ALJDEC decisions subject to certification as final
24A-2021020356-NUR · State Board of Nursing · 2024-02-21
IN THE OFFICE OF ADMINISTRATIVE HEARINGS
IN THE MATTER OF THE REGISTERED NURSE LICENSE NO. RN075132 ISSUED TO:
STACIE LOUISE DOMINGUEZ,
RESPONDENT.
No. 24A-[number redacted]-NUR
ADMINISTRATIVE LAW JUDGE DECISION
HEARING: December 28, 2023, and January 3, 2024, with the record held open until January 31, 2024.
APPEARANCES: Respondent Stacie Louise Dominguez appeared on her own behalf. The Arizona State Board of Nursing was represented by Assistant Attorney General Deborah Abbey.
ADMINISTRATIVE LAW JUDGE: Tammy L. Eigenheer
EXHIBITS ADMITTED INTO EVIDENCE: Board’s Exhibits 1 through 38
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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 Ariz. Rev. Stat. §§ 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, Ariz. Rev. Stat. §§ 32-1601 to -1669 and Ariz. Admin. Code Rules 4-19-101 to -815.
Stacie Louise Dominguez (“Respondent”) holds Board issued registered nurse license number RN075132 in the State of Arizona.
Complaints Received by the Board
On or about February 25, 2021, the Board received a self-report from Respondent notifying the Board that, while working as a Registered Nurse (“RN”) for Summit Regional Medical Center (“SRMC”) in Show Low, Arizona, Respondent was cited for a DUI on September 13, 2020.
On or about April 14, 2021, the Board received a complaint from Carolyn Jacobs, RN CNO at SRMC, alleging that while working as an RN at SRMC in Show Low, Arizona, Respondent was pulled over for an extreme DUI.
On or about December 2, 2021, the Board received a complaint from Veronica Stedman, RN and co-worker of Respondent’s at SRMC in Show Low, Arizona, alleging that on November 9, 2021, while working as an RN in the cardiac catheterization procedure lab, Respondent’s reported dosage administered and wasted of Fentanyl and Versed did not match.
On or about August 15, 2022, the Board received a complaint from Jane Braaten, RN Director of Quality and Patient Safety at Centura Parker Adventist Hospital (“Centura”) in Parker, Colorado, alleging that while working as an RN in the cardiac catheterization procedure lab, Respondent did not accurately document her administration and waste of controlled substances Fentanyl, Versed, and Morphine.
DUI
On or about September 13, 2020, at approximately 1503 hours, according to Navajo County Sheriff’s Office (AZ) incident report 2009-0150, an officer observed Respondent almost veering into another lane, several times and conducted a traffic stop. At 1654 hours, Respondent submitted to a breath test which yielded an alcohol content of .215 and again at 1701 hours with an alcohol content of .222.
Respondent was cited for DUI, DUI alcohol concentration above .08 and DUI extreme with alcohol concentration above .20.
Respondent failed to report this charge to the Board within 10 days.
On February 18, 2021, in case number TR2020-000086, Respondent was convicted, pursuant to a guilty plea of DUI .08 or more, a class 1 misdemeanor in Lakeside Justice Court, Arizona.
Medication Administration
Patient JH
On or between November 2, 2021, and November 5, 2021, while working at SRMC, Respondent removed 250 mcg of Fentanyl (schedule II controlled substance Opioid) from the Omnicell (automated medication dispensing system) for Patient JH the day prior to his procedure and 250 mcg of Fentanyl the day of Patient JH’s procedure on November 3, 2021.
On November 3, 2021, Respondent administered 250 mcg of Fentanyl and 175 mcg were witnessed as waste, leaving 75 mcg unaccounted.
Patient JH was discharged on November 3, 2021.
Between November 4, 2021 and November 5, 2021, Respondent removed 750 mcg of Fentanyl the two days following Patient JH’s procedure without documenting administration, waste, or return.
Patient PA
On or about November 2, 2021, while working at SRMC, Respondent removed 250 mcg of Fentanyl and 5 mg of Versed, the day before Patient PA’s procedure
On or about November 3, 2021, the day of Patient PA’s procedure, Respondent removed 250 mcg of Fentanyl and 4 mg of Morphine from the Omnicell for Patient PA.
On or about November 3, 2021, Respondent administered 250 mcg of Fentanyl and 100 mcg witnessed waste, leaving 150 mcg unaccounted.
On or about November 3, 2021, Respondent administered 4 mg of Versed and none documented as waste, leaving 1 mg unaccounted.
On or about November 3, 2021, Respondent administered 1 mg of Morphine and 2mg witnessed return, leaving 1 mg unaccounted.
Patient PA was discharged on November 3, 2021.
On or about November 4, 2021, the day after Patient PA’s procedure, Respondent removed 250 mcg of Fentanyl without documenting administration, waste or return.
Patient MB
Patient MB died on November 3, 2021, following a procedure.
On or about November 4, 2021, while working at SRMC, Respondent removed 500 mcg of Fentanyl from the Omnicell for Patient MB. Respondent did not document return or waste of the Fentanyl.
Patient RJ
On or between November 2, 2021, and November 5, 2021, while working at SRMC, Respondent removed 1000 mcg of Fentanyl and 10 mg of Versed from the Omnicell for Patient RJ, but there was no procedure performed on Patient RJ between November 2, 2021, and November 5, 2021.
On November 2, 2021, Respondent removed 250 mcg of Fentanyl and 5 mg of Versed and had a witnessed waste of both on November 3, 2021.
On November 5, 2021, Respondent removed 750 mcg of Fentanyl and did not document administration, return, or waste.
Patient GW
On or about November 9, 2021, while working at SRMC, Respondent removed 750 mcg of Fentanyl from the Omnicell for Patient GW on November 9, 2021, prior to her procedure.
Respondent administered 300 mcg of Fentanyl during the procedure and 150 mcg were witnessed waste, leaving 300 mcg unaccounted.
Respondent removed 250 mcg of Fentanyl after Patient GW’s procedure was completed on November 9, 2021, and did not document administration, waste or return.
Patient PC
On or about June 8, 2022, while working at Centura, Respondent removed 400 mcg of Fentanyl and 6 mg of Versed for Patient PC from the Omnicell.
Respondent documented in the nursing note she administered Fentanyl 275 mcg and Versed 6 mg during Patient PC’s cath procedure.
According to Patient PC’s medication administration record (MAR) and the cath lab procedure note Respondent administered 250 mcg of Fentanyl. There was no documentation of waste or return. There was a discrepancy of 75 mcg of Fentanyl.
According to Patient PC’s medication administration record (MAR) and the cath lab procedure note Respondent administered 5.5 mg of Versed. There was no documentation of waste or return. There was a discrepancy of 0.5 mg of Versed.
Patient RG
On or about June 19, 2022, while working at Centura, Respondent removed 200 mcg of Fentanyl and 4 mgs of Versed for Patient RG from the Omnicell. Respondent documented in the nursing note she administered 150 mcg of Fentanyl and 3 mg of Versed during Patient RG’s cath procedure.
According to Patient RG’s MAR and the cath lab procedure note Respondent administered 125 mcg of Fentanyl. There was no documentation of waste or return. There was a discrepancy of 25 mcg of Fentanyl.
According to Patient RG’s MAR and the cath lab procedure note Respondent administered 2.5 mg of Versed. There was no documentation of waste or return. There was a discrepancy of 0.5 mg of Versed.
Patient MP
On or about July 6, 2022, while working at Centura, Respondent removed 4 mgs of Morphine and 5 mgs of Versed for Patient MP. Respondent documented in the nursing note she administered 4mg of Morphine and 4 mg of Versed during the procedure for Patient MP.
According to Patient MP’s MAR and the cath lab procedure note Respondent gave 3 mg of Morphine during the procedure. There was a discrepancy of 1 mg of Morphine.
According to Patient MP’s MAR and the cath lab procedure note Respondent gave 3 mg of Versed during the procedure. There was a discrepancy of 1 mg of Versed.
Board Actions
On or about April 8, 2022, Respondent underwent a 14-panel hair drug test, which was negative for all substances.
On or about August 30, 2023, the Board requested Respondent undergo a PETH Test for alcohol.
Respondent replied that she did not understand the need for the test because alcohol was not illegal. Respondent also indicated that she had a breath test at work, had been spontaneously drug tested twice, and she had a hair test all of which were negative for any substances.
On or about August 31, 2023, the Board requested Respondent undergo a comprehensive psychological evaluation to include a substance use disorder evaluation.
On or about August 31, 2023, Respondent replied that she “had already done that testing to get her driver license back after the DUI in 2021. Thank you.”
On or about September 1, 2023, the Board responded and asked Respondent to elaborate on who did the evaluation, when it was done, and what type of evaluation was completed. Respondent did not respond.
On or about September 14, 2023, the Board sent Respondent an Executive Director’s Interim Order for a comprehensive psychological evaluation with an evaluation for substance abuse.
As of the date of the hearing, Respondent had not completed a comprehensive psychological evaluation.
On November 16, 2023, based upon the facts and circumstances set forth above, the Board found that the public health safety and welfare imperatively required Emergency action. Consequently, the Board ordered, pursuant to Ariz. Rev. Stat. § 41-1092.11(B), and effective immediately, that Respondent was summarily suspended pending proceedings for revocation and other action by the Board.
On April 15, 2020, the Board issued a Complaint and Notice of Hearing, alleging that cause existed to discipline Respondent’s registered nurse license under Ariz. Rev. Stat. § 32-1601(27)(d), (g), (h), and (j); Ariz. Admin. Code R4-19-403(1), (7), (8), (16), (18), (28), (31); and Ariz. Admin. Code R4-19-402(B). The Complaint and Notice of Hearing was sent via certified mail to Respondent at her address of record.
The Board referred the matter to the Office of Administrative Hearings.
Hearing Testimony
At hearing, Respondent testified that she did not divert any medications and just wanted to prove her innocence. Respondent stated that she underwent testing and counseling in relation to her DUI conviction and did not feel it was necessary to do all the additional measures requested by the Board.
Respondent asserted that, after logging into the Omnicell system at SRMC, an individual remained logged in for 30 minutes, so anyone could have accessed the system under her log in and removed the medications. Respondent was unable to explain the reported missing medications at Centura, but merely stated “Well, I don’t believe that. I don’t. I don’t believe that there was medication missing at Centura. That just didn’t happen.” Respondent also maintained that, if she were doing anything nefarious, she would not remove medication for a patient that had died and that proved the point she was not at fault.
Respondent maintained that, since her DUI, she had been targeted by the facilities and the Board. Respondent questioned why no other employees had been subject to drug testing.
CONCLUSIONS OF LAW
This matter lies within the Board’s jurisdiction under Ariz. Rev. Stat. § 32-1606(B)(10).
The Board bears the burden of proof and must establish cause to penalize Respondent’s registered nurse 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.”
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.”
The Board established by a preponderance of the evidence that Respondent failed to report her DUI charge within 10 days as required.
The Board established by a preponderance of the evidence that Respondent failed to properly document medication administration or waste. The inconsistency among the removal of medication from the system, the administration in patient records, and the waste recorded in the system could not be adequately explained absent Respondent’s unprofessional conduct.
The Board established by a preponderance of the evidence that Respondent failed to comply with the Board orders.
Respondent’s conduct constituted unprofessional conduct as defined by Ariz. Rev. Stat. § 32-1601(27)(d), (g), (h), and (j); Ariz. Admin. Code R4-19-403(1), (7), (8), (16), (18), (28), (31); and Ariz. Admin. Code R4-19-402(B).
Given Respondent’s failure to comply with the terms of the Interim Order, Respondent has demonstrated that she cannot be regulated at this time. Thus, the Board established cause to impose a disciplinary sanction against Respondent’s license under Ariz. Rev. Stat. § 32-1663(D) and Ariz. Rev. Stat. § 32-1664(N).
RECOMMENDED ORDER
Based on the foregoing, the Administrative Law Judge recommends that the Board affirm its order summarily suspending Respondent Stacie Louise Dominguez’s Registered Nurse License Number RN075132.
The Administrative Law Judge further recommends that the Board revoke Respondent Stacie Louise Dominguez’s Registered Nurse License Number RN075132.
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.
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-137160-45720000Done this day, February 21, 2024.
/s/ Tammy L. Eigenheer
Administrative Law Judge
Transmitted by either mail, e-mail, or facsimile to:
Joey Ridenour, RN, MN, Executive Director
State Board of Nursing
Deborah Abbey
Assistant Attorney General
[email redacted]
Stacie Louise Dominguez
[email redacted]
By: OAH Staff