ALJDEC decisions subject to certification as final
20A-1801013-NUR · State Board of Nursing · 2020-03-11
IN THE OFFICE OF ADMINISTRATIVE HEARINGS
IN THE MATTER OF REGISTERED NURSE LICENSE NO. RN146054
ISSUED TO:
KRISTIE JUNE KIEFFER,
AKA: Hawkins, Kristie June
RESPONDENT.
No. 20A-1801013-NUR
ADMINISTRATIVE LAW JUDGE DECISION
HEARING: December 9, 2019, and reconvened on January 29, 2020.
APPEARANCES: Kristie June Kieffer appeared on December 8, 2019 but failed to appear on January 29, 2020.
Assistant Attorney General Sunita Krishna represented the Arizona State Board of Nursing.
ADMINISTRATIVE LAW JUDGE: Kay Abramsohn
_____________________________________________________________________
FINDINGS OF FACT
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, and 32-1664. 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 through 32-1669 and Arizona Administrative Code (A.A.C.) R4-19-101 through R4-19-815.
Kristie June Kieffer (Respondent) holds Board-issued Registered Nurse (RN) License No. RN146054 in the State of Arizona; the RN license was issued on May 18, 2007.
RELEVANT EMPLOYMENT
In November of 2017, Respondent was employed as an RN with PAM Specialty Hospital in San Antonio, Texas (PAMSH), while utilizing a [Texas] “Privilege to Practice” nursing based on her Arizona licensure.
From February 16, 2018 to March 5, 2018, Respondent was employed as an RN with Kindred Hospital in San Antonio, Texas (Kindred), while utilizing a [Texas] “Privilege to Practice” nursing based on her Arizona licensure. Kindred terminated Respondent on March 5, 2018 due to narcotic record discrepancies and Kindred’s determined violations of standards of nursing practice and Kindred Code of Conduct.
In August of 2018 until sometime in November of 2018, Respondent was employed as an RN with Yavapai Regional Medical Center in Prescott, Arizona (YRMC).
In December of 2018 until January 17, 2019, Respondent was employed as an RN with Arizona Pioneers’ Home (APH) in Prescott, Arizona. She was terminated on January 17, 2019.
In June of 2019 until October 31, 2019, Respondent was employed as a home-hospice nurse through Good Samaritan Society (GSS) in Prescott, Arizona. She was terminated on October 31, 2019.
COMPLAINT INFORMATION AND BOARD REQUESTS
On January 8, 2018, the Board received information from the Texas Board of Nursing regarding Respondent having diverted numerous narcotic medication while employed at PAMSH.
On May 8, 2018, the Board sent Respondent an investigative questionnaire to Respondent’s address of record. That mailing was returned to the Board as “unable to deliver, return to sender.”
On November 14, 2018, the Board received a complaint from the Director of Nursing, Rebecca Risaliti, with YRMC regarding Respondent allegedly diverting numerous medications, which had resulted in Respondent being terminated from employment at that facility.
On January 22, 2019, the Board sent Respondent an investigative questionnaire to Respondent’s address of record with regard to Complaint #2. Respondent has never responded, as is required by law, to that questionnaire.
On January 22, 2019, the Board received a complaint from the Nursing Supervisor, Bryan Myrick, with APH regarding Respondent allegedly signing out medication for a resident who was not at the facility at that time on that day and documenting the “effectiveness” of that medication dose.
On July 18, 2019, the Board sent Respondent an investigative questionnaire to Respondent’s address of record with regard to Complaint #3. Respondent has never responded, as is required by law, to that questionnaire.
On November 5, 2019, the Board received a complaint from the Executive Director, Julia Cowing, of GSS regarding Respondent allegedly ordering Oxycodone 5mg, on behalf of a home-care patient, but diverting over 1200 doses of that medication from the patient.
On July 18, 2019, the Board sent Respondent an investigative questionnaire to Respondent’s address of record with regard to Complaint #4. Respondent has never responded, as is required by law, to that questionnaire.
BOARD INVESTIGATION AND DETERMINATIONS
The Board’s Senior Investigator, David Elson, reviewed PAMSH medical records, various employment records, the Texas Board’s charges against Respondent, Arizona Controlled Substance Prescription Monitoring Program (CSPMP) records, and Prescott Police Department reports.
The PAMSH records demonstrated that on or about November 11, 2017, Respondent withdrew Oxycodone 10mg and Hydromorphone 2mg from the medDISPENSE Station for Patient V.M. but failed to document and/or completely and accurately document the administration of those medications in the Medication Administration Records (MARS) or in the nursing notes. Respondent failed to document the medications as being given, wasted or returned.
The PAMSH records demonstrated that on or about November 11, 2017, Respondent withdrew the Oxycodone and Hydromorphone from the medDISPENSE Station for Patient V.M. but failed to follow the PAMSH policy and procedure regarding wastage of unused portions of the medications.
On or about November 11, 2017, Respondent either misappropriated one 10 mg tablet of Oxycodone and 1mg of Hydromorphone from Patient V.M. and/or from the facility, or failed to take precautions, under nursing practice standards of care, to prevent such misappropriations.
The Kindred records demonstrated that that on or about February 24, 2018 through February 25, 2018, Respondent withdrew Fentanyl 100mcg thirteen (13) times from the medication dispensing system for Patient DN0002165710 but failed to document and/or completely and accurately document the administration of those medications in the Medication Administration Records (MARS) or in the nursing notes.
The Kindred records demonstrated that that on or about February 24, 2018 through February 25, 2018, Respondent withdrew Fentanyl 100mcg at least thirteen (13) times from the medication dispensing system for Patient DN0002165710 but failed to follow the Kindred policy and procedure regarding wastage of unused portions of the medications.
On February 24, 2018 and February 25, 2018, Respondent either misappropriated 13 vials/syringes of Fentanyl 100mcg from Patient DN0002165710 or the facility, or failed to take precautions, under nursing practice standards of care, to prevent such misappropriations.
At APH, on January 5, 2019, at approximately 5:00 p.m., Respondent left routine non-narcotic medication at the bedside of a resident; she then documented administration of the medication. However, that resident was not at the facility at that time on that day and did not return until the evening of the January 6, 2019.
At APH, on January 5, 2019, at approximately 6:00 p.m., Respondent signed out Tramadol (under a PRN Order) for this same resident and Respondent subsequently documented that the dosage had been “effective” for the resident’s pain management. The non-narcotic medication was found at the resident’s bedside on the morning of January 6, 2019, while the Tramadol was not with that bedside medication.
On or about October 27, 2019, a home-hospice patient, J.J., who had been assigned to and cared for by Respondent, was admitted to GSS’s inpatient facility, Marley House, for respite care. J.J. brought with him three containers of prescription medication, each labeled as Oxycodone 5mg, each with different fill dates; Respondent had been responsible for ordering, refilling, and managing/administering his medication at his home. J.J. indicated to Marley House personnel that he had been taking up to 11 a day and indicated that they were not giving him any relief from his pain. The medications therein were counted and documented as follows:
a. For the prescription of 45 tablets refilled on September 15, 2019, there were 22 tablets present and the tablets were not Oxycodone but were Hydroxyzine.
b. For the prescription of 90 tablets refilled on October 16, 2019, there were 65 tablets present and the tablets were not Oxycodone but unmarked large-sized tablets of unknown substance.
c. For the prescription of 90 tablets filled on October 24, 2019, there were 36 tablets present and the tablets were not Oxycodone but were unmarked medium-sized tablets of unknown substance.
On November 14, 2019, the Board summarily suspended Respondent’s RN license and requested prompt institution of an administrative hearing. The Board subsequently referred the matter to the Office of Administrative Hearings (Tribunal), an independent agency, for an evidentiary hearing.
Under specific conditions, on November 18, 2019, Respondent voluntarily surrendered the Privilege to Practice nursing based on her Arizona licensure within the State of Texas.
On November 25, 2019, the Board issued a Complaint and Notice of Hearing, setting the matter for formal administrative hearing.
The Board’s Complaint and Notice of Hearing is hereby incorporated into the official hearing record.
VIOLATION ALLEGATIONS
The Board’s Complaint and Notice of Hearing alleged that cause exists to discipline Respondent’s RN license under A.R.S. § 32-1601(26)(d), (g), and (j) and A.A.C. R4-19-403(1), (7), (8), (9), (16), (17), (18), (25)(a), and (31). The Complaint and Notice of Hearing was sent via email, via first class mail, and via certified mail to Respondent at her address of record.
Respondent appeared at the December 2019 noticed date and time, and the matter was set for a status update on possible informal settlement. However, Respondent failed to appear at the rescheduled hearing. Although the start of the reschedule hearing was delayed approximately fifteen (15) minutes to allow Respondent additional time to appear, she did not appear, personally or through any designated representative or attorney, and did not contact the OAH to request that the start of the hearing be further delayed. Consequently, Respondent did not present any evidence to dispute the allegations within the Board Complaint or to defend her RN license.
At hearing, the Board submitted 11 exhibits and presented the testimony of its Senior Investigator David Elson, witness Bryan Myrick (Nursing Supervisor at APH), and witness Deanna Makrauer (Nightime RN at Marley House).
Mr. Elson presented credible and undisputed testimony regarding the at-issue documented actions of Respondent with regard to inappropriate and fraudulent medicine draws at Respondent’s places of employment, with regard to inaccurate and inappropriate recording of medicine administration and wastage at Respondent’s places of employment, and with regard to the Board’s investigation process and determination. Mr. Elson’s credible testimony was fully supported by the documented, confidential, exhibits.
Mr. Myrick presented credible and undisputed testimony regarding the at-issue documented actions of Respondent at APH; his credible testimony was fully supported by the documented, confidential, exhibit #7.
Ms. Makrauer presented credible and undisputed testimony regarding the presentation of hospice patient at Marley House with prescription containers of wholly inaccurate prescription medication of which Respondent had maintained at the patient’s home; her testimony was fully supported by the documented, confidential evidence. Ms. Makrauer provided credible and undisputed testimony regarding the Marley House administration of Oxycodone 5mg medication that resolved the patient’s pain.
The hearing record concluded on February 21, 2020 following receipt of the Board’s prepared transcript, as the official written record of this administrative hearing, and after the Administrative Law Judge’s review of the entire record.
The Administrative Law Judge determines that the Board proved each of the allegations of law and rule the Board had made in its Complaint and Notice of Hearing regarding Respondent.
CONCLUSIONS OF LAW
The Complaint and Notice of Hearing that the Board e-mailed 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).
This matter lies within the Board’s jurisdiction under A.R.S. § 32-1606(B).
The Board bears the burden of proof and must establish cause to discipline Respondent’s RN 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).
“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 § 5 (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).
The Board established by a preponderance of the evidence that Respondent acted in violation of Federal laws, Arizona laws and Arizona Board-regulated standards and practices as defined in A.R.S. § 32-1601(26)(d), (g), and (j); A.R.S. §§ 32-1663 and 32-1664; and A.A.C. R4-19-403(1), (7), (8), (9), (16), (17), (18), (25)(a), and (31).
Given the determined violations of law and rules applicable to Respondent and Respondent’s failure to attend the hearing in this matter, Respondent has demonstrated that she cannot be regulated. Thus, the Board established cause to impose a disciplinary sanctions of suspension or revocation against Respondent’s license under the foregoing laws and rules.
RECOMMENDED ORDER
Based on the foregoing, the Administrative Law Judge recommends that the Board uphold its November 14, 2019 Summary Suspension Order and, further recommends that the Board revoke RN License 146054 issued to Respondent Kristie June Kieffer.
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 11, 2020.
/s/ Kay Abramsohn
Administrative Law Judge
Transmitted electronically to:
Joey Ridenour, RN, MN, Executive Director
State Board of Nursing