ALJDEC - Licensing
23A-2022040207-NUR · State Board of Nursing · 2023-05-10
IN THE OFFICE OF ADMINISTRATIVE HEARINGS
IN THE MATTER OF APPLICATION FOR LICENSE BY:
YUN YOUNG CHOI
AKA: YOON CHOI; NATASHA CHOI;
YOUNG CHOI,
TO PRACTICE REGISTERED
NURSING IN THE STATE OF ARIZONA.
No. 23A-[number redacted]-NUR
ADMINISTRATIVE LAW JUDGE DECISION
HEARING: March 27, 2023
APPEARANCES: Yun Choi, Respondent; Charlie Hover, Assistant Attorney General for the Arizona Board of Nursing.
ADMINISTRATIVE LAW JUDGE: Kay A. Abramsohn
_____________________________________________________________________
FINDINGS OF FACT
The hearing in this matter convened regarding the appeal of Yun Young Choi (Respondent) appeal of the Arizona Board of Nursing (Board) denial of Respondent’s application for relicensure.
On March 24, 2017, the Board revoked Respondent’s previous License No. RN 157733 following the Board’s consideration of a January 30, 2017 Administrative Law Judge Decision containing Findings of Fact, Conclusions of Law and Recommendation.
In the Board’s March 24, 2017 Order No. 13A-1207029-NUR, the Board adopted the following Factual Allegations:
1. Yoon Choi (“Respondent”) holds Board issued registered nurse license no. RN157733, originally issued June 1, 2009.
2. In Respondent’s written response to the Investigative Questionnaire, dated October 18, 2012, Respondent disclosed a felony arrest for “possession of ‘Morphine Sulfate’ vial” in September, 2002, in Oakland, California. Respondent wrote that she pled guilty and attended AA five times/week for a year, after which time the charges were dismissed. On or about July25, 2012, and again on or about January 16, 2013, Respondent stated to Board staff that she inadvertently removed a partially used vial of Morphine, a pain medication and controlled substance, from Kaiser Hospital in Oakland, California, placed the vial in her car and was subsequently pulled over 2-3 months later and charged with possession of a controlled substance-narcotic without a valid prescription. In a letter that the Board received on January 9, 2014, Respondent again admitted that the incident occurred but stated that she took a “closed morphine syringe,” not an “open vial.” Respondent’s conduct violated the standard of care, which requires a nurse to immediately waste all controlled substances that were not administered to a patient, and to not remove controlled substances from a facility. On or about May 27, 2009, Respondent submitted a request for a temporary license to the Board and incorrectly answered “no” to the question of whether she had been charged with or pled guilty to a felony.
3. On or about September 9, 2010, while employed as a RN at Maryvale Hospital in Maryvale, Arizona, Respondent inserted an IV line in the right arm of a patient diagnosed with a right arm deep vein thrombosis, placing the patient at risk for complications, without assessing or reviewing the patient’s medical history. This violated the standard of care for Arizona nurses that requires that a nurse assess possible IV sites for suitability including reviewing the patient’s medical history to determine history of mastectomy, stroke, shunts or other injuries/conditions such as a history of deep vein thrombosis in the extremity that would render placement of the IV in a particular site unsuitable or unsafe for the patient.
4. On or about May 6, 2012, while employed as an RN at Arizona Heart Hospital in Phoenix, Arizona, Respondent fell asleep during her break, overslept by an hour, and failed to notify her co-workers regarding where they could find her, in violation of the hospital’s policies and procedures, entitled “Work Conditions and Pay – Meal and Rest Periods.”
5. On or about May 8, 2012, while employed as an RN at the Arizona Heart Hospital in Phoenix, Arizona, Respondent claimed she conducted frequent cardiac checks and assessments of patient L.M., but did not document the alleged cardiac checks and assessments in L.M.’s medical record. This violated the standard of care for Arizona nurses that requires nurses to conduct frequent cardiac checks and to document them in the patient’s medical record
6. On or about May 8, 2012, Respondent also put L.M.’s cardiac monitor on “standby status,” believing that it was malfunctioning, but failed to take patient L.M.’s cardiac monitor off “standby status” and failed to properly determine whether patient L.M.’s cardiac monitor was functioning properly in violation of the hospital’s policy entitled “Cardiac Monitoring.” The standard of care for Arizona nurses requires nurses to troubleshoot all malfunctioning equipment and notify appropriate personnel of the non-functioning equipment, not unilaterally place it in “standby status,” and instead obtain either another telemetry monitoring pack or a bedside cardiac monitor. Respondent’s failure to properly activate L.M.’s cardiac monitor or obtain alternative monitoring equipment meant that L.M.’s heart was not monitored and no hospital staff were aware that L.M.’s condition deteriorated until L.M. had a cardiac arrest and expired during Respondent’s shift.
7. Respondent also failed to ensure that cardiac monitoring strips for patient L.M. were obtained and analyzed at least twice during her shift in violation of the hospital’s “Cardiac Monitoring” policy and the standard of care for Arizona nurses, which requires these actions. In addition, on or about May 8, 2012, at or around 2144 and 2145, patient L.M.’s cardiac rhythm per pacemaker history was “V-Tach with conversion,” but Respondent failed to document this dysrhythmia in L.M.’s medical record or notify the physician, as required by the standard of care for Arizona nurses, and in violation of the hospital’s “Cardiac Monitoring” policy.
8. On or about June 3, 2012, while employed as an RN at Arizona Heart Hospital in Phoenix, Arizona, Respondent fell asleep during her break and overslept, from between a half hour to an hour, in violation of the hospital’s “Work Conditions and Pay – Meal and Rest Periods” policy.
9. On or about October 18, 2012, in her response to the Board’s Investigative Questionnaire, Respondent failed to disclose she had been terminated on June 16, 2012, for sleeping at work (twice) while employed as an RN at Arizona Heart Hospital in Phoenix, Arizona.
10. On or about April 10, 2013, Respondent underwent a psychological evaluation with Phillip D. Lett, PhD. Dr. Lett concluded that Respondent would benefit from psychological intervention focusing on improving interpersonal communications and relational effectiveness, and recommended that Respondent undergo counseling with a Ph.D. level behavioral health specialist with competency treating persons with cultural differences twice a month for at least six months to differentiate a diagnosis and facilitate treatment planning and address interpersonal factors. Dr. Lett also recommended bi-monthly monitoring reports from the behavioral professional to the Board regarding compliance.
11. On or about April 30, 2013, Respondent underwent a Nurse Practice Evaluation at Arizona State University and performed below a safe level in all 9 categories (Professional Responsibility, Client Advocacy, Attentiveness, Clinical Reasoning – Noticing, Clinical Reasoning – Understanding, Communication, Prevention, Procedural Competency, and Documentation) and during all 3 scenarios, suggesting “extensive remediation” was needed related to 9 areas of nurse competencies.
In the Board’s March 24, 2017 Order, the Board determined that Respondent had violated multiple laws and rules concluding that the evidence of record had demonstrated the following:
A. The conduct and circumstances described in the Factual Allegations 2 - 11 constitute unprofessional conduct pursuant to A.R.S. § 32-1601(16)(d) and (j) and § 32-1601(18)(d) and (j) and § 32-1601(22)(d) and (j): (d) (any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public), and (j)(violating a rule that is adopted by the Board), and is grounds for disciplinary action pursuant to A.R.S. § 32-1663 and § 32-1664.
B. The conduct and circumstances described in Factual Allegations 2 –11 constitute unprofessional conduct pursuant to A.R.S. § 32-1601(16/18/22)(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.
C. The conduct and circumstances described in the above Factual Allegations constitute unprofessional conduct pursuant to A.R.S. § 32-1601(16/18/22)(d) and (j), and is grounds for disciplinary action pursuant to A.R.S. § 32-1663 and § 32-1664,specifically: Facts 2 –8: A.A.C. R4-19-4035(1) (A pattern of failure to maintain minimum standards of acceptable and prevailing nursing practice.); Facts 2 – 8: A.A.C. R4-19-403(9) (Failing to take appropriate action to safeguard a patient’s welfare or follow policies and procedures of the nurse’s employer designed to safeguard the patient.); Fact 2: 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.); Facts 2- 8: 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).
After waiting the statutory five year period, Respondent applied for relicensure through her application dated April 4, 2022.
Pursuant to A.A.C. R4-19-404, a person whose license was revoked may apply to the Board to reissue the license five years after the revocation date. A person who applies for relicensure must present, with the written application, “substantial evidence that the basis for ... revoking the license has been removed and that the ... re-issuance of the license will not be a threat to public health or safety.”
On July 29, 2022, a Board staff member presented to Respondent specific information and questionnaire regarding documentation that was required to be provided; further, that information instructed that Respondent needed to provide written explanation and police and court records regarding each arrest, citation, or charge.
On August 10, 2022, the Board received Respondent’s completed questionnaire, which provided little to no information regarding how, if at all, the basis for the revocation had been removed. Additionally, while Respondent wrote that no other State had taken any action on her licensure, the Board discovered that, on November 26, 2018, Illinois had refused to renew Respondent’s Illinois RN licensure based on the Arizona revocation; further, that as of October 28, 2022, Illinois had not reinstated Respondent’s RN licensure.
By ORDER dated November 16, 2022, the Board denied relicensure.
Respondent did not appear at the Board’s December 21, 2022 meeting at which her application was considered.
On December 21, 2022, the Board issued its ORDER OF DENIAL [of licensure] for the reason that Respondent had failed to submit substantial evidence that the basis for the previous revocation had been removed.
On February 15, 2023, The Board issued its Notice of Public Hearing On Denial of Licensure setting the matter for administrative hearing.
At hearing, the Board witness, Senior Investigator Stephanie Cruz, discussed her review of the application and the information that Respondent had provided. Ms. Cruz testified regarding the lack of any substantial, or contemporary, information regarding how Respondent may have remediated or reeducated herself regarding the previously-determined nursing practice issues. The Board argued that, as to relicensure, Respondent had failed to meet the requirements to qualify for reissuance of license.
At hearing, as to the reapplication process and as to the 2017 findings, Respondent essentially argued that no one had really explained to her what she had needed to, or had been expected to, provide to the Board; she argued that she did not understand what she was supposed to get better at. Respondent argued that she had been unable to obtain any continuing education credits due to her not being able to give a license number but that she had been reading articles about doctors nurses, psychologists, etc.; she further noted that over the years she had been taking care of her mother and taking her to hospitals she was learning from the example of other nurses. Finally, Respondent argued that she had undergone a psych evaluation in 2013 and he had not given her any recommendations.
Respondent’s native language is Korean. When she was admitted to the Nursing Program at North Park University in 1995, there was no requirement that she pass a language proficiency test. Respondent indicated that she learned English through daily activities but also stated that she knew nursing/medical terminology, and that she was “not perfect” but “really good” in English about explaining things to patients.
Respondent requested consideration in this matter as to the relicensure, stating that she just wanted to be a nurse again and “spend her lifetime as a better nurse than before.”
CONCLUSIONS OF LAW
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). 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, it may take disciplinary action. The Board has the burden of proof and the standard of proof on all issues is by a preponderance of the evidence. See A.R.S. 41-1092.07(G).
Arizona law defines unprofessional conduct in the nursing profession at A.R.S. § 32-1601(22), which provides as follows:
"Unprofessional conduct" includes the following, whether occurring in this state or elsewhere:
* * *
(d) Any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public.
(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.
* * *
(j) Violating this chapter or a rule that is adopted by the board pursuant to this chapter.
A.A.C. R4-19-403 further describes unprofessional conduct that may be harmful or dangerous to patients includes a pattern of failure to maintain minimum standards of acceptable and prevailing nursing practice (A.A.C. R4-19-403(1)) failing to take appropriate action to safeguard a patient’s welfare or follow policies and procedures of the nurse’s employer designed to safeguard the patient, (A.A.C. R4-19-403(9)), 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 (A.A.C. R4-19-403(16)), and practicing in any other manner that gives the Board reasonable cause to believe the health of a patient or the public may be harmed (A.A.C. R4-19-403(31)).
A.R.S. § 32-1663 provides as follows:
A. If an applicant for licensure or certification commits an act of unprofessional conduct, the board, after an investigation, may deny the application or take other disciplinary action.
B. In its denial order, the board shall immediately invalidate any temporary license or certificate issued to the applicant.
C. Any person aggrieved by an order of the board issued under the authority granted by subsection A of this section may request an administrative hearing pursuant to title 41, chapter 6, article 10.
D. If the board finds, after affording an opportunity to request an administrative hearing pursuant to title 41, chapter 6, article 10, that a person who holds a license or certificate issued pursuant to this chapter has committed an act of unprofessional conduct, it may take disciplinary action.
E. If the board finds after giving the person an opportunity to request an administrative hearing pursuant to title 41, chapter 6, article 10 that a nurse who practices in this state and is licensed by another jurisdiction pursuant to section 32-1668 committed an act of unprofessional conduct, the board may limit, suspend or revoke the privilege of that nurse to practice in this state.
F. If the board determines pursuant to an investigation that reasonable grounds exist to discipline a person pursuant to subsection D or E of this section, the board may serve on the licensee or certificate holder a written notice that states:
1. That the board has sufficient evidence that, if not rebutted or explained, will justify the board in taking disciplinary actions allowed by this chapter.
2. The nature of the allegations asserted and that cites the specific statutes or rules violated.
3. That unless the licensee or certificate holder submits a written request for a hearing within thirty days after service of the notice by certified mail, the board may consider the allegations admitted and may take any disciplinary action allowed pursuant to this chapter without conducting a hearing.
G. If the state board of nursing acts to modify any registered nurse practitioner's prescription writing privileges, it shall immediately notify the state board of pharmacy of the modification.
Commensurate with the Board’s authority to take disciplinary action, the Administrative Law Judge finds that the action taken in this matter was appropriate because the evidence of record supports the Board’s action to deny Respondent’s application for relicensure.
RECOMMENDED DECISION
Based on the foregoing considerations, the undersigned Administrative Law Judge hereby recommends that Respondent’s relicense application be Denied.
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, May 10, 2023.
/s/ Kay A. Abramsohn
Administrative Law Judge
Transmitted by either mail, e-mail, or facsimile to:
Joey Ridenour, RN, MN
Executive Director
State Board of Nursing
ATTN: Trina Smith
[email redacted]
Yun Young Choi
[email redacted]
Charles S. Hover, III
Assistant Attorney General
[email redacted]
By: OAH Staff