ALJDEC decisions subject to certification as final
21A-2020080216-NUR · State Board of Nursing · 2021-08-02
IN THE OFFICE OF ADMINISTRATIVE HEARINGS
IN THE MATTER OF REGISTERED NURSE LICENSE NO. RN136597
ISSUED TO:
JAMES ALLEN WILSON,
A.K.A.: JIM WILSON,
RESPONDENT.
No. 21A-[number redacted]-NUR
ADMINISTRATIVE LAW JUDGE DECISION
HEARING: June 9, 2021
APPEARANCES: Respondent failed to appear. Assistant Attorney General Elizabeth Campbell represented the Board of Nursing (Board).
ADMINISTRATIVE LAW JUDGE: Kay A. Abramsohn
_____________________________________________________________________
FINDINGS OF FACT
1. The hearing in this matter was conducted to determine whether grounds exist to take disciplinary action, including suspension or revocation against James Allen Wilson who holds a registered nurse license to perform as a registered nurse (“RN”) in the State of Arizona.
2. James Allen Wilson (“Respondent”) holds Board-issued license number RN136597 in the State of Arizona.
3. On July 22 to July 23, 2020, and while working as a RN in the Intensive Care Unit at Western Arizona Regional Medical Center, located in Bullhead City, Arizona, Respondent failed to account for about 65 mg of IV Midazolam, a schedule IV controlled substance and a benzodiazepine, and at least 530 mcg of IV Fentanyl, a narcotic analgesic and a schedule II controlled substance. It is a standard of nursing care for a nurse administering IV infusions of controlled substances to ensure that all medication is accounted for as either administered or wasted.
4. On July 23, 2020, Respondent, while working as a RN in the Intensive Care Unit at Western Arizona Regional Medical Center, failed to keep adequate patient records, failed to follow provider orders, and failed to follow the standards of nursing practice when Respondent failed to establish the patient’s health status at admission to maintain and track any changes in the patient’s condition for continuity of care when he did not document an initial patient assessment, any vital signs or intake and output data for Patient PG, who was admitted at approximately 1:30 a.m. Respondent acknowledged receiving the patient at 2:14 a.m., but he failed to perform an initial assessment and document any vital signs or intake and output data during his shift, which ended at 6:30 a.m. The standard of practice for ICU patients is to assess a patient at the time of admission or soon thereafter, and to obtain and document vital signs and intake and output data every hour.
5. On July 23, 2020, at about 6:26 a.m., while on duty as a RN at Western Arizona Regional Medical Center and assigned to care for two critical care patients, Respondent abandoned his patient assignment and was found acting confused, unaware of his surroundings, and talking to himself in the hospital parking lot by hospital leadership staff and brought to the facility’s Emergency Department for evaluation. At 8:00 AM, Respondent’s 6-panel urine drug test was positive for benzodiazepines and THC (Cannabinoid). Fentanyl was not tested. Respondent did not have a prescription for benzodiazepines.
6. On August 28, 2020, Board staff mailed an Investigative Questionnaire to Respondent’s address of record. The questionnaire was not returned to Board offices. On November 25, 2020, Board staff sent Respondent an email to his email address of record. Respondent has not provided a written statement to the Board and as required by the Arizona Nurse Practice Act.
7. On May 27, 2021, the Board summarily suspended Respondent’s registered nurse license.
8. On June 1, 2021, the Board issued a Complaint and Notice of Hearing, alleging that cause existed to discipline Respondent’s registered nurse license. The Complaint and Notice of Hearing was sent via certified mail to Respondent at his address of record.
9. The Board referred the matter to the Office of Administrative Hearings (the OAH), an independent agency, for an evidentiary hearing. A hearing was conducted through virtual means on June 9, 2019.
10. Respondent did not make any specific request regarding the duly noticed hearing and did not request that the scheduled hearing be continued. Although the start of the virtual hearing was delayed allow Respondent additional time to appear, he did not appear, personally or through an 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 defend his registered nurse license.
11. The Board submitted seven exhibits and presented the testimony of Amy Winkler Heistandt, Investigator with the Board.
CONCLUSIONS OF LAW
1. The 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, and 41-1092.11(B). This matter lies within the Board’s jurisdiction.
2. The Board also has the authority, pursuant to A.R.S. § 32-1663 and A.R.S. § 32-1664, to impose disciplinary sanctions against the holders of nursing licenses/certified nursing assistants for violations of the Nurse Practice Act, A.R.S. §§ 32-1601 through 1669, and A.A.C. R4-19-101 to R-19-815. If the Board determines that a licensee has committed unprofessional conduct, The Board may take disciplinary action.
3. The Complaint and Notice of Public Hearing that the Board mailed to Respondent at his 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).
4. The Board bears the burden of proof and must establish cause to penalize Respondent’s registered nurse 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 Vazzano v. Superior Court, 74 Ariz. 369, 372, 249 P.2d 837 (1952).
5. “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).
6. The conduct and circumstances described in paragraphs 3, 4, 5, and 6 of the Findings of Fact herein constitutes unprofessional conduct pursuant to A.R.S. § 32-1601(26)(d)(any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public) and is grounds for disciplinary action pursuant to A.R.S. § 32-1663 and § 32-1664.
7. The conduct and circumstances described in paragraphs 3, 4, and 5 of the Findings of Fact herein constitutes unprofessional conduct pursuant to A.R.S. § 32-1601(26)(e)(Being mentally incompetent or physically unsafe to a degree that is or might be harmful or dangerous to the health of a patient or the public) and is grounds for disciplinary action pursuant to A.R.S. § 32-1663 and § 32-1664.
8. The conduct and circumstances described in paragraphs 3, 4, 5, and 6 of the Findings of Fact herein constitutes unprofessional conduct pursuant to A.R.S. § 32-1601(26)(g) (Willfully or repeatedly violating a provision of this chapter or a rule adopted pursuant to this chapter) and are grounds for disciplinary action pursuant to A.R.S. § 32-1663 and § 32-1664.
9. The conduct and circumstances described in paragraphs 3, 4, 5, and 6 of the Findings of Fact herein constitutes unprofessional conduct pursuant to A.R.S. § 32-1601(26)(j) (Violating a Board statute or rule) and is grounds for disciplinary action pursuant to A.R.S. § 32-1663 and § 32-1664.
10. For purposes of A.R.S. § 32-1601(26)(d), the conduct described in the paragraphs 4 and 5 of the Findings of Fact herein constitutes a conduct or practice that is or might be harmful to the health of a patient or the public pursuant to A.A.C. R4-19-403(5)(Abandoning or neglecting a patient who requires immediate nursing care without making reasonable arrangement for continuation of care).
11. For purposes of A.R.S. § 32-1601(26)(d), the conduct described in the paragraphs 3 and 5 of the Findings of Fact herein constitutes a conduct or practice that is or might be harmful to the health of a patient or the public pursuant to A.A.C. R4-19-403(16)(Removing, without authorization, a narcotic, drug, controlled substance, supply, equipment, or medical record from any health care facility, school, institution, or other work place location).
12. For purposes of A.R.S. § 32-1601(26)(d), the conduct described in the paragraphs 3, 4, and 5 of the Findings of Fact herein constitutes a conduct or practice that is or might be harmful to the health of a patient or the public pursuant to A.A.C. R4-19-403(17)(A pattern of using or being under the influence of alcohol, drugs, or a similar substance to the extent that judgment may be impaired and nursing practice detrimentally affected, or while on duty in any health care facility, school, institution, or other work location).
13. For purposes of A.R.S. § 32-1601(26)(d), the conduct described in the paragraphs 3 and 5 of the Findings of Fact herein constitutes a conduct or practice that is or might be harmful to the health of a patient or the public pursuant to A.A.C. R4-19-403(18)(Obtaining, possessing, administering, or using any narcotic, controlled substance, or illegal drug in violation of any federal or state criminal law, or in violation of the policy of any health care facility, school, institution, or other work location at which the nurse practices). Midazolam is a Schedule IV Controlled Substance (A.R.S. § 36-2515) and a Dangerous Drug (A.R.S. § 13-3401). It is illegal to use Dangerous Drugs without a valid prescription. A.R.S. § 13-3407. Fentanyl is a Schedule II Controlled Substance (A.R.S. § 36-2513) and a Narcotic Drug (A.R.S. § 13-3401). It is illegal to use Narcotic Drugs without a valid prescription. A.R.S. § 13-3408.
14. For purposes of A.R.S. § 32-1601(26)(d), the conduct described in the paragraph 6 of the Findings of Fact herein constitutes a conduct or practice that is or might be harmful to the health of a patient or the public pursuant to A.A.C. R4-19-403(25)(a)(Failing to furnish in writing a full and complete explanation of a matter reported pursuant to A.R.S. § 32-1664)
15. For purposes of A.R.S. § 32-1601(26)(d), the conduct described in the paragraphs 3, 4, and 5 of the Findings of Fact herein constitutes a conduct or practice that is or might be harmful to the health of a patient or the public pursuant to A.A.C. R4-19-403(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).
16. The Board established by a preponderance of the evidence that Respondent’s actions and conduct were in violation of applicable nursing practice statutes and rules with respect to multiple requirements. Further, Respondent’s failure to submit a completed Investigative Questionnaire, Respondent’s failure to respond to the Board’s communications as well as Respondent’s failure to attend the administrative hearing in this matter, Respondent has demonstrated that he cannot be regulated at this time. Thus, the Board established cause to impose a disciplinary sanction against Respondent’s license under A.R.S. § 32-1663(D) and A.R.S. § 32-1664(N).
RECOMMENDED ORDER
Based on the foregoing, the Administrative Law Judge recommends that the Board revoke License No. RN136597 previously issued to Respondent James Allen Wilson.
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, August 2, 2021.
/s/ Kay A. Abramsohn
Administrative Law Judge
Transmitted electronically to:
Joey Ridenour, RN, MN, Executive Director
State Board of Nursing