ALJDEC decisions subject to certification as final

22A-1705059-NUR · State Board of Nursing · 2022-08-22

IN THE OFFICE OF ADMINISTRATIVE HEARINGS

IN THE MATTER OF THE REGISTERED NURSE LICENSE NO. RN169994 AND ADVANCED PRACTICE REGISTERED NURSE (ACUTE CARE FOCUS) CERTIFICATE NO. AP7893 ISSUED TO:

SARA LIN MOSS,

AKA: SARA LIN GANIR,

Respondent

IN THE MATTER OF THE APPLICATION FOR ADVANCED PRACTICE REGISTERED NURSE (FAMILY NURSE PRACTITIONER FOCUS) BY:

SARA LIN MOSS

AKA: SARA LIN GANIR

APPLICANT

No. 22A-1705059-NUR

ADMINISTRATIVE LAW JUDGE

DECISION

HEARING: February 17 and April 27, 2022

APPEARANCES: Elizabeth Campbell, Esq. for the Board of Nursing; Sara Stark, Esq. and Renee Osipov, Esq. appeared for Sara Lin Moss

ADMINISTRATIVE LAW JUDGE: Thomas Shedden

FINDINGS OF FACT

The Arizona State Board of Nursing (“Board”) is the authority for licensing and regulating the practice of nursing in the State of Arizona. Ariz. Rev. Stat. §§ 32-1606, 32-1663, 32-1664.

Sara Lin Moss holds license number RN169994 and advanced practice certificate number AP7893 as an adult/gerontological acute care nurse practitioner (“ACNP”).

Ms. Moss received her ACNP after graduating from Grand Canyon University’s program in April 2015.

On or about May 24, 2017, the Board received from Arizona Department of Economic Security’s Adult Protective Services a complaint regarding Ms. Moss’s treatment of patient MG.

Although APS did not substantiate the allegation against Ms. Moss and closed the case on October 3, 2017, the Board conducted its own investigation and it alleges that Ms. Moss committed acts of unprofessional conduct in her treatment of MG.

On November 30, 2017, Moss self-reported to the Board that she had provided medical care including writing prescriptions for controlled substances to her father, patient MM.

On March 23, 2020, Ms. Moss applied for a second advanced practice certificate as a family nurse practitioner (“FNP”).

Through an Order of Denial dated July 23, 2021, the Board denied Ms. Moss’s application after concluding that she had committed acts of unprofessional conduct related to: (1) her treatment of her father, patient MM; (2) events while she was teaching at Grand Canyon University, including her being fired; (3) an allegation that she made a false or misleading statement a job application she submitted to Paradise Valley School District; and (4) her treatment of patient MG.

Ms. Moss appealed the Board’s Order of Denial, but apparently no hearing was set.

On January 11, 2022, the Board issued a “Complaint and Notice of Hearing” alleging that Ms. Moss had committed acts of unprofessional conduct based on essentially the same facts set out in its July 23, 2021 Order of Denial and setting a hearing to determine whether grounds exist to take disciplinary action against Ms. Moss’s RN license and ACNP certificate.

The parties agreed that Ms. Moss’s appeal of the Board’s Order of Denial and the disciplinary hearing should be conducted in a single proceeding.

On February 4, 2022, the Board issued a Notice of Public Hearing on Complaint and Denial of Licensure setting both matters for hearing on February 17, 2022 at the Office of Administrative Hearings in Phoenix, Arizona. That Notice incorporates the July 23, 2021 Order of Denial and the January 11, 2022 Complaint.

The Board presented the testimony of Robert Gaunt RN, a faculty supervisor at GCU; clinical psychologist Andrea Waddell-Pratt, Ph.D.; nurse practice consultant Stephanie Chambers, RN, MN; Associate Director of Licensing, ATD/Compliance and Hearings Andrea Vasquez, RN, MSN, FNP-C; and it called Ms. Moss.

Ms. Moss was represented by counsel and presented her own testimony, and that of Cheryl Pietkiewicz, RRT, MA, a Faculty Manager at GCU; and John Paul Blanchard MSN, AGACNP-BC, CCRN.

While she was in the ACNP program at Grand Canyon, Ms. Moss obtained clinical neuro-surgical experience at Barrow Neurological Institute under the direction of Abigail Tittle, ACNP. During that time she also obtained clinical experience related to psychiatric issues under the direction of Daniel Bishop, M.D. in the emergency department at St. Joseph’s Hospital and Medical Center.

Through her clinical work at St. Joseph’s and through her coursework at Grand Canyon, Ms. Moss obtained education and experience regarding drug toxicity.

Ms. Moss is the CEO of the Rolling Recovery Room that operates under an urgent care model, providing acute care services, and is not intended to provide long-term treatment.

As of February 17, 2022, Ms. Moss was employed as a school nurse practitioner with Paradise Valley School District, a position she had held since March 15, 2019.

Her Father

Ms. Moss provided medical care to her father from May through October 2017. In June, July and August 2017, Ms. Moss wrote five prescriptions for controlled substances to her father.

On or about November 29, 2017, a pharmacist informed Ms. Moss that her treatment of her father was in violation of the Board’s rules.

On November 30, 2017, Ms. Moss self-reported to the Board providing that she had not been aware that her treatment was a violation of the rules until she researched the issue after the pharmacist brought it to her attention. Ms. Moss was not obligated to make her self-report.

At the hearing, Ms. Moss acknowledged that it was a violation of the Board’s rules to write the prescriptions for her father, but she also testified to the effect that she had not been aware of that at the time she provided the treatment.

Patient MG

After receiving from DES/APS the May 24, 2017 complaint regarding Ms. Moss’s treatment of patient MG, the Board initiated an investigation.

Ms. Moss first provided treatment to MG on June 20, 2016. The Board alleges that Ms. Moss’s treatment ended in May 2017, whereas Ms. Moss’s position is that a treatment note dated February 28, 2017 “suggests” that this was her last treatment.

Regardless, MG was transitioned to the care of Dr. Parker, a psychiatrist at EMPACT on or about February 23, 2017, and to the care of Dr. Jigar Rathod, a neurologist, on or about June 30, 2017.

MG had complex chronic neurological developmental and behavioral issues, including a complicated long-standing history of Autism spectrum disorder, moderate-severe cognitive/developmental delay, aggressive/violent behaviors, and a complicated long standing history of uncontrolled seizures.

On the June 20, 2016 visit, Ms. Moss listed MG’s medications as: (1) Onfi 10 mg 1 tab orally twice a day (an anti-seizure benzodiazepine); (2) Zonisamide 100 mg – 2 tabs orally twice a day (anti-seizure); (3) Diazepam 5 mg 1 tab by mouth twice a day (an anti-seizure benzodiazepine); (4) Haldol 5 mg – 1 tab orally three times a day (an antipsychotic); and (5) Risperidone 2 mg orally dissolving tablet (ODT) at bedtime (an antipsychotic).

The Board alleges that Ms. Moss did not document what medical records she reviewed when she began treating MG. Ms. Moss does not dispute that it is “best practice” to obtain a patient’s records, but she asserts that this is not always possible. Ms. Moss acknowledged that her records should have provided more accurate information as to what medical records she received and reviewed, but argues that she had sufficient information to “assist in the continuity of his care.”

Ms. Moss’s initial care plan for MG called for his father to establish care with a psychiatric provider for medication and behavioral therapy and that he establish care with a neurology/epilepsy clinic for medication and evaluation.

This plan was consistent with the Rolling Recovery Room’s focus on providing acute care services and Ms. Moss testified to the effect that she did not intend to see MG after his initial visit.

Implementing the plan required MG’s father to establish insurance coverage through the Department of Economic Security’s Division of Developmental Disabilities (“DDD”), which would then enable him to establish care with the appropriate specialists.

There were delays in obtaining coverage through DES/DDD and then delays in getting MG appointments and treatment, with the father reporting to Ms. Moss that MG’s appointments with EMPACT to see a psychiatric provider were being delayed or rescheduled.

Ms. Moss believed that the patient could suffer significant harm if she abruptly stopped treating him, particularly with respect to MG’s medication management, consequently, she continued to treat MG. And although Ms. Moss testified that it was incumbent on MG’s father to obtain the appointments with the specialists, not her, she began assisting MG’s father in establishing the specialist care he needed, and she continued to push the father to establish care.

Ms. Moss was comfortable treating MG based on her clinical experience with NP Tittle at Barrows and her clinical experience with Dr. Bishop at St. Joseph’s. Nevertheless, Ms. Moss testified that when it became clear that establishing care with specialists would be delayed, she did additional reading and took CME to increase her knowledge base.

Ms. Moss’s treatment included conducting AIMs screening, which she stated was standard of practice for a patient taking Haldol. She was screening more often than called for as she was being overly cautious because she is not a specialist like a psychiatric NP.

On July 21, 2016, Ms. Moss wrote prescriptions for the anti-seizure medications Onfi, Zonisamide, and diazepam. Ms. Moss did not receive documentation from a neurologist before writing those prescriptions, but testified that later, after she wrote the prescriptions, she did receive documents from 2006 and 2012. On July 21, 2016, the plan again included establishing care with a psychiatric provider and a neurologist.

On October 27, 2016, Ms. Moss saw MG regarding his Haldol; MG’s father brought in MG’s current medication bottles and discharge paperwork from a December 28, 2015 visit to Mayo Clinic’s ER.

The Mayo paperwork shows that MG’s Haldol dosage had been increased in 2015, and it called for continuation of the Haldol (Haloperidol) and for continuation of Onfi (Clobazam) and Zonisamide. Diazepam is not listed in the Mayo paperwork.

On October 27th, again the plan included establishing care with the specialists, but also included a notation to keep calling DDD for assistance.

In November 2016, an intake for MG to open General Mental Health services at La Frontera/EMPACT was conducted. To Ms. Moss’s recollection, it was shortly after the intake that she first spoke to Dr. Parker. She spoke to him a couple of times, but only extensively once, which was in February 2017, as discussed below.

On November 4, 2016, MG presented for AIMS screening. The plan included establishing care with the specialists, including contacting authorized insurance providers and to continue calling DDD for assistance.

On November 24, 2016, MG presented for AIMS screening. The plan included establishing care with the specialists, including contacting authorized insurance providers and to continue calling DDD for assistance.

On December 25, 2016, MG presented for AIMS screening. The plan included establishing care with the specialists.

On January 21, 2017, Ms. Moss wrote a prescription for Haldol in which she lowered the dosage. That prescription was not filled and she wrote a replacement prescription on January 24th. According to Ms. Moss she made this change because MG’s father called her saying that he was going to ask MG’s group home to stop giving MG the Haldol; she informed him that doing so could cause problems; and she then spoke briefly with Dr. Parker, who confirmed that the medication should not be stopped, but the dosage could be reduced.

Ms. Moss acknowledged that she failed to document her conversation with Dr. Parker and that the conversation should have been documented.

On February 12, 2017, Ms. Moss discontinued the Haldol and reduced the Diazepam dosage. Ms. Moss testified that it was necessary to discontinue the Haldol and reduce the Diazepam because MG was experiencing tardive dyskinesia and extrapyramidal symptoms (“EPS”).

EPS is considered a medical emergency. Ms. Moss’s opinion is that MG could have died had she not discontinued the Haldol.

Ms. Vasquez agreed that discontinuing the Haldol could be appropriate, she nevertheless was of the opinion that Ms. Moss was required to work in tandem with the appropriate provider.

On February 13, 2017, Ms. Moss documented instructions for reducing MG’s Onfi over ten days.

On February 23, 2017, La Frontera’s Dr. Parker conducted a psychiatric evaluation of MG and started medication services.

On February 28, 2017 Ms. Moss changed the neurological diagnosis from “a complicated long standing [history] of uncontrolled seizures” to a “[c]omplicated long standing [history] of stress induced seizures (psychogenic non epileptic seizures)” and a “long standing misdiagnosed [history] of epilepsy.”

Ms. Moss testified that she called Dr. Parker after she discontinued the Haldol and that this consultation occurred on the weekend of February 12th and 13th, before she made the changes to MG’s anti-seizure medications and before changing MG’s neurological diagnosis. She acknowledged that she had not properly documented this consultation.

The Board notes however that an evaluation of MG conducted by Ms. Moss on February 11, 2017 (the day before she consulted with Dr. Parker) includes a note showing that Ms. Moss was weaning MG off of Onfi.

Regarding her consultation with Dr. Parker, Ms. Moss testified that she discussed with him MG’s father’s statements that he could “pull” MG out of a seizure by distracting him with, for example, an offer to watch a movie. According to Ms. Moss, someone who is having an “an organic seizure,” that is activity in the brain, cannot be pulled out of it.

Ms. Moss’s opinion was to the effect that the father’s description was consistent with a “pseudoseizure.” She testified that Dr. Parker explained this was now called a “PNES.”

Ms. Moss testified that Dr. Parker advised that the patient should be weaned off the seizure medications, which in this case were Zonisamide, Onfi, and diazepam. She testified that she then asked Dr. Parker to advise her or to clarify things, which he did, and she told him that she would add the diagnosis to MG’s notes.

Even though she and Dr. Parker believed the updated diagnosis was correct, Ms. Moss was she still recommending that the patient follow-up with neurology.

Ms. Moss acknowledges that Dr. Parker is a psychiatrist, not a neurologist, but her opinion is that MG’s labs and the father’s description of the seizures suggested that the patient’s seizures may not be neurological in nature.

Relying on GCU’s Acute Care Nurse Practitioner Clinical Manual and the American Association of Critical-Care Nurses Scope and Standards publication, Ms. Moss asserts that ACNP may treat chronic, complex, and chronically ill patients. Ms. Moss acknowledges however that it would not be appropriate for her to practice exclusively on mental health and psychiatric care. She argues however that some cross-over must be allowed.

Ms. Moss asserts that based on her clinical training and education, she was educationally prepared and had established the competency to maintain the treatment of MG’s psychiatric and neurological issues until MG could establish care with a psychiatrist and a neurologist.

In support of her position that a properly educated ACNP is competent to provide psychiatric-medication management, Ms. Moss presented the testimony of Mr. Blanchard.

Mr. Blanchard works as an ACNP in a jail setting where an estimated 75% of his patients have psychiatric issues and require medication management. His opinion was to the effect that he is competent to make changes to those medications, but at times he does find it necessary to consult with a psychiatric provider. His opinion was that Ms. Moss did not act outside her scope when she discontinued Haldol and changed the dosage for diazepam and Onfi.

Ms. Vasquez testified that it was not within Ms. Moss’s scope of practice as an ACNP to independently manage MG’s psychiatric issues, and that as an ACNP, the standard of care required that Moss make referrals for MG’s psychiatric and neurological conditions to the appropriate specialists and that she receive the specialists’ input for management of those conditions. Ms. Vasquez’s opinion was to the effect that this was true regardless of the fact that MG had not established care with the appropriate specialists.

Ms. Vasquez testified that the management of a seizure disorder, including medication management, must be provided by a neurologist or epileptologist, and is not within Ms. Moss’s scope as an ACNP.

Ms. Vasquez testified that, as an ACNP, it was not within Ms. Moss’s scope of practice to make a change in MG’s seizure diagnosis, with the standard of practice requiring that a neurologist or an epileptologist make any such change. She also testified that this was a significant change in diagnosis and that Ms. Moss should have documented the rationale for the change, which Ms. Moss did not do.

Ms. Vasquez acknowledged that as a FNP she could see a patient with a seizure disorder, but she added that she would not make that diagnosis or make changes to the treatment, but rather she would work in tandem with a neurologist or epileptologist. She also acknowledged that an ACNP could treat certain psychiatric conditions such as “common, self-limiting depression or anxiety,” but not complex psychiatric and behavioral issues.

Termination from Grand Canyon University

Ms. Moss was a faculty member at GCU from August 2017 to February 6, 2019, on which date GCU involuntarily terminated her employment.

There was friction between Ms. Moss and other staff and faculty at GCU, based at least in part on Ms. Moss’s dissatisfaction with changes that had been made to ACNP program. At one point, Ms. Moss sent Mr. Gaunt a text threatening to quit teaching. Subsequently, Ms. Moss sent an email to GCU’s program lead asking, "Does [another faculty member] have chapstick on while kissing your ass?”

GCU’s Involuntary Termination Request shows the basis for the request as a trend of unprofessional communication between students, faculty, and leadership with persistent violation of university policies; job performance has not fulfilled the responsibility and expectations for full-time faculty.

Ms. Moss originally taught in “pre-care” and then in the family nurse practitioner program.

Mr. Gaunt has been GCU’s faculty lead for the FNP program since sometime in 2018 and became Ms. Moss’s manager when she transferred to the FNP program. He was one of three signatories to GCU’s order terminating her employment.

Ms. Pietkiewicz was a faculty training and development specialist in GCU’s Faculty Training and Development Department, and she was on the Code of Conduct Committee that reviews student complaints.

Ms. Pietkiewicz acknowledged that she was not Ms. Moss’s supervisor, but stated that that GCU’s “lingo” is confusing. When asked to elaborate, she explained that the Department consists of 20 to 30 people whose job is to work with the incoming faculty to ensure they take and pass the orientation trainings. Ms. Pietkiewicz explained that the specialists became the faculty member’s “BFF” to negotiate GCU’s processes.

The Department also investigates complaints made against faculty members; there are a lot of complaints from students, which is why there is a Faculty Training and Development Department.

Ms. Pietiewicz was assigned to investigate complaints for the evening classes, which are the graduate level classes. On receiving a complaint, Ms. Pietkiewicz would investigate by checking the virtual classroom, and typically would discuss the complaint with the faculty member to resolve the matter.

Ms. Pietkiewicz investigated the student complaints against Ms. Moss, which included grades being late, that she was not responsive, and that she did not provide enough feedback.

Ms. Pietkiewicz’s recollection was that none of the students’ complainants against Ms. Moss related to grades were found to have merit (i.e., Ms. Moss’s assessments of the grades were correct).

With respect to complaints about late feedback, Ms. Pietkiewicz testified to the effect that there was some late feedback, but it was nothing unusual as compared to other faculty members that Ms. Pietkiewicz dealt with. Ms. Pietiewicz discussed her findings with Ms. Moss and they discussed strategies that Ms. Moss could employ to better meet the required time-frame for providing feedback, which strategies Ms. Moss was amenable to.

Ms. Moss would visit classrooms in response to complaints and on a “pop-in” basis. Ms. Pietkiewicz had observed Ms. Moss’s classes and found that Ms. Moss ran a strong and organized class.

Ms. Moss had been the instructor for a clinical class or classes that Mr. Blanchard took. He found her to be a very fair instructor who had high standards. He was aware that some students felt her expectations were too high and that she was a hard grader and too brash. Ms. Blanchard testified that Ms. Moss was not “touchy feely,” and his opinion was that students had been coddled, whereas Ms. Moss was not a coddler.

PVSD Job Application

Ms. Moss began working as a nurse for Paradise Valley School District on March 15, 2019. The Board’s Exhibit 9 is a copy of her application showing that it was updated on March 29, 2019.

The application shows she was employed at GCU from August 2017 to February 2019, and that she left because she needed more flexibility as she was back pursuing a Post Master’s degree. The Board alleges that this was a false or misleading statement because she had been terminated from GCU.

According to Ms. Moss, she completed the application in November or December 2018, before she was terminated from GCU, and that on March 29, 2019 she accessed the system put an end date on her GCU employment history.

The Board argues that Ms. Moss is not credible on this point because: (1) the information about GCU is not in the “Present Employment” portion of the application, but instead appears in the previous employment section; (2) Ms. Moss wrote on the application that her reason for leaving GCU was that she “needed” more flexibility, indicating that her employment had already ended; and (3) Ms. Moss wrote on the application that the increased flexibility was necessary because she was “back pursuing a Post Masters degree,” but she also testified that she had started the family nurse practitioner program at GCU on the day GCU terminated her.

Dr. Waddell-Pratt’s Evaluation and Recommendations

Following the advice of ethics evaluator Denise Atwood, the Board referred Ms. Moss for a psychological evaluation that was conducted by Dr. Waddell-Pratt on May 14, 2021.

Most of Dr. Waddell-Pratt’s testimony and her written report were designated as non-public.

Dr. Waddell-Pratt’s evaluation consisted on a clinical component and application of the MMPI.

Dr. Waddell-Pratt expects the person being evaluated to show that she understands the issues and that she understands what is being asked of her.

Based on the MMPI, Dr. Waddell-Pratt’s opinion was to the effect that Ms. Moss did not do so, but rather provided only vague or general statements and that she projected a lack of clarity about the need for the evaluation. This was of concern to Dr. Waddell-Pratt because it suggested that Ms. Moss might not adjust her nursing practice to fit in line with good practice or the practice of the Board.

Dr. Waddell-Pratt testified that Ms. Moss’s MMPI “flagged” in a manner that was suggestive of defensiveness, whereby definitive conclusions could not be drawn about her psychological well-being to indicate whether she was psychologically well or unwell.

Dr. Waddell-Pratt conclusions included finding that given the self-favorable manner in which Ms. Moss approached the evaluation, it could not be stated with certainty that Ms. Moss is absent of psychological issues. Consequently, Dr. Waddell-Pratt recommended that Ms. Moss participate in psychotherapy aimed at understanding her staunchly held self-favorable stance. The purpose of the therapy was to offer Ms. Moss a different venue for hearing, assessing and processing the issue before her with the Board, with the hope being that Ms. Moss would gain a more balanced view of herself.

Dr. Waddell-Pratt recommended that Ms. Moss undergo eight sessions of psychotherapy over four to five months and that she be re-evaluated (presumably by Dr. Waddell-Pratt) in twelve months to determine the effectiveness of the psychotherapy treatment. The hope is that Ms. Moss might present a more valid perspective of herself such that definitive statements could be made about her psychological health.

Dr. Waddell-Pratt did not consider eight sessions to be excessive considering that the first session or two would consist of information gathering and identifying the treatment goals, and that it takes time for a patient to become comfortable enough to open up to the provider.

Dr. Waddell-Pratt’s opinion was that Ms. Moss had practiced outside the scope of her ACNP certification. She asserted that this opinion had no bearing on her recommendation, and testified to the effect that even it was determined that Ms. Moss had not done so, this would not change Dr. Waddell-Pratt’s opinion of the MMPI assessment.

Dr. Waddell-Pratt also recommended that Ms. Moss be required to practice under supervision. She made that recommendation because she saw Ms. Moss as unwilling to hear that something she was doing could be altered or changed, which raised questions about her objectivity.

CONCLUSIONS OF LAW

The Board bears the burden of persuasion to show that discipline should be imposed on Ms. Moss’s license. Ariz. Rev. Stat. § 41-1092.07(G)(2).

Ms. Moss bears the burden of persuasion to show that her application for a FNP advanced practice certificate should be granted. Ariz. Rev. Stat. § 41-1092.07(G)(1).

The standard of proof on all issues is that of 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 Board has jurisdiction over the practice of nursing in Arizona. Ariz. Rev. Stat. §§ 32-1606, 32-1663, 32-1664.

A registered nurse practitioner shall only provide health care services (including prescribing) within the RNP’s population focus and role and for which the RNP is educationally prepared and for which competency has been established and maintained. Ariz. Admin. Code § R4-19-508(C); § R4-19-501(B)(listing foci).

Ms. Moss has misconstrued subsection R4-19-508(C) in that she has addressed only the educational and competency prong and has not address the requirement that the RNP is limited to treating patients within her population focus.

The preponderance of the evidence shows that Ms. Moss failed to maintain MG’s patient record to accurately reflect the nursing assessment, care, treatment, or other nursing services she provided to MG, which is a violation of Ariz. Admin. Code section 4-19-403(7), unprofessional conduct under Ariz. Rev. Stat. sections 32-1601(26)(d) (conduct that is, or might be, harmful or dangerous to the health of a patient or the public) and (26)(j)(violation of a statute or rule).

As an ACNP, Ms. Moss’s population focus does not include psychiatric-mental health, which is a separate focus. Consequently, the preponderance of the evidence shows that Ms. Moss assumed patient care responsibilities that are outside the scope of her practice, which is a violation of Ariz. Admin. Code section R4-19-403(12), and unprofessional conduct under Ariz. Rev. Stat. sections 32-1601(26)(d) and (26)(j).

Ms. Moss prescribed controlled substances to her father, which is an act prohibited under subsection R4-19-511(D). Consequently, the preponderance of the evidence shows that Ms. Moss assumed patient care responsibilities that are outside the scope of her practice, which is a violation of Ariz. Admin. Code section R4-19-403(30), and unprofessional conduct under Ariz. Rev. Stat. sections 32-1601(26)(d) and (26)(j).

Ms. Moss prescribed psychiatric medications to MG, which is an act prohibited under subsection R4-19-511(D) because it is not within her population focus as an ACNP. Consequently, the preponderance of the evidence shows that Ms. Moss assumed patient care responsibilities that are outside the scope of her practice, which is a violation of Ariz. Admin. Code sections R4-19-403(30) and R4-19-508(C), and unprofessional conduct under Ariz. Rev. Stat. sections 32-1601(26)(d) and (26)(j).

The Board alleges that Ms. Moss made a false or misleading statement on her PVCC application but has not proven this by a preponderance of the evidence. Consequently, the Board has not proven that Ms. Moss violated Ariz. Admin. Code section R4-19-403(27).

The Board has not proven by a preponderance of the evidence that Ms. Moss violated Ariz. Admin. Code section R4-19-403(31).

Ms. Moss proved by a preponderance of the evidence that she had the requisite knowledge and experience to treat MG while his father tried to get MG placed under the care of specialists, and that she was consulting with Dr. Parker during the course of her treatment. Consequently, the Board has not proven that Ms. Moss violated Ariz. Admin. Code section R4-19-508(A).

The preponderance of the evidence shows that Ms. Moss repeatedly violated the Board’s statutes or rules, which is unprofessional conduct under Ariz. Rev. Stat. section 32-1601(26)(g) and Ariz. Admin. Code section R4-19-403(1).

Because Ms. Moss has committed unprofessional conduct, the Board has authority to discipline her registered nurse license and her ACNP. The Board also has authority to deny Ms. Moss’s application for a FNP certificate. Ariz. Rev. Stat. §§ 32-1663 and 32-1664.

The Board request probation with supervision of Ms. Moss’s practice, and that she undergo “treatment” and re-evaluation by Dr. Waddell-Pratt. The Board has not proven that the psychiatric therapy recommended by Dr. Waddell-Pratt is necessary as shown by Dr. Waddell-Pratt’s statements that she could not determine definitively that Ms. Moss did have psychological deficits.

In this case, Ms. Moss’s unprofessional conduct occurred in 2017 more than five years ago and her transgressions were primarily based on her failed understanding of the Board’s regulations that prohibited her from prescribing for her father and that prohibited her from providing psychiatric and neurologic treatment to MG.

Considering the facts and circumstances of this matter, it recommended that Ms. Moss’s ACNP certificate and practice be placed on twelve months’ probation, under such conditions that the Board believes are appropriate.

Ms. Moss has not met her burden to show that the Board’s denial of her FNP certification was in error.

RECOMMENDED ORDER

IT IS ORDERED that Sara Lin Moss’s license number RN169994 and advanced practice certificate number AP7893 be subject to twelve months’ probation, under such terms and conditions that the Board finds to be appropriate;

IT IS FURTHER ORDERED that the Board’s denial of Ms. Moss’s application for certification as a family nurse practitioner is affirmed.

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.

-54864001

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-137160-45720000Done this day, August 22, 2022.

/s/ Thomas Shedden

Thomas Shedden

Administrative Law Judge

Transmitted electronically to:

Joey Ridenour, RN, MN, Executive Director

State Board of Nursing

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-137160-45720000By Miranda Alvarez

Legal Secretary