ALJDEC - Licensing
22A-201910460-NUR-RES · Sate Board of Nursing · 2023-09-06
IN THE OFFICE OF ADMINISTRATIVE HEARINGS
IN THE MATTER OF THE PRACTICAL NURSE LICENSE NO. LP226123
ISSUED TO:
ADELE SOJOURNER COOK,
AKA: ADELE COOK
RESPONDENT.
No. 22A-[number redacted]-NUR-RES
ADMINISTRATIVE LAW JUDGE DECISION
HEARING: July 27, 2023 with the record held open until August 17, 2023 allow the court reporter’s transcript to be included in the record, and to allow Respondent Adele Sojourner Cook to submit additional evidence.
APPEARANCES: Respondent Adele Sojourner Cook AKA: Adele Cook represented herself. Assistant Attorney General Deborah Abbey represented the Arizona State Board of Nursing.
ADMINISTRATIVE LAW JUDGE: Velva Moses-Thompson
_____________________________________________________________________
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.
Respondent holds Board issued practical nurse license no. LP226213.
From August 2018 to October 2018, Respondent worked for Concentric Staffing Agency (Concentric).. During that time, Concentric received a report from one of its clients complaining that Respondent was rude and disrespectful to the client. The client stated that it would cancel the contract. Concentric staff person, J. Gardener, called Respondent and notified her of the complaint. Respondent became aggressive and J. Gardener placed Respondent on an inactive status (Respondent would not be assigned to jobs).
On October 29, 2019, the Board received a complaint from an employee with a medical staffing agency in Londonderry, New Hampshire reporting that on September 21, 2019, while on assignment at Good Samaritan Society (Good Samaritan) in Prescott Valley, AZ, Respondent was not found for some time and then Respondent called out the next day, September 22, 2019, and has been unresponsive to attempts at contact. This was considered a walk off and put the facility at risk of being short staffed. Based on this information, the Board conducted an investigation.
The investigation was assigned to Stephanie Cruz, the Board’s Senior Investigator.
After receiving the complaint, the Board issued an Investigative Questionnaire inquiring about Respondent’s employment. However, Respondent did not provide employment information. Therefore, Ms. Cruz submitted an inquiry to the Arizona Department of Economic Security (Department) to obtain information regarding Respondent’s employment history. Ms. Cruz subpoenaed Respondent’s employment records from the employers provided by the Department. regarding employment records from Respondent’s employers.
During Ms. Cruz’s investigation, Ms. Cruz spoke with Respondent regarding the complaint from Good Samarian. Respondent told Ms. Cruz that she left a voice mail with the staffing agency because no one was in the office. Respondent also told Ms. Cruz that she sent a text to the hiring manager, Julia Castelo. Respondent alleged that Ms. Castelo threatened her and only wanted to “make money from her.”
On December 31, 2020, the Board received a complaint from a faculty member, Nursing program instructor with Northland Pioneer College in Winslow, Arizona, stating that around August 2020, Respondent exhibited concerning and threatening behaviors, such as yelling and escalating aggression.
During the investigation, Board staff identified that Respondent has a pattern of unprofessional conduct of aggressive behavior, incomplete work practices, and on or around May 30, 2018, Respondent, who was working as a licensed practical nurse at Desert Highland Center, in Kingman, Arizona, failed to pass her 90-day probationary period, had 2 call offs since April 19, 2018, and numerous written and or verbal complaints from residents, families and co-workers.
In addition to complaints about her, Respondent also submitted during her employment from April 19, 2018 – May 30, 2018 an incomplete accident report (a falls report 7 days post fall without a signature), left an order sheet intact and unsigned in a resident’s medical record, blatantly disregarded facility protocols by sitting in nurse’s station and charting rather than assisting CNAs on her team during a fire drill, discontinued a Foley catheter on patient AF on May 21, 2018, without a provider’s order on a resident who has urinary retention due to stricture, resulting in unnecessary hospitalization.
This behavior is in violation of the Desert Highland Care Center Employee Handbook specific to company goals of treating patients, families and co-workers respectfully, and violation of personal conduct specific to respect for patients, families and co-workers and failure to perform duties as required.
On November 12, 2019, the Respondent questionnaire was sent. It was returned December 9, 2019 partially completed. Questionnaire sent again on December 13, 2019 Respondent failed to cooperate in the Board investigation and complete the employment portion of the Respondent questionnaire.
On May 21, 2018, Respondent removed the Foley Catheter from patient AF at Desert Highland Care Center in Kingman, Arizona without a provider order resulting in urine retention and transfer to the hospital for treatment.
This is a violation of the Desert Highland Personal Handbook, Personal Conduct (November 2021) and is considered negligence in performance of duty; including, but not limited to, physical, mental, verbal abuse of any resident or employee or misappropriation of resident property. Negligent behavior can result in harm to the patient.
In January and February of 2020, Respondent worked for Rim Country Health & Retirement Community (Rim). On February 7, 2020, Respondent was terminated from Rim for sleeping on the job, disruptive behavior during orientation, and failure to take direction during orientation.
On January 21, 2021, during Ms. Cruz’s investigation, she received a call from Linda Crux, the Hiring Director at Tim. Linda Cruz reported that during an hour and a half orientation, Respondent left for approximately twenty minutes after Linda Cruz asked her for her driver’s license. Respondent did not return with her driver’s license. Based on Respondent’s conduct during the orientation, Linda Cruz did not believe that Respondent would comply with Rim’s policies and procedures.
Respondent was not available to care for patients and administer medications as requested by patients at Rim. This is a violation of Rim’s handbook professional conduct policies. Respondent was not available to care for patients and administer medications as requested by patients. Nursing staff are required to be awake and available for patient care duties. Failure to be awake and prepared for patient care results in abandonment of care and the patient(s) are at risk for injury. Abandoning or neglecting a patient who requires immediate nursing care without making reasonable arrangements for continuation of care places the patient at risk for harm or injury.
On September 2, 2020, Respondent, an RN student at Northern Pioneer College in Show Low, Arizona, was threatening, aggressive, yelling and escalating aggressively towards faculty member.
Respondent expressed anger when requested to complete dosage calculation examination by faculty. Respondent was loud, interrupting, used unprofessional language and was threatening, stating you are going to regret this. Respondent stated, “What’s it going to take? Do you want somebody to bomb the place? Do I have to scream Black Lives Matter?” Faculty received a text message later that stated, “Please disconnect me from this and all chat. Black nurses' lives matter. You will hear from my lawyer.” This is a violation of the Northland Pioneer Student behavior, physical attacks, verbal or physical threats of violence, physical intimidation, stalking, and property damage.
In January of 2020, Respondent worked for Haven Health of Show Low (Haven). Ms. Cruz spoke with Denise Lewis of Haven who explained that Respondent had a pattern of locking herself in the medical room to sleep. Ms. Lewis reported that staff was unable to access medication for patients. Haven staff took photographs of Respondent sleeping while at work.
During her investigation, Respondent contacted Ms. Cruz and stated that she wanted to report Haven for wrongful termination. Respondent told Ms. Cruz that Haven should take care of its residents instead of taking photographs. Respondent also stated that Haven did not issue her last pay check.
On Respondent’s employment application, January 30, 2020, to Rim in Payson, AZ Respondent listed her reason for leaving Haven, January 23, 2020, was because “no Day Shift Position offered”, when she was actually terminated from Haven for sleeping on the job on January 24, 2020. Nurses are expected to provide accurate information on all documents. Failure to provide accurate information can lead to inaccurate assessments and inappropriate actions.
In October of 2020, Respondent worked for Sacred Heart Nursing. Respondent was removed from the schedule because she had a bad attitude while working and consistently complained.”
In October of 2020, Respondent filed a complaint against Northland Pioneer College. Respondent alleged that the complaints involving Northland Pioneer College were retaliation for the complaint that she filed against the college. Respondent alleged the syllabus was changed with less than 48 hours of notification, that content, such as medication calculations, were not covered by the instructors, that the program required students to purchase a software two days before an exam, and she alleged unprofessional conduct by two faculty members.
In her investigation, Ms. Cruz learned that staff from Northland Pioneer College reported threats made by Respondent to the Winslow Police Department. According to the report, Respondent made threats related to a bombing, shooting, and suicide. Respondent also stated that he school would regret the way that it treated its students.
On May 28, 2021, the Board issued an Interim Order for a Comprehensive Psychological Evaluation to include an anger management evaluation to be completed by a Board approved licensed psychologist, and to include any additional testing deemed necessary by the evaluator, to be completed within 45 days and return to the Board.
On September 3, 2021, a Board approved evaluator, Cindy Rollins, Psy.D., provided a report of Respondent’s comprehensive psychological evaluation that included anger management and additional testing to the Board.
In the “Psychological Status, Including Anger Management” section of Dr. Rollins’s therapeutic considerations and recommendations, Dr. Rollins wrote, “During the discussion of the numerous accounts of conflictual interactions where she was documented behaving “aggressive or threatening,” [Respondent] was unable to take personal responsibility for her part. She denied any culpability, indicating she was being mistreated due to racism by her previous employers and school in Arizona. It is important to note the empirical research highlights the prevalence of systemic racism Nurses of Color experience, especially in rural, white dominated areas. However, this phenomenon does not explain [Respondent’s] lack of acknowledgement or accountability for her personal reactions in the conflictual interactions identified. She endorses and extremely high level of psychological adjustment and extremely low level of anger reactions, which are inconsistent with the documentation of her behavior provided by the Board. Thus, “Respondent] is either lacking awareness of her anger reactions or minimizing her behavior.”
Under the “Assessment of the ability to function safely and applicable parameter under which this may occur” section of Dr. Rollins’s therapeutic considerations and recommendations, Dr. Rollins wrote,” [Respondent] has been working as an LPN since 1994, and as a travel nurse since 2013. Since 2018, there is documentation of unprofessional conduct, aggressive/uncooperative behavior, and conduct that might be harmful or dangerous to the health of the patent or the public while employed as a nurse and;/or enrolled in nursing school in Arizona.
I recommended that [Respondent] benefit from participation in the Board’s monitoring program as she continues to provide nursing services in Arizona.” Dr. Rollins also recommended: monthly individual therapy sessions with a licensed mental health provider for 12 months, engagement in group anger management group therapy and a psychological re-evaluation upon completing treatment recommendations. Respondent is also required to complete continuing education in ethics in nursing.
On November 19, 2021, the Board considered the matter and voted to offer Respondent a Consent Agreement for probation with terms and conditions. The vote contained a provision that if the Consent Agreement was not signed within 30 days, based upon the information in the investigative report, a Notice of Charges would be issued.
On December 15, 2021, Board Staff mailed the Consent Agreement to Respondent, who responded by email on December 15, 2021, and informed board staff she would not sign the consent agreement and requested a hearing.
On June 6, 2023, the Board issued a Complaint and Notice of Hearing setting the above-captioned matter for hearing on July 27, 2023, at the Office of Administrative Hearings in Phoenix, Arizona.
A hearing was held on July 27, 2023.
At hearing, the Board presented the testimony of Ms. Cruz and Shannon Bitza, the Associate Director of Education for the Board. The Board submitted exhibits 1 through 20. Respondent testified on behalf of herself and presented the testimony of former co-workers, Amanda Jelks and Elizabeth Zuniga. Although Respondent was given additional time to submit exhibits, Respondent did not submit additional evidence after the hearing concluded.
Respondent alleged that Dr. Rollins told her that she did not believe that anything was wrong with her. Respondent stated that Dr. Rollins recommended that she complete therapy because the Board wanted Dr. Rollins to “say something” given the Board’s allegations against Respondent.
Respondent asserted that she received an order from the nephrologist to
remove the Foley catheter because the patient’s Foley bag was filled with blood and waste. The nephrologist told her that she could remove the chart if there was nothing in the chart prohibiting the removal of the bag. Respondent stated that she removed the bag and the patient’s pain stopped.
37. Respondent asserted at hearing that she “goes above and beyond” for her patients and that she was called the “n” word constantly.
38. Respondent denied that she was missing from work for anything other than a break or lunch break.
39 Respondent did not deny that she slept while at work.
40. Ms. Jelks testified at hearing that she has previously worked with Respondent and never saw her behave aggressively or abusive with staff or residents. However, Ms. Jelks confirmed that she never worked with Respondent on any of the jobs that were included in the Board’s investigation.
41. Ms. Zuniga explained that she has worked with Respondent in the past and she recalled an incident where a patient was sharing a room with her husband.
Ms. Zuniga explained that the patient became very impatient and verbally aggressive with Respondent. Ms. Zuniga stated that the patient threw items at Respondent. Ms. Zuniga stated that she has never seen Respondent be verbally aggressive with anyone.
CONCLUSIONS OF LAW
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, 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.
The Board bears the burden of proof to establish cause to penalize Respondent’s practical nurse’s license by a preponderance of the evidence. “A preponderance of the evidence is such proof as convinces the trier of fact that the contention is more probably true than not.”
The Board established by a preponderance of the evidence that Respondent committed unprofessional conduct as defined by A.R.S. § 32-1601(27)(d), as more specifically defined at A.A.C. R4-19-403(1),(2),(5),(9),(13), (25)(a), (27) and (31).
The Board established by a preponderance of the evidence that Respondent committed unprofessional conduct as defined by A.R.S. § 32-1601(27)(g),(h), and (j).
The Board has established cause to impose disciplinary sanctions against
Respondent’s license under A.R.S. §§ 32-1663(D) and 32-1664(N).
RECOMMENDED ORDER
Based on the foregoing, the Administrative Law Judge recommends that the Board revoke Respondent Adele Sojourner Cook’s Practical Nurse License No. LP226123.
Pursuant to A.R.S. § 41-1092.08(I), the licensee may accept the Administrative Law Judge Decision by advising the Office of Administrative Hearings in writing not more than ten (10) days after receiving the decision. If the licensee accepts the Administrative Law Judge Decision, the decision shall be certified as the final decision by the Office of Administrative Hearings.
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 forty (40) days from the date of that certification.
Done this day, September 6, 2023.
/s/ Velva Moses-Thompson
Administrative Law Judge
Transmitted by either mail, e-mail, or facsimile to:
Joey Ridenour, RN, MN, Executive Director
State Board of Nursing
Joey Ridenour, RN, MN
State Board of Nursing
ATTN: Trina Smith
1740 W Adams, Suite 2000
Phoenix, Arizona 85007
[email redacted]
Deborah Abbey
Office of the Attorney General
[email redacted]
Adele Cook
[email redacted]
By: OAH Staff