ALJDEC - Licensing
24A-2022030518-NUR · State Board of Nursing · 2024-07-03
IN THE OFFICE OF ADMINISTRATIVE HEARINGS
IN THE MATTER OF THE APPLICATION FOR REGISTERED NURSE LICENSURE BY:
RITA NTUSA ANAGHO
AKA: Rita N. Anagho,
-and-
IN THE MATTER OF THE PRIVILEGE TO PRACTICE NURSING UNDER THE NURSE LICENSURE COMPACT IN THE STATE OF ARIZONA ISSUED TO:
RITA NTUSA ANAGHO
AKA: Rita N. Anagho,
RESPONDENT
(North Carolina RN17831; AP8450 PMHNP) Multistate Privilege to Practice
No. 24A-[number redacted]-NUR
ADMINISTRATIVE LAW JUDGE DECISION
HEARING: May 6, 2024 and May 16, 2024, with the record held open until June 13, 2024, for the purpose of allowing the court reporter’s transcript to be included in the record.
APPEARANCES: Assistant Attorney General Deborah Abbey represented the Arizona State Board of Nursing (Board). Rita Ntusa Anagho AKA: Rita N. Anagho (Respondent) represented herself.
ADMINISTRATIVE LAW JUDGE: Velva Moses-Thompson
EXHIBITS ADMITTED INTO EVIDENCE: Board Exhibits 1 through 27.
_____________________________________________________________________
FINDINGS OF FACTS
On December 31, 2021, at 3:45pm, according to Humphreys
County Sheriff’s Office (TN) report number 725-21, an officer was dispatched to interstate 40 for a reckless driver headed eastbound, about to enter Humphreys County from Benton County. The vehicle was driven by Applicant, who was weaving all over the road. Officer followed Applicant and observed the vehicle cross the center line and onto the shoulder several times, nearly striking the guardrails more than once. The officer pulled Applicant over and could smell a strong odor of alcohol coming from the vehicle and observed an empty Jack Daniel’s bottle on the floor. Applicant stated she had not had anything to drink since the prior day. Applicant displayed signs of significant intoxication, and nearly fell more than once on standard field sobriety tests. Applicant became very uncooperative once she was informed she was being arrested for a DUI. After being handcuffed, Applicant would not comply and became combative, to the point it could be a resisting arrest. Applicant was observed attempting to jump out into traffic to commit suicide, then complained of chest pain to the officer, so an ambulance was dispatched to the scene, and when it arrived, Applicant was irate and repeatedly attempted to attack one of the medics. Applicant was cleared for arrest but stated if she was going to be arrested, then she had chest pain. A deputy accompanied her to Three Rivers ER. Applicant submitted to a blood draw which revealed a blood alcohol concentration (“BAC”) result of 0.227%. On December 31, 2021 in case number 725-21, a Complaint was filed charging Applicant with DUI in Humphreys County, Waverly, TN. On July 28, 2022, Applicant was convicted, pursuant to a guilty plea, of DUI, a misdemeanor. Applicant failed to report the charge to the Board within 10 days (or ever).
On or about January 10, 2022, Applicant, while working as a Psychiatric Mental
Health Nurse Practitioner (PMHNP) at self-owned Tusa Mental Health Services (Tusa), in Tempe, AZ, failed to report to the Board a DUI from December 31, 2021 in Humphreys County, Waverly, TN, within 10 days, or ever, as required by statute and rule, and on February 22, 2022, failed to disclose the DUI on her RN license application.
On or about August 22, 2022, Applicant, while working as a PMHNP at self-
owned Tusa, in Tempe, AZ was issued a criminal citation for one count of Failure to Leave Required Information at an Accident and failed to report this charge to the Board within 10 days, or ever, as required by statute and rule.
On or about March 21, 2024, the Board summarily suspended Respondent’s
Privilege to Practice Nursing Under the Nurse Licensure Compact in the State of Arizona.
On or about March 21, 2024, the Board denied Respondent’s application for a
license to practice as a registered nurse in the State of Arizona.
On or about April 2, 2024, the Board issued a Complaint and Notice of Hearing
(NOH) setting Respondent’s Summary Suspension and Application Denial for hearing on May 6, 2024.
A hearing was held on May 6, 2024 and May 16, 2024. Respondent testified on
behalf of herself and presented the testimony of Harriett Namakula, the house manager of the Nakkuz home in Surprise, AZ. The Board presented the testimony of
Rachel Kimes, an employee in the Board’s complaints and investigations
Department.
Through the NOH, the Board alleges that Respondent provided substandard
services to Patients AB, JB, CC, and CD while working as a Psychiatric Mental Health Nurse Practitioner (PMHNP) and Clinical Director for Arizona Wellcare, LLC in Phoenix, AZ. The Board further alleges that Respondent documented services that were not performed in the medical records of Patients AB, JB, CC, and CD, with request for AHCCCS insurance reimbursement.
In support of its case, asserts that Respondent was suspended from AHCCCS
for fraudulent billing practices. However, the evidence presented at hearing shows that Respondent was suspended from AHCCCS for potential fraudulent billing. Furthermore, there was no direct evidence presented at hearing that Respondent documented services that were not performed in the medical records of Patients AB, JB, CC, and CD, nor did Respondent request for AHCCCS insurance reimbursement for services that were not provided. Although the medical records provided in Exhibit 21 show the name, “Rita Anagho, MD,” Respondent provided credible testimony at hearing that she would never sign or enter “MD” on any document because she is not a medical doctor. Respondent holds a Doctor of Nursing Practice (DNP) degree. Respondent explained that she takes pride in herself as a DNP. Respondent also explained that she did not conduct group therapies and she did not sign the records in Exhibit 21.
Through the NOH, the Board alleges that while Respondent acted as the
Clinical Director of Arizona Wellcare, LLC, she forged patient records to support improper billing. The Board also noted that Respondent is subject to Indictment CR2023-006554.
At hearing, the Board presented evidence of a report summary from Roy
Garrison of the Special Investigations Section of the Office of the Attorney General.
Mr. Garrison implies through his report that Rhonda Russell of Arizona Wellcare, LLC enlisted Respondent to create volumes of forged notes. Mr. Garrison found that the activity occurred while Respondent was the Clinical Director. Mr. Garrison also found that Evaluation/Assessment for a minor that would have been signed off by Respondent. Although the report makes references to e-mails that purported show forged medical documentation, the e-mails were not provided at hearing. The only witness who testified at hearing on behalf of the Board was Ms. Kimes. The individuals listed in his summary did not testify at hearing. There was no direct evidence that Respondent forged medical documentation, nor that Respondent was involved in an effort to falsify medical records.
Through the NOH, the Board alleges that Respondent did not keep medical
records, including medication lists at Tusa, of Patients MM, JM, DW, SM, SI, AF, and DL. The Board further alleges that the records were not available when requested by Nicole LeVere of Adult protective Services (APS) at an in person onsite inspection. However, the evidence presented at hearing shows that Ms. LeVere conducted an on-site inspection of a Nakkuz group home. Harriet Namakula explained at hearing that she had never met Respondent before an APS investigator came to her home.
Ms. Namakula explained that Respondent never saw the patients in the home. Furthermore, Ms. LeVere nor any of the individuals that she interviewed, other than Ms. Namakula, were present at the hearing. The Board failed to establish that Respondent failed to keep medication lists and records for patients of Respondent or a facility under Respondent’s ownership or control.
On or about March 15, 2023, in case no. CR2023-006554, an Indictment was
filed charging Applicant with illegally conducting an enterprise, a class 3 felony; and 2 counts of fraudulent schemes and artifices, class 2 felonies, in Maricopa County Superior Court, AZ. This conduct occurred on or between July 20, 2020 and September 17, 2021. Applicant failed to report to the Board that she had been charged with 3 felonies within 10 days, or ever, as required by statute and rule.
On March 21, 2024, the Board found that the public health safety and welfare
imperatively required Emergency action. Consequently, the Board ordered, pursuant to A.R.S. § 41-1092.11(B), and effective immediately, that Respondent , the holder of registered nurse license number (North Carolina RN178331 and advanced practice license number AP8450) Multistate Privilege to Practice Under the Nurse Licensure Compact in the State of Arizona was summarily suspended from practice.
CONCLUSIONS OF LAW
This matter lies within the Board’s jurisdiction under Ariz. Rev. Stat. § 32-1606(A)(8).
The Board bears the burden of persuasion to establish cause to penalize Respondent’s privilege to Practice Under the Nurse Licensure Compact in the State of Arizona. Ariz. Rev. Stat. § 41-1092.07(G)(2);
Respondent has the burden of persuasion to establish that she is qualified to hold a registered nurse license to perform as a nurse in the State of Arizona. 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 facts, as set forth previously, establish that Respondent engaged in conduct that might be harmful to the public as defined by Ariz. Rev. Stat. section 32-1601(27)(d) and (h). Furthermore, the facts, as set forth previously, establish that Respondent committed unprofessional conduct as defined in Ariz. Rev. Stat. section 32-1601(27)(g),(j), and (l); A.A.C. R4-19-403(28) and (29).
Because Respondent has committed unprofessional conduct, the Board has authority to deny her application for a registered nurse license. Ariz. Rev. Stat. § 32-1663(D); and § 32-1664(O).
Respondent’s criminal convictions and citation show that at the
time the conduct occurred, Respondent engaged in conduct that was harmful to the public. However, the Board failed to establish that at the time of the issuance of the Order of Summary Suspension, the public health, safety or welfare imperatively required that her privilege to practice summarily suspended. Moreover, most of the allegations presented by the Board to support the summary suspension were based on indirect and unreliable evidence.
RECOMMENDED ORDER
Based on the foregoing, the Administrative Law Judge recommends that the Board’s denial of Respondent’s application for a registered nurse license be affirmed.
The Administrative Law Judge further recommends that Order of Summary Suspension be overturned.
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, July 3, 2024.
/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
Deborah Abbey
Office of the Attorney General
[email redacted]
[email redacted]
Rita Ntusa Anagho
[email redacted]
By: OAH Staff