ALJDEC decisions subject to certification as final

18A-1510008-NUR · State Board of Nursing · 2018-02-15

IN THE OFFICE OF ADMINISTRATIVE HEARINGS

IN THE MATTER OF THE REGISTERED NURSE LICENSE NO. RN177628

ISSUED TO:

JARRID RUBEN ORTIZ,

RESPONDENT.

No. 18A-1510008-NUR

ADMINISTRATIVE LAW JUDGE DECISION

HEARING: January 4, 2018, with the record held open until January 26, 2018.

APPEARANCES: No one appeared for Respondent Jarrid Ruben Ortiz. 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. 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 30 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 MedDispense.

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 MedDispense

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 0151 on 11/08/16, 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 50 mcg was entered as a verbal order with readback. See Exhibit 9. Patient TL’s Clinical Orders and Medical Administration Report show:

At 2055, Respondent withdrew 100 mcg from the MedDispense 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 MedDispense (this withdrawal was in

Patient was discharged at 0207

At 0701 on 11/07/16, 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 4 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 1mg, listing himself as the ordering provider and stating that order was “per protocol” and 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. Midriff 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. Midriff stated that there is a great potential for narcotic pain medications to depress central nervous system function and respiration.

26. Ms. Midriff opined stated that the standard of care requires that a pain assessment be completing before administering Morphine. Ms. Midriff also testified that the standard of care requires that a pain assessment must be completed before after administering Lorazepam.

27. Ms. Midriff 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. Midriff 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. Midriff’s testimony to be credible.

CONCLUSIONS OF LAW

This matter lies within the Board’s jurisdiction under Ariz. Rev. Stat. § 32-1606(A)(8).

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);

The Board’s burden is a preponderance of the evidence. Ariz. Admin. Code § R2-19-119.

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).

The facts, as set forth previously, establish that Mr. Ortiz committed unprofessional conduct as defined by Ariz. Rev. Stat. section 32-1601(24)(d),(g)(j); Ariz. Rev. Stat. section 32-1601(22)(h), A.A.C. R4-19-403(1)(7)(9)(12)(27)(31),

(8)(a-b), and (25) (a).

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(O).

RECOMMENDED ORDER

Based on the foregoing, the Administrative Law Judge recommends that

Jarrid Ruben Ortiz’s registered license No. RN177628 be 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 15, 2018.

/s/ Velva Moses-Thompson

Administrative Law Judge

Transmitted electronically to:

Joey Ridenour, RN, MN, Executive Director

State Board of Nursing