ALJDEC decisions subject to certification as final
20A-1605090-NUR · State Board of Nursing · 2020-03-17
IN THE OFFICE OF ADMINISTRATIVE HEARINGS
IN THE MATTER OF THE REGISTERED
NURSE LICENSE NO. RN133100
ISSUED TO:
HANI SALEH,
RESPONDENT
No. 20A-1605090-NUR
ADMINISTRATIVE LAW JUDGE DECISION
HEARING: January 28, 2020
APPEARANCES: Respondent Hani Saleh appeared on behalf of himself. 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 A.R.S. §§ 32-1606, 32-1663, 32-1664, 41-1092.11(B). 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.
2. Hani Selah holds Board issued registered nurse license number RN133100in the State of Arizona.
3. In April of 2016, Andrew Wood worked as a House Supervisor for Banner Heart and Banner Baywood. Andrew Wood is a Nurse Practitioner and has worked as a manager for approximately 10 years. During April of 2016, Mr. Wood was asked by Erin Leuthold, DON, to come to work early to help with cause testing on another employee. See Exhibit 2, Bates 006.
4. The hospital received a routine report from a pharmacy that Mr. Saleh had three more pulls from PIXS than any other nurse on the floor. A PIXS is a medication dispensary where the nurse must provide their thumbprint to the machine to gain access. The nurse must also provide a patient’s name and the dispensary opens similar to a cash register. Mr. Wood wanted to discuss Mr. Saleh’s behavior.
5. Mr. Wood and Ms. Leuthold met with Mr. Saleh in the Mariposa room of the hospital. See Bates 008. They discussed the information provided by the pharmacy with Mr. Selah. Mr. Selah admitted to giving patients morphine and Percocet at the simultaneously. Mr. Wood explained that Percocet and morphine should not be administered together. Mr. Wood explained that a patient should be given the Percocet first to determine whether it is effective. The nurse would then wait 45 minutes to an hour. If the Percocet is not effective, the morphine is administered. Because Percocet is not predictable. Nurses should give the lowest effective dosage. Mr. Wood gave a patient morphine for chest pain and shortness of breath. Mr. Wood explained that morphine is not appropriate for shortness of breath.
6. Mr. Selah was also notified during the meeting that the hospital needed a specimen. Mr. Selah requested water. Mr. Selah stated that he wanted to put his things in his car. Mr. Wood escorted Mr. Selah to his car. Mr. Selah got into his vehicle and turned on his car. Mr. Wood stated that he asked Mr. Selah to toll down the window. Mr. Wood told Mr. Selah that he could be terminated if he left. Mr. Selah did not roll down the window but drove and almost dragged Mr. Wood with his car. Mr. Wood subsequently met with Ms. Leuthold and security and explained what happened.
7. Mr. Selah was immediately terminated.
8. Karen Stockton is the Director of Nursing Telemetry at Dignity Health/Chandler Regional Medical Center. Ms. Stockton has been the director for eight years. During the time that Mr. Selah worked at Dignity, Ms. Stockton was not his direct supervisor.
9. On June 12, 2017, Ms. Stockton issued a Corrective Action to Mr. Selah because he showed up to work exhibiting signs of impairment. See Exhibit 3, Bates 14. Mr. Saleh worked for the cardiovascular telemetry unit at the time. Ms. Stockton received a report from her supervisor and several nurses that Mr. Selah used aggressive, foul and vulgar language with other employees. An employee named “Deb” reported that Mr. Selah exhibited behaviors of impairment on June 2, 2017. See Bates 017. During Ms. Stockton’s meeting with Mr. Selah, he seemed confused and repeated the same comments. Ms. Stockton wondered if Mr. Selah was in a condition to drive and whether he would work that evening. Mr. Selah was non-responsive to Ms. Stockton’s questions. Mr. Selah did not acknowledge the events that took place.
Mr. Selah was terminated because Ms. Stockton did not think it was safe to continue his employment. See Bates 015 and 016.
10. Ms. Stockton explained that patient and employee safety is important to Dignity Health. Ms. Stockton explained that she must give her employees the conscientious thing to do. Ms. Stockton believed that Mr. Selah did not know that he made others feel nervous.
11. Ashleigh Gerhardt was an employee at Honor Health and an RN on the night shift at the time that Mr. Selah was employed. Ms. Gerhardt is the Assistant Chief Nursing Officer. In June of 2019, Ms. Gerhardt filed a complaint with the Board regarding Mr. Selah.
12. Ms. Gerhardt worked at Shea Medical Center. A patient named MM complained after being discharged that she never received some of the medications listed on the discharge sheet. Patient MM was very upset. Patient MM also stated that Mr. Selah argued with him. See Exhibit 10.
13. Ms. Gerhardt explained that Mr. Saleh gave Patient MM 10 mg of Oxycodone at 20:33 on May 1, 2019, and10mg of Oxycodone on May 2, 2019. Patient MM reported that he did not receive those dosages. It was documented that Mr. Saleh withdrew Morphine for Patient HH at 20:32:57 on April 26, 2019, but returned it at 20:34:46 for Patient HH. It was also documented that Mr. Saleh withdrew morphine for Patient HH at 20:35:10 on April 26, 2019, but wasted the morphine at 20:35:20 the same day. See Exhibits 8 and 9.
14. Ms. Gerhardt explained that the process of withdrawing and returning medication is a great concern because nurses must always withdraw medication for a reason. See Exhibit 9.
15. On May 9, 2019, Mr. Selah met with the diversion response team and was adamant that he gave the medication to the patient, but did not see the patient take the medication. Ms. Gerhardt explained that it is a standard of care for nurse to watch a patient consume medication. At the time, Ms. Gerhardt asked for a urine sample and the drug test could not be completed because Mr. Selah explained that he could not consume water at that time due to his religious beliefs.
16. Mr. Selah returned to work. After Mr. Selah returned to work, Honor Health received two additional complaints through shift evaluations from concerned peers.
Mr. Selah’s peers complained that he would go off to an unknown place when the bed alarm went off. See Exhibit 8, Bates 053. At times, Mr. Selah would leave the unit, but failed to state that he was leaving. Mr. Selah disappeared into the bathroom multiple times and exhibited erratic behavior. See Bates 054.
17. Ms. Gerhardt discovered that Mr. Selah gave 15 mg of Oxycodone to Patient LP at 21:38. However, there was no documentation that Mr. Selah had conducted a pain assessment since 18:20. Ms. Gerhardt explained that it is standard procedure to assess the patient’s pain level at the time of medication administration, and 20-35 minutes after medication administration to evaluate the effectiveness of the medication.
18. The PIXS record shows that on May 27, 2019, Mr. Selah gave Patient AG 10 mg of Oxycodone at 22:09. Mr. Selah was required to administer the medication every four hours. Mr. Selah gave Patient AG another 10 mg of Oxy at 1:17, only three hours later.
19. On May 28, 2019, Ms. Gerhardt met with Mr. Selah to discuss the shift evaluations. Bates 049. Ms. Gerhardt informed Mr. Selah that the hospital wanted to conduct a drug screen and he signed a document approving the drug screen. Mr. Selah expressed that he had not drank any water and he was given water. However, Mr. Selah did not void. A second attempt to void was made 14 minutes later. Mr. Selah was informed that he only needed to produce 20-30 ml. Mr. Selah requested to be straight cathetered. Ms. Gerhardt attempted times to collect specimen but Mr. Selah stated that he could not void. During the drug test attempts, Mr. Hani asked if he could turn off the lights. Mr. Selah was informed that he needed to be observed urinating to ensure that the specimen was actually from him. See Bates 049 and 050.
20. On June 4, 2019, Mr. Selah was terminated for negative shift reports, inaccurate, inappropriate, or missing completely patient charting and inappropriate substandard controlled substance handling and documentation.
21. Elizabeth Kearney is the Chief Nursing Officer at Mountain Vista Medical Center. In October of 2019, Ms. Kearney filed a complaint with the Board for medicine mismanagement and missing medication. Ms. Kearny reported that pain medication was given every 3 hours instead of every four hours as prescribed. The pharmacy noted that Benadryl IV was missing on shifts where Mr. Selah was also working.
22. On September 24, 2017, Benadryl was counted prior to Mr. Selah coming on shift and at the end of the shift, 10 vials were missing. Ms. Kearney observed a videotape of Mr. Selah accessing the PXIS drawer and having several vials on his hand. Mr. Selah accessed the Benadryl, put the vials into his pocket, and then cancelled the order. See Exhibits 11 and 12; Bates 051-052 and 055-058, and Bates 062. Bates 021.
23. Ms. Stephanie Chambers is a Registered Nurse. Ms. Chambers has been an RN for 36 years. Ms. Chambers is a Nurse Practice Consultant for the Arizona State Board of Nursing. Ms. Chambers investigates board complaints and has worked in acute behavioral health and substance abuse. Ms. Chambers began an investigation into Mr. Selah after it received the Banner Baywood complaint. Ms. Chambers issued a subpoena to Banner Baywood for its employee records for Mr. Selah. See Exhibit 2, 5, and 6.
24. Ms. Chambers stated that it’si.leserved to be a charge nurse.lht at he was sorry that he has so many letters behind his name. important that nurses communicate professionally and effectively because the patient is the focus. It is inappropriate to argue with a patient as it interferes with safety and effective care. The Board issued an order requiring that Mr. Selah undergo a psychological evaluation. Ms. Chambers also stated that nurses should not come to work impaired.
25. On March 18, 2019, Mr. Selah underwent a psychological evaluation pursuant to the Board’s Order. The evaluator recommend workplace performance evaluations and continuing education.
26. Hani Selah stated that the management at Banner Heart was bad. Mr. Selah asserted that he was assigned more patients than the other nurses. Mr. Selah stated that the hospital was having a problem with charting pain and populating dates. Mr. Selah stated that he was retaliated against for speaking up on behalf of an Indian nurse who was declined a position even though she had more advanced degrees than the person that was hired. Mr. Selah stated that for two years, The Senior Clinic Manger Tracy Lopez tried to hurt him and find anything to use against him. They did not like that he exposed them.
27. Mr. Selah stated that he was not allowed to apply for the charge nurse position. Mr. Selah he did not understand for approximately a year abandoned the drug test. Mr. Selah stated that he felt betrayed and violated. Mr. Selah expressed that he felt like he would explode. Mr. Selah stated that Ms. Gerhardt lied because she stated that he was allowed to consume his drinks but he was not allowed to consume the liquids. Mr. Selah stated that he asked for a second bottle of water but his request was declined. Mr. Selah asserted that he was told he needed to void 100 ccs. Mr. Selah stated that he did not intentionally get into an argument with MM. Mr. Selah explained that people always ask him where he is from and after he told the patient, her husband mentioned a political action taken by President Trump.
28. Mr. Selah denied stealing Benadryl and stated there was nothing wrong with him putting syringes in his pocket. Mr. Selah stated that he received a verbal order from a doctor to give Percocet and morphine together. Mr. Selah stated that his practices might be little aggressive. Mr. Selah stated that morphine is appropriate to give a patient to treat chest pain. Mr. Selah stated that he was sorry that he has so many letters behind his name. Mr. Selah asserted that he was mocked by the nurse. Mr. Selah stated that nurses chart incorrectly because they are busy. Mr. Selah asserted that he respects all people and stands up for people. Mr. Selah asserted “they don’t like people to tell the truth.” Mr. Selah asserted that he was subject to religious discrimination and was under the microscope. Mr. Selah expressed that he deserved to be a charge nurse.
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. Selah’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. Selah committed unprofessional conduct as defined by Ariz. Rev. Stat. section 32-1601(22)(d), (j); (26)(d) ; A.A.C. R4-19-403(9),(12),(17), and (31).
Because Mr. Selah has committed unprofessional conduct, the Board has authority to revoke his registered nurse license. Ariz. Rev. Stat. § 32-1663(D); and § 32-1664(O).
Considering the facts and circumstances of this matter, it is recommended
that Mr. Selah’s registered nurse license number RN133100 be revoked.
RECOMMENDED ORDER
Based on the foregoing, the Administrative Law Judge recommends that the Board revoke Hani Selah’s registered nurse license number RN133100.
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, March 17, 2020.
/s/ Velva Moses-Thompson
Administrative Law Judge
Transmitted electronically to:
Joey Ridenour, RN, MN, Executive Director
State Board of Nursing