ALJDEC - Licensing

24A-2021080014-NUR · State Board of Nursing · 2025-04-20

IN THE OFFICE OF ADMINISTRATIVE HEARINGS

IN THE MATTER OF ADVANCED PRACTICE CERTIFICATE

NO. APRN-RNP8274 ISSUED TO:

NANCY LEE GAINES-DILLARD

a.k.a. NANCY LEE GAINES,

RESPONDENT.

No. 24A-[number redacted]-NUR

ADMINISTRATIVE LAW JUDGE DECISION

HEARING: February 11, 2025; record held open for review after transcript received; record closed April 1, 2025.

APPEARANCES: The Arizona State Board of Nursing was represented by Assistant Attorney General Roberto Pulver. Respondent Nancy Lee Gaines-Dillard a.k.a. Nancy Lee Gaines appeared on her own behalf.

ADMINISTRATIVE LAW JUDGE: Kay Abramsohn

EXHIBITS ADMITTED INTO EVIDENCE: Arizona State Board of Nursing’s Exhibits 1 through 10 were admitted into evidence; Respondent’s Exhibits A-1, A-2, A-3, A-4, and B were admitted into evidence.

_____________________________________________________________________

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 Arizona Revised Statutes (“A.R.S.”) §§ 32-1606, 1663, and 1664. The Board also has the authority to determine whether licensees have committed unprofessional conduct, thereby furnishing cause for discipline under the Nurse Practice Act, A.R.S. §§ 32-1601 through 1667 and Arizona Administrative Code (“A.A.C”) R 4-19-101 through 4-19-815.

Nancy Gaines-Dillard (“Respondent”) received her Bachelor of Science in Nursing degree in 1996 from Delaware State University (Dover, DE), her Master of Science in Nursing degree in 2022 from Wilmington University (New Castle, DE), and her Doctor in Nursing Practice degree in 2014 from Widener University (Chester, PA). Respondent holds Arizona Advanced Practice Certificate number APRN-RNP8274 to perform as an advanced practice nurse in the State of Arizona; the certificate was issued on October 2, 2015.

On or about August 2, 2021, the Board received an anonymous complaint. The writer indicated that Respondent has a “DNP” and was calling herself “Doctor Nancy.” The writer indicated that Respondent was doing so on a TV show and on Facebook. The writer expressed concern about people being misled and indicated that some people believed “Dr. Nancy” to be medical doctor. Based upon this information, the Board began an investigation.

In 2022, Dr. Michelle Stazzone, DNP, was assigned to the matter after its initial assignment to another investigator in 2021. Dr. Stazzone developed the investigative report (“Report”).

Dr. Stazzone reviewed available internet information regarding the following: Respondent’s practice - Dr. Nancy Integrated Medicine, with 2 locations; Respondent’s business - Dr. Nancy’s Medical Training Academy; “Dr. Nancy Knows” podcasts; “Dr. Nancy Knows” YouTube videos; and activities on Facebook and Instagram.

Dr. Stazzone found multiple instances wherein Respondent did refer to herself as “Doctor” but did not clarify her nursing status as either Doctor of Nursing Practice (“DNP”) or Nurse Practitioner. Dr. Stazzone substantiated the allegations that were made in the August 2021 complaint.

Following Respondent’s November 2, 2022 interview with Dr. Stazzone, Respondent took actions to clarify and/or correct her nursing status in her online presence. Additionally, in December 2022, Respondent updated the Board’s online nurse portal and listed AZ as her primary state of residence and also updated her address with a current Arizona address.

As a result of the investigation, in May 2023, the Board determined to offer Respondent a Consent Order with a civil penalty with a deadline of 30 days to accept. The offer was emailed to Respondent in June 2023.

Respondent did not sign and return the Consent Order and, thereafter, the Board issued its August 2023 Notice of Charges to Respondent.

Subsequently, in December 2023, the Board issued its Complaint and Notice of Hearing, alleging violations of A.R.S. § 32-1601(26)(d), (h), and (j) and A.A.C. R4-19-403(1), (23), and (31). The Board’s Complaint and Notice of Hearing is incorporated by reference herein.

The Board set the matter for administrative hearing to convene on January 29, 2024 at the Arizona Office of Administrative Hearings (“Tribunal”).

The parties requested a continuance while the parties discussed settlement options, and the Tribunal issued an ORDER for a status report on March 1, 2024. On March 1, 2024, the parties requested a further continuance.

On March 2, 2024, the Board received another anonymous complaint against Respondent. The writer made allegations regarding Respondent referring to herself as “Doctor Nancy” to her patients, online and on Social Media, which the writer denoted as “portraying herself as a Doctor.” The writer indicated that Respondent was practicing under “Dr. Nancy Integrated Medicine” and that her website called her “A Different Kind of Doctor.” The writer wanted the Board to investigate, and clarify for her patients, whether Respondent is a Nurse Practitioner or a Doctor. The writer also noted that, when she looked further, she found that Respondent was a Nurse Practitioner.

In June 2024, Respondent provided a summary of her actions to remediate the Board’s concerns regarding accurate reflection and presentation of her nursing status as Nurse Practitioner and Doctor of Nursing Practice (“DNP”). Respondent indicated that she had revised all marketing materials, including social media profiles, to accurately reflect her credentials as a Nurse Practitioner.

At some point after the September 2024 Board meeting, the parties met in an informal settlement conference. During that conference, Respondent explained that she had not designed her website and that she had to reach out to others to make the online changes for her. Respondent further indicated that she had changed and clarified the things that she was able to do by herself but that some social media items, once placed on the sites, could not be modified by Respondent.

At the Board’s September 20, 2024 meeting, the Board determined to offer Respondent a Consent Order with a probationary period and a civil penalty. The offer was emailed to Respondent on September 26, 2024.

On October 4, 2024, Respondent notified the Board that she would not accept the Consent Order and requested a hearing.

The matter was subsequently reset for administrative hearing.

At hearing, Dr. Stazzone testified consistent with her investigation and her

Updated Report. After the March 2, 2024 complaint, Dr. Stazzone again reviewed online content; she found no new podcasts but was able to find old podcasts on YouTube. Dr. Stazzone found that clarification had been made to Respondent’s webpage and YouTube web page; additionally Respondent had added the “DNP” certification and her degrees after her name in the new “Meet Dr. Nancy (A Different Kind of Doctor)” introduction on the webpage. However, Dr. Stazzone also found a few instances wherein Respondent’s nursing status was not clearly indicated.

Dr. Stazzone testified that, absent the clarification of being a DNP, the public or Respondent’s patients could be confused and think they are being treated by a medical doctor (i.e., an MD) rather than a nurse practitioner who is also qualified to see patients.

Dr. Stazzone testified that, after the first Board meeting, the Board gave no clear instructions to Respondent regarding what the Board felt Respondent was required to do. However, Dr. Stazzone acknowledged that Respondent made multiple changes to clarify her status and that, after the second Board meeting, Respondent had made additional changes. Further, Dr. Stazzone acknowledged the Board had not received any complaints about Respondent regarding patient care, patient safety, or public safety.

At hearing, Respondent credibly testified that she had not intentionally created any marketing content to be deceptive or misleading and that she had simply intended to communicate to the public her credentials and her advanced education in nursing. Respondent credibly testified that, when a patient asked her about her status, she would tell them she was a nurse practitioner. Respondent now informs all patients of her DNP qualification and nurse practitioner status, versus being a medical doctor, at the beginning of each patient interaction and such explanation is also now reflected in her written communications.

After receiving the first complaint, Respondent had “retired” the Dr. Nancy’s Integrative Medicine branding and created the “Scottsdale Health” brand. Respondent also registered the new business trade name of “Dr. Nancy Knows” in July of 2024. Regarding her website and promotional materials, Respondent has now included explicit language regarding her DNP credentialing along with an explanation of what that means.

Respondent noted that the March 2024 complaint raised, essentially, the same issue and should not be considered as an additional violation. Respondent requested that the Board consider dismissing the matter or, alternatively, issue a non-punitive letter of concern based on (1) the proactive actions she had taken to remedy the allegations and to correct and clarify her practices and marketing and (2) given her expressed ongoing commitment of compliance with the Nurse Practice Act.

The Board requested that Respondent be disciplined with a $1,500.00 civil penalty for the alleged and demonstrated violations.

CONCLUSIONS OF LAW

This matter lies within the Board’s jurisdiction under A.R.S. § 32-1606(B)(10).

The Board bears the burden of proof and must establish cause to penalize Respondent’s licensure 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).

“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).

Based upon the above, the Board established by a preponderance of the evidence that Respondent engaged in some of the allegations of unprofessional conduct as alleged in the Complaint and Notice of Hearing of having violated the Nurse Practice Act, A.R.S. §§ 32-1601 to -1669 and Arizona Administrative Code (“A.A.C.”) Rules 4-19-101 to -815.

There is no question that Respondent has attained a level of education to the professional level of a doctorate. A person who has attained a level of education to the professional level of a doctorate is entitled to refer to themselves as a doctor.

In the instant case, the Board established by a preponderance of the evidence that Respondent engaged in unprofessional conduct, pursuant to A.R.S. § 32-1601(27)(j), when she violated a rule that was adopted by the Board, namely A.A.C. R4-19-403(A)(1) and (A)(23). The hearing record demonstrates that, until she made the clarifications after the first complaint, Respondent had a pattern of failing to maintain minimum standards of acceptable and prevailing nursing practice by advertising her practice of nursing with inconsistent, and therefore misleading, statements about her credentialing. As such, the Board established cause to impose disciplinary sanction against Respondent’s advanced practice certification under A.R.S. § 32-1663(D).

In the instant case, there was no evidence presented to demonstrate that Respondent either acted or practiced in a manner that was or might have been harmful or dangerous to the health of a patient or the public. Therefore, the Board has not established that Respondent violated either A.R.S. § 32-1601(27)(d) or (h) or A.A.C. R4-19-403(31).

Finally, Respondent’s credible testimony that she never intended to deceive the public or her patients is considered in mitigation.

RECOMMENDED ORDER

Based on the foregoing, the Administrative Law Judge recommends that the Board impose a $500.00 civil penalty on Respondent’s Advanced Practice Certification number APRN-RNP8274.

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, April 20, 2025.

/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

Nancy Gaines-Dillard

2142 E. Kesler Lane

Chandler, AZ 85225

[email redacted]

Roberto Pulver

Office of the Attorney General

Licensing & Enforcement Section

2005 N. Central Avenue

Phoenix, AZ 85004

[email redacted]

[email redacted]

By: OAH Staff