ALJDEC decisions subject to certification as final
19A-1506065-NUR · State Board of Nursing · 2020-06-08
IN THE OFFICE OF ADMINISTRATIVE HEARINGS
IN THE MATTER OF THE REGISTERED
NURSE LICENSE NO. RN176166
ISSUED TO:
ROBIN LYNN PATTEE,
RESPONDENT.
No. 19A-1506065-NUR
ADMINISTRATIVE LAW JUDGE DECISION
HEARING: February 24, 2020 and May 18, 2020
APPEARANCES: Assistant Attorney General Elizabeth Campbell appeared on behalf of the Arizona State Board of Nursing. Teresia Sanzio, Esq. appeared on behalf of Respondent Robin Lynn Pattee.
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 Arizona Revised Statutes (A.R.S.) §§ 32-1606, 32-1663, 32-1664, 41-1092.11(B).
2. The Board also has the authority to impose disciplinary sanctions against the holders of nursing licenses for violations of the Nurse Practice Act, A.R.S. §§ 32-1601 to -1669 and Arizona Administrative Code (A.A.C.) Rules 4-19-101 to -815.
3. Robin Lynn Pattee holds Board issued registered nurse (RN) license number RN1761666 in the State of Arizona.
4. On December 9, 2019, the Board issued a Notice of Hearing setting the above captioned matter for hearing on January 31, 2020 (Notice of Hearing). The Notice of Hearing provided that the issue set for determination is “whether grounds exist to take disciplinary action, including suspension or revocation against Robin Lynn Pattee, registered nurse license number RN176166 to perform as a nurse in the State of Arizona.”
5. A hearing was held on February 24, 2020 and May 18, 2020.
6. At hearing, Ms. Pattee testified on behalf of herself and presented the testimony of her mother, Sandra Russell. The Board presented the testimony of Dana Zimmerman, Erin Hummel, and its Nurse Practice Consultant, Michael Pilder.
7. Ms. Pattee was employed as a RN at Kingman Regional Medical Center (Kingman Regional) in Kingman, Arizona, from November 2013 until her employment was terminated effective January 24, 2014. After a series of unscheduled absences, coworkers observed Ms. Pattee sleeping while on duty in the post anesthesia care unit on December 31, 2013.
8. On January 24, 2014, Ms. Pattee was involuntarily terminated from Kingman Regional for absenteeism.
9. In May of 2015, Ms. Pattee was employed as a RN for The Lingenfelter Center (Lingenfelter). Lingenfelter serves patients suffering from dementia and Alzheimer’s disease. Ms. Pattee worked in the Ocotillo unit during the evening shift from 6:30 p.m. to 6:30 a.m.
10. In May of 2015, Erin Hummel was the Director of Nursing at Lingenfelter.
11. Ms. Pattee worked the evening shift from May 26, 2015 to May 27, 2015.
12. On May 26, 2015, at about 6:00 p.m., Patient 9 was admitted to Lingenfelter Center. Although Ms. Pattee conducted the initial nursing assessment of Patient 9, she did not document the new admission until May 29, 2015. See Exhibit 3, Bates 033.
13. Ms. Hummel noticed that Ms. Pattee had failed to complete required documentation.
14. On May 27, 2015, Ms. Hummel notified Ms. Pattee that she needed to come to the unit to complete charting that had not been completed during Ms. Pattee’s shift.
15. Ms. Hummel decided to review video footage of Ms. Pattee’s shift. Ms. Hummel observed video footage of Ms. Pattee’s shift from May 26, 2015 to May 27, 2015. Ms. Pattee also observed video footage of the evening shift of May 28, 2015 to May 29, 2015. Ms. Pattee did not work the evening shift of May 27, 2015 to May 28, 2015.
16. Ms. Hummel observed Ms. Pattee and two assistants, one of them named Denise, that were assigned to the Ocotillo unit exit the Lingenfelter at 4:03:05 a.m. on May 27, 2015. See Exhibit 3, Bates 026. At Lingenfelter, one nurse was assigned to each unit along with two nursing assistants. Floaters were not available. Staff are always required to have someone on the unit. Ms. Hummel observed Ms. Pattee, Denise, and the third nursing assistant assigned to the Ocotillo unit reenter Lingenfelter at 4:15 a.m. See id.
17. Ms. Hummel explained that at Lingenfelter, the evening shift medication pass occurred at 8:00 p.m. and 6:00 a.m. Ms. Hummel explained that nurses had one hour window before and after the start time to administer the medication.
18. Ms. Hummel observed that during Ms. Pattee’s evening shift from May 26, 2015 to May 27, 2015, Ms. Pattee did not start the medication pass until 1:15:39 a.m. Ms. Pattee ended the medication pass at 3:30 a.m. See Exhibit 3, Bates 028. 19. On May 29, 2015, Ms. Pattee documented that Patient 9 was admitted and noted that the entry was a “late entry for new admission.” Ms. Hummel explained that nurses are expected to complete notes during their shift. However, nurses have 24 hours to complete their notes.
20. Ms. Hummel explained that when Ms. Pattee came to Lingenfelter on May 29, 2015 to complete documentation, Ms. Pattee documented physical assessments that did not occur. Ms. Hummel explained that Ms. Pattee noted that she completed a physical assessment on May 29, 2015 at 1:43 a.m. However, when Ms. Hummel observed the video footage, Ms. Hummel never observed Ms. Pattee entering Patient 9’s room on May 29, 2015.
21. Ms. Hummel explained that Ms. Pattee never entered any patient room on her shift from May 26, 2015 to May 27, 2015. Ms. Hummel explained that Ms. Pattee came to Lingenfelter on May 29, 2015 to complete required documentation. Ms. Pattee was not the assigned nurse during the May 28, 2015 to May 29, 2015 evening shift and that Ms. Pattee remained in the nurse’s station the entire time. Ms. Hummel stated that Ms. Pattee documented the assessments late but failed to provide a “late entry” note. Ms. Hummel explained that it is important for nurses to document the date that the assessments were completed. See Exhibit 3, Bates 035-040. Nurses are required to complete detailed quarterly assessments of residents to satisfy Medicare requirements.
22. Ms. Hummel concluded that Ms. Pattee had falsified patient records.
23. On or about May 29, 2015, Ms. Hummel completed and signed a corrective action related to Ms. Pattee’s performance from May 26, 2015 to May 29, 2015. Through the corrective action, Ms. Hummel alleged that Ms. Pattee falsified residents’ medical records, failed to document physical assessments at the time of assessment, and failed to administer medication per the physician’s order. Ms. Hummel also alleged that Ms. Pattee failed to perform documentation in a timely manner and that she failed to perform physical assessments needed to complete documentation.
24. Ms. Pattee was terminated on May 29, 2015 based on her performance from May 26, 2015 to May 29, 2015.
25. On June 2, 2015, Ms. Hummel filed a complaint with the Board. The complaint provided, in relevant part, as follows:
On 5/29/2015 was terminated due to the following findings: failure to administer medications within the timeframe ordered, failure to secure controlled substances, failure to perform resident assessments, and falsification of documentation.
26. Ms. Pattee was employed as a RN in the inpatient psychiatric unit at Mohave Mental Health in Kingsman, Arizona, from July 2015 until October 2018.
27. In April of 2018, Dana Zimmerman was a Nurse Manager at Mohave.
28. On April 27, 2018, Ms. Pattee while working at Mohave Mental Health, failed to ensure that staff removed all restraints from a patient who was sitting on the restraint bed with one leg restrained. In her statement to Mohave Mental Health, Ms. Pattee stated that she did not realize the patient was only in one restraint.
29. Ms. Zimmerman testified to the effect that leaving a patient with a single leg restrained is contrary to the standard of care because it creates an injury risk for the patient. Ms. Zimmerman stated that one wrist and ankle should be restrained for the safety of the patient and others.
30. Ms. Pattee initiated the restraint for the patient. Ms. Pattee agreed to take over another nurse's shift who had to testify in court on the morning of April 27, 2018. Ms. Pattee was the Senior Nurse on duty. When Ms. Zimmerman arrived, Ms. Pattee was in possession of the keys to the restraint.
31. Mohave issued an Employee Discipline Warning Notice (Notice) regarding proper restraint usage. Ms. Pattee signed the Notice at the end of April 29, 2018.
Ms. Zimmerman signed the notice on May 11, 2018.
32. Subsequently, Ms. Pattee went on medical leave for about 14 – 15 weeks. Ms. Pattee returned to work at the end of August 2018. Ms. Zimmerman explained that initially, Ms. Pattee seemed to be doing well. However, at the end of August 2018,
Ms. Pattee called Ms. Zimmerman and told her that she could not work her shift because she stepped on a scorpion. Ms. Pattee told Ms. Zimmerman that she took one of her mother’s “benzos.” Ms. Zimmerman explained that benzo is short for benzodiazepine. Ms. Zimmerman explained Ms. Pattee admitted that she took a Xanax from her mother in a text that Ms. Pattee sent to Ms. Zimmerman’s phone. See Exhibit 67.
33. During the beginning of September of 2018, Ms. Zimmerman traveled to California for a training. While in California, Ms. Zimmerman received a call from a Nurse Practitioner. The Nurse Practitioner told Ms. Zimmerman that she received a call from someone who purported to be Ms. Pattee, but the person did not sound like Ms. Pattee. The Nurse Practitioner said that she was concerned because she believed that the person she was speaking with should not be received Nurse Practitioner orders.
34. Ms. Zimmerman explained that on or about September 5, 2019, she received a call from a medication nurse who reported that Ms. Pattee was unable to focus at work and talked about taking her mother’s pain medication. Ms. Pattee reported to the nurse that she took a pain injection that she purchased in Mexico.
Ms. Zimmerman also explained that she spoke with a charge nurse who had the same report as the medication nurse. However, the charge nurse told Ms. Zimmerman that the Hospital Administrator was handling the situation. Ms. Zimmerman then contacted the Mohave Administrator, Jettie Blanton. Ms. Blandon who told Ms. Zimmerman that Ms. Pattee would not be conducting any further patient care.
35. After Ms. Zimmerman arrived back in town, she was asked to come into Mohave by the day shift charge nurse to observe Ms. Pattee. Ms. Zimmerman explained that Ms. Pattee appeared to be interacting appropriately with the patient. However, Ms. Zimmerman observed that at times, Ms. Pattee appeared to stare at the computer screen. Ms. Zimmerman talked with Ms. Pattee that day. Ms. Pattee explained that she had been having difficulty focusing due to a lack of sleep.
Ms. Pattee stated that she had been non-compliant with her BiPAP machine.
36. On September 14, 2019, Ms. Zimmerman met with Ms. Pattee and Ms. Blanton. Ms. Pattee’s recent work performance was discussed. Ms. Pattee explained that she had been having difficulty working due to her medical issues. Ms. Pattee expressed that perhaps she was not ready to return to work. Ms. Pattee expressed that she was not safe to practice. Ms. Pattee, Ms. Blanton, and Ms. Zimmerman all agreed that it would be best if Ms. Pattee resigned.
37. Ms. Pattee resigned from Mohave about a week after the September 14, 2019 meeting.
38. I find the testimony of Mr. Pilder, Ms. Zimmerman, and Ms. Hummel to be credible.
39. Michael Pilder is a Nurse Practice Consultant for the Board. Mr. Pilder has been a RN since 2008. Mr. Pilder has worked for the Board or 7 to 8 years. Mr. Pilder explained that a RN who sleeps while on duty jeopardizes a patient’s safety. Nurses should be awake and alert. A nurse who is frequently absent puts patients at risk because it places an extra burden on other nurses.
40. Ms. Russell is Ms. Pattee’s mother. Ms. Russell testified that her last prescription for Xanax was in 2006 and that she completely used the prescription.
Ms. Russell explained that she did not have Xanax in 2018. Ms. Russell testified that she was in the home with Ms. Pattee when Ms. Pattee was bit by a scorpion in 2009.
Ms. Russell explained that she gave Ms. Pattee a Zyrtec, not a Xanax.
41. Ms. Pattee clarified that she purchased a Vitamin B shot from Mexico which had an anti-inflammatory Diclofenac.
42. Ms. Pattee denied that she was sleeping at the job while working for Kingman.
43. Ms. Pattee testified that she worked during the evening shift of May 28, 2015 to May 29, 2015 at Lingenfelter. Ms. Pattee testified that she conducted all of the assessments documented on May 29, 2015. Ms. Pattee testified that the date of May 29, 2015 that she entered with regard to the admission of Patient 9 on Exhibit 3, Bates 033, was a “typo.” Ms. Pattee asserted that she intended to enter May 28, 2015 because Patient 9 was admitted on May 28, 2015. When asked on cross examination whether the late entry notation was also an error, Ms. Pattee initially stated that it was a typo. Later in her testimony Ms. Pattee testified that the late entry was not a typo.
44. Ms. Pattee explained that she was bit by a scorpion in August of 2018 and that it was extremely painful. Ms. Pattee denied that she told Ms. Zimmerman that she had taken her mother’s Xanax. Ms. Pattee testified that she knew that her mother gave her a Zyrtec. Ms. Pattee testified that she told Ms. Zimmerman that her mother gave her a Zyrtec. Ms. Pattee explained that at the time that she was bit by a scorpion, she believed that her mother gave her a Zyrtec and a Xanax. Ms. Zimmerman explained that she did not learn that her mother did not give her a Xanax until the latter part of November 2018 when she reviewed a report. Ms. Zimmerman stated that she contacted her mother who told her that she did not have a prescription for Xanax.
45. I do not find the testimony of Ms. Russell and Ms. Pattee to be credible.
CONCLUSIONS OF LAW
This matter lies within the Board’s jurisdiction under Ariz. Rev. Stat. § 32-1606.
The Board bears the burden of persuasion to establish cause to penalize Ms. Pattee’s RN 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).
Benzodiazepines are controlled substances and dangerous drugs. A.R.S. § 13-3401 and A.R.S. § 36-2515. It is illegal to possess or use dangerous drugs without a prescription. A.R.S. § 13-3407. It is illegal to possess or use a prescription-only drug without a prescription. A.R.S. § 13-3406.
The facts, as set forth previously, establish that Ms. Pattee committed unprofessional conduct as defined by Ariz. Rev. Stat. section 32-1601(6)(d), (e), (h), (j); A.A.C. R4-19-814(17), (18), (28) and (32); A.A.C. R4-19-403(1)(A), (7)(8)(a)(9)(18)(31).
Because Ms. Pattee has committed unprofessional conduct, the Board has authority to revoke her RN license. Ariz. Rev. Stat. § 32-1663(D); and § 32-1664(O).
Considering the facts and circumstances of this matter, it is recommended
that Ms. Pattee’s RN license number RN176166 be revoked.
RECOMMENDED ORDER
Based on the foregoing, the Administrative Law Judge recommends that the Board revoke Robin Lynn Pattee’s RN license number RN176166.
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, June 8, 2020.
/s/ Velva Moses-Thompson
Administrative Law Judge
Transmitted electronically to:
Joey Ridenour, RN, MN, Executive Director
State Board of Nursing