because Mr. Ortiz has committed unprofessional conduct, the Board has authority to

impose discipline on Mr. Ortiz's nursing license. ARIZ. REV. STAT. § 32-1663(D); and§ 32-1664(0).

ORDER In view of the Findings of Fact and Conclusions of Law, the Board issues the following Order: Pursuant to A.R.S. § 32-1664(N), the Board REVOKES registered nurse license number

RN177628 issued to Jarrid Ruben Ortiz.

That provision has subsequently been renumbered as subsection (26)(d). That provision has subsequently been renumbered as subsection (26)(g). That provision has subsequently been renumbered as subsection (26)(j). That provision has subsequently been renumbered as subsection (26)(h).

RIGHT TO PETITION FOR REHEARING OR REVIEW Pursuant to A.R.S. § 41-1092.09, Respondent may file, in writing, a motion for rehearing or review within 30 days after service of this decision with the Arizona State Board of Nursing. The motion for rehearing or review shall be made to the attention of Hearing Department,

Arizona State Board of Nursing, 1740 West Adams Street, Suite 2000, Phoenix AZ 85007, and

must set forth legally sufficient reasons for granting a rehearing. A.A.C. R4-19-608. For answers to questions regarding a rehearing, contact the Hearing Department at (602) 771-7844. Pursuant to A.R.S. § 41-1092.09(B), if Respondent fails to file a motion for rehearing

or review within 30 days after service of this decision, Respondent shall be prohibited from

seeking judicial review of this decision. This decision is effective upon expiration of the time for filing a request for rehearing or review, or upon denial of such request, whichever is later, as mandated in A.A.C. R4-19-609.

Respondent may apply for reinstatement of the said license pursuant to A.A.C. R4-19-404 after

a period of five years. DATED this 23rd day of March, 2018. ARIZONA STATE BOARD OF NURSING SEAL

Joey Ridenour, R.N., M.N., F.A.A.N Executive Director

COPIES mailed this 26th day of March, 2018, by First Class Mail and Certified Mail No. [account number redacted] 7835 to:

Jarrid Ruben Ortiz 16462 N 178th Ave Surprise, AZ 85379 COPIES of the foregoing mailed this 26th day of March, 2018, to: Case Management Office of Administrative Hearings 1740 West Adams Street, Lower Level Phoenix AZ 85007

Elizabeth Campbell Assistant Attorney General Arizona Attorney General’s Office 2005 North Central Avenue Phoenix, Arizona 85004

By: T. Smith