FINACT19a-201902331-NUR.pdf

19A-201902331-NUR · State Board of Nursing · 2019-07-30

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 Home Page: http://www.azbn.gov

TO: Case Management Office of Administrative Hearings

FROM: Trina Smith Legal Assistant Hearing Department

DATE: July 26, 2019

RE: Christine Ann Larkin Docket No. 19A-[number redacted]-NUR ______________________________________________________________________________

On July 26, 2019, the Board considered the Administrative Law Judge Decision (“ALJ Decision”), which recommended that the Board Revoke Registered Nurse License Number RN073639 issued to Christine Ann Larkin.

The Board adopted the Findings of Fact, Conclusions of Law and Recommended Order in its entirety. ARIZONA STATE BOARD OF NURSING 1740 West Adams Street, Suite 2000 Phoenix AZ 85007 602-771-7800

IN THE MATTER OF REGISTERED NURSE LICENSE NO. RN073639 FINDINGS OF FACT, ISSUED TO: CONCLUSIONS OF LAW AND ORDER CHRISTINE ANN LARKIN NO. 19A-[number redacted]-NUR AKA: CHRISTINE ANN RICHESON; CHRISTINE LARKIN RYAN, RESPONDENT

A hearing was held before Antara Nath Rivera, Administrative Law Judge (“ALJ”), at 1740

West Adams Street, Lower Level, Phoenix Arizona, on June 4, 2019. Sunita A. Krishna, Assistant

Attorney General, appeared on behalf of the State. Christine Ann Larkin (“Respondent”) was not present and was not represented by counsel. On July 2, 2019, the ALJ issued Findings of Fact, Conclusions of Law and Recommendations.

On July 26, 2019, 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. The Arizona State Board of Nursing (the Board) has the authority to regulate and control

the practice of nursing in the State of Arizona, pursuant to Sections 32-1606, 1663, and 1664 of the Arizona Revised Statutes. 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. § 32-1601-1667.

2. Christine Ann Larkin (Respondent) holds Board-issued RN License No. RN073639

(initially issued in August 1990) in the State of Arizona.

3. On or about January 28, 2019, Patient MB, was admitted to Honor Health/John C. Lincoln Medical Center in Phoenix, AZ (JCL) for multiple gunshot wounds and other traumatic injuries.

4. On or about January 31, 2019, Respondent was witnessed making unprofessional

comments, demonstrating a lack of concern towards Patient MB’s changing physical condition and the reasons for his admission and hospitalization. Respondent’s failure to meet this standard of care may have contributed to or resulted in the death of trauma Patient MB, on or around February 1, 2019.

5. On or about January 31, 2019, Respondent did not complete or document the critical

physical changes or vital signs leading up to the Code Blue event on Patient MB, who was under her care. Respondent failed to document vital signs, including blood pressures of Patient MB, whose blood pressures were dropping and heart rates were increasing (per the monitor alarms). 6. On or about January 31, 2019, Respondent failed to assess and document Patient MB’s

pain level before administering narcotic medications of one Oxycodone 10 mg tablet and one Tramadol

50 mg tablet at 2153, and then administering narcotic medication of Dilaudid 1mg IV at 2154. Respondent failed to assess and document Patient MB’s pain scores and his response to the narcotic intervention after it was administered, and failed to respond and intervene when Patient MB’s monitor

alarmed due to increased heart rates and decreased blood pressures.

7. On or about January 31, 2019, Respondent was witnessed by supervisory and ICU staff sitting in the back ICU nursing station eating while Patient MB’s monitors continued to alarm for decreased blood pressures in the 70’s and increased heart rates up to the 130’s. This medical situation

occurred because Respondent administered multiple narcotic pain medications to the patient. In

addition, Respondent was witnessed at 11:00 pm leaving the ICU to go outside to smoke, during which

time Patient MB’s monitor was alarming with increased heart rates in the 170’s. A Code Blue was called on Patient MB shortly after Respondent returned back to the ICU. 8. In a written statement to Loral Pultz, BSN, RN, (Ms. Pultz), Nurse Practice Consultant,

Respondent admitted to making the unprofessional comment, “I don’t care if he lives or dies.”

Respondent added that these statements were made in response to the fact that Patient MB was admitted to the hospital for a home invasion where he was shot multiple times by the home owner. Respondent also stated that she gave Patient MB Fentanyl, only, for pain.

9. During a telephonic interview, with Ms. Pultz, on April 17, 2019, Respondent stated that

she was “no longer working in nursing.” Respondent further stated, “I’ve worked for over 30 years as a nurse, and I am now driving a tractor trailer across the miles.” Lastly she added that she has “no desire to work in nursing anymore, it’s time for the younger ones to take over.” 10. On April 22, 2019, Ms. Pultz spoke with Respondent again. Ms. Pultz asked Respondent

about her written statement and Respondent corroborated her written statement and also stated that she

administered Fentanyl for pain. She stated she did not administer any other narcotics. Respondent told Ms. Pultz that Patient MB’s blood pressure was not low for ICU purposes. She further stated that she does not record blood pressure numbers because the electronic system pulls up the numbers. When

asked if she received professional counseling for using inappropriate racial slurs towards a patient,

Respondent answered that it “was in the past.” 11. On May 17, 2019, the Board issued a Complaint, Notice of Hearing, and Summary Suspension Hearing alleging that cause existed to discipline Respondent’s registered nurse license and

advanced practice certificate under A.R.S. § 32-1601(26)(d), (g), (h), and (j) 1(2017) 2 and A.A.C. R4-

19-403(1), (3), (4), (26), (27), and(31). 3

A.R.S. § 32-1601(26)(d), (g), (h) and (j) defines “unprofessional conduct” to include, respectively, “[a]ny

12. The Board referred the matter to the Office of Administrative Hearings (the OAH), an independent agency, for an evidentiary hearing. A hearing was scheduled to convene on June 4, 2019. Respondent failed to appear. When asked if the Board had any contact with Respondent, the Board

replied that they did not have any contact with Respondent. Furthermore, Respondent did not contact

the OAH for her reason for her absence, for a continuance, or to request a telephonic appearance. The hearing commenced as scheduled in abstentia. 13. At the hearing, the Board presented witness Andrea McCray MSN, RN, CCRN (Ms.

McCray) a Staff Nurse at JCL. Ms. McCray testified regarding Respondent’s conduct and comments

made while she was employed at JCL on January 31, 2019. Ms. McCray testified that she worked with the Respondent on the night of January 31, 2019. Ms. McCray stated that the Respondent’s treatment of

conduct or practice that is or might be harmful or dangerous to the health of a patient or the public,”“[w]illfully or repeatedly violating a provision of this chapter or a rule adopted pursuant to this chapter,” “[c]ommitting an act that deceives, defrauds or harms the public,” and “[v]iolating this chapter or a rule that is adopted by the board pursuant to this chapter.” A.R.S. § 32-1601(26) was effective August 9, 2017. For conduct occurring before August 9, 2017, A.R.S. § 32-1601(24) (with language identical to the 2017 statute) applies. For conduct occurring before July 1, 2016, A.R.S. § 32-1601(22) (with language identical to the 2017 statute) applies. This decision will reference only the 2017 version of the statute for simplicity. 3 A.A.C. R4-19-403 provides “any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public includes one or more of the following:” 1. A pattern of failure to maintain minimum standards of acceptable and prevailing nursing practice; 3. Failing to maintain professional boundaries or engaging in a dual relationship with a patient, resident, or any family member of a patient or resident; 4. Engaging in sexual conduct with a patient, resident, or any family member of a patient or resident who does not have a pre-existing relationship with the nurse, or any conduct in the work place that a reasonable person would interpret as sexual; .... 26. Making a written false or inaccurate statement to the Board or the Board’s designee in the course of an investigation; 27. Making a false or misleading statement on a nursing or health care related employment or credential application concerning previous employment, employment experience, education, or credentials; ....

31. Practicing in any other manner that gives the Board reasonable cause to believe the health of a patient or the public may be harmed.

Patient MB fell below the standard of care in that Respondent failed to monitor Patient MB’s blood pressure, failed to conduct manual blood pressure checks, and failed to care for Patient MB by not addressing the cause of Patient MB’s monitor alarm.

14. Ms. McCray stated that when she asked Respondent about Patient MB’s monitor alarm,

Respondent stated, “I don’t give a fuck if he lives or dies.” Ms. McCray stated that the Respondent stated this while she ate a salad. Ms. McCray also testified that later in the night, while the monitor alarm continued to go off, Respondent took a smoke break. Ms. McCray further testified that

Respondent made culturally and racially insensitive comments, in the past, about patients and their

families. 15. Ms. McCray opined that Respondent put Patient MB at risk by failing to provide him with the best patient care. 16. At the hearing, Ms. Pultz testified to her investigation of the Respondent’s treatment of

Patient MB. She testified that the Respondent’s treatment of Patient MB fell below the standard of care.

Ms. Pultz stated the following standards of care. a. The standard of care for professional behavior is for the nurse to deliver patient care in a nonjudgmental and nondiscriminatory manner, value diversity in the workplace, and

respect cultural, racial, and ethnic diversity.

b. The standard of care for nursing documentation is for the nurse to provide complete and accurate documentation of critical physical changes and vital signs involving the patient to ensure information is communicated to physicians and health team

members in order to provide a thorough continuum of patient care.

c. The standard of practice for safe medication administration is for the nurse to frequently monitor respirations, sedation level, and oxygen saturation levels, and respond promptly to adverse reactions to prevent treatment delays.

d. The standard of practice for patient intervention is for the nurse to remain attentive to

a patient’s change in condition in order to provide immediate nursing care and treatments in a critical patient situation.

CONCLUSIONS OF LAW 1. The Complaint, Notice of Public Hearing, and Summary Suspension Hearing that the Board emailed and mailed to Respondent at her address of record was reasonable, and Respondent is

deemed to have received notice of the hearing. See A.R.S § 41-1092.04; A.R.S. § 41-1061(A).

2. This matter lies within the Board’s jurisdiction under A.R.S. § 32-1606(B)(10). 3. The Board bears the burden of proof and must establish cause to penalize Respondent’s registered nurse’s license by a preponderance of the evidence. See A.R.S. § 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 such proof as convinces the trier of fact that the contention is more probably true than not.” MORRIS K. UDALL, ARIZONA LAW OF EVIDENCE § (1960). A preponderance of the evidence is “evidence which is of greater weight or more convincing than 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 1120 (8th ed. 2004).

5. On or about January 31, 2019, Respondent, while employed, and on duty as a RN in the intensive care unit (ICU) at JCL, failed to demonstrate professional integrity and professional behavior towards Patient MB.

6. On or about January 31, 2019, Respondent failed to meet the standards of practice per JCL ICU policy for patient assessment and documentation. 7. On or about January 31, 2019, Respondent failed to meet the standard of care for safe

medication administration.

8. On or about January 31, 2019, Respondent failed to meet the standard of care for nursing treatment. 9. The Board established, by a preponderance of the evidence, that Respondent engaged in

the conduct alleged in the Complaint, Notice of Public Hearing, and Summary Suspension Hearing.

10. In light of the risk of potential harm to patients as a result of Respondent’s actions and violations of the Nurse Practice Act, the Board established cause to impose a disciplinary sanction against Respondent’s license under A.R.S. § 32-1663(D) 4 and A.R.S. § 32-1664(N). 5

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(O), the Board REVOKES registered nurse license number

RN073639 issued to CHRISTINE ANN LARKIN. 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.

Service is complete five days after the date that this decision is mailed. A.R.S. § 41-1092.09(C).

The motion for rehearing or review shall be made to the attention of Hearing Department,

4 A.R.S. § 32-1663(D) provides that if the Board determines a licensee has committed an act of unprofessional conduct, the Board may revoke or suspend the license, impose a civil penalty, censure the license, place the licensee on probation, or accept the voluntary surrender of the license. A.R.S. § 32-1664(N) provides that if the Board finds that the licensee has committed an act of unprofessional conduct, the Board may revoke or suspend the license.

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 26th day of July, 2019. ARIZONA STATE BOARD OF NURSING SEAL

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

COPIES mailed this 26th day of July, 2019, by First Class Mail and Certified Mail No. [account number redacted] 5064 to:

Christine Ann Larkin 5202 W Corrine Drive Glendale, AZ 85304 Respondent

COPIES of the foregoing mailed this 26th day of July, 2019, 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